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Zhao Y, Xiao X. Efficacy of ultrasound-guided stellate ganglion block in relieving acute postoperative pain: a systematic review and meta-analysis. J Int Med Res 2024; 52:3000605241252237. [PMID: 38759220 PMCID: PMC11107331 DOI: 10.1177/03000605241252237] [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: 01/03/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE The efficacy of ultrasound-guided stellate ganglion block (SGB) in alleviating postoperative pain remains unclear. This meta-analysis was performed to determine the efficacy of ultrasound-guided SGB in relieving acute postoperative pain in patients undergoing surgery with general anesthesia. METHODS This systematic review and meta-analysis focused on randomized controlled trials comparing SGB with control or placebo. The primary outcome was the pain score at 24 hours after surgery. A random-effects model was used to calculate the mean difference (MD) or risk ratio with a confidence interval (CI) of 95%. RESULTS Eight studies involving 470 patients were included in the meta-analysis. The results revealed that ultrasound-guided SGB was significantly associated with a lower pain score at 24 hours after surgery (MD = -0.74; 95% CI = -1.39, -0.08; I2 = 86%; low evidence) and at 8 hours after surgery (MD = -0.65; 95% CI = -1.03, -0.28; I2 = 29%; moderate evidence). CONCLUSION Ultrasound-guided SGB is effective in alleviating acute postoperative pain. However, considering the limited number of trials performed to date, more large-scale and high-quality randomized controlled trials are required to confirm these findings.
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Affiliation(s)
- Yan Zhao
- Department of Anesthesiology, Beihai People’s Hospital, Beihai, China
| | - Xiangli Xiao
- Department of Anesthesiology, Beihai People’s Hospital, Beihai, China
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Yang F, Du Y, Yuan C, Han L, Zhao Y, Xie Y, Peng W. Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy. Am J Transl Res 2024; 16:1018-1028. [PMID: 38586110 PMCID: PMC10994798 DOI: 10.62347/rxrn7802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To investigate the effect of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and serum S100B during carotid endarterectomy (CEA). METHODS Patients who were prospectively enrolled to receive CEA under elective general anesthesia were randomized into an SGB group and a control group (ChiCTR2000033385). Before anesthesia, the SGB group underwent ipsilateral SGB under ultrasound guidance, while the control group did not. Ultrasound-guided right subclavian internal jugular vein catheterization was performed under general anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were monitored at various time points (T0-T4). Arterial and internal jugular venous bulb blood were collected for blood gas analysis, determining jugular venous oxygen saturation (SjvO2), arteriovenous oxygen difference (AVDO2), cerebral oxygen extraction ratio (COER), lactate production rate (LPR), and lactate-oxygen index (LOI). The serum concentration of S100B in the internal jugular venous bulb at each time point was measured. RESULTS The results revealed significantly lower HR during anesthesia induction and surgery in the SGB group, with more stable MAP and HR during endotracheal intubation and surgery compared to the control group (P<0.05). The control group exhibited decreases at T3 and a slight increase at T4. SjvO2 was significantly higher in the SGB group, while AVDO2 and COER gradually decreased over time, but they were significantly higher in the control group (P<0.05). LPR and LOI in both groups peaked at T3 and were significantly different between T4 and T2 (P<0.05). Serum S100B levels in both groups rose and then decreased at each time point, but they were consistently lower in the SGB group (P<0.05). CONCLUSION SGB before CEA effectively suppresses the stress response, maintains intraoperative hemodynamic stability, improves brain tissue oxygen supply, and demonstrates a neuroprotective effect.
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Affiliation(s)
- Fen Yang
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Yulong Du
- School of Medicine, Shaoxing UniversityShaoxing 312000, Zhejiang, China
- Department of Anesthesiology, Jinhua Municipal Central Hospital, Jinhua Hospital, Zhejiang University School of MedicineJinhua 321000, Zhejiang, China
| | - Chen Yuan
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Li Han
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Yue Zhao
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Yang Xie
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Wenyong Peng
- Department of Anesthesiology, Jinhua Municipal Central Hospital, Jinhua Hospital, Zhejiang University School of MedicineJinhua 321000, Zhejiang, China
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Yang Y, Zhang Y, Zhou G, Yang Z, Yan H, Zhang J. Efficacy of epidural esketamine on postoperative sleep quality after laparoscopic and robotic lower abdominal surgeries: a study protocol for randomised, double-blind, controlled trial. BMJ Open 2024; 14:e081589. [PMID: 38417951 PMCID: PMC10900385 DOI: 10.1136/bmjopen-2023-081589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Postoperative sleep disturbances significantly impair postoperative recovery. The administration of intravenous esketamine has been shown to potentially improve postoperative sleep quality. However, the effectiveness of epidural esketamine in improving postoperative sleep quality remains to be elucidated. This study aims to explore the impact of both intraoperative and postoperative use of epidural esketamine on the postoperative sleep quality of patients undergoing minimally invasive lower abdominal surgeries. METHODS AND ANALYSIS This randomised, double-blind, parallel-group, placebo-controlled trial will be conducted at the Fudan University Shanghai Cancer Centre. A total of 128 adults undergoing minimally invasive lower abdominal surgeries will be randomly allocated in a 1:1 ratio to either the esketamine group or the placebo group. In the esketamine group, epidural esketamine will be administered intraoperatively (0.2 mg/kg) and postoperatively (25 mg). Postoperatively, all patients will receive epidural analgesia. The primary outcome of the study is the incidence of poor sleep quality on the third day after surgery. The sleep quality assessment will be conducted using the Pittsburgh Sleep Quality Index and a Numeric Rating Scale of sleep. The main secondary outcomes include postoperative pain and anxiety and depression scores. The postoperative pain, both rest pain and movement pain, will be assessed using a Numerical Rating Scale within 5 days after surgery. Anxiety and depression scores will be evaluated using the Hospital Anxiety and Depression Scale both before and after the surgery. Safety outcomes will include delirium, fidgeting, hallucinations, dizziness and nightmares. The analyses will be performed in accordance with intention-to-treat principle ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Ethics Committee of the Shanghai Cancer Centre (2309281-9). Prior to participation, all patients will provide written informed consent. The results of the trial are intended to be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR2300076862.
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Affiliation(s)
- Yuecheng Yang
- Department of Anaesthesiology, Shanghai Cancer Centre, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yunkui Zhang
- Department of Anaesthesiology, Shanghai Cancer Centre, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Guoxia Zhou
- Department of Anaesthesiology, Shanghai Cancer Centre, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Zaixian Yang
- Department of Anaesthesiology, Shanghai Cancer Centre, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Han Yan
- Department of Anaesthesiology, Shanghai Cancer Centre, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Jun Zhang
- Department of Anaesthesiology, Shanghai Cancer Centre, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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Prasad S, Jain N, Umar TP, Radenkov I, Ahmed SK, Sakagianni V, Kollia S, Hingora MJ, Kumari N, Akbari AR, Renemane L, Bachu A. Sympathetic nerve blocks for posttraumatic stress disorder: an evidentiary review for future clinical trials. Front Psychiatry 2023; 14:1309986. [PMID: 38188052 PMCID: PMC10771322 DOI: 10.3389/fpsyt.2023.1309986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Posttraumatic stress disorder (PTSD) is a chronic disorder resulting from exposure to traumatic events. In recent years, sympathetic nerve blocks have gained interest as an emerging treatment modality for PTSD. They have been shown to reduce autonomic dysfunction associated with PTSD symptoms, particularly in refractory and treatment-resistant patients. However, there is limited evidence regarding the technique's effectiveness in PTSD patients. Therefore, this scoping review was designed to update and summarize the current literature on this topic to inform the design of future clinical trials and studies. Our review of 22 studies (mostly case reports and series) included 1,293 PTSD patients who received sympathetic nerve blocks, primarily military service members and veterans, with a median age of 42.2 years. 0.5% Ropivacaine was the preferred anesthetic, and the right sided stellate ganglion block was the most commonly used technique. Relapse of symptoms was reported commonly, resulting in additional nerve block sessions. Most reported side effects were mild and transient. Despite the encouraging results, we remain cautious in interpreting the benefit of the technique due to the lack of sufficient standardized clinical trial data, heterogeneity in reported results, and the potential for bias in reporting. Future studies should focus on evaluating and addressing the technique's effectiveness, safety, tolerability, and indications.
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Affiliation(s)
- Sakshi Prasad
- Faculty of Medicine, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, Riga, Latvia
| | - Tungki Pratama Umar
- UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Igor Radenkov
- Faculty of Medicine, St. Cyril and Methodius University, Skopje, North Macedonia
| | - Sirwan Khalid Ahmed
- Department of Adult Nursing, College of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan, Iraq
| | - Virginia Sakagianni
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Kollia
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikita Kumari
- Sindh Medical College (SMC), Jinnah Sindh Medical University (JSMU), Karachi, Pakistan
| | - Amir Reza Akbari
- Emergency Department, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom
| | - Lubova Renemane
- Department of Psychiatry and Narcology, Riga Stradinš University, Riga, Latvia
| | - Anil Bachu
- Baptist Health– UAMS Psychiatry Residency Education Program, North Little Rock, AR, United States
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