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Admiraal M, Marhofer P, Hopkins PM, Hollmann MW. Peripheral regional anaesthesia and outcomes: a narrative review of the literature from 2013 to 2023. Br J Anaesth 2024; 132:1082-1096. [PMID: 37957079 PMCID: PMC11103102 DOI: 10.1016/j.bja.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023] Open
Abstract
The use of peripheral regional anaesthesia continues to increase, yet the evidence supporting its use and impact on relevant outcomes often lacks scientific rigour, especially when considering the use of specific blocks for a particular surgical indication. In this narrative review, we consider the relevant literature in a 10-yr period from 2013. We performed a literature search (MEDLINE and EMBASE) for articles reporting randomised controlled trials and other comparative trials of peripheral regional anaesthetic blocks vs systemic analgesia in adult patients undergoing surgery. We evaluated measures of effective treatment and complications. A total of 128 studies met our inclusion criteria. There remains variability in the technical conduct of blocks and the outcomes used to evaluate them. There is a considerable body of evidence to support the use of interscalene blocks for shoulder surgery. Saphenous nerve (motor-sparing) blocks provide satisfactory analgesia after knee surgery and are preferred to femoral nerve blocks which are associated with falls when patients are mobilised early as part of enhanced recovery programmes. There are additional surgical indications where the efficacy of cervical plexus, intercostal nerve, and ilioinguinal/iliohypogastric nerve blocks have been demonstrated. In the past 10 yr, there has been a consolidation of the evidence indicating benefit of peripheral nerve blocks for specific indications. There remains great scope for rigorous, multicentre, randomised controlled trials of many peripheral nerve blocks. These would benefit from an agreed set of patient-centred outcomes.
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Affiliation(s)
- Manouk Admiraal
- Department of Anaesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Peter Marhofer
- Department of Anaesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria.
| | - Philip M Hopkins
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Pandey SP, Yadav U, Khan MMA, Singh AK, Verma S, Nigam S. Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Percutaneous Nephrolithotomy. Cureus 2023; 15:e40186. [PMID: 37431344 PMCID: PMC10329850 DOI: 10.7759/cureus.40186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Background Percutaneous nephrolithotomy (PCNL) is presently the preferred method for managing renal calculi. Visceral pain from the kidney and ureter and somatic pain from the incision site are the primary causes of immediate postoperative pain following PCNL. Poor pain control is associated with unwanted consequences such as patient discomfort, delayed recovery, and prolonged hospital stay. Recently, the erector spinae plane (ESP) block has been used in many thoracic and abdominal surgeries for the control of postoperative pain. In this study, we aimed to assess the effectiveness of the ultrasound-guided ESP block following PCNL. Methodology This was a prospective, double-blind, randomized controlled study including 60 patients who were scheduled for elective PCNL under general anesthesia. Patients were randomly divided into two groups. Group E underwent an ultrasound-guided ESP block with 20 mL of the local anesthetic mixture at the T-9 level unilaterally on the side of surgery, and group C was a sham group in which 20 mL of normal saline was injected on the side of surgery. Changes in postoperative pain score were the primary outcome, and the duration of analgesia, the total analgesic requirement in 24 hours, and patient satisfaction were the secondary outcomes. Results The demographic data of both groups were comparable. The Visual Analog Scale score was considerably lower in group E than in group C at two, four, six, and eight hours postoperatively. In group E, the mean analgesic duration was substantially longer than that in group C (8.87 ± 2.45 hours vs. 5.67 ± 1.58 hours, respectively). The tramadol requirement was higher in group C (286.67 ± 62.88 mg) than in group E (133.33 ± 47.95 mg) during the 24-hour postoperative period. At 12 hours, patient satisfaction was considerably higher in group E than in group C (6.73 ± 0.45 vs. 5.87 ± 0.35, respectively). Conclusions The ultrasound-guided ESP block provided efficient postoperative pain relief, prolonged duration of analgesia, and reduced tramadol intake after PCNL surgery.
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Affiliation(s)
- Satya P Pandey
- Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Urvashi Yadav
- Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | | | - Amit K Singh
- Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Shipra Verma
- Anaesthesiology, Shaikh-Ul-Hind Maulana Mahmood Hasan Medical College, Saharanpur, IND
| | - Shuchi Nigam
- Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, IND
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Choppa S, Gurajala I, Kar P, Jayaram K, Durga P, Devraj R, Chilumula R. Effect of pregabalin on postoperative pain and instrumentation-induced dysuria in patients undergoing percutaneous nephrolithotomy: A prospective randomized, double-blinded placebo-controlled study. J Anaesthesiol Clin Pharmacol 2022; 38:566-571. [PMID: 36778815 PMCID: PMC9912870 DOI: 10.4103/joacp.joacp_689_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/16/2021] [Accepted: 03/07/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Aims The manipulation of urinary tract, the mandatory requirement of ureteral stenting, and bladder catheterization in patients undergoing percutaneous nephrolithotomy (PCNL) produces significant pain and dysuria postoperatively. The present study compared the efficacy of pregabalin with placebo in attenuation of these symptoms in patients undergoing PCNL. Material and Methods This randomized controlled study was conducted in 110 patients of either sex, aged 18-65 years undergoing elective PCNL requiring nephrostomy tube under general anesthesia. Group G (n: 53) received pregabalin 150 mg and Group P received placebo (n: 49) orally 1 h before the anesthetic induction. All the patients received standard anesthetic protocol. Pain at the site of nephrostomy, instrumentation-induced dysuria (IID), anxiety, and sedation scores were recorded at 0 min, 15 min, 30 min, 1 h, 2 h, 4 h, 8 h, 12 h, 24 h postoperatively. Hemodynamics, total requirement of rescue analgesia, and incidence of any adverse effects were also noted. Results Patients were demographically comparable between the two groups. There is no difference in nephrostomy site pain between the groups at different points of measurements. IID was less with pregabalin at 0 min, 15 min, 30 min, 1 h, and 2 h after extubation (P value < 0.05, 43% in Group G vs. 68% in group P). Severe urgency was seen in 4%, moderate in 31%, and mild in 33% of patients in placebo group. No patient in pregabalin had severe grade of instrumentation-induced dysuria score (P < 0.05). Patients in Group P required more rescue analgesic (P: 0.009). Anxiety scores, sedation scores, and hemodynamic parameters were comparable. Conclusion A single dose of 150 mg pregabalin as oral premedication given 1 h before surgery reduced the incidence and intensity of IID compared to placebo in patients undergoing PCNL without significant adverse effects.
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Affiliation(s)
- Shivakrishna Choppa
- Department of Anesthesia and Critical Care, Nizam’s Institute of Medical Sciences, Telangana, India
| | - Indira Gurajala
- Department of Anesthesia and Critical Care, Nizam’s Institute of Medical Sciences, Telangana, India
| | - Prachi Kar
- Department of Anesthesia and Critical Care, Nizam’s Institute of Medical Sciences, Telangana, India
| | - Kavitha Jayaram
- Department of Anesthesia and Critical Care, Nizam’s Institute of Medical Sciences, Telangana, India
| | - Padmaja Durga
- Department of Anesthesia and Critical Care, Nizam’s Institute of Medical Sciences, Telangana, India
| | - Rahul Devraj
- Department of Urology, Nizam’s Institute of Medical Sciences, Telangana, India
| | - Ramreddy Chilumula
- Department of Urology, Nizam’s Institute of Medical Sciences, Telangana, India
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Patient-Controlled Intravenous Analgesia with or without Ultrasound-Guided Bilateral Intercostal Nerve Blocks in Children Undergoing the Nuss Procedure: A Randomized, Double-Blinded, Controlled Trial. Pain Res Manag 2022; 2022:5776833. [PMID: 35910406 PMCID: PMC9337970 DOI: 10.1155/2022/5776833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
Background Two analgesic strategies have been described for pain treatment after the pectus excavatum surgery: the patient-controlled intravenous analgesia (PCIA) and ultrasound-guided intercostal nerve block. In this prospective, randomized and double-blinded trial and the short and long-term outcomes were compared in patients after surgery. Methods The children were randomized to either the intercostal or control group. Ultrasound-guided intercostal nerve block was with 0.25% ropivacaine and 5 mg dexamethasone in the intercostal group, while the control group was with 0.9% normal saline. The block was performed in the intercostal space corresponding to the lowest depression of the sternum and repeated bilaterally in the spaces above and below. Postoperatively, the children in the two-groups received PCIA with fentanyl for 48 hours. The primary outcome was a pain score on the postoperative day 1, as measured by the Visual Analogue Scale (VAS). Results Sixty children undergoing the Nuss procedure were enrolled in the trial. The mean differences in VAS scores between the two groups were 3.2 in the PACU (p < 0.001), 1.7 on postoperative day 1 (p < 0.001) and 0.7 on postoperative day 2 (p=0.015). The opioid consumption was significantly lower in the intercostal group during the postoperative 48 hours (p < 0.05). The anxiety and QOL scores in the intercostal group were significantly improved on some points of time (p < 0.05). The incidence of adverse events was markedly lower in the intercostal group during the postoperative 48 hours (p < 0.05). Conclusions Our results suggest ultrasound-guided intercostal nerve block with PCIA may be more effective than PCIA alone in children who underwent the Nuss procedure.
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Supine versus prone percutaneous nephrolithotomy for renal calculi: Our experience. Curr Urol 2022; 16:25-29. [PMID: 35633854 PMCID: PMC9132181 DOI: 10.1097/cu9.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: To compare operative times, safety, and effectiveness of percutaneous nephrolithotomy in the supine versus the prone position. Materials and methods: An observational study of 100 patients was conducted in our institution for 2years from 2018 to 2020 divided into 2 groups: 50 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and 50 patients underwent standard prone PCNL. The inclusion criteria included a renal calculus (calyx or pelvis) of any size for which PCNL was indicated and exclusion criteria were patients having contraindications for PCNL such as bleeding disorders, pregnancy, high risk, and co-morbid conditions. The measured data included operative time, number of punctures, stone-free rate, length of hospital stays, and rate of complications. Results: The 2 groups were comparable in mean age, male to female ratio, calculus size, number of punctures, residual calculi, and postoperative fever and pain. The mean difference of hemoglobin in the supine PCNL group was 0.37 g/dL whereas in the prone PCNL group it was 0.61 g/dL. The p value was significant at 0.043. The mean time to finish from initial postion was 72.24 minutes in supine PCNL and 88.12 minutes in prone PCNL. The p value was significant (p < 0.001). The mean time before puncture was 20.92 minutes in the supine position and 31.84 minutes in the prone position. The p value was significant (p < 0.001). The mean time from puncture to finish was 51.32 minutes in the supine position and 56.28 minutes in the prone position. The p value was significant (p < 0.001). Conclusions: As observed from this study, supine PCNL is associated with a significantly reduced operating time when compared to conventional prone position PCNL procedures. The postoperative complications such as pain and fever were not significantly different. Hence, the supine PCNL is an equally effective modality for treatment of a renal calculus with benefits of simultaneous retrograde access and less operative time compared to the prone PCNL.
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Elkhashab Y, Wang D. A Review of Techniques of Intercostal Nerve Blocks. Curr Pain Headache Rep 2021; 25:67. [PMID: 34738179 DOI: 10.1007/s11916-021-00975-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Intercostal nerve blocks are indicated for multiple chronic pain and acute pain conditions including rib fractures, herpes zoster, post-thoracotomy pain syndrome, and intercostal neuralgia. Intercostal neuralgia is a type of neuropathic pain that is in the distribution of intercostal nerves. The purpose of this review is to evaluate the different techniques used to perform intercostal nerve blocks and review their efficacy and safety including blind technique using anatomical landmarks, and fluoroscopically guided and ultrasound-guided intercostal nerve blocks. RECENT FINDINGS Literature search was performed with the keywords including intercostal neuralgia, treatment, intercostal nerve blocks, and radiofrequency ablation on PubMed and Google Scholar. Three studies and one case report were identified. Literature review revealed that ultrasound-guided techniques and fluoroscopically guided techniques are superior to landmark-based technique in terms of efficacy. There was no difference in efficacy and complication rates between ultrasound and fluoroscopic guidance. Ultrasound-guided techniques and fluoroscopically guided techniques can both be performed safely and effectively for various chronic pain conditions. Ultrasound guidance has its advantages of direct visualization of nerves, vessels, muscles, and the lung. It is potentially a superior technique in terms of improving accuracy and decreasing complications. Further large population randomized control studies should be conducted to compare the efficacy of intercostal nerve blocks performed under ultrasound and fluoroscopy.
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Affiliation(s)
| | - Dajie Wang
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Winoker JS, Koo K, Alam R, Matlaga B. Opioid-sparing analgesic effects of peripheral nerve blocks in percutaneous nephrolithotomy: a systematic review. J Endourol 2021; 36:38-46. [PMID: 34314232 DOI: 10.1089/end.2021.0402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Multimodal analgesia regimens incorporating peripheral nerve blocks (PNB) have demonstrated reduced postoperative pain, opioid use, and recovery time in various disease states. However, this remains a subject of limited investigation in the percutaneous nephrolithotomy (PCNL) domain. In the face of an ongoing opioid epidemic and collective push to enhance prescribing stewardship, we sought to examine the potential opioid-sparing effect of PNB in PCNL. METHODS A systematic review of Embase and PubMed was performed to identify all randomized controlled trials evaluating the use of a PNB with general anesthesia (GA) versus GA alone for pain control following PCNL. Studies evaluating neuraxial (epidural and spinal) anesthesia and those without GA as the control arm were excluded. RESULTS Seventeen trials evaluating 1012 procedures were included. Five different blocks were identified and evaluated: paravertebral (n=8), intercostal nerve (n=3), quadratus lumborum (n=2), transversus abdominis plane (n=1), and erector spinae (n=3). 9/16 (56%) studies observed lower pain scores with PNB use throughout the 24-hour postop period. By comparison, improved pain scores with PNB were limited to the early (<6 hours) recovery period in 5 studies and 2 found no difference. Total analgesia and opioid requirements were significantly higher in the GA control arm in nearly all studies (12/14, 86%). Operative times were similar and there were no differences in rates of intercostal access or nephrostomy tube insertion between study arms in any trial. CONCLUSION While greater analgesic use with GA alone likely minimizes or obscures differences in patient-reported pain scores, PNB may offer a significant opioid-sparing analgesic effect during postoperative recovery after PCNL.
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Affiliation(s)
- Jared S Winoker
- Johns Hopkins University School of Medicine, 1500, 600 N. Wolfe Street, Baltimore, MD, Baltimore, Maryland, United States, 21205-2105;
| | - Kevin Koo
- Mayo Clinic, 6915, 200 First St SW, Rochester, Minnesota, United States, 55905;
| | - Ridwan Alam
- Johns Hopkins University James Buchanan Brady Urological Institute, 117539, 600 N. Wolfe St., Marburg 134, Baltimore, Maryland, United States, 21287;
| | - Brian Matlaga
- Johns Hopkins University, Brady Urological Institute, Baltimore, Maryland, United States;
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Chen T, Zhu Z, Du J. Efficacy of Intercostal Nerve Block for Pain Control After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:623605. [PMID: 33585552 PMCID: PMC7876386 DOI: 10.3389/fsurg.2021.623605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/04/2021] [Indexed: 12/29/2022] Open
Abstract
Background: We aimed to assess the efficacy of intercostal nerve block (ICNB) for pain relief after percutaneous nephrolithotomy (PCNL). Methods: An electronic search of the databases of PubMed, Science Direct, BioMed Central, CENTRAL, Embase, and Google Scholar was conducted. All types of studies conducted on adult patients undergoing PCNL, comparing ICNB with control or any other anesthetic method, and reporting postoperative pain outcomes were included. Results: Six studies were included. Studies compared ICNB with peritubal (PT) infiltration and with control. Pooled analysis of ICNB vs. PT infiltration indicated no difference between the two groups for pain scores at 6–8 h (MD −0.44; 95% CI −3.41, 2.53; I2 = 99%; p = 0.77), 12 h (MD −0.98; 95% CI −4.90, 2.94; I2 = 99%; p = 0.62) and 24 h (MD 0.16; 95% CI −0.90, 1.21; I2 = 88%; p = 0.77). Time for first analgesic demand was also not significantly different between the two groups. Meta-analysis of ICNB vs. control indicated statistical significant difference in pain scores between the two groups at 8 h (MD −1.55; 95% CI −2.60, −0.50; I2 = 47%; p = 0.04), 12 h (SMD −2.49; 95% CI −4.84, −0.13; I2 = 96%; p = 0.04) and 24 h (SMD −1.22; 95% CI −2.12, −0.32; I2 = 88%; p = 0.008). The total analgesic requirement in morphine equivalents was not significantly different between the two groups. Conclusions: ICNB may be effective in reducing postoperative pain after PCNL. However, its efficacy may not be greater than PT infiltration. Current evidence is from a limited number of studies. Further, high-quality randomized controlled trials are needed to provide robust evidence.
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Affiliation(s)
- Tao Chen
- Department of Anesthesiology, Tongxiang First People's Hospital, Tongxiang, China
| | - ZhenQiang Zhu
- Department of Anesthesiology, Tongxiang First People's Hospital, Tongxiang, China
| | - Jianlong Du
- Department of Anesthesiology, Tongxiang First People's Hospital, Tongxiang, China
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Kottooran C, Sternberg K, Stern KL, Pais VM, Eisner BH. Opioids and Kidney Stones. Semin Nephrol 2021; 41:19-23. [PMID: 33896469 DOI: 10.1016/j.semnephrol.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In recent years, the use of opioids in medical practice has come under significant scrutiny. This, in part, is owing to evidence of overprescription and overuse of opioid medications, as well as the unintended consequences and side effects for patients who take these medications. Here, we review the role of opioids and the responsible use of these medications with respect to kidney stone disease and surgical interventions for kidney stones.
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Affiliation(s)
| | | | | | | | - Brian H Eisner
- Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Medical School, Boston, MA.
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Rangalakshmi S, Shankar K, Priyanka D, Kailash P, Deepak V. Comparison of peritubal infiltration and single level T10 paravertebral block in percutaneous nephrolithotomy (PCNL). J Anaesthesiol Clin Pharmacol 2021; 37:586-591. [PMID: 35340975 PMCID: PMC8944380 DOI: 10.4103/joacp.joacp_64_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Material and Methods: Results: Conclusion:
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Resnick A, Chait M, Landau S, Krishnan S. Erector spinae plane block with catheter for management of percutaneous nephrolithotomy: A three case report. Medicine (Baltimore) 2020; 99:e22477. [PMID: 33019439 PMCID: PMC7535648 DOI: 10.1097/md.0000000000022477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy is a procedure used for management of refractory renal calculi. Oral and parenteral opioids, along with local anesthetic infiltration, neuraxial anesthesia, and paravertebral blocks are the most common methods of managing intra-operative and post-operative pain for these patients. The erector spinae plane block with catheter (ESPC) is a newer interfascial regional anesthetic technique that can be used to manage peri-operative pain in these patients. CLINICAL FINDINGS Three patients complained of significant flank pain were scheduled for percutaneous nephrolithotomy under general anesthesia in the prone position. DIAGNOSES Patients were diagnosed with large renal calculi. THERAPEUTIC INTERVENTIONS Patients received ESPC in the pre-operative holding area at the level of the T7 transverse process. The ESPCS were bolused with a solution of 30 mL 0.25% bupivacaine with 4 mg dexamethasone prior to surgery. Patients also received oral tramadol 50 mg and acetaminophen 1 g as part of the multimodal pain protocol prior to surgery. After the procedure, the patients were bolused with 0.25% bupivacaine or started on an infusion of 0.25% bupivacaine to manage their pain. OUTCOMES No opioid or other pain medications, other than the local anesthetic solution given in the ESPCs, were used during the intra-operative or post-operative period for management of pain in these patients. Visual analogue scale (VAS) scores were below 4 for all patients in the post-operative period, and patients did not report any issues with post-operative nausea or vomiting. CONCLUSION These patients were compared to 3 prior patients who had undergone percutaneous nephrolithotomy without ESPC. The 3 patients without ESPC placement reported increased VAS scores, had increased opioid/pain medication consumption intraoperatively and postoperatively, and had increased incidence of perioperative nausea when compared to our ESPC patients. Our report shows that ESPC, in combination with a multimodal pain protocol, can be a good option for management of patients undergoing percutaneous nephrolithotomy.
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Affiliation(s)
- Andrew Resnick
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
| | - Michael Chait
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
| | - Steven Landau
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
| | - Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit
- Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
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Chen L, Ji J, Tian Y, Sun Q, Qiu X, Li X, Li B. Retrospective study of quadratus lumborum block for postoperative analgesia in patients undergoing percutaneous nephrolithotomy. BMC Anesthesiol 2020; 20:217. [PMID: 32867683 PMCID: PMC7457541 DOI: 10.1186/s12871-020-01134-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background The postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified; however, the efficacy of QLB using the lateral approach (QLB-L) is still in debate. Therefore, this retrospective study was conducted to investigate the effect of a single-shot block with QLB-L on postoperative analgesia for patients undergoing percutaneous nephrolithotomy (PCNL). Methods The medical information of the patients undergoing PCNL was retrieved from the electronic charter system (Medisystem, Suzhou, China) in our Nanjing Drum Tower Hospital during the period of Jan/2019 to Jun/2019. Among the total of 57 patients, there are 17, 18, and 22 patients subjected to QLB-L, QLB-TM, or routine treatment, respectively. The primary observational parameter was to assess postoperative pain with visual analog scales (VAS) at rest 30 min after extubation, 24 h, and 48 h after surgery, respectively. The secondary observatory endpoints, including the consumption of intraoperative opioids, the cumulative dose of non-steroid anti-inflammatory drugs (NSAIDs) and the incidence of adverse events related to postoperative analgesia, were evaluated as well. Results The static VAS score at 24 h after surgery and the intraoperative consumption of sufentanil were significantly lower in patients receiving either intervention of QLB-L or QLB-TM as compared with those receiving routine treatment. However, one shot of QLB had no impact on VAS scores at 30 min post-extubation, 48 h after PCNL procedure compared with the patients receiving routine treatment. The percentage of non-ambulatory patients within 24 h post-PCNL was significantly higher in the QLB-TM group compared with the routine treatment group (P = 0.04). There were no significant differences in the incidence of postoperative nausea and vomit (PONV), itches, respiratory depression, the time for the first defecation, and the length of hospital stay (LOS) among the three groups. Conclusions QLB-L procedure may exert as equivalent as QLB-TM in terms of abrogating postoperative pain within 24 h post-surgery and decreasing intraoperative sufentanil consumption in patients undergoing PCNL procedure as well. The caution should be taken to avoid lower extremities weakness in the patients after QLB-TM within the first 24 h post-PCNL procedure.
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Affiliation(s)
- Luning Chen
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Jingjing Ji
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Yali Tian
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Qing Sun
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Xuefeng Qiu
- Department of Surgery, Urology Surgery, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Xiaogong Li
- Department of Surgery, Urology Surgery, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Bingbing Li
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China.
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Zheng Y, Wang H, Ma X, Cheng Z, Cao W, Shao D. Comparison of the effect of ultrasound-guided thoracic paravertebral nerve block and intercostal nerve block for video-assisted thoracic surgery under spontaneous-ventilating anesthesia. Rev Assoc Med Bras (1992) 2020; 66:452-457. [PMID: 32578778 DOI: 10.1590/1806-9282.66.4.452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/10/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of the current study was to compare the efficacy of two different techniques for blocking chest nerves during video-assisted thoracic surgery (VATS) under spontaneous-ventilating anesthesia. METHODS One hundred patients were recruited in this study and divided into two groups. The first, P group, underwent the TPVB approach; the second, I group, underwent the ICNB approach. Then, the rate of clinical efficacy, duration of the block procedure, and its complications were recorded for comparison of the effect of the two approaches. RESULTS No difference was found in the clinical effect of chest nerve blocks between the two groups. Two patients in the ICNB group were converted to general anesthesia due to severe mediastinal flutter (grade three). The number of patients who had grade one mediastinal flutter in the TPVB group was significantly higher than in the ICNB group. Vascular puncture was detected in four patients in the ICNB group and in one patient in the TPVB group. No other complications were observed. CONCLUSIONS No difference was found regarding the clinical efficacy in the two groups. However, ultrasound-guided TPVB was superior to ultrasound-guided ICBN during VATS for pulmonary lobectomy under spontaneous-ventilating anesthesia. Additionally, vascular puncture should receive more attention.
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Affiliation(s)
- Yongfeng Zheng
- . Department of Anesthesiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212002, China
| | - Hong Wang
- . Department of Anesthesiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212002, China
| | - Xiaodong Ma
- . Department of Anesthesiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212002, China
| | - Zheng Cheng
- . Department of Anesthesiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212002, China
| | - Weibao Cao
- . Department of Anesthesiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212002, China
| | - Donghua Shao
- . Department of Anesthesiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212002, China
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14
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Amirhosseini M, Dehghan M, Mangolian Shahrbabaki P, Pakmanesh H. Effectiveness of Aromatherapy for Relief of Pain, Nausea, and Vomiting after Percutaneous Nephrolithotomy: A Randomized Controlled Trial. Complement Med Res 2020; 27:440-448. [PMID: 32575103 DOI: 10.1159/000508333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postoperative pain, nausea, and vomiting are common side effects of percutaneous nephrolithotomy. Nowadays, non-pharmacological and complementary therapies have been noticed. Therefore, a study was conducted to determine the effectiveness of lavender and clary sage on the pain, nausea, and vomiting after percutaneous nephrolithotomy. METHODS This is a randomized clinical trial study on 79 patients undergoing percutaneous nephrolithotomy. Patients were randomly divided into three groups of lavender aromatherapy (n = 27), clary sage aromatherapy (n = 26), and a control group (n = 26). Each of the intervention groups received the inhalation aromatherapy immediately and 3 and 6 h after the operation. Pain, nausea, and emetic episodes in patients of the three groups were measured before the intervention and 30 min after each intervention using a visual analog scale and checklist. RESULTS Pain decreased significantly in the clary sage aromatherapy group. Nausea had a downward trend in the two groups of aromatherapy. The lavender aromatherapy group had the lowest incidence of emetic episodes compared to the other groups. CONCLUSION Regarding the annoying pain, nausea, and vomiting after percutaneous nephrolithotomy for patients, and taking into account the complications of drug therapy, the use of complementary non-pharmacological methods can help increase the comfort of patients.
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Affiliation(s)
- Mojdeh Amirhosseini
- Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran,
| | - Hamid Pakmanesh
- Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
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15
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Gultekin MH, Erdogan A, Akyol F. Evaluation of the Efficacy of the Erector Spinae Plane Block for Postoperative Pain in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Trial. J Endourol 2020; 34:267-272. [DOI: 10.1089/end.2019.0777] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mehmet Hamza Gultekin
- Department of Urology, Mengucek Gazi Education and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Abdullah Erdogan
- Department of Urology, Mengucek Gazi Education and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Fethi Akyol
- Department of Anesthesiology, Mengucek Gazi Education and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, Turkey
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16
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Elsharkawy H, Hamadnalla H, Altinpulluk EY, Gabriel RA. Rhomboid intercostal and subserratus plane block -a case series. Korean J Anesthesiol 2020; 73:550-556. [PMID: 32046475 PMCID: PMC7714629 DOI: 10.4097/kja.19479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/11/2020] [Indexed: 01/09/2023] Open
Abstract
Background The rhomboid intercostal and subserratus plane (RISS) block is a new interfascial block technique that has shown promising results for abdominal and thoracic surgeries. Our objective was to describe the improved analgesia and dermatomal coverage in patients who received bilateral RISS blocks after a major abdominal surgery. Case Twenty-one patients who underwent abdominal surgery received the rhomboid intercostal component of the block at the T5 to T6 levels, and the subserratus component block was performed at the T6 to T9 levels.The RISS blocks provided effective postoperative analgesia. There was a variation in the dermatomal coverage ranging from T3 to T12. Patients reported a high satisfaction rate from pain management. Conclusions The RISS block in abdominal surgery seems to have an important role in perioperative pain management, complementing the multimodal analgesic regimen. To determine the efficacy of the RISS block for abdominal surgery, we need further randomized control trials.
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Affiliation(s)
- Hesham Elsharkawy
- Department of Outcomes Research Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.,Case Western University, MetroHealth Campus, Cleveland, OH, USA
| | - Hassan Hamadnalla
- Department of Outcomes Research Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ece Yamak Altinpulluk
- Department of Outcomes Research Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpaşa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA
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17
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Akıncı G, Hatipoğlu Z, Güleç E, Özcengiz D. Effects of Ultrasound-Guided Thoracic Paravertebral Block on Postoperative Pain in Children Undergoing Percutaneous Nephrolithotomy. Turk J Anaesthesiol Reanim 2019; 47:295-300. [PMID: 31380510 DOI: 10.5152/tjar.2019.81205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/26/2018] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the effects of ultrasound-guided thoracic paravertebral block (PVB) and intravenous paracetamol on postoperative pain control in paediatric patients undergoing percutaneous nephrolithotomy (PNL). Methods Forty patients aged 1-5 years, with an American Society of Anesthesiologists physical status I-II, scheduled for PNL were enrolled into this prospective randomised controlled trial. After arrival in the operating room, all patients were administered standardised general anaesthesia. Patients in Group PVB received ultrasound-guided PVB using bupivacaine 0.5% at a total volume of 0.5 mL kg-1 at the vertebral levels T11, T12 and L1. Patients in Group P were administered paracetamol intravenously (15 mg kg-1) before the beginning of surgery. Patients in both groups were given tramadol (1 mg kg-1) for supplemental analgesia. Patient demographics, haemodynamic parameters, peripheral oxygen saturation and sevoflurane concentration were recorded. The Face, Legs, Activity, Cry and Consolability pain scores; satisfaction of parents; the number of patients requiring supplemental analgesia; and complications were evaluated during the postoperative period. Results Pain scores were significantly lower in Group PVB compared with Group P (p=0.001). There were no analgesic requirements in Group PVB; however, all patients needed a supplemental analgesic in Group P. Parental satisfaction was higher in Group PVB than in Group P. Conclusion This study demonstrated that ultrasound-guided PVB provides more effective postoperative analgesia with no side effects compared to intravenous paracetamol in children undergoing PNL.
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Affiliation(s)
- Gülşah Akıncı
- Clinic of Anaesthesiology and Reanimation, 25 December State Hospital, Gaziantep, Turkey
| | - Zehra Hatipoğlu
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
| | - Ersel Güleç
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
| | - Dilek Özcengiz
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
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18
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Lee HJ, Park HS, Moon HI, Yoon SY. Effect of Ultrasound-Guided Intercostal Nerve Block Versus Fluoroscopy-Guided Epidural Nerve Block in Patients With Thoracic Herpes Zoster: A Comparative Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:725-731. [PMID: 30244489 DOI: 10.1002/jum.14758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/31/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To compare the efficacy of a conventional fluoroscopy-guided epidural nerve block and an ultrasound (US)-guided intercostal nerve block in patients with thoracic herpes zoster (HZ). METHODS This work was a comparative study of 38 patients with thoracic HZ pain and a chest wall herpetic eruption, aged 18 years or older, with pain intensity of 5 or greater on a numeric rating scale (NRS) for less than a 1-month duration. Patients were consecutively enrolled and assigned to 2 groups in which the intervention was either the US-guided intercostal nerve block or the fluoroscopy-guided epidural nerve block approach with the addition of a 5-mL mix of 2.5 mg of dexamethasone plus 0.5% lidocaine. The primary outcome measure was the NRS score reduction for the pain. Secondary outcomes included the duration of treatment, number of repeated injections until the final visit, and proportion of patients with pain relief after the first and final visits. RESULTS All patients within both intervention groups showed significant pain relief on the NRS at the final follow-up point (P < .05). There was no significant difference in the mean value of NRS improvement based on the intervention type. There was also no statistically significant difference in the duration of treatment and the frequency of injection for pain relief. CONCLUSIONS These findings showed that both the US-guided intercostal nerve block and the fluoroscopy-guided epidural nerve block were effective in patients with thoracic HZ. Compared data showed no significant differences in the pain reduction, duration of treatment, and frequency of injection. The US-guided intercostal nerve block, which is more accessible than the fluoroscopy-guided epidural nerve block, might be an alternative option for thoracic HZ.
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Affiliation(s)
- Hyo Jeong Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Seongnam-si, Korea
| | - Hong Souk Park
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Seongnam-si, Korea
| | - Hyun Im Moon
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Seongnam-si, Korea
| | - Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Seongnam-si, Korea
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19
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Kaushal B, Chauhan S, Saini K, Bhoi D, Bisoi AK, Sangdup T, Khan MA. Comparison of the Efficacy of Ultrasound-Guided Serratus Anterior Plane Block, Pectoral Nerves II Block, and Intercostal Nerve Block for the Management of Postoperative Thoracotomy Pain After Pediatric Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:418-425. [DOI: 10.1053/j.jvca.2018.08.209] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 11/11/2022]
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20
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Singh I, Yadav OK, Gupta S. Efficacy of intercostal nerve block with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial. Urol Ann 2019; 11:363-368. [PMID: 31649454 PMCID: PMC6798289 DOI: 10.4103/ua.ua_141_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction and Aim: Several techniques have been used to lower the morbidity of percutaneous nephrostomy (PCN) tube after percutaneous nephrolithotomy (PCNL). The outcomes of intercostal nerve block (ICB) versus peritubal block (PTB) with 0.25% bupivacaine to alleviate post-PCNL pain were compared. Materials and Methods: After obtaining an informed written consent and local institutional ethics clearance, 64 patients undergoing PCNL were computer randomized to receive either an intercostal block/ICB (Group I) or a peritubal block/PTB (Group II) using 0.25% bupivacaine infiltration, after termination of the procedure. They were evaluated for visual analog scale (VAS) score, first analgesic requirement, and the total analgesic demand along with fall in hematocrit, PCN indwelling time, blood transfusion rate, complications, and mean hospital stay in the postoperative period. The protocol was registered with CTRI/2018/03/012717. Results: Patients in both the groups were comparable on the basis of demographic data, preoperative renal function, stone burden, and hematocrit value. The mean VAS score at 6, 12, 24, and 48 h was significantly lower in the Group II versus Group I (P < 0.001). The total mean analgesic requirement was 160.16 and 103.13 mg of diclofenac sodium in Group I and Group II, respectively, which was significantly higher in Group I versus Group II (P < 0.001). The time to first analgesic demand was significantly higher in PT group (8.06 ± 1.99 h vs. 12.97 ± 1.96 h) in Group I/ICNB and Group II/PT, respectively (P < 0.001). Both the groups were comparable in terms of postoperative hematuria, hematocrit fall, nephrostomy site leak, hospital stay, need of blood transfusions, stone-free rate/retreatment rate, postoperative urinary tract infections, and overall complication rate (Modified Clavien–Dindo classification) which were not statistically significant. Conclusion: Post PCNL, PTB was associated with significantly lower post operative pain and discomfort versus ICB as demonstrated by the significantly lower DVAS pain scores, higher mean time to first analgesic demand and lower mean total analgesic demandt with ICB. Bupivacaine was a safe and effective local anesthetic agent for PTB in select patients for facilitating quick relief from the morbid postoperative pain and discomfort following PCNL.
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Affiliation(s)
- Iqbal Singh
- Division of Urology, Department of Surgery, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
| | - Om Kumar Yadav
- Department of Surgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sanjay Gupta
- Department of Surgery, University College of Medical Sciences and GTB Hospital, Delhi, India
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21
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Kendall MC, Alves LJC, Suh EI, McCormick ZL, De Oliveira GS. Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials. Local Reg Anesth 2018; 11:91-109. [PMID: 30532585 PMCID: PMC6244583 DOI: 10.2147/lra.s185554] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Regional anesthesia is becoming increasingly popular among anesthesiologists in the management of postoperative analgesia following pediatric surgery. The main objective of this review was to systematically evaluate the last 5 years of randomized controlled trials on the role of regional anesthesia techniques in alleviating postoperative pain associated with various pediatric surgical procedures. Forty studies on 2,408 pediatric patients were evaluated. The majority of the articles published from 2013 to 2017 reported that the use of regional anesthesia minimized postoperative pain and reduced opioid consumption. Only a few surgical procedures (cholecystectomy, inguinal hernia repair, and non-laparoscopic major abdominal surgery) reported no significant difference in the postoperative pain relief compared with the standard anesthetic management. The growing number of randomized controlled trials in the pediatric literature is very promising; however, additional confirmation is needed to reinforce the use of specific regional anesthesia techniques to provide optimal postoperative pain relief for a few surgical procedures (reconstructive ear surgery, chest wall deformity, hypospadias, umbilical hernia, cleft palate repair) in pediatric patients. More randomized controlled trials are needed to establish regional anesthesia as an essential component of postoperative analgesia management in children.
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Affiliation(s)
- Mark C Kendall
- Department of Anesthesiology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA,
| | | | - Edward I Suh
- Department of Anesthesiology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA,
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Gildasio S De Oliveira
- Department of Anesthesiology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA,
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22
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Chang KV, Wu WT, Özçakar L. Ultrasound Imaging of Metastatic Colon Cancer in a Case of Intractable Intercostal Neuralgia: Scan Before You Block. PAIN MEDICINE 2018; 18:995-997. [PMID: 28339513 DOI: 10.1093/pm/pnw259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ke-Vin Chang
- Departments of Physical Medicine, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.,Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.,Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taiwan.,Rehabilitation, China Medical University Hospital, Taichung, Taiwan
| | - Levent Özçakar
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey
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23
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Koh WU, Lee JH. Ultrasound-guided truncal blocks for perioperative analgesia. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.2.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Won Uk Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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24
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Zhu M, Gu Y, Sun X, Liu X, Chen W, Miao C. Ultrasound-Guided Intercostal Nerve Block Following Esophagectomy for Acute Postoperative Pain Relief in the Postanesthesia Care Unit. Pain Pract 2018; 18:879-883. [DOI: 10.1111/papr.12689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/03/2018] [Accepted: 02/09/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Mengqi Zhu
- Department of Anesthesiology; Shanghai Cancer Center; Fudan University; Shanghai China
| | - Yuechao Gu
- Department of Anesthesiology; Shanghai Cancer Center; Fudan University; Shanghai China
- Department of Oncology; Shanghai Medical College; Fudan University; Shanghai China
| | - Xia Sun
- Department of Anesthesiology; Shanghai Cancer Center; Fudan University; Shanghai China
- Department of Oncology; Shanghai Medical College; Fudan University; Shanghai China
| | - Xi Liu
- Department of Anesthesiology; Shanghai Cancer Center; Fudan University; Shanghai China
- Department of Oncology; Shanghai Medical College; Fudan University; Shanghai China
| | - Wankun Chen
- Department of Anesthesiology; Shanghai Cancer Center; Fudan University; Shanghai China
- Department of Oncology; Shanghai Medical College; Fudan University; Shanghai China
| | - Changhong Miao
- Department of Anesthesiology; Shanghai Cancer Center; Fudan University; Shanghai China
- Department of Oncology; Shanghai Medical College; Fudan University; Shanghai China
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25
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Choi SW, Cho SJ, Moon HW, Lee KW, Lee SH, Hong SH, Choi YS, Bae WJ, Ha US, Hong SH, Lee JY, Kim SW, Cho HJ. Effect of Intercostal Nerve Block and Nephrostomy Tract Infiltration With Ropivacaine on Postoperative Pain Control After Tubeless Percutaneous Nephrolithotomy: A Prospective, Randomized, and Case-controlled Trial. Urology 2018; 114:49-55. [DOI: 10.1016/j.urology.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022]
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26
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Comparison of Ultrasonography-guided Bilateral Intercostal Nerve Blocks and Conventional Patient-controlled Intravenous Analgesia for Pain Control After the Nuss Procedure in Children: A Prospective Randomized Study. Clin J Pain 2018; 33:604-610. [PMID: 27841838 PMCID: PMC5462349 DOI: 10.1097/ajp.0000000000000449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives: Patients experience severe pain after pectus excavatum (PE) surgery. The aim of this prospective, randomized study was to compare analgesic effects of ultrasonography-guided bilateral intercostal nerve blocks (UG-ICNBs) with those of conventional patient-controlled intravenous analgesia (PCIA) on acute pain after the Nuss procedure for PE repair in children. Methods: A prospective randomized study was performed in children with PE who were scheduled for the Nuss procedure. Participants were randomly assigned to receive either UG-ICNBs or PCIA for postoperative analgesia. Faces Pain Scale-Revised scores, opioid consumption, analgesia-associated side effects (respiratory depression, pruritus, nausea, vomiting) during the first 24 hours, and lengths of stay in the postanesthesia care unit (PACU) and hospital were recorded after the surgery. Results: Sixty-two children undergoing the Nuss procedure were enrolled in the trial. Faces Pain Scale-Revised scores were significantly decreased in the UG-ICNBs group compared with the PCIA group for up to 6 hours after surgery. The opioid doses required in the PACU and during the first 24 hours after surgery were significantly greater in the PCIA group compared with the UG-ICNBs group. Accordingly, patients in the UG-ICNBs group showed a lower incidence of analgesia-associated side effects and faster PACU discharge compared with the PCIA group. Conclusions: Our study suggests that UG-ICNBs might be more effective than PCIA for postoperative analgesia in children who undergo the Nuss procedure for PE.
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27
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Hatipoglu Z, Gulec E, Turktan M, Izol V, Arıdogan A, Gunes Y, Ozcengiz D. Comparative study of ultrasound-guided paravertebral block versus intravenous tramadol for postoperative pain control in percutaneous nephrolithotomy. BMC Anesthesiol 2018; 18:24. [PMID: 29454333 PMCID: PMC5816552 DOI: 10.1186/s12871-018-0479-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure for renal calculi, and nephrostomy tubes lead to postoperative pain after PCNL. Regional techniques (e.g., epidural analgesia and peripheral blocks) and opioids are applied for postoperative pain treatment. The aim of this study was to compare effectiveness of ultrasound-guided paravertebral block (PVB) and tramadol on postoperative pain in patients who underwent PCNL. METHOD Fifty-three patients were included in this prospective randomized study. The patients were allocated into two groups: the PVB group (group P, n = 26) and the tramadol group (group T, n = 27). All patients were administered standard general anaesthesia. Ultrasound-guided PVB was performed at the T11- L1 levels using 0.5% bupivacaine for a total dose of 15 mL in group P. Patients in group T were intravenously administered a loading dose of 1 mg/kg tramadol. Patients in both groups were given patient-controlled analgesia. Haemodynamic parameters, visual analogue scale (VAS) scores, side effects, and complications, tramadol consumption and additional analgesic requirements of the patients were recorded after surgery. RESULTS Haemodynamic parameters were statistically similar between the groups. The VAS in group P were statistically lower than in group T. In the 24-h period after surgery, total PCA tramadol consumption was statistically lower in group P than in group T. The use of supplemental analgesic in group T was higher than in group P. CONCLUSIONS Ultrasound-guided PVB was found to be an effective analgesia compared to tramadol, and no additional complications were encountered. TRIAL REGISTRATION ClinicalTrials.gov, NCT02412930 , date of registration: March 27, 2015, retrospectively registered.
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Affiliation(s)
- Zehra Hatipoglu
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey.
| | - Ersel Gulec
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey
| | - Mediha Turktan
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey
| | - Volkan Izol
- Faculty of Medicine, Department of Urology, Cukurova University, Adana, Turkey
| | - Atilla Arıdogan
- Faculty of Medicine, Department of Urology, Cukurova University, Adana, Turkey
| | - Yasemin Gunes
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey
| | - Dilek Ozcengiz
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey
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Jonnavithula N, Chirra RR, Pasupuleti SL, Devraj R, Sriramoju V, Pisapati MV. A comparison of the efficacy of intercostal nerve block and peritubal infiltration of ropivacaine for post-operative analgesia following percutaneous nephrolithotomy: A prospective randomised double-blind study. Indian J Anaesth 2017; 61:655-660. [PMID: 28890561 PMCID: PMC5579856 DOI: 10.4103/ija.ija_88_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Aims: Intercostal nerve blockade (ICNB) and peritubal infiltration of the nephrostomy tract are well-established regional anaesthetic techniques for alleviating pain after percutaneous nephrolithotomy (PCNL). This prospective study compared the efficacy of ICNB and peritubal local anaesthetic infiltration of the nephrostomy tract in providing post-operative analgesia following PCNL. Methods: Sixty American Society of Anesthesiologist physical status 1 and II patients scheduled for PCNL requiring nephrostomy tube were randomised to receive either peritubal infiltration or ICNB. At the completion of the procedure, patients in Group P received peritubal infiltration and those in Group I received ICNB at 10, 11, 12th spaces using fluoroscopy guidance. Postoperatively, patients were followed for 24 h for pain using Visual Analogue Scale (VAS) and Dynamic VAS. Rescue analgesia was inj. tramadol 1 mg/kg IV when pain score exceeded 4. Time to first rescue analgesia, number of doses and patient's satisfaction were noted in all patients. Results: Pain scores were lower in the group I at all points of measurement than group P. The mean time to first demand for rescue analgesia was higher in Group I (13.22 ± 4.076 h vs 7.167 ± 3.92 h P - 0.001). The number of demands and the amount of analgesics consumed were less in Group I. Conclusion: ICNB provided superior analgesia as evidenced by longer time to first demand of analgesic, reduced number of demands and consumption of rescue analgesic. Peritubal infiltration, although less efficacious, may be a safe and simple alternative technique.
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Affiliation(s)
- Nirmala Jonnavithula
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Raveendra Reddy Chirra
- Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sai Lakshman Pasupuleti
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rahul Devraj
- Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vidyasagar Sriramoju
- Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Murthy Vln Pisapati
- Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Abstract
OBJECTIVE The aim of this article is to provide an overview of peripheral nerve blocks, the use of peripheral nerve block within and outside interventional radiology, and the complications of peripheral nerve block. CONCLUSION Interventional radiologists are often responsible for sedation and pain management in the majority of interventional radiology procedures. Peripheral nerve block is increasingly being used in interventional radiology.
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Chakraborty A, Khemka R, Datta T. Ultrasound-guided truncal blocks: A new frontier in regional anaesthesia. Indian J Anaesth 2016; 60:703-711. [PMID: 27761032 PMCID: PMC5064693 DOI: 10.4103/0019-5049.191665] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The practice of regional anaesthesia is rapidly changing with the introduction of ultrasound into the working domain of the anaesthesiologist. New techniques are being pioneered. Among the recent techniques, notable are the truncal blocks, for example, the transversus abdominis plane block, rectus sheath block, hernia block and quadratus lumborum block in the abdomen and the pectoral nerves (Pecs) block 1 and 2, serratus anterior plane block and intercostal nerve block. This narrative review covers the brief anatomical discourse along with technical description of the ultrasound-guided truncal blocks.
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Affiliation(s)
| | - Rakhi Khemka
- Tata Medical Center, Kolkata, West Bengal, India
| | - Taniya Datta
- Tata Medical Center, Kolkata, West Bengal, India
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31
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Affiliation(s)
- Sang Ho Moon
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Song Lee
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Jae Il Lee
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
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