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Volk T, Kubulus C. Regional anesthesia with single shot blocks and current outcome measures: in and out of the anesthesiological radar. J Clin Anesth 2024; 96:111354. [PMID: 38044178 DOI: 10.1016/j.jclinane.2023.111354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Thomas Volk
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
| | - Christine Kubulus
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
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Rubin JE, Ng V, Chung J, Salvatierra N, Rippon B, Khatib D, Girardi NI, Pryor KO, Weinberg RY, Jiang S, Khairallah S, Mick SL, Tedore TR. Efficacy of parasternal peripheral nerve catheters versus no block for median sternotomy: a single-centre retrospective study. BJA OPEN 2024; 11:100288. [PMID: 39007154 PMCID: PMC11245929 DOI: 10.1016/j.bjao.2024.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/08/2024] [Indexed: 07/16/2024]
Abstract
Background Sternal pain after cardiac surgery results in considerable discomfort. Single-injection parasternal fascial plane blocks have been shown to reduce pain scores and opioid consumption during the first 24 h after surgery, but the efficacy of continuous infusion has not been evaluated. This retrospective cohort study examined the effect of a continuous infusion of local anaesthetic through parasternal catheters on the integrated Pain Intensity and Opioid Consumption (PIOC) score up to 72 h. Methods We performed a retrospective analysis of patients undergoing cardiac surgery with median sternotomy at a single academic centre before and after the addition of parasternal nerve catheters to a standard multimodal analgesic protocol. Outcomes included PIOC score, total opioid consumption in oral morphine equivalents, and time-weighted area under the curve pain scores up to 72 h after surgery. Results Continuous infusion of ropivacaine 0.1% through parasternal catheters resulted in a significant reduction in PIOC scores at 24 h (-62, 95% confidence interval -108 to -16; P<0.01) and 48 h (-50, 95% CI -97 to -2.2; P=0.04) compared with no block. A significant reduction in opioid consumption up to 72 h was the primary factor in reduction of PIOC. Conclusions This study suggests that continuous infusion of local anaesthetic through parasternal catheters may be a useful addition to a multimodal analgesic protocol in patients undergoing cardiac surgery with sternotomy. Further prospective study is warranted to determine the full benefits of continuous infusion compared with single injection or no block.
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Affiliation(s)
- John E. Rubin
- Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Vanessa Ng
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL, USA
| | - Justin Chung
- Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Nicolas Salvatierra
- Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Brady Rippon
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Diana Khatib
- Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Natalia I. Girardi
- Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Kane O. Pryor
- Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Roniel Y. Weinberg
- Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Silis Jiang
- Center for Perioperative Outcomes, Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Sherif Khairallah
- Department of Cardiothoracic Surgery, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Stephanie L. Mick
- Department of Cardiothoracic Surgery, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
| | - Tiffany R. Tedore
- Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
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Domagalska M, Ciftsi B, Janusz P, Reysner T, Daroszewski P, Kowalski G, Wieczorowska-Tobis K, Kotwicki T. Effectiveness of the Bilateral and Bilevel Erector Spinae Plane Block (ESPB) in Pediatric Idiopathic Scoliosis Surgery: A Randomized, Double-Blinded, Controlled Trial. J Pediatr Orthop 2024; 44:e634-e640. [PMID: 38689466 PMCID: PMC11232938 DOI: 10.1097/bpo.0000000000002707] [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: 05/02/2024]
Abstract
BACKGROUND This study aimed to compare the effect of the ultrasound-guided bilateral and bilevel erector spinae plane block (ESPB) on pain scores, opioid requirement, intraoperative motor-evoked potentials (MEPs), and stress response to surgery expressed by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) versus standard analgesia methods following idiopathic scoliosis surgery. METHODS This was a prospective, double-blinded, randomized controlled trial. Sixty patients aged 10 to 18 years and physical status ASA 1 or 2 were randomized into 2 equal groups, each receiving an ESPB or sham block. The primary outcome was the pain scores (Numerical Rating Scale, NRS) within 48 hours after spinal correction and fusion surgery for idiopathic thoracic scoliosis. The secondary outcomes were total opioid consumption, NLR, and PLR levels at 12 and 24 hours postoperatively and intraoperative MEPs. RESULTS ESPB patients presented lower NRS scores, signifying less pain, at all time points (30, 60, 90, 120 min; and 6, 12, 24, and 48 h after surgery), all P <0.0001. The total opioid consumption, the incidence of nausea or vomiting, and the need for remifentanil and propofol during surgery were significantly lower in the ESPB group. The surgery-induced stress response expressed by NLR and PLR was considerably lower in the ESPB group. ESPB did not affect the intraoperative MEP's amplitude. CONCLUSIONS ESPB is effective for postoperative analgesia, can reduce opioid consumption in patients undergoing scoliosis surgery, and reduces the stress response to surgery. ESPB does not interfere with neuromonitoring. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | - Bahadir Ciftsi
- Departments of Spine Disorders and Pediatric Orthopedics
| | - Piotr Janusz
- Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
| | - Tomasz Reysner
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences
| | - Przemysław Daroszewski
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
| | - Grzegorz Kowalski
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences
| | | | - Tomasz Kotwicki
- Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
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Zhang JJ, Wang SL, He L, Yang DD, Qian W, Zhao Y. Ultrasound-guided serratus anterior plane block enhances postoperative analgesia and recovery in thoracoscopic surgery. World J Clin Cases 2024; 12:3717-3724. [PMID: 38994302 PMCID: PMC11235445 DOI: 10.12998/wjcc.v12.i19.3717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/25/2024] [Accepted: 05/22/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The serratus anterior muscle, located in the lateral aspect of the thorax, plays a crucial role in shoulder movement and stability. Thoracoscopic surgery, while minimally invasive, often results in significant postoperative pain, complicating patient recovery and potentially extending hospital stays. Traditional anesthesia methods may not adequately address this pain, leading to increased complications such as agitation due to inadequate pain management. AIM To evaluate the application value of ultrasound-guided serratus anterior plane block (SAPB) in patients undergoing thoracoscopic surgery, focusing on its effects on postoperative analgesia and rehabilitation. METHODS Eighty patients undergoing thoracoscopic surgery between August 2021 and December 2022 were randomly divided into two groups: An observation group receiving ultrasound-guided SAPB and a control group receiving standard care without SAPB. Both groups underwent general anesthesia and were monitored for blood pressure, heart rate (HR), oxygen saturation, and pulse. The primary outcomes measured included mean arterial pressure (MAP), HR, postoperative visual analogue scale (VAS) scores for pain, supplemental analgesic use, and incidence of agitation. RESULTS The observation group showed significantly lower cortisol and glucose concentrations at various time points post-operation compared to the control group, indicating reduced stress responses. Moreover, MAP and HR levels were lower in the observation group during and after surgery. VAS scores were significantly lower in the observation group at 1 h, 4 h, 6 h, and 12 h post-surgery, and the rates of analgesic supplementation and agitation were significantly reduced compared to the control group. CONCLUSION Ultrasound-guided SAPB significantly improves postoperative analgesia and reduces agitation in patients undergoing thoracoscopic surgery. This technique stabilizes perioperative vital signs, decreases the need for supplemental analgesics, and minimizes postoperative pain and stress responses, underscoring its high application value in enhancing patient recovery and rehabilitation post-thoracoscopy.
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Affiliation(s)
- Jing-Jing Zhang
- Department of Anaesthesiology, The Second People’s Hospital of Wuhu, Wuhu 241000, Anhui Province, China
| | - Shao-Lin Wang
- Department of Anaesthesiology, The Second People’s Hospital of Wuhu, Wuhu 241000, Anhui Province, China
| | - Lei He
- Department of Anaesthesiology, The Second People’s Hospital of Wuhu, Wuhu 241000, Anhui Province, China
| | - Ding-Dong Yang
- Department of Anaesthesiology, The Second People’s Hospital of Wuhu, Wuhu 241000, Anhui Province, China
| | - Wei Qian
- Department of Anaesthesiology, The Second People’s Hospital of Wuhu, Wuhu 241000, Anhui Province, China
| | - Ying Zhao
- Department of Anaesthesiology, The Second People’s Hospital of Wuhu, Wuhu 241000, Anhui Province, China
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Li Q, Xu S, Ou Y, Zhou L, Huang F, Jiang W, Xie H, Zou X, Gao J, Jin S, Zhou H, Huang Y, Pan Z, Liu J, Wang G, Li X, Sun C, Zhao L, Li L, Liu Q, Duan K, Wang S. Evaluating the efficacy and safety of perianal injection of liposomal ropivacaine HR18034 for postoperative analgesia following hemorrhoidectomy: A multicenter, randomized, double-blind, controlled phase II clinical trial. J Clin Anesth 2024; 97:111524. [PMID: 38941870 DOI: 10.1016/j.jclinane.2024.111524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/30/2024]
Abstract
STUDY OBJECTIVE HR18034, composed of the ropivacaine encapsulated in multi-lamellar, concentric circular structure liposomes as the major component and a small amount of free ropivacaine, has performed well in animal experiments and phase I clinical trials. This trial was to investigate the efficacy, safety, pharmacokinetic profile and the minimum effective dose of HR18034 for postoperative analgesia after hemorrhoidectomy compared with ropivacaine. DESIGN A multicenter, randomized, double-blind trial. SETTING 19 medical centers in China. PATIENTS 85 patients undergoing hemorrhoidectomy between October 2022 to November 2022. INTERVENTIONS Patients were randomly divided into HR 18034 190 mg group, 285 mg group, 380 mg group and ropivacaine 75 mg group, receiving single local anesthetic perianal injection for postoperative analgesia. MEASUREMENTS The primary outcome was the area under the resting state NRS score -time curve within 72 h after injection. The second outcomes included the proportion of patients without pain, the proportion of patients not requiring rescue analgesia, cumulative morphine consumption for rescue analgesia, etc. Safety was evaluated by adverse events incidence and plasma ropivacaine concentrations were measured to explore the pharmacokinetic characteristics of HR18034. MAIN RESULTS The areas under the NRS score (at rest and moving states)-time curve were significantly lower in HR 18034 380 mg group than ropivacaine 75 mg at 24 h, 48 h, and 72 h after administration. However, this superiority was not observed in HR18034 190 mg group and 285 mg group. There was no difference in cumulative morphine consumption for rescue analgesia between HR 18034 groups and ropivacaine group. CONCLUSIONS HR 18034 380 mg showed superior analgesic efficacy and equivalent safety compared to ropivacaine 75 mg after hemorrhoidectomy, thus preliminarily determined as minimum effective dose.
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Affiliation(s)
- Qiuwen Li
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Shouyu Xu
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Yangwen Ou
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Lianbang Zhou
- The Second Affiliated Hospital of Anhui Medical University, Hefei 230022, People's Republic of China
| | - Furong Huang
- The First People's Hospital of Changde, Changde, People's Republic of China
| | - Wanwei Jiang
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116011, People's Republic of China
| | - Haihui Xie
- Dongguan people's Hospital, Dongguan, Guangdong, People's Republic of China
| | - Xiaohua Zou
- The Affiliated Hospital of Guizhou Medical University, Guiyang, People's Republic of China
| | - Jihua Gao
- Traditional Chinese Medicine Hospital of Hebei Province, Shijiazhang,People's Republic of China
| | - Shu''an Jin
- Central Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Hongmei Zhou
- Jiaxing Second Hospital, Jiaxing, People's Republic of China
| | - Yanjuan Huang
- Nanning Second People's Hospital, Nanning, People's Republic of China
| | - Zhihao Pan
- Li Huili Hospital of Ningbo Medical Center, Ningbo, People's Republic of China
| | - Juying Liu
- Taihe Hospital Affiliated Hospital of Hubei University of medicine, Shiyan, People's Republic of China
| | - Guyan Wang
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Xiangkui Li
- Sichuan Provincial People's Hospital, Chengdu, People's Republic of China
| | - CanLin Sun
- Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Ling Zhao
- The First Affiliated Hospital of Xi'an Medical University, Xi'an, People's Republic of China
| | - Lin Li
- General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Qin Liu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Kaiming Duan
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Saiying Wang
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China.
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Xu H, Wu W, Chen X, He W, Shi H. Opioid-sparing effects of ultrasound-guided erector spinae plane block for video-assisted thoracoscopic surgery: a randomized controlled study. Perioper Med (Lond) 2024; 13:53. [PMID: 38849882 PMCID: PMC11161975 DOI: 10.1186/s13741-024-00413-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/01/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND The erector spinae plane block (ESPB) is a new analgesic method used in thoracic surgery. However, few studies have characterized their effects on perioperative opioid consumption. We aimed to evaluate the effects of ESPB on perioperative opioid consumption in patients who underwent video-assisted thoracoscopic surgery (VATS). METHODS This was a randomized, observer-blinded clinical trial at a single-centre academic hospital. Eighty patients were scheduled for thoracoscopic segmentectomy or lobectomy by VATS for lung cancer. Forty participants were randomly assigned to ESPB or control group. All patients received intravenous patient-controlled postoperative analgesia. Perioperative opioid consumption, visual analogue scale (VAS) scores, and adverse events were recorded. RESULTS Intraoperative and postoperative opioid consumption and static/dynamic VAS scores were significantly lower in the early hours after VATS in the ESPB group (p < 0.05) than the control group. No significant differences were observed in adverse effects between the two groups. CONCLUSIONS ESPB reduced intraoperative opioid consumption and early postoperative pain in patients undergoing VATS. Our findings support the view that ESPB is a safe and highly effective option for regional analgesia for VATS. TRIAL REGISTRATION http://www.chictr.org.cn , ChiCTR1800019335.
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Affiliation(s)
- Huan Xu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Wei Wu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Xue Chen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China.
| | - Hong Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China.
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Xin L, Wang L, Feng Y. Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass surgery: a double-blinded randomized controlled trial. Can J Anaesth 2024; 71:784-792. [PMID: 37989939 PMCID: PMC11233300 DOI: 10.1007/s12630-023-02637-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE Minimally invasive direct coronary artery bypass (MIDCAB) surgery is associated with significant postoperative pain. We aimed to investigate the efficacy of ultrasound-guided erector spinae plane block (ESPB) for analgesia after MIDCAB. METHODS We conducted randomized controlled trial in 60 patients undergoing MIDCAB who received either a single-shot ESPB with 30 mL of ropivacaine 0.5% (ESPB group, n = 30) or normal saline 0.9% (control group, n = 30). The primary outcome was numerical rating scale (NRS) pain scores at rest within 48 hr postoperatively. The secondary outcomes included postoperative NRS pain scores on deep inspiration within 48 hr, hydromorphone consumption, and quality of recovery-15 (QoR-15) score at 24 and 48 hr. RESULTS Compared with the control group, the ESPB group had lower NRS pain scores at rest at 6 hr (estimated mean difference, -2.1; 99% confidence interval [CI], -2.7 to -1.5; P < 0.001), 12 hr (-1.9; 99% CI, -2.6 to -1.2; P < 0.001), and 18 hr (-1.2; 99% CI, -1.8 to -0.6; P < 0.001) after surgery. The ESPB group also showed lower pain scores on deep inspiration at 6 hr (-2.9; 99% CI, -3.6 to -2.1; P < 0.001), 12 hr (-2.3; 99% CI, -3.1 to -1.5; P < 0.001), and 18 hr (-1.0; 99% CI, -1.8 to -0.2; P = 0.01) postoperatively. Patients in the ESPB group had lower total intraoperative fentanyl use, lower 24-hr hydromorphone consumption, a shorter time to extubation, and a shorter time to intensive care unit (ICU) discharge. CONCLUSION Erector spinae plane block provided early effective postoperative analgesia and reduced opioid consumption, time to extubation, and ICU discharge in patients undergoing MIDCAB. TRIAL REGISTRATION www.chictr.org.cn (ChiCTR2100052810); registered 5 November 2021.
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Affiliation(s)
- Ling Xin
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Lu Wang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
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Bhushan S, Liu X, Jiang F, Wang X, Mao L, Xiao Z. A progress of research on the application of fascial plane blocks in surgeries and their future direction: a review article. Int J Surg 2024; 110:3633-3640. [PMID: 38935829 PMCID: PMC11175748 DOI: 10.1097/js9.0000000000001282] [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: 07/21/2023] [Accepted: 02/22/2024] [Indexed: 06/29/2024]
Abstract
Fascial plane blocks (FPBs) are gaining popularity in clinical settings owing to their improved analgesia when combined with either traditional regional anesthesia or general anesthesia during the perioperative phase. The scope of study on FPBs has substantially increased over the past 20 years, yet the exact mechanism, issues linked to the approaches, and direction of future research on FPBs are still up for debate. Given that it can be performed at all levels of the spine and provides analgesia to most areas of the body, the erector spinae plane block, one of the FPBs, has been extensively studied for chronic rational pain, visceral pain, abdominal surgical analgesia, imaging, and anatomical mechanisms. This has led to the contention that the erector spinae plane block is the ultimate Plan A block. Yet even though the future of FPBs is promising, the unstable effect, the probability of local anesthetic poisoning, and the lack of consensus on the definition and assessment of the FPB's success are still the major concerns. In order to precisely administer FPBs to patients who require analgesia in this condition, an algorithm that uses artificial intelligence is required. This algorithm will assist healthcare professionals in practicing precision medicine.
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Affiliation(s)
- Sandeep Bhushan
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Xian Liu
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Fenglin Jiang
- Department of Anesthesia and Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, People’s Republic of China
| | - Xiaowei Wang
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Long Mao
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Zongwei Xiao
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
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Zhao Y, Liu M, Li W, Tao G. Topical lyophilized thrombin application improves wound healing for posterior spinal surgery. Heliyon 2024; 10:e31335. [PMID: 38813190 PMCID: PMC11133810 DOI: 10.1016/j.heliyon.2024.e31335] [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: 05/23/2023] [Revised: 04/23/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024] Open
Abstract
Background The erector spinae plane block (ESPB) was proposed as a part of the postoperative multimodal analgesic regimen to improve pain management after posterior spinal surgery. However, ESPB might cause more surgical incisional wound exudate and poor wound healing, which might be improved after topical lyophilized thrombin application. Materials and methods We performed a retrospective study on patients who received posterior spinal surgery between January 2018 and December 2021. These patients were assigned into three groups: group A (general anesthesia), group B (general anesthesia with ESPB), and group C (general anesthesia with ESPB and topical 1000-unit thrombin application). Postoperative outcomes, including times of dressing changes, duration of suture removal, and incisional wound healing, were compared among these groups. Results Our study included 89 patients, with 48, 20, and 21 patients in groups A, B, and C, respectively. Baseline demographics, height, weight, comorbidities, and operation duration were comparable among the three groups. Group B required statistically significantly more dressing changes and had a prolonged duration of suture removal than group A (9.4 ± 4.7 versus 6.5 ± 2.0 times, 16.2 ± 3.7 versus 14.2 ± 1.4 days, respectively), which could be statistically significantly improved after the thrombin application in group C. Group B also had more frequent poor wound healing (25.0 %), which could also be improved after the thrombin application (0.0 %). Conclusions ESPB could cause more dressing changes and poor surgical wound healing after posterior spinal surgery, which could be improved by topical lyophilized thrombin powder application.
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Affiliation(s)
- Yinjie Zhao
- Department of Anesthesiology, Guiqian International General Hospital, Guiyang, 550024, China
| | - Ming Liu
- Department of Orthopedics and Sports Medicine, Heyou International Hospital, Guangdong, 528000, China
| | - Wenyao Li
- Department of Pain Management, Guigian International General Hospital, Gui Yang, 550024, China
| | - Guocai Tao
- Department of Anesthesiology, Guiqian International General Hospital, Guiyang, 550024, China
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Ní Eochagáin A, Carolan S, Buggy DJ. Regional anaesthesia truncal blocks for acute postoperative pain and recovery: a narrative review. Br J Anaesth 2024; 132:1133-1145. [PMID: 38242803 DOI: 10.1016/j.bja.2023.12.020] [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: 04/14/2023] [Revised: 10/22/2023] [Accepted: 12/04/2023] [Indexed: 01/21/2024] Open
Abstract
Significant acute postoperative pain remains prevalent among patients who undergo truncal surgery and is associated with increased morbidity, prolonged patient recovery, and increased healthcare costs. The provision of high-quality postoperative analgesia is an important component of postoperative care, particularly within enhanced recovery programmes. Regional anaesthetic techniques have become increasingly prevalent within multimodal analgesic regimens and the widespread adoption of ultrasonography has facilitated the development of novel fascial plane blocks. The number of described fascial plane blocks has increased significantly over the past decade, leading to a burgeoning area of clinical investigation. Their applications are increasing, and truncal fascial plane blocks are increasingly recommended as part of procedure-specific guidelines. Some fascial plane blocks have been shown to be more efficacious than others, with favourable side-effect profiles compared with neuraxial analgesia, and are increasingly utilised in breast, thoracic, and other truncal surgery. However, use of these blocks is debated in regional anaesthesia circles because of limitations in our understanding of their mechanisms of action. This narrative review evaluates available evidence for the analgesic efficacy of the most commonly practised fascial plane blocks in breast, thoracic, and abdominal truncal surgery, in particular their efficacy compared with systemic analgesia, alternative blocks, and neuraxial techniques. We also highlight areas where investigations are ongoing and suggest priorities for original investigations.
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Affiliation(s)
- Aisling Ní Eochagáin
- Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland; Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Seán Carolan
- Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland
| | - Donal J Buggy
- Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland; Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Euro-Periscope, The ESA-IC Oncoanaesthesiology Research Group, Europe
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Ní Eochagáin A, Buggy DJ. Regional anaesthesia truncal blocks for acute postoperative pain and recovery. Response to Br J Anaesth 2024; 132: 1166-7. Br J Anaesth 2024; 132:1168. [PMID: 38448272 DOI: 10.1016/j.bja.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Aisling Ní Eochagáin
- Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Donal J Buggy
- Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College, Dublin, Ireland; EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, Brussels, Belgium; Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
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Fallon F, Moorthy A, Skerritt C, Crowe GG, Buggy DJ. Latest Advances in Regional Anaesthesia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:735. [PMID: 38792918 PMCID: PMC11123025 DOI: 10.3390/medicina60050735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024]
Abstract
Training and expertise in regional anaesthesia have increased significantly in tandem with increased interest over the past two decades. This review outlines the most recent advances in regional anaesthesia and focuses on novel areas of interest including fascial plane blocks. Pharmacological advances in the form of the prolongation of drug duration with liposomal bupivacaine are considered. Neuromodulation in the context of regional anaesthesia is outlined as a potential future direction. The growing use of regional anaesthesia outside of the theatre environment and current thinking on managing the rebound plane after regional block regression are also discussed. Recent relevant evidence is summarised, unanswered questions are outlined, and priorities for ongoing investigation are suggested.
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Affiliation(s)
- Frances Fallon
- Department of Anaesthesia, Mater Misericordiae University Hospital, Eccles St, D07 WKW8 Dublin, Ireland;
| | - Aneurin Moorthy
- Department of Anaesthesia, National Orthopaedic Hospital Cappagh/Mater Misericordiae University Hospital, Eccles St, D07 WKW8 Dublin, Ireland; (A.M.)
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Conor Skerritt
- Department of Anaesthesia, National Orthopaedic Hospital Cappagh/Mater Misericordiae University Hospital, Eccles St, D07 WKW8 Dublin, Ireland; (A.M.)
| | - Gillian G. Crowe
- Department of Anaesthesia, Cork University Hospital, Wilton, T12 DC4A Cork, Ireland
| | - Donal J. Buggy
- Department of Anaesthesia, Mater Misericordiae University Hospital, Eccles St, D07 WKW8 Dublin, Ireland;
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- The ESA-IC Oncoanaesthesiology Research Group and Outcomes Research, Cleveland, OH 44195, USA
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13
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Clairoux A, Moore A, Caron-Goudreault M, Soucy-Proulx M, Thibault M, Brulotte V, Bélanger ME, Raft J, Godin N, Idrissi M, Desroches J, Ruel M, Fortier A, Richebé P. Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial. BMC Anesthesiol 2024; 24:156. [PMID: 38654164 DOI: 10.1186/s12871-024-02544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION There is a sizable niche for a minimally invasive analgesic technique that could facilitate ambulatory video-assisted thoracoscopic surgery (VATS). Our study aimed to determine the analgesic potential of a single-shot erector spinae plane (ESP) block for VATS. The primary objective was the total hydromorphone consumption with patient-controlled analgesia (PCA) 24 h after surgery. METHODS We conducted a randomized, controlled, double-blind study with patients scheduled for VATS in two major university-affiliated hospital centres. We randomized 52 patients into two groups: a single-shot ESP block using bupivacaine or an ESP block with normal saline (control). We administered a preoperative and postoperative (24 h) quality of recovery (QoR-15) questionnaire and assessed postoperative pain using a verbal numerical rating scale (VNRS) score. We evaluated the total standardized intraoperative fentanyl administration, total postoperative hydromorphone consumption (PCA; primary endpoint), and the incidence of adverse effects. RESULTS There was no difference in the primary objective, hydromorphone consumption at 24 h (7.6 (4.4) mg for the Bupivacaine group versus 8.1 (4.2) mg for the Control group). Secondary objectives and incidence of adverse events were not different between the two groups at any time during the first 24 h following surgery. CONCLUSION Our multi-centre randomized, controlled, double-blinded study found no advantage of an ESP block over placebo for VATS for opioid consumption, pain, or QoR-15 scores. Further studies are ongoing to establish the benefits of using a denser block (single-shot paravertebral with a continuous ESP block), which may provide a better quality of analgesia.
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Affiliation(s)
- A Clairoux
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - A Moore
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada.
| | - M Caron-Goudreault
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - M Soucy-Proulx
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - M Thibault
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - V Brulotte
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - M E Bélanger
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - J Raft
- Institut de Cancérologie de Lorraine, Nancy, France
| | - N Godin
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - M Idrissi
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - J Desroches
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - M Ruel
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - A Fortier
- Montreal Health Innovations Coordinating Center, Montréal, Québec, Canada
| | - P Richebé
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
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González-Santos S, Mugabure B, Granell M, Aguinagalde B, López IJ, Aginaga A, Zubelzu I, Iraeta H, Zabaleta J, Izquierdo JM, González-Jorrín N, Sarasqueta C, Herreros-Pomares A. Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial. J Clin Med 2024; 13:1972. [PMID: 38610735 PMCID: PMC11012894 DOI: 10.3390/jcm13071972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Lung resection using video-assisted thoracoscopic surgery (VATS) improves surgical accuracy and postoperative recovery. Unfortunately, moderate-to-severe acute postoperative pain is still inherent to the procedure, and a technique of choice has not been established for the appropriate control of pain. In this study, we aimed to compare the efficacy and safety of intrathecal morphine (ITM) with that of intercostal levobupivacaine (ICL). Methods: We conducted a single-center, prospective, randomized, observer-blinded, controlled trial among 181 adult patients undergoing VATS (ISRCTN12771155). Participants were randomized to receive ITM or ICL. Primary outcomes were the intensity of pain, assessed by a numeric rating scale (NRS) over the first 48 h after surgery, and the amount of intravenous morphine used. Secondary outcomes included the incidence of adverse effects, length of hospital stay, mortality, and chronic post-surgical pain at 6 and 12 months after surgery. Results: There are no statistically significant differences between ITM and ICL groups in pain intensity and evolution at rest. In cough-related pain, differences in pain trajectories over time are observed. Upon admission to the PACU, cough-related pain was higher in the ITM group, but the trend reversed after 6 h. There are no significant differences in adverse effects. The rate of chronic pain was low and did not differ significantly between groups. Conclusions: ITM can be considered an adequate and satisfactory regional technique for the control of acute postoperative pain in VATS, compatible with the multimodal rehabilitation and early discharge protocols used in these types of surgeries.
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Affiliation(s)
- Silvia González-Santos
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Borja Mugabure
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Manuel Granell
- Department of Anesthesiology, Postoperative Care and Pain Management, Hospital General Universitario de València, 46014 Valencia, Spain
- Department of Surgery, Universitat de València, 46010 Valencia, Spain
| | - Borja Aguinagalde
- Department of Thoracic Surgery, Donostia University Hospital, 20014 San Sebastián, Spain; (B.A.); (I.J.L.); (J.Z.); (J.M.I.)
| | - Iker J. López
- Department of Thoracic Surgery, Donostia University Hospital, 20014 San Sebastián, Spain; (B.A.); (I.J.L.); (J.Z.); (J.M.I.)
| | - Ainhoa Aginaga
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Inmaculada Zubelzu
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Haritz Iraeta
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Jon Zabaleta
- Department of Thoracic Surgery, Donostia University Hospital, 20014 San Sebastián, Spain; (B.A.); (I.J.L.); (J.Z.); (J.M.I.)
| | - Jose Miguel Izquierdo
- Department of Thoracic Surgery, Donostia University Hospital, 20014 San Sebastián, Spain; (B.A.); (I.J.L.); (J.Z.); (J.M.I.)
| | - Nuria González-Jorrín
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Cristina Sarasqueta
- Department of Clinical Epidemiology, Donostia University Hospital, ISS Bioguipuzcoa, 20014 San Sebastián, Spain;
| | - Alejandro Herreros-Pomares
- Department of Biotechnology, Universitat Politècnica de València, 46022 Valencia, Spain;
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029 Madrid, Spain
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15
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Li J, Dong Y, Guo J, Wang L, Tian J, Wang L, Che G. Thoracoscopic Intercostal Nerve Block with Cocktail Analgesics for Pain Control After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study. J Pain Res 2024; 17:1183-1196. [PMID: 38524689 PMCID: PMC10959176 DOI: 10.2147/jpr.s446951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Objective To evaluate whether using a cocktail of intercostal nerve blocks (TINB) during thoracoscopic surgery results in better clinical outcomes than patient-controlled analgesia (PCIA). Methods Patients in two medical groups undergoing video-assisted thoracoscopic surgery (VATS) for pulmonary nodules in West China Hospital of Sichuan University were collected consecutively between March 2022 and December 2022. The groups were divided into two subgroups based on their analgesic program, which were TINB group and PCIA group. The primary outcome was the visual analogue scale (VAS) of the two groups at different stage after surgery and after discharge. Any analgesic related adverse events (ARAEs) were also recorded. Results A total of 230 patients who underwent VATS were enrolled, in which 113 patients (49.1%) received a cocktail TINB after surgery, and 117 patients (50.9%) received a PCIA. After PSM, 62 patients in each group were selected. The difference of resting VAS (RVAS) and active VAS (AVAS) at different stage during hospitalization was only related to the change of period (p < 0.05, p < 0.05), and the two groups showed no significant differences in RVAS or AVAS during hospitalization (p = 0.271, p = 0.915). However, the rates of dizziness (4.84% vs 25.81%, p = 0.002), nausea and vomiting (0 vs 22.58%, p < 0.05), fatigue (14.52% vs 34.87%, p = 0.012), and insomnia (0 vs 58.06%, p < 0.05) in TINB group were lower than that in PCIA group. Besides, AVAS and RVAS at 7, 14, and 30 days after discharge in TINB group were both significantly lower than that in PCIA group (p < 0.05, p < 0.05). Conclusion Cocktail TINB provided better analgesia after discharge and reduced the incidence of ARAEs in patients undergoing VATS.
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Affiliation(s)
- Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yingxian Dong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jiawei Guo
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, People’s Republic of China
| | - Lei Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jie Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Li Wang
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, People’s Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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16
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Wu W, Wang D, Liu Y, Zhu T, He W, Shi H. Comparison of ultrasound-guided subtransverse process interligamentary plane block with paravertebral block for postoperative analgesia in thoracic surgery: protocol for a randomised non-inferiority trial. BMJ Open 2024; 14:e082135. [PMID: 38485177 PMCID: PMC10941127 DOI: 10.1136/bmjopen-2023-082135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/26/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION The subtransverse process interligamentary (STIL) plane block is an emerging interfascial plane block that has garnered attention for its potential to provide effective postoperative analgesia for breast and thoracic surgeries. However, a direct comparative assessment between the STIL plane block and the paravertebral block is currently lacking. Consequently, our study aims to assess the analgesic efficacy of the STIL block in comparison to paravertebral block for patients undergoing video-assisted thoracoscopic surgery (VATS). METHODS AND ANALYSIS This study is a randomised, parallel-controlled, double-blind, non-inferiority trial, with the goal of enrolling 114 participants scheduled for uniportal VATS at Shanghai Pulmonary Hospital. Participants will be randomly assigned in a 1:1 ratio through block randomisation to receive either the STIL plane block (n=57) or the paravertebral block (n=57). The primary outcome of the study is the area under the curve of Numerical Rating Scale(NRS) scores recorded over a 48-hour period following the surgical procedure. Secondary outcomes encompass the evaluation of Quality of Recovery-40, cumulative sufentanil consumption, serum inflammatory factors, rescue medication usage, the incidence of adverse events and the patient satisfaction scores. ETHICS AND DISSEMINATION This study has received approval from the Medical Ethics Committee of Shanghai Pulmonary Hospital (approval no. L22-329). Written informed consent will be obtained from all participants. The findings will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2200066909.
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Affiliation(s)
- Wei Wu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Danyang Wang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yang Liu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianyi Zhu
- School of Medicine, Tongji University, Shanghai, China
| | - Wenxin He
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hong Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Capuano P, Sepolvere G, Toscano A, Scimia P, Silvetti S, Tedesco M, Gentili L, Martucci G, Burgio G. Fascial plane blocks for cardiothoracic surgery: a narrative review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:20. [PMID: 38468350 PMCID: PMC10926596 DOI: 10.1186/s44158-024-00155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
In recent years, there has been a growing awareness of the limitations and risks associated with the overreliance on opioids in various surgical procedures, including cardiothoracic surgery.This shift on pain management toward reducing reliance on opioids, together with need to improve patient outcomes, alleviate suffering, gain early mobilization after surgery, reduce hospital stay, and improve patient satisfaction and functional recovery, has led to the development and widespread implementation of enhanced recovery after surgery (ERAS) protocols.In this context, fascial plane blocks are emerging as part of a multimodal analgesic in cardiac surgery and as alternatives to conventional neuraxial blocks for thoracic surgery, and there is a growing body of evidence suggesting their effectiveness and safety in providing pain relief for these procedures. In this review, we discuss the most common fascial plane block techniques used in the field of cardiothoracic surgery, offering a comprehensive overview of regional anesthesia techniques and presenting the latest evidence on the use of chest wall plane blocks specifically in this surgical setting.
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Affiliation(s)
- Paolo Capuano
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (IRCCS-ISMETT), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy.
| | - Giuseppe Sepolvere
- Department of Anesthesia and Cardiac Surgery Intensive Care Unit, Casa Di Cura San Michele, Maddaloni, Caserta, Italy
| | - Antonio Toscano
- Department of Anesthesia, Critical Care and Emergency, "Città Della Salute E Della Scienza" Hospital, Turin, Italy
| | - Paolo Scimia
- Intensive Care Unit, Department of Anesthesia, G. Mazzini Hospital, Teramo, Italy
| | - Simona Silvetti
- Department of Cardioanesthesia and Intensive Care, Policlinico San Martino IRCCS Hospital - IRCCS Cardiovascular Network, Genoa, Italy
| | - Mario Tedesco
- Department of Anesthesia and Intensive Care Unit and Pain Therapy, Mater Dei Hospital, Bari, Italy
| | - Luca Gentili
- Intensive Care Unit, Department of Anesthesia, S. Maria Goretti Hospital, Latina, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (IRCCS-ISMETT), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy
| | - Gaetano Burgio
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (IRCCS-ISMETT), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy
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Kumar S, Bt A, Neelakandan E, Rv R, Segaran S, Solomon P. Efficacy of Bilateral Erector Spinae Block in Patients Undergoing Posterior Spine Fusion Surgeries: A Comparative Randomised Controlled Trial. Cureus 2024; 16:e55366. [PMID: 38434605 PMCID: PMC10907871 DOI: 10.7759/cureus.55366] [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: 03/01/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction During spine surgeries, various levels of tissue injury can result in varying hemodynamic responses and significant postoperative pain. Perioperative pain management is essential to controlling hemodynamic responses and postoperative pain management. Erector spinae plane (ESP) blocks can help alleviate this pain by blocking the dorsal rami of the spinal nerve. This study aims to evaluate the efficacy of ESP by assessing the perioperative opioid requirement, hemodynamic parameters, and visual analogue score (VAS) during the postoperative period. Methods In this study, 56 patients underwent elective posterior spine fusion surgeries under conventional anaesthesia and were allocated into two groups: 28 patients were included in the conventional group (Group C) and 28 patients in the ESP group (Group E). Group C patients received 20 ml of 0.9% sodium chloride (NaCl) on each side, and Group E patients received 20 ml of 0.25% bupivacaine + 4 mg dexamethasone on each side under ultrasound sonography guidance. Postoperative pain was assessed using the VAS score. The hemodynamic parameters during the intraoperative period, the time for the first opioid analgesia requirement until 24 hours in the postoperative period, and the amount of cumulative opioid consumption during the perioperative period were observed. Results Postoperative VAS was lower in Group E (P < 0.001). There were significant differences in hemodynamic parameters: heart rate (P < 0.045), systolic blood pressure (P < 0.002), diastolic blood pressure (P < 0.003), and mean arterial pressure (P < 0.002) at the time of incision in Group E. Intraoperative opioid requirements at the time of incision (P < 0.036), 60th minutes (P < 0.023), 120th minutes (P < 0.023), and postoperative opioid requirements at the first hour (P < 0.001), sixth hour (P < 0.004), 14th hour (P < 0.025), 20th hour (P < 0.009), and 24th hour (P < 0.025) had lower opioid requirements in Group E than Group C. Conclusion ESP block is a more site-specific dorsal rami block with a better perioperative hemodynamic profile, a part of multimodal analgesia intraoperatively, and excellent postoperative analgesia with fewer postoperative opioid requirements in multilevel spine fusion surgeries.
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Affiliation(s)
- Suresh Kumar
- Anaesthesiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Arish Bt
- Anaesthesiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Eashwar Neelakandan
- Anaesthesiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Ranjan Rv
- Anaesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, IND
| | - Sivakumar Segaran
- Anaesthesiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Prince Solomon
- Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, IND
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Ott S, Müller-Wirtz LM, Sertcakacilar G, Tire Y, Turan A. Non-Neuraxial Chest and Abdominal Wall Regional Anesthesia for Intensive Care Physicians-A Narrative Review. J Clin Med 2024; 13:1104. [PMID: 38398416 PMCID: PMC10889232 DOI: 10.3390/jcm13041104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Multi-modal analgesic strategies, including regional anesthesia techniques, have been shown to contribute to a reduction in the use of opioids and associated side effects in the perioperative setting. Consequently, those so-called multi-modal approaches are recommended and have become the state of the art in perioperative medicine. In the majority of intensive care units (ICUs), however, mono-modal opioid-based analgesic strategies are still the standard of care. The evidence guiding the application of regional anesthesia in the ICU is scarce because possible complications, especially associated with neuraxial regional anesthesia techniques, are often feared in critically ill patients. However, chest and abdominal wall analgesia in particular is often insufficiently treated by opioid-based analgesic regimes. This review summarizes the available evidence and gives recommendations for peripheral regional analgesia approaches as valuable complements in the repertoire of intensive care physicians' analgesic portfolios.
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Affiliation(s)
- Sascha Ott
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Deutsches Herzzentrum der Charité-Medical Heart Center of Charité and German Heart Institute Berlin, Department of Cardiac Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Lukas M Müller-Wirtz
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Saarland University Faculty of Medicine, 66424 Homburg, Germany
| | - Gokhan Sertcakacilar
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, 34147 Istanbul, Turkey
| | - Yasin Tire
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, Konya City Hospital, University of Health Science, 42020 Konya, Turkey
| | - Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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20
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Oostvogels L, Weibel S, Meißner M, Kranke P, Meyer-Frießem CH, Pogatzki-Zahn E, Schnabel A. Erector spinae plane block for postoperative pain. Cochrane Database Syst Rev 2024; 2:CD013763. [PMID: 38345071 PMCID: PMC10860379 DOI: 10.1002/14651858.cd013763.pub3] [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: 02/15/2024]
Abstract
BACKGROUND Acute and chronic postoperative pain are important healthcare problems, which can be treated with a combination of opioids and regional anaesthesia. The erector spinae plane block (ESPB) is a new regional anaesthesia technique, which might be able to reduce opioid consumption and related side effects. OBJECTIVES To compare the analgesic effects and side effect profile of ESPB against no block, placebo block or other regional anaesthetic techniques. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Web of Science on 4 January 2021 and updated the search on 3 January 2022. SELECTION CRITERIA Randomised controlled trials (RCTs) investigating adults undergoing surgery with general anaesthesia were included. We included ESPB in comparison with no block, placebo blocks or other regional anaesthesia techniques irrespective of language, publication year, publication status or technique of regional anaesthesia used (ultrasound, landmarks or peripheral nerve stimulator). Quasi-RCTs, cluster-RCTs, cross-over trials and studies investigating co-interventions in either arm were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all trials for inclusion and exclusion criteria, and risk of bias (RoB), and extracted data. We assessed risk of bias using the Cochrane RoB 2 tool, and we used GRADE to rate the certainty of evidence for the primary outcomes. The primary outcomes were postoperative pain at rest at 24 hours and block-related adverse events. Secondary outcomes were postoperative pain at rest (2, 48 hours) and during activity (2, 24 and 48 hours after surgery), chronic pain after three and six months, as well as cumulative oral morphine requirements at 2, 24 and 48 hours after surgery and rates of opioid-related side effects. MAIN RESULTS We identified 69 RCTs in the first search and included these in the systematic review. We included 64 RCTs (3973 participants) in the meta-analysis. The outcome postoperative pain was reported in 38 out of 64 studies; block-related adverse events were reported in 40 out of 64 studies. We assessed RoB as low in 44 (56%), some concerns in 24 (31%) and high in 10 (13%) of the study results. Overall, 57 studies reported one or both primary outcomes. Only one study reported results on chronic pain after surgery. In the updated literature search on 3 January 2022 we found 37 new studies and categorised these as awaiting classification. ESPB compared to no block There is probably a slight but not clinically relevant reduction in pain intensity at rest 24 hours after surgery in patients treated with ESPB compared to no block (visual analogue scale (VAS), 0 to 10 points) (mean difference (MD) -0.77 points, 95% confidence interval (CI) -1.08 to -0.46; 17 trials, 958 participants; moderate-certainty evidence). There may be no difference in block-related adverse events between the groups treated with ESPB and those receiving no block (no events in 18 trials reported, 1045 participants, low-certainty evidence). ESPB compared to placebo block ESPB probably has no effect on postoperative pain intensity at rest 24 hours after surgery compared to placebo block (MD -0.14 points, 95% CI -0.29 to 0.00; 8 trials, 499 participants; moderate-certainty evidence). There may be no difference in block-related adverse events between ESPB and placebo blocks (no events in 10 trials reported; 592 participants; low-certainty evidence). ESPB compared to other regional anaesthetic techniques Paravertebral block (PVB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to PVB (MD 0.23 points, 95% CI -0.06 to 0.52; 7 trials, 478 participants; low-certainty evidence). There is probably no difference in block-related adverse events (risk ratio (RR) 0.27, 95% CI 0.08 to 0.95; 7 trials, 522 participants; moderate-certainty evidence). Transversus abdominis plane block (TAPB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to TAPB (MD -0.16 points, 95% CI -0.46 to 0.14; 3 trials, 160 participants; low-certainty evidence). There may be no difference in block-related adverse events (RR 1.00, 95% CI 0.21 to 4.83; 4 trials, 202 participants; low-certainty evidence). Serratus anterior plane block (SAPB) The effect on postoperative pain could not be assessed because no studies reported this outcome. There may be no difference in block-related adverse events (RR 1.00, 95% CI 0.06 to 15.59; 2 trials, 110 participants; low-certainty evidence). Pectoralis plane block (PECSB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to PECSB (MD 0.24 points, 95% CI -0.11 to 0.58; 2 trials, 98 participants; low-certainty evidence). The effect on block-related adverse events could not be assessed. Quadratus lumborum block (QLB) Only one study reported on each of the primary outcomes. Intercostal nerve block (ICNB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to ICNB, but this is uncertain (MD -0.33 points, 95% CI -3.02 to 2.35; 2 trials, 131 participants; very low-certainty evidence). There may be no difference in block-related adverse events, but this is uncertain (RR 0.09, 95% CI 0.04 to 2.28; 3 trials, 181 participants; very low-certainty evidence). Epidural analgesia (EA) We are uncertain whether ESPB has an effect on postoperative pain intensity at rest 24 hours after surgery compared to EA (MD 1.20 points, 95% CI -2.52 to 4.93; 2 trials, 81 participants; very low-certainty evidence). A risk ratio for block-related adverse events was not estimable because only one study reported this outcome. AUTHORS' CONCLUSIONS ESPB in addition to standard care probably does not improve postoperative pain intensity 24 hours after surgery compared to no block. The number of block-related adverse events following ESPB was low. Further research is required to study the possibility of extending the duration of analgesia. We identified 37 new studies in the updated search and there are three ongoing studies, suggesting possible changes to the effect estimates and the certainty of the evidence in the future.
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Affiliation(s)
- Lisa Oostvogels
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Stephanie Weibel
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Meißner
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Peter Kranke
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christine H Meyer-Frießem
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, BG-Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Alexander Schnabel
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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21
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Hoogma DF, Brullot L, Coppens S. Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery. Curr Opin Anaesthesiol 2024; 37:64-68. [PMID: 38085865 DOI: 10.1097/aco.0000000000001325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
PURPOSE OF REVIEW Thoracic surgery is evolving, necessitating an adaptation for perioperative anesthesia and analgesia. This review highlights the recent advancements in perioperative (multimodal) analgesia for minimally invasive thoracic surgery. RECENT FINDINGS Continuous advancements in surgical techniques have led to a reduction in surgical trauma. However, managing perioperative pain remains a major challenge, impeding postoperative recovery. The traditional neuraxial technique is now deemed outdated for minimally invasive thoracic surgery. Instead, newer regional techniques have emerged, and traditional approaches have undergone (re-)evaluation by experts and professional societies to establish guidelines and practices. Assessing the quality of recovery, evenafter discharge, has become a crucial factor in evaluating the effectiveness of these strategies, aiding clinicians in making informed decisions to improve perioperative care. SUMMARY In the realm of minimally invasive thoracic surgery, perioperative analgesia is typically administered through systemic and regional techniques. Nevertheless, collaboration between anesthesiologists and surgeons, utilizing surgically placed nerve blocks and an active chest drain management, has the potential to significantly improve overall patient care.
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Affiliation(s)
- Danny Feike Hoogma
- Department of Anesthesiology, University Hospitals of Leuven
- Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | | | - Steve Coppens
- Department of Anesthesiology, University Hospitals of Leuven
- Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
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22
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Suzuka T, Tanaka N, Kadoya Y, Ida M, Iwata M, Ozu N, Kawaguchi M. Comparison of Quality of Recovery between Modified Thoracoabdominal Nerves Block through Perichondrial Approach versus Oblique Subcostal Transversus Abdominis Plane Block in Patients Undergoing Total Laparoscopic Hysterectomy: A Pilot Randomized Controlled Trial. J Clin Med 2024; 13:712. [PMID: 38337406 PMCID: PMC10856699 DOI: 10.3390/jcm13030712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA) provides a wide analgesic range. Herein, we examined the quality of recovery (QoR) of M-TAPA for total laparoscopic hysterectomy (TLH) compared with oblique subcostal transversus abdominis plane block (OSTAPB) and measured plasma levobupivacaine concentrations (PClevo). Forty female patients undergoing TLH were randomized to each group. Nerve blocks were performed bilaterally with 25 mL of 0.25% levobupivacaine administered per side. The primary outcome was changes in QoR-15 scores on postoperative days (POD) 1 and 2 from the preoperative baseline. The main secondary outcomes were PClevo at 15, 30, 45, 60, and 120 min after performing nerve block. Group differences (M-TAPA-OSTAPB) in mean changes from baseline in QoR-15 scores on POD 1 and 2 were -11.3 (95% confidence interval (CI), -24.9 to 2.4, p = 0.104; standard deviation (SD), 22.8) and -7.0 (95% CI, -20.5 to 6.6, p = 0.307; SD, 18.7), respectively. Changes in PClevo were similar in both groups. The post hoc analysis using Bayesian statistics revealed that posterior probabilities of M-TAPA being clinically more effective than OSTAPB were up to 22.4 and 24.4% for POD 1 and 2, respectively. In conclusion, M-TAPA may not be superior to OSTAPB for TLH.
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Affiliation(s)
- Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
| | - Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
| | - Yuma Kadoya
- Department of Anesthesiology, Ikeda City Hospital, 3-1-18 Jonan, Ikeda 635-8501, Osaka, Japan;
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
| | - Masato Iwata
- Department of Anesthesiology, Yamatotakada Municipal Hospital, 1-1, Isonokita-cho, Yamatotakada 635-8501, Nara, Japan;
| | - Naoki Ozu
- Institute for Clinical and Translational Science, Nara Medical University Hospital, 840 Shijocho, Kashihara 634-8522, Nara, Japan;
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
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Muhammad QUA, Sohail MA, Azam NM, Bashir HH, Islam H, Ijaz R, Aquil S, Mansoor T, Dhakal B, Fatima T, Noor J, Khan AS, Iqbal A, Khatri M, Kumar S. Analgesic efficacy and safety of erector spinae versus serratus anterior plane block in thoracic surgery: a systematic review and meta-analysis of randomized controlled trials. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:3. [PMID: 38217050 PMCID: PMC10785351 DOI: 10.1186/s44158-023-00138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/23/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) are regional anesthesia techniques that have shown favorable results in pain management following thoracic surgeries; however, their relative superiority is unclear. This review (PROSPERO: CRD42023443018) aims to compare the analgesic efficacy of ESPB and SAPB in patients undergoing thoracic surgeries through the pooled analysis of co-primary outcomes: postoperative oral-morphine-equivalent (mg) consumption in 24 h and pain scores (static) at 24 h. METHODS A literature search was conducted across PubMed, Cochrane Library, and Google Scholar to identify randomized controlled trials (RCTs) from inception to May 2023, comparing ESPB and SAPB in thoracic surgeries. Statistical pooling was done using Review Manager 5.4.1. Bias assessment employed the Cochrane Collaboration Risk-of-Bias 2.0 tool. The strength of evidence was assessed using the guidelines from the GRADE working group. RESULTS Nine RCTs (485 patients) were included in the study. Postoperative pain scores (static) at 24 h (mean difference (MD) = - 0.31 [- 0.57, 0.05], p = 0.02) and postoperative oral-morphine-equivalent (mg) consumption in 24 h (MD = - 19.73 [- 25.65, - 13.80], p < 0.00001) were significantly lower in the ESBP group. However, the MDs did not exceed the set threshold for clinical importance. No significant differences were observed in the opioid-related adverse effects and block-related complications. CONCLUSION Our statistically significant results imply that ESPB has superior analgesic efficacy compared to SAPB; however, this difference is clinically unimportant. The safety profile of the two blocks is comparable; hence, current evidence cannot define the relative superiority of one block over the other. Our findings warrant further research with standardized methodologies and a longer duration of analgesic efficacy assessment to yield robust evidence for better clinical applications.
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Affiliation(s)
- Qurat Ul Ain Muhammad
- Rawalpindi Medical University, Chamanzar Colony, Tipu Road, Rawalpindi, 46000, Pakistan.
| | | | - Noor Mahal Azam
- Rawalpindi Medical University, Chamanzar Colony, Tipu Road, Rawalpindi, 46000, Pakistan
| | | | - Hira Islam
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Rana Ijaz
- Services Institute of Medical Sciences, Lahore, Pakistan
| | - Sakina Aquil
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Bishal Dhakal
- Nepalese Army Institute of Medical Sciences, Kathmandu, Nepal
| | | | - Javeria Noor
- Rawalpindi Medical University, Chamanzar Colony, Tipu Road, Rawalpindi, 46000, Pakistan
| | - Alina Sami Khan
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Arham Iqbal
- Dow University of Health Sciences, Karachi, Pakistan
| | - Mahima Khatri
- Dow University of Health Sciences, Karachi, Pakistan
| | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
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24
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van den Broek RJC, Postema JMC, Koopman JSHA, van Rossem CC, Olsthoorn JR, van Brakel TJ, Houterman S, Bouwman RA, Versyck B. Continuous erector spinae plane block versus thoracic epidural analgesia in video-assisted thoracoscopic surgery: a prospective randomized open-label non-inferiority trial. Reg Anesth Pain Med 2024:rapm-2023-105047. [PMID: 38212049 DOI: 10.1136/rapm-2023-105047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND AND OBJECTIVES The evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a multimodal analgesia regimen is non-inferior to continuous thoracic epidural analgesia (TEA) in terms of quality of postoperative recovery for patients undergoing elective unilateral video-assisted thoracoscopic surgery. METHODS We conducted a multicenter, prospective, randomized, open-label non-inferiority trial between July 2020 and December 2022. Ninety patients were randomly assigned to receive either continuous ESP block or TEA. The primary outcome parameter was the Quality of Recovery-15 (QoR-15) score, measured before surgery as a baseline and on postoperative days 0, 1, and 2. Secondary outcome parameters included pain scores, length of hospital stay, morphine consumption, nausea and vomiting, itching, speed of mobilization, and urinary catheterization. RESULTS Analysis of the primary outcome showed a mean QoR-15 difference between the groups ESP block versus TEA of 1 (95% CI -9 to -12, p=0.79) on day 0, -1 (95% CI -11 to -8, p=0.81) on day 1 and -2 (95% CI -14 to -11, p=0.79) on day 2. CONCLUSIONS The continuous ESP block is non-inferior to TEA in video-assisted thoracoscopic surgery. TRIAL REGISTRATION NUMBER Dutch Trial Register (NL6433).
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Affiliation(s)
- Renee J C van den Broek
- Department of Anesthesiology and Pain medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Jonne M C Postema
- Department of Anesthesiology and Pain Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Joseph S H A Koopman
- Department of Anesthesiology and Pain Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology and Pain medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Barbara Versyck
- Department of Anaesthesiology and Pain Medicine, General Hospital Turnhout Campus Saint Elisabeth, Turnhout, Belgium
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25
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Alver S, Ciftci B, Celik EC, Sargolzaeimoghaddam M, Cetinkal A, Erdogan C, Ahiskalioglu A. Postoperative recovery scores and pain management: a comparison of modified thoracolumbar interfascial plane block and quadratus lumborum block for lumbar disc herniation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:118-125. [PMID: 37314577 DOI: 10.1007/s00586-023-07812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/27/2023] [Accepted: 06/03/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE In this prospective, randomized study, we aimed to compare the global recovery scores and postoperative pain management between US-guided mTLIP block versus QLB after lumbar spine surgery. METHODS 60 patients with ASA score I-II planned for microendoscopic discectomy under general anesthesia were included. We allocated the patients into two groups: the QLB group (n = 30) or the mTLIP group (n = 30). QLB and mTLIP was performed with 30 ml 0.25% bupivacaine in the groups. Paracetamol 1 g IV 3 × 1 was ordered to the patients at the postoperative period. If the NRS score was ≥ 4, 1 mg/kg tramadol IV was administered as rescue analgesia. RESULTS There was a significant between-group difference in the mean global QoR-40 scores 24 h postsurgery. Both the static and dynamic NRS scores were significantly lower in the postoperative 1-16 h period in the mTLIP group. There was no significant between-group difference in the NRS scores 24 h postsurgery. There was no significant between-group difference in postoperative rescue analgesia consumption. However, the need for rescue analgesia was lower in the postoperative first 5 h in the mTLIP group, and survival probability was higher in the mTLIP group according to Kaplan-Meier survival analysis. There was no significant difference between the groups in the rate of adverse events. CONCLUSION mTLIP provided superior analgesia compared to posterior QLB. The QoR-40 scores in the mTLIP group were higher than those in the QLB group.
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Affiliation(s)
- Selcuk Alver
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34040, Istanbul, Turkey
| | - Bahadir Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34040, Istanbul, Turkey.
| | - Erkan Cem Celik
- Department of Anesthesiology and Reanimation, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | | | - Ahmet Cetinkal
- Department of Neurosurgery, Istanbul Medipol University, Istanbul, Turkey
| | - Cem Erdogan
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34040, Istanbul, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
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26
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Huang X, Zeng Y, Sandeep B, Yang J. Clinical impact of fascial plane blocks: defining the research agenda. Br J Anaesth 2023; 131:e180-e183. [PMID: 37770253 DOI: 10.1016/j.bja.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Xin Huang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Yan Zeng
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Sichuan, Chengdu, China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, China.
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27
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Guo M, Tang S, Wang Y, Liu F, Wang L, Yang D, Zhang J. Comparison of intrathecal low-dose bupivacaine and morphine with intravenous patient control analgesia for postoperative analgesia for video-assisted thoracoscopic surgery. BMC Anesthesiol 2023; 23:395. [PMID: 38041014 PMCID: PMC10691143 DOI: 10.1186/s12871-023-02350-3] [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: 07/23/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Thoracoscopic surgical techniques continue to advance, yet the intensity of postoperative pain remains significant, impeding swift patient recovery. This study aimed to evaluate the differences in postoperative pain and recuperation between patients receiving intrathecal morphine paired with low-dose bupivacaine and those administered general anesthesia exclusively. METHODS This randomized controlled trial enrolled 100 patients, who were allocated into three groups: Group M (5 μg/kg morphine intrathecal injection), Group B (5 μg/kg morphine combined with bupivacaine 3 mg intrathecal injection) and Group C (intrathecal sham injection). The primary outcome was the assessment of pain relief using the Numeric Rating Scale (NRS). Additionally, intraoperative remifentanil consumption was quantified at the end of the surgery, and postoperative opioid use was determined by the number of patient-controlled analgesia (PCIA) compressions at 48 h post-surgery. Both the efficacy of the treatments and any complications were meticulously recorded. RESULTS Postoperative NRS scores for both rest and exercise at 6, 12, 24, and 48 h were significantly lower in groups M and B than in group C (P<0.05). The intraoperative remifentanil dosage was significantly greater in groups M and C than in group B (P<0.05), while there was no significant difference between groups M and C (P>0.05). There was no significant difference in intraoperative propofol dosage across all three groups (P>0.05). Postoperative dosages of both sufentanil and Nonsteroidal anti-inflammatory drugs (NSAIDs) were significantly less in groups M and B compared to group C (P<0.05). The time of first analgesic request was later in both groups M and B than in group C (P<0.05). Specific and total scores were elevated at 2 days postoperative when compared to scores at 1 day for all groups (P<0.05). Furthermore, at 1 day and 2 days postoperatively, both specific scores and total scores were higher in groups M and B compared to group C (P<0.05). CONCLUSION Intrathecal administration of morphine combined with bupivacaine has been shown to effectively ameliorate acute pain in patients undergoing thoracoscopic surgery. TRIAL REGISTRATION The trial was registered on ClinicalTrials.gov: ChiCTR2200058544, registered 10/04/2022.
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Affiliation(s)
- Miao Guo
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, China
| | - Suhong Tang
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, China
| | - Yixin Wang
- Graduate School of Dalian Medical University, Dalian, 116000, China
| | - Fengxia Liu
- Graduate School of Dalian Medical University, Dalian, 116000, China
| | - Lin Wang
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, China
| | - Dawei Yang
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, China
| | - Jianyou Zhang
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, China.
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Cavaliere F. Highlights of the December 2023 issue. Minerva Anestesiol 2023; 89:1063-1064. [PMID: 38019171 DOI: 10.23736/s0375-9393.23.17846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
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29
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Omindo WW, Zhang N. Management of Post-Thoracoscopy Pain: Should Erector Spinae Plane Block Be the Optimal Choice? J Cardiothorac Vasc Anesth 2023; 37:2687-2688. [PMID: 37775343 DOI: 10.1053/j.jvca.2023.08.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Willis Wasonga Omindo
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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30
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Wu W, Xu H, Chen X, He W, Shi H. Comparison of erector spinae plane block and serratus anterior plane block for postoperative analgesia in uniportal thoracoscopic lobectomy: a randomized controlled trial. BMC Anesthesiol 2023; 23:394. [PMID: 38041029 PMCID: PMC10691001 DOI: 10.1186/s12871-023-02353-0] [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: 07/13/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Postoperative pain remains a significant concern following uniportal thoracoscopic surgery. The analgesic efficacy of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in terms of postoperative opioid consumption in uniportal thoracoscopic surgery still needs further studies. METHODS A randomized controlled trial was conducted, enrolling 150 patients who underwent uniportal thoracoscopic lobectomy. The patients were randomly allocated to three groups in a 1:1:1 ratio: the ESPB group (administered 20 ml of 0.5% ropivacaine), the SAPB group (administered 20 ml of 0.5% ropivacaine), and the standard care (control) group. The primary endpoint was the consumption of sufentanil during the first 24 h following surgery. Secondary endpoints assessed the area under the curve (AUC) of pain numerical rating scale (NRS) scores, occurrence of moderate to severe pain, time to initial sufentanil request, and postoperative adverse events. RESULTS No significant difference was observed in the consumption of sufentanil during the first 24 h following surgery between the ESPB and SAPB groups (adjusted difference, 1.53 [95% CI, -5.15 to 2.08]). However, in comparison to the control group, both intervention groups demonstrated a significant decrease in sufentanil consumption, with adjusted differences of -9.97 [95% CI, -13.10 to -6.84] for the ESPB group and -12.55 [95% CI, -15.63 to -9.47] for the SAPB group. There were no significant differences in AUC of NRS scores during rest and movement between the ESPB and SAPB groups, with adjusted differences of -7.10 [95% CI, 1.33 to -15.55] for the rest condition and 5.61 [95% CI, -13.23 to 2.01] for the movement condition. At 6 h postoperatively, there were fewer patients with moderate to severe pain in the ESPB group compared with those in the SAPB group (adjusted difference, -1.37% [95% CI, -2.29% to -0.45%]. The time to first sufentanil request significantly differed among the three groups (ESPB vs Control P < 0.01, SAPB vs Control P < 0.01, ESPB vs SAPB P = 0.015). CONCLUSIONS In patients undergoing uniportal thoracoscopic lobectomy, although the differences between the two groups are not statistically significant, both the ESPB and SAPB demonstrate effective reduction in postoperative opioid consumption and the need for rescue analgesics compared to the control group. Moreover, the ESPB group experienced a significantly lower incidence of moderate to severe pain at 6 h postoperatively compared to the SAPB group. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (registration No: ChiCTR1900021695, Date of registration: March 5th, 2019).
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Affiliation(s)
- Wei Wu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Huan Xu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Xue Chen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China.
| | - Hong Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China.
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Sarridou DG, Mouratoglou SA, Mitchell JB, Cox F, Boutou A, Braoudaki M, Lambrou GI, Konstantinidou M, Argiriadou H, Walker CPR. Post-Operative Thoracic Epidural Analgesia and Incidence of Major Complications according to Specific Safety Standardized Documentation: A Large Retrospective Dual Center Experience. J Pers Med 2023; 13:1672. [PMID: 38138898 PMCID: PMC10744802 DOI: 10.3390/jpm13121672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Thoracic epidural analgesia is considered the gold standard in post-operative pain management following thoracic surgery. This study was designed to explore the safety of thoracic epidural analgesia and to quantify the incidence of its post-operative complications and side effects in patients undergoing thoracotomy for major surgery, such as resection of lung malignancies and lung transplantation. (2) Methods: This is a retrospective, dual-center observational study including patients that underwent major thoracic surgery including lung transplantation and received concurrent placement of thoracic epidural catheters for post-operative analgesia. An electronic system of referral and documentation of complications was used, and information was retrieved from our electronic critical care charting system. (3) Results: In total, 1145 patients were included in the study. None of the patients suffered any major complication, including hematoma, abscess, or permanent nerve damage. (4) Conclusions: the present study showed that in experienced centers, post-operative epidural analgesia in patients with thoracotomy is a safe technique, manifesting minimal, none-serious complications.
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Affiliation(s)
- Despoina G. Sarridou
- Department of Anesthesia and Intensive Care, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.A.M.); (H.A.)
- Department of Anesthesia and Intensive Care, The Royal Brompton and Harefield Hospital NHS, Middlesex, London UB9 6JH, UK; (J.B.M.); (F.C.)
| | - Sophia Anastasia Mouratoglou
- Department of Anesthesia and Intensive Care, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.A.M.); (H.A.)
| | - Jeremy B. Mitchell
- Department of Anesthesia and Intensive Care, The Royal Brompton and Harefield Hospital NHS, Middlesex, London UB9 6JH, UK; (J.B.M.); (F.C.)
| | - Felicia Cox
- Department of Anesthesia and Intensive Care, The Royal Brompton and Harefield Hospital NHS, Middlesex, London UB9 6JH, UK; (J.B.M.); (F.C.)
| | - Afroditi Boutou
- Respiratory Medicine Department, Hippokration Hospital, 54942 Thessaloniki, Greece;
| | - Maria Braoudaki
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK;
| | - George I. Lambrou
- Choremeio Research Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Maria Konstantinidou
- Department of Respiratory Medicine, G. Papanikolaou General Hospital, 57010 Thessaloniki, Greece;
| | - Helena Argiriadou
- Department of Anesthesia and Intensive Care, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.A.M.); (H.A.)
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Feray S, Lemoine A, Aveline C, Quesnel C. Pain management after thoracic surgery or chest trauma. Minerva Anestesiol 2023; 89:1022-1033. [PMID: 37671536 DOI: 10.23736/s0375-9393.23.17291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Accidental or surgically induced thoracic trauma is responsible for significant pain that can impact patient outcomes. One of the main objectives of its pain management is to promote effective coughing and early mobilization to reduce atelectasis and ventilation disorders induced by pulmonary contusion. The incidence of chronic pain can affect more than 35% of patients after both thoracotomy and thoracoscopy as well as after chest trauma. As the severity of acute pain is associated with the incidence of chronic pain, early and effective pain management is very important. In this narrative review, we propose to detail systemic and regional analgesia techniques to minimize postoperative pain, while reducing transitional pain, surgical stress response and opioid side effects. We provide the reader with practical recommendations based on both literature and clinical practice experience in a referral level III thoracic trauma center.
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Affiliation(s)
- Sarah Feray
- Department of Anesthesia and Surgical Intensive Care, Hôpital Tenon, APHP, Paris, France -
| | - Adrien Lemoine
- Department of Anesthesia and Surgical Intensive Care, Hôpital Tenon, APHP, Paris, France
| | - Christophe Aveline
- Department of Anesthesia and Surgical Intensive Care, Sévigné Hospital, Cesson Sévigné, France
| | - Christophe Quesnel
- Department of Anesthesia and Surgical Intensive Care, Hôpital Tenon, APHP, Paris, France
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Mermer A, Simsek G, Mermer HA, Tire Y, Kozanhan B. Effect of sacral erector spinae plane block on post-hemorrhoidectomy pain: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e35168. [PMID: 37713873 PMCID: PMC10508424 DOI: 10.1097/md.0000000000035168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Hemorrhoidectomy is a common surgical procedure associated with significant postoperative pain. The conventional analgesic methods used for hemorrhoidectomy often have adverse effects and may not provide adequate pain relief. The sacral erector spinae plane block (ESPB) is a newly introduced technique that has shown promise in various surgical procedures. This prospective, randomized, controlled trial aimed to evaluate the analgesic effects of sacral ESPB following hemorrhoidectomy. METHODS Seventy patients undergoing hemorrhoidectomy were divided into 2 groups: the control group and the sacral ESPB group. Bilateral sacral ESPB was performed in the sacral ESPB group, whereas no intervention was performed in the control group. The numeric rating scale at rest and during the active period (mobilizing) was used as the primary outcome measure. Secondary outcome measures were the cumulative doses of tramadol, the number of patients who required rescue analgesia postoperatively, and quality of recovery-15 Turkish version patient recovery quality. RESULTS The sacral ESPB group had significantly low numeric rating scale scores at various time points (P < .05). More patients in the control group needed rescue analgesia during the postoperative period (P < .001). The dosages of tramadol consumption after the first 24 hours postoperatively were significantly lower in the sacral ESPB group compared with the control group (P < .001). Furthermore, quality of recovery-15 Turkish version scores were high in the sacral ESPB group (P < .001). CONCLUSION The results suggest that sacral ESPB is an effective method for post-hemorrhoidectomy pain management, reducing the need for additional analgesics and improving patient recovery.
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Affiliation(s)
- Aydin Mermer
- Department of Anesthesiology and Reanimation, Konya City Hospital, Konya, Turkey
| | - Gurcan Simsek
- Department of General Surgery, Konya City Hospital, Konya, Turkey
| | - Hasan Alp Mermer
- Department of Anesthesiology and Reanimation, Konya City Hospital, Konya, Turkey
| | - Yasin Tire
- Department of Anesthesiology and Reanimation, Konya City Hospital, Konya, Turkey
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH
| | - Betül Kozanhan
- Department of Anesthesiology and Reanimation, Konya City Hospital, Konya, Turkey
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Wang X, Jia X, Li Z, Zhou Q. Rhomboid intercostal block or thoracic paravertebral block for postoperative recovery quality after video-assisted thoracic surgery: A prospective, non-inferiority, randomised controlled trial. Eur J Anaesthesiol 2023; 40:652-659. [PMID: 37377368 DOI: 10.1097/eja.0000000000001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND The analgesic characteristics of rhomboid intercostal block (RIB) remain unclear. Before it can be fully recommended, we compared the recovery quality and analgesic effects of RIB and thoracic paravertebral block (TPVB) for video-assisted thoracoscopic surgery (VATS). OBJECTIVE The current study aimed to investigate whether there is a difference in postoperative recovery quality between TPVB and RIB. DESIGN A prospective, non-inferiority, randomised controlled trial. SETTING Affiliated Hospital of Jiaxing University in China from March 2021 to August 2022. PATIENTS Eighty patients aged 18 to 80 years, with ASA physical status I to III, and scheduled for elective VATS were enrolled in the trial. INTERVENTION Ultrasound-guided TPVB or RIB was performed with 20 ml 0.375% ropivacaine. MAIN OUTCOME MEASURES The primary outcome of the study was the mean difference of quality of recovery-40 scores 24 h postoperatively. The non-inferiority margin was defined as 6.3. Numeric rating scores (NRS) for pain at 0.5, 1, 3, 6, 12, 24 and 48 h postoperatively in all patients were also recorded. RESULTS A total of 75 participants completed the study. The mean difference of quality of recovery-40 scores 24 h postoperatively was -1.6 (95% CI, -4.5 to 1.3), demonstrating the non-inferiority of RIB to TPVB. There was no significant difference between the two groups in the area under the curve for pain NRS over time, at rest and on movement, at 6, 12, 24 and 48 h postoperatively (all P > 0.05), except for the area under the curve pain NRS over time on movement at 48 h postoperatively ( P = 0.046). There were no statistical differences between the two groups in the postoperative sufentanil use at 0 to 24 h or 24 to 48 h (all P > 0.05). CONCLUSION Our study suggests that RIB was non-inferior to TPVB for the quality of recovery, with almost the same postoperative analgesic effect as TPVB after VATS. CLINICAL TRIAL REGISTRATION chictr.org.cn: ChiCTR2100043841.
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Affiliation(s)
- Xuru Wang
- From the Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China (XW, XJ, ZL, QZ)
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Schwenk ES, Lam E, Abulfathi AA, Schmidt S, Gebhart A, Witzeling SD, Mohamod D, Sarna RR, Roy AB, Zhao JL, Kaushal G, Rochani A, Baratta JL, Viscusi ER. Population pharmacokinetic and safety analysis of ropivacaine used for erector spinae plane blocks. Reg Anesth Pain Med 2023; 48:454-461. [PMID: 37085287 DOI: 10.1136/rapm-2022-104252] [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: 12/05/2022] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Erector spinae plane blocks have become popular for thoracic surgery. Despite a theoretically favorable safety profile, intercostal spread occurs and systemic toxicity is possible. Pharmacokinetic data are needed to guide safe dosing. METHODS Fifteen patients undergoing thoracic surgery received continuous erector spinae plane blocks with ropivacaine 150 mg followed by subsequent boluses of 40 mg every 6 hours and infusion of 2 mg/hour. Arterial blood samples were obtained over 12 hours and analyzed using non-linear mixed effects modeling, which allowed for conducting simulations of clinically relevant dosing scenarios. The primary outcome was the Cmax of ropivacaine in erector spinae plane blocks. RESULTS The mean age was 66 years, mean weight was 77.5 kg, and mean ideal body weight was 60 kg. The mean Cmax was 2.5 ±1.1 mg/L, which occurred at a median time of 10 (7-47) min after initial injection. Five patients developed potentially toxic ropivacaine levels but did not experience neurological symptoms. Another patient reported transient neurological toxicity symptoms. Our data suggested that using a maximum ropivacaine dose of 2.5 mg/kg based on ideal body weight would have prevented all toxicity events. Simulation predicted that reducing the initial dose to 75 mg with the same subsequent intermittent bolus dosing would decrease the risk of toxic levels to <1%. CONCLUSION Local anesthetic systemic toxicity can occur with erector spinae plane blocks and administration of large, fixed doses of ropivacaine should be avoided, especially in patients with low ideal body weights. Weight-based ropivacaine dosing could reduce toxicity risk. TRIAL REGISTRATION NUMBER NCT04807504; clinicaltrials.gov.
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Affiliation(s)
- Eric S Schwenk
- Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Edwin Lam
- Clinical Pharmacokinetics Research Lab, National Institutes of Health, Bethesda, Maryland, USA
| | - Ahmed A Abulfathi
- Pharmaceutics, University of Florida College of Medicine, Orlando, Florida, USA
- Clinical Pharmacology and Therapeutics, University of Maiduguri, Maiduguri, Borno, Nigeria
| | - Stephan Schmidt
- Pharmaceutics, University of Florida College of Medicine, Orlando, Florida, USA
| | - Anthony Gebhart
- Pharmaceutics, University of Florida College of Medicine, Orlando, Florida, USA
| | - Scott D Witzeling
- Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Dalmar Mohamod
- Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rohan R Sarna
- Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Akshay B Roy
- Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Joy L Zhao
- Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Gagan Kaushal
- Pharmaceutical Science, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ankit Rochani
- Pharmaceutical Science, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Pharmaceutical Sciences, St John Fisher University Wegmans School of Pharmacy, Rochester, New York, USA
| | - Jaime L Baratta
- Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Eugene R Viscusi
- Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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Fenta E, Kibret S, Hunie M, Tamire T, Mekete G, Tiruneh A, Fentie Y, Dessalegn K, Teshome D. The analgesic efficacy of erector spinae plane block versus paravertebral block in thoracic surgeries: a meta-analysis. Front Med (Lausanne) 2023; 10:1208325. [PMID: 37663669 PMCID: PMC10470835 DOI: 10.3389/fmed.2023.1208325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Acute postoperative pain after thoracic surgery might lead to chronic postsurgical pain (PSP), which lowers quality of life. The literature suggests thoracic paravertebral block (PVB) as a pain management approach. The ESPB (erector spinae plane block) is regarded to be an effective PVB alternative. The analgesic efficacy of the two analgesic therapies is controversial. The purpose of this study is to compare the analgesic efficacy of ESPB and PVB in preventing acute PSP. Methods We searched relevant articles in PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar databases. The primary outcome was postoperative pain score, with secondary outcomes including analgesic consumption, the frequency of rescue analgesia, and postoperative nausea and vomiting. Results This meta-analysis included ten RCTs with a total of 670 patients. PVB significantly lowered the pain scores at movement at 12 h following surgery as compared to the ESPB. The PVB group used much less opioids within 24 h after surgery compared to the ESPB group. However, there were no significant differences between the groups in terms of postoperative rescue analgesia or in the incidence of postoperative nausea and vomiting (p > 0.05). Conclusion PVB produced superior analgesia than ESPB in patients who underwent thoracic surgeries. In addition, PVB demonstrated greater opioid sparing effect by consuming much less opioids. Systematic review registration This trial is registered on PROSPERO, number CRD42023412159.
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Affiliation(s)
- Efrem Fenta
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Mehta S, Jen T, Hamilton D. Regional analgesia for acute pain relief after open thoracotomy and video-assisted thoracoscopic surgery. BJA Educ 2023; 23:295-303. [PMID: 37465231 PMCID: PMC10350558 DOI: 10.1016/j.bjae.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- S. Mehta
- Royal Brompton and Harefield Hospitals, London, UK
| | - T.T.H. Jen
- St Paul's Hospital, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - D.L. Hamilton
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- University of Sunderland, Sunderland, UK
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Chung HW, Chang H, Hong D, Yun HJ, Chung HS. Optimal ropivacaine concentration for ultrasound-guided erector spinae plane block in patients who underwent video-assisted thoracoscopic lobectomy surgery. Niger J Clin Pract 2023; 26:1139-1146. [PMID: 37635608 DOI: 10.4103/njcp.njcp_63_23] [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] [Indexed: 08/29/2023]
Abstract
Background An ultrasound-guided erector spinae plane block (ESPB) has emerged as an effective way to control postoperative pain and may be a good alternative way to an epidural block. However, relevant research on the appropriate concentration of local anesthetics for an ESPB remains scarce. Aims This study aimed to investigate the optimal concentration of ropivacaine for an ESPB in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods A total of 68 patients who underwent a VATS lobectomy were enrolled. An ipsilateral ultrasound-guided ESPB was performed with three different ropivacaine concentrations as a local anesthetic: 0.189% (G1), 0.375% (G2), and 0.556% (G3). The total amount of perioperative remifentanil administered, patient-controlled analgesia (PCA) applied, and rescue drugs for postoperative analgesia during the 24 h after surgery were acquired, and numeric rating scale (NRS) scores were obtained. Results The total amount of intraoperative remifentanil administered was 7.20 ± 3.04 mcg/kg, 5.32 ± 2.70 mcg/kg, and 4.60 ± 1.75 in the G1, G2, and G3 groups, respectively. G2 and G3 had significantly lower amounts of remifentanil administered than the G1 group (P = 0.02 vs. G2; P = 0.003 vs. G3). The G3 group needed more inotropes than the G1 and G2 groups in the perioperative period (P = 0.045). The NRS scores, PCA, and rescue drug were not significantly different in the three groups. Conclusion The optimal concentration of ropivacaine recommended for an ESPB was 0.375%, which was effective in controlling pain and reducing the intraoperative opioid requirements with minimal adverse reactions such as hypotension.
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Affiliation(s)
- H W Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H Chang
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - D Hong
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H J Yun
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H S Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Jiang F, Wu A, Liang Y, Huang H, Tian W, Chen B, Liu D. Assessment of Ultrasound-Guided Continuous Low Serratus Anterior Plane Block for Pain Management After Hepatectomy: A Randomized Controlled Trial. J Pain Res 2023; 16:2383-2392. [PMID: 37469957 PMCID: PMC10353558 DOI: 10.2147/jpr.s406498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
Purpose Adequate postoperative analgesia is a key to earlier recovery from open surgery. This work investigated the pain control and quality of patient recovery after hepatectomy to evaluate the modified continuous serratus anterior plane block (called low SAPB) for postoperative analgesia. Patients and Methods This single-center, blinded, randomized, controlled study included 136 patients who underwent hepatectomy under general anesthesia. For postoperative analgesia, the patients in the SAPB group were given a continuous low SAPB at the 7th intercostal space in the right mid-axillary line, and the patients in the control group were given continuous intravenous opioid analgesia. The numeric pain rating scale (NPRS) was used for pain assessment. The postoperative assessment focused on the remedial drug consumption, the occurrence of adverse postoperative analgesic reactions, and the quality of patient recovery evaluated with the QoR-15 questionnaire. Results Compared to the controls, the SAPB patients had significantly lower NPRS scores at 12 h and 24 h at rest and 6 h, 12 h, and 24 h in motion, and a longer time to first use of remedial analgesics at 24 h, and higher overall QoR-15 scores at 24 h [124 (121, 126) vs 121 (120, 124)] and 48 h [129 (126, 147) vs 126 (125, 128)], after surgery. There was no significant difference in the incidence of analgesia-related adverse reactions between the two groups. Conclusion The continuous low SAPB could achieve superior pain control, especially for motor pain, to intravenous opioid analgesia during the first 24 h post-surgery. Even with no significant difference in the incidence of postoperative adverse reactions, patients with continuous low SAPB appeared to have a higher quality of recovery in the first two days post-surgery than patients with continuous intravenous analgesia.
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Affiliation(s)
- Fei Jiang
- Department of Anesthesiology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, People’s Republic of China
| | - Ailing Wu
- Department of Anesthesiology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, People’s Republic of China
| | - Yan Liang
- Department of Anesthesiology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, People’s Republic of China
| | - Hui Huang
- Department of Anesthesiology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, People’s Republic of China
| | - Wei Tian
- Department of Anesthesiology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, People’s Republic of China
| | - Bogang Chen
- Department of Anesthesiology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, People’s Republic of China
| | - Di Liu
- Department of Anesthesiology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, People’s Republic of China
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Nyima T, Palta S, Saroa R, Kaushik R, Gombar S. Ultrasound-guided erector spinae plane block compared to serratus anterior muscle block for postoperative analgesia in modified radical mastectomy surgeries: A randomized control trial. Saudi J Anaesth 2023; 17:311-317. [PMID: 37601524 PMCID: PMC10435788 DOI: 10.4103/sja.sja_716_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/25/2022] [Indexed: 08/22/2023] Open
Abstract
Background and Objectives The present study was undertaken to compare the analgesic efficacy of erector spinae plane (ESP) block with serratus anterior muscle (SAM) block in patients undergoing modified radical mastectomy (MRM). We hypothesized that ESP block would provide better postoperative pain relief than SAM block following MRM. Methods Eighty American Society of Anaesthesiologists (ASA) I-II adult females, scheduled for MRM, were randomly allocated to receive either ultrasound-guided ipsilateral single-shot ESP or SAM block after induction in the respective planes, using 20 ml of 0.25% ropivacaine. Both the groups received postoperative intravenous patient-controlled analgesia (IV-PCA) (morphine) for 24 h. The primary outcome was to assess pain severity using a visual analogue scale (VAS) score. Postoperative 24-h opioid consumption, time to first opioid analgesia, hemodynamic variables, total dose of antiemetics, and safety profile of both the blocks were also evaluated. Data analysis was carried out using Statistical Package for the Social Sciences version 21.0 (SPSS Inc. Chicago, Illinois, USA). Results VAS scores were lower in the ESP block group, at rest and on movement, and the difference was statistically significant (p < 0.05). Postoperative morphine consumption was also significantly less in patients receiving ESP block as compared to SAM block (3.13 ± 1.44 mg vs 4.33 ± 1.69 mg; P = 0.001). The time to first analgesia request was significantly prolonged in the ESP group as compared to the SAM group (9.58 ± 4.11 h vs 6.46 ± 2.95 h; P = 0.001). No major side effects were observed in any of the study groups. Conclusions ESP block provides better analgesia as compared to SAM block after MRM. Clinical trial registration number CTRI/2019/03/018067.
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Affiliation(s)
- Tenzin Nyima
- Department of Anaesthesia and Intensive Care, GMCH, Chandigarh, India
| | - Sanjeev Palta
- Department of Anaesthesia and Intensive Care, GMCH, Chandigarh, India
| | - Richa Saroa
- Department of Anaesthesia and Intensive Care, GMCH, Chandigarh, India
| | - Robin Kaushik
- Department of General Surgery, GMCH, Chandigarh, India
| | - Satinder Gombar
- Department of Anaesthesia and Intensive Care, GMCH, Chandigarh, India
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Alfirevic A, Marciniak D, Duncan AE, Kelava M, Yalcin EK, Hamadnalla H, Pu X, Sessler DI, Bauer A, Hargrave J, Bustamante S, Gillinov M, Wierup P, Burns DJP, Lam L, Turan A. Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair: a randomised clinical trial. Br J Anaesth 2023; 130:786-794. [PMID: 37055276 DOI: 10.1016/j.bja.2023.02.038] [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: 12/08/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Minimally invasive cardiac surgery provokes substantial pain and therefore analgesic consumption. The effect of fascial plane blocks on analgesic efficacy and overall patient satisfaction remains unclear. We therefore tested the primary hypothesis that fascial plane blocks improve overall benefit analgesia score (OBAS) during the initial 3 days after robotically assisted mitral valve repair. Secondarily, we tested the hypotheses that blocks reduce opioid consumption and improve respiratory mechanics. METHODS Adults scheduled for robotically assisted mitral valve repairs were randomised to combined pectoralis II and serratus anterior plane blocks or to routine analgesia. The blocks were ultrasound-guided and used a mixture of plain and liposomal bupivacaine. OBAS was measured daily on postoperative Days 1-3 and were analysed with linear mixed effects modelling. Opioid consumption was assessed with a simple linear regression model and respiratory mechanics with a linear mixed model. RESULTS As planned, we enrolled 194 patients, with 98 assigned to blocks and 96 to routine analgesic management. There was neither time-by-treatment interaction (P=0.67) nor treatment effect on total OBAS over postoperative Days 1-3 with a median difference of 0.08 (95% confidence interval [CI]: -0.50 to 0.67; P=0.69) and an estimated ratio of geometric means of 0.98 (95% CI: 0.85-1.13; P=0.75). There was no evidence of a treatment effect on cumulative opioid consumption or respiratory mechanics. Average pain scores on each postoperative day were similarly low in both groups. CONCLUSIONS Serratus anterior and pectoralis plane blocks did not improve postoperative analgesia, cumulative opioid consumption, or respiratory mechanics during the initial 3 days after robotically assisted mitral valve repair. CLINICAL TRIAL REGISTRATION NCT03743194.
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Affiliation(s)
- Andrej Alfirevic
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA.
| | - Donn Marciniak
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Andra E Duncan
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Marta Kelava
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Esra Kutlu Yalcin
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Hassan Hamadnalla
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Xuan Pu
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Bauer
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Hargrave
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Sergio Bustamante
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery and Cleveland Clinic, Cleveland, OH, USA
| | - Per Wierup
- Department of Cardiothoracic Surgery, Lund University, Lund, Sweden
| | - Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery and Cleveland Clinic, Cleveland, OH, USA
| | - Louis Lam
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
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Jiang W, Wang M, Wang X, Jin S, Zhang M, Zhang L, Zhang Y, Wu Y. Effects of Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Total Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial. Pain Ther 2023; 12:811-824. [PMID: 37052813 PMCID: PMC10199987 DOI: 10.1007/s40122-023-00505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Total laparoscopic hysterectomy (TLH) is a common surgical procedure that is frequently associated with substantial postoperative pain. As part of multimodal analgesia, the erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (TQLB) have been demonstrated to be effective. This study aimed to evaluate whether ESPB and TQLB reduce postoperative pain and opioid consumption after TLH. METHODS A total of 90 female patients undergoing TLH were randomized to receive either ESPB, TQLB, or no intervention before general anesthesia. All patients received a patient-controlled sufentanil analgesia postoperatively. Postoperative pain and sufentanil consumption were evaluated. The primary outcome was cumulative sufentanil consumption at 12 h postoperatively. RESULTS The cumulative sufentanil consumption at 12 h postoperatively was significantly lower in Group ESPB than in Group CON after Bonferroni correction (median [interquartile range], 0 [0, 4] μg vs. 6 [0, 10] μg; median difference = - 3; 95% confidence interval, - 6-0; P = 0.010). There were no significant differences between Group TQLB and CON (0 [0, 4] μg vs. 6 [0, 10] μg; P = 0.098) or between the two block groups (P = 1.000). When compared with Group CON, ESPB and TQLB persistently reduced pain scores until 6 and 4 h after surgery, respectively (P < 0.05). However, no significant differences were found in pain scores between the two block groups. CONCLUSIONS ESPB and TQLB improved the quality of multimodal analgesia for TLH. ESPB may be more favorable due to the prolonged period of analgesia and decreased opioid consumption after TLH. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2100048165, Registry URL: http://www.chictr.org.cn/showproj.aspx?proj=129578 . Date of registration: July 4, 2021. The patient enrollment began on July 12, 2021.
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Affiliation(s)
- Weiwei Jiang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Min Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Xiaoli Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Shiyun Jin
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Miao Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Lili Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Ye Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China.
| | - Yun Wu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China.
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Chen L, Li N, Zhang Y. High-impact papers in the field of anesthesiology: a 10-year cross-sectional study. Can J Anaesth 2023; 70:183-190. [PMID: 36418743 PMCID: PMC9684867 DOI: 10.1007/s12630-022-02363-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study was performed to evaluate trends in and provide future direction for anesthesiology education, research, and clinical practice. METHODS We collected high-impact papers, ranking in the top 10% in the field of anesthesiology and published from 2011 to 2020, by the InCites tool based on the Web of Science Core Collection. We analyzed the trends, locations, distribution of subject categories, research organizations, collaborative networks, and subject terms of these papers. RESULTS A total of 4,685 high-impact papers were included for analysis. The number of high-impact papers increased from 462 in 2011 to 520 in 2020. The paper with the highest value of category normalized citation impact (115.95) was published in Anesthesia and Analgesia in 2018. High-impact papers were mainly distributed in the subject categories of "Anesthesiology," "Clinical Neurology," "Neurosciences," and "Medicine General Internal." They were primarily cited in "Anesthesiology," "Clinical Neurology," "Neurosciences," "Medicine General Internal," and "Surgery." Most of these high-impact papers came from the USA, UK, Canada, Germany, and Australia. The most productive institutions were the League of European Research Universities, Harvard University, University of Toronto, University of London, University of California System, and University Health Network Toronto. Research collaboration circles have been formed in the USA, UK, and Canada. Subject-term analysis indicated postoperative analgesia, chronic pain, and perioperative complications were high-interest topics, and COVID-19 became a new hot topic in 2020. CONCLUSIONS The current study provides a historical view of high-impact papers in anesthesiology in the past ten years. High-impact papers were mostly from the USA. Postoperative analgesia, chronic pain, and perioperative complications have been hot topics, and COVID-19 became a new topic in 2020. These findings provide references for education, research, and clinical practice in the field of anesthesiology.
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Affiliation(s)
- Lingmin Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Nian Li
- Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, China
| | - Yonggang Zhang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
- Department of Periodical Press and National Clinical Research Center for Geriatrics & Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
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Balzani E, Rosboch GL, Ceraolo E, Lyberis P, Filippini C, Piccioni F, Guerrera F, Ruffini E, Pedoto A, Brazzi L. The effect of peripheral regional analgesia in thoracic surgery: a systematic review and a meta-analysis of randomized-controlled trials. TUMORI JOURNAL 2023; 109:6-18. [PMID: 35361015 DOI: 10.1177/03008916221081891] [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: 02/03/2023]
Abstract
BACKGROUND Several peripheral regional anaesthesia (RA) techniques are commonly used in thoracic surgery even in the absence of precise indications regarding their effectiveness on postoperative pain management. OBJECTIVE This systematic review and meta-analysis aims to describe and evaluate the relative effectiveness of different peripheral regional blocks and systemic analgesia in the context of video-assisted thoracoscopic surgery (VATS) or thoracotomy. DESIGN Systematic review of randomized controlled clinical trials (RCTs) with meta-analyses. DATA SOURCES We searched PubMed and Embase for all RCTs comparing the 24 hour morphine equivalents (MMEs) consumption following peripheral regional blocks and systemic analgesia (SA). ELIGIBILITY CRITERIA We selected only RCTs including adult participants undergoing thoracic surgery, including esophagectomy and reporting on postoperative pain outcomes including 24 hour MMEs consumption. RESULTS Among the 28 randomized studies including adult participants undergoing thoracic surgery and reporting on 24 hour opioid consumption, 11 reporting a comparison of individual blocks with systemic analgesia were meta-analyzed. RA was effective for almost all peripheral blocks. Regarding intercostal block, its antalgic effect was not well evaluated SMD -1.57 (CI -3.88, 0.73). RA in VATS was more effective in reducing MMEs than thoracotomy SMD -1.10 (CI -1.78, -0.41). CONCLUSIONS RA is a useful choice in thoracic surgery. However, it is still not possible to determine the most appropriate block in the individual surgical settings to be performed due to RCTs paucity.
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Affiliation(s)
- Eleonora Balzani
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Giulio Luca Rosboch
- Department of Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Edoardo Ceraolo
- Department of Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Paraskevas Lyberis
- Department of Cardiovascular and Thoracic Surgery, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Claudia Filippini
- Clinical Statistics, Department of Surgical Sciences, University of Torino, Corso Bramante 88, Turin, Italy
| | - Federico Piccioni
- General and Specialistic Surgical Department, Anesthesia and Intensive Care Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Francesco Guerrera
- Department of Surgical Science, University of Turin, Torino, Italy.,Department of Cardiovascular and Thoracic Surgery, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Enrico Ruffini
- Department of Surgical Science, University of Turin, Torino, Italy.,Department of Cardiovascular and Thoracic Surgery, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
| | - Alessia Pedoto
- Clinical Attending Department of Anesthesia and CCM, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Luca Brazzi
- Department of Surgical Science, University of Turin, Torino, Italy.,Department of Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza di Torino' Hospital, Torino, Italy
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Programmed intermittent bolus infusion vs. continuous infusion for erector spinae plane block in video-assisted thoracoscopic surgery: A double-blinded randomised controlled trial. Ugeskr Laeger 2023; 40:130-137. [PMID: 36592009 DOI: 10.1097/eja.0000000000001788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The optimal form of administration for erector spinae plane block has not been established. OBJECTIVE To compare the efficacy of programmed intermittent bolus infusion (PIB) and continuous infusion for erector spinae plane block. DESIGN A prospective, randomised, double-blind study. SETTING A single centre between June 2019 and March 2020. PATIENTS Included patients had an American Society of Anesthesiologists physical status 1 to 3 and were scheduled for video-assisted thoracic surgery. INTERVENTIONS Patients were randomised to receive continuous infusion (0.2% ropivacaine 8 ml h-1; Group C) or PIB (0.2% ropivacaine 8 ml every 2 h; Group P). MAIN OUTCOME MEASURES The primary outcome was the number of desensitised dermatomes in the midclavicular line, measured 21 h after first bolus injection. RESULTS Fifty patients were randomly assigned to each group; finally, the data of 24 and 25 patients in Group C and P, respectively, were analysed. The mean difference in the number of desensitised dermatomes in the midclavicular line at 5 and 21 h after the initial bolus administration was 1.0 [95% confidence interval (CI) 0.5 to 1.5] and 1.6 (95% CI 1.1 to 2.0), respectively, which was significantly higher in Group P than in Group C (P < 0.001). The median difference in rescue morphine consumption in the early postoperative period (0 to 24 h) was 4 (95% CI 1 to 8) mg, which was significantly lower in Group P (P = 0.035). No significant difference in the postoperative numerical rating scale score was found between the groups. CONCLUSIONS PIB for erector spinae plane block in video-assisted thoracic surgery resulted in a larger anaesthetised area and required a lower anaesthetic dose to maintain the analgesic effect. Therefore, it is more suitable for erector spinae plane block than continuous infusion. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR, ID: UMIN000036574, Principal investigator: Taro Fujitani, 04/22/2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041671).
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ZENGİN M, BALDEMİR R, ÜLGER G, SAZAK H, ALAGÖZ A. Comparison of deep and combined serratus anterior plane block after video-assisted thoracoscopic surgery; a prospective randomized trial. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1185437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aim: Ultrasound-guided plane blocks have been employed frequently in Video-assisted thoracoscopic surgery (VATS). The aim of this study was to evaluate the effect of deep and combined serratus anterior plane block (SAPB) after VATS.
Material and Method: The patients, in the age range of 18 to 65 years, with the American Society of Anesthesiologists (ASA) physical status of I-III, and body mass index (BMI) of 18-30 kg/m2, and undergoing lung resection with VATS were included in the study. Patients were informed about the study, and their written consent was obtained. Patients were divided into Deep SAPB (DSAPB) (Group 1) and combined SAPB (CSAPB) (Group 2) groups according to the analgesia protocol.
Results: There was no statistically significant difference between the groups in terms of demographic characteristics and surgical features (p > 0.05). When the groups were evaluated in terms of the block performance time, it was found to be statistically significantly longer in the CSAPB group than in the DSAPB group (p < 0.001). When the groups were evaluated in terms of VAS resting scores, the 1st, 2nd, 4th, 8th, and 16th, 24th, and 48th-hour VAS resting results were found to be statistically significantly higher in the DSAPB group than the CSAPB group (p < 0.05). VAS cough scores were statistically significantly higher in the DSAPB group at the 1st, 2nd, 4th, 8th, and 16th, 24th, and 48th-hour (p < 0.05). When the groups were evaluated in terms of the side effects, additional analgesic use, and morphine consumption, they were found to be statistically significantly higher in the DSAPB group than in the CSAPB group (p: 0.026, p: 0.020, p < 0.001, respectively).
Conclusion: CSAPB provided effective analgesia after VATS for 48 hours. In addition, morphine consumption and the need for additional analgesics were low in CSAPB. However, the duration of the block procedure was longer in the CSAPB application.
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Affiliation(s)
- Musa ZENGİN
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic
| | - Ramazan BALDEMİR
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic
| | - Gülay ÜLGER
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic
| | - Hilal SAZAK
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic
| | - Ali ALAGÖZ
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic
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Moorthy A, Ní Eochagáin A, Dempsey E, Wall V, Marsh H, Murphy T, Fitzmaurice GJ, Naughton RA, Buggy DJ. Postoperative recovery with continuous erector spinae plane block or video-assisted paravertebral block after minimally invasive thoracic surgery: a prospective, randomised controlled trial. Br J Anaesth 2023; 130:e137-e147. [PMID: 36109206 DOI: 10.1016/j.bja.2022.07.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) guidelines recommend erector spinae plane (ESP) block or paravertebral block (PVB) for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). However, there are few trials comparing the effectiveness of these techniques on patient-centric outcomes, and none evaluating chronic postsurgical pain (CPSP). Furthermore, there are no available trials comparing ultrasound-guided ESP with surgically placed PVB in this patient cohort. METHODS We conducted a two-centre, prospective, randomised, double-blind, controlled trial, comparing anaesthesiologist-administered, ultrasound-guided ESP catheter with surgeon-administered, video-assisted PVB catheter analgesia among 80 adult patients undergoing VATS. Participants received a 20 ml bolus of levobupivacaine 0.375% followed by infusion of levobupivacaine 0.15% (10-15 ml h-1) for 48 h. Primary outcome was Quality of Recovery-15 score (QoR-15) at 24 h. Secondary outcomes included QoR-15 at 48 h, peak inspiratory flow (ml s-1) at 24 h and 48 h, area under the pain verbal response score vs time curve (AUC), opioid consumption, Comprehensive Complication Index, length of stay, and CPSP at 3 months after surgery. RESULTS Median (25-75%) QoR-15 at 24 h was higher in ESP (n=37) compared with PVB (n=37): 118 (106-134) vs 110 (89-121) (P=0.03) and at 48 h: 131 (121-139) vs 120 (111-133) (P=0.03). There were no differences in peak inspiratory flow, AUC, Comprehensive Complication Index, length of hospital stay, and opioid consumption. Incidence of CPSP at 3 months was 12 (34%) for ESP and 11 (31%) for PVB (P=0.7). CONCLUSIONS Compared with video-assisted, surgeon-placed paravertebral catheter, erector spinae catheter improved overall QoR-15 scores at 24 h and 48 h but without differences in pain or opioid consumption after minimally invasive thoracic surgery. CLINICAL TRIAL REGISTRATION NCT04729712.
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Affiliation(s)
- Aneurin Moorthy
- Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College, Dublin, Ireland.
| | | | - Eamon Dempsey
- Department of Anaesthesiology, St James's University Hospital, Dublin, Ireland
| | - Vincent Wall
- Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hannah Marsh
- Department of Anaesthesiology, St James's University Hospital, Dublin, Ireland
| | - Thomas Murphy
- Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gerard J Fitzmaurice
- Department of Cardiothoracic Surgery, St James's University Hospital, Dublin, Ireland
| | - Rory A Naughton
- Department of Anaesthesiology, St James's University Hospital, Dublin, Ireland
| | - Donal J Buggy
- Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College, Dublin, Ireland; EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, Brussels, Belgium; Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
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Moore RP, Burjek NE, Brockel MA, Strine AC, Acks A, Boxley PJ, Chidambaran V, Vricella GJ, Chu DI, Sankaran-Raval M, Zee RS, Cladis FP, Chaudhry R, O'Reilly-Shah VN, Ahn JJ, Rove KO. Evaluating the role for regional analgesia in children with spina bifida: a retrospective observational study comparing the efficacy of regional versus systemic analgesia protocols following major urological surgery. Reg Anesth Pain Med 2023; 48:29-36. [PMID: 36167478 PMCID: PMC10026848 DOI: 10.1136/rapm-2022-103823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/15/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Regional techniques are a key component of multimodal analgesia and help decrease opioid use perioperatively, but some techniques may not be suitable for all patients, such as those with spina bifida. We hypothesized peripheral regional catheters would reduce postoperative opioid use compared with no regional analgesia without increasing pain scores in pediatric patients with spina bifida undergoing major urological surgery. METHODS A retrospective review of a multicenter database established for the study of enhanced recovery after surgery was performed of patients from 2009 to 2021 who underwent bladder augmentation or creation of catheterizable channels. Patients without spina bifida and those receiving epidural analgesia were excluded. Opioids were converted into morphine equivalents and normalized to patient weight. RESULTS 158 patients with pediatric spina bifida from 7 centers were included, including 87 with and 71 without regional catheters. There were no differences in baseline patient factors. Anesthesia setup increased from median 40 min (IQR 34-51) for no regional to 64 min (IQR 40-97) for regional catheters (p<0.01). The regional catheter group had lower median intraoperative opioid usage (0.24 vs 0.80 mg/kg morphine equivalents, p<0.01) as well as lower in-hospital postoperative opioid usage (0.05 vs 0.23 mg/kg/day morphine equivalents, p<0.01). Pain scores were not higher in the regional catheters group. DISCUSSION Continuous regional analgesia following major urological surgery in children with spina bifida was associated with a 70% intraoperative and 78% postoperative reduction in opioids without higher pain scores. This approach should be considered for similar surgical interventions in this population. TRIAL REGISTRATION NUMBER NCT03245242.
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Affiliation(s)
- Robert P Moore
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Stony Brook Children's Hospital, Stony Brook, New York, USA
| | - Nicholas E Burjek
- Division of Pediatric Anesthesiology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Megan A Brockel
- Division of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Anesthesiology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Andrew C Strine
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Austin Acks
- Department of Surgery, Division of Urology, Washington University in St Louis, St. Louis, Missouri, USA
| | - Peter J Boxley
- Department of Surgery, Division of Urology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Vidya Chidambaran
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gino J Vricella
- Department of Surgery, Division of Urology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
- Department of Pediatric Urology, St Louis Children's Hospital, St Louis, Missouri, USA
| | - David I Chu
- Division of Urology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Marie Sankaran-Raval
- Division of Pediatric Anesthesiology, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | - Rebecca S Zee
- Division of Urology, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | - Franklyn P Cladis
- Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Rajeev Chaudhry
- Division of Pediatric Urology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Vikas N O'Reilly-Shah
- Department of Pediatric Anesthesiology, University of Washington, Seattle, Washington, USA
- Deperatment of Pedaitric Anesthesiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jennifer J Ahn
- Department of Urology, University of Washington, Seattle, Washington, USA
- Department of Urology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kyle O Rove
- Department of Surgery, Division of Urology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, Colorado, USA
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49
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Su P, Kong M, Yang E. Effect of combined erector-spinae plane blocks on the immediate postoperative neuronal and stress biomarkers after thoracoscopic radical resection for lung cancers. Asian J Surg 2023; 46:405-411. [PMID: 35581042 DOI: 10.1016/j.asjsur.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/15/2022] [Accepted: 05/06/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study evaluates the impact of general anesthesia combined with erector spinae plane blocks (ESPB) on patients who underwent thoracoscopic radical resection (TRR) for lung cancer. METHODS There involved a total of 108 patients undergoing TRR for lung cancers. Patients enrolled were equally allocated into experimental group (general anesthesia combined with ESPB) and control group (general anesthesia). The following parameters, including baseline characteristics, serum markers of neurological disorders, postoperative pain degree, dosage of narcotic, adverse events and early postoperative rehabilitation quality, were compared between the two groups. RESULTS Based on Visual Analogue Scale, the postoperative pain degree was significantly lower in experimental group on 6h postoperative (P<0.001). And markedly lower results were observed in the levels of serum markers of neurological disorders in the experimental group one day after surgery (all P<0.05). Moreover, the dosage of narcotic and early postoperative rehabilitation quality based on QoR-40 scale were significantly lower in experimental group (all P<0.05). CONCLUSION Adding ESPB with general anesthesia reduce the postoperative pain up to 6 h, reduce the requirement of postoperative narcotic and help early postoperative rehabilitation quality.
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Affiliation(s)
- Peng Su
- Department of Anesthesiology, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Min Kong
- Department of Pharmacy, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
| | - En Yang
- Department of Anesthesiology, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China.
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50
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Scorsese G, Jin Z, Greenspan S, Seiter C, Jiang Y, Huang MB, Lin J. Effectiveness of Thoracic Wall Blocks in Video-Assisted Thoracoscopic Surgery, a Network Meta-Analysis. J Pain Res 2023; 16:707-724. [PMID: 36915281 PMCID: PMC10007985 DOI: 10.2147/jpr.s396530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Thoracic epidural analgesia (TEA) and thoracic paravertebral blocks (PVB) are well-established techniques for pain management in thoracotomy. Here, we examine the efficacy of various thoracic fascial plane blocks vs TEA and PVB for intraoperative and postoperative analgesia for video assisted thoracoscopy surgery (VATS) with network meta-analysis. Methods A search for prospective randomized control studies using adult patients undergoing VATS with general anesthesia. The interventions of interest were any regional anesthesia techniques used for postoperative pain control after VATS. Primary outcomes of interest were 24-hour opioid requirement and 24-hour pain scores. A Bayesian network meta-analysis was conducted. Results We identified 42 studies that fulfilled our inclusion criteria. For patients who underwent VATS, TEA (MD = -27MME, 95% CI = -46.2 to -9MME), ESP (MD = -20MME, 95% CI -33 to -7.9MME), PVB (MD = -15MME, 95% CI = -26 to -4.5MME) demonstrated significant opioid sparing efficacy, as well as reduction in cumulative 24-hour static pain scores. However, exclusion of one study due to high risk of bias revealed that TEA did not significantly reduce opioid consumption, nor did it reduce the incidence of PONV, pulmonary complications, or LOS when compared to ESP, SAP, PVB, ICN, or PECS blocks. Conclusion Our findings suggest that TEA did not provide superior pain relief compared to ESP, SAP, PVB, ICN, or PECS blocks following VATS. Therefore, we propose ESP as a suitable intervention for the prevention of postoperative pain after VATS.
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Affiliation(s)
- Giacomo Scorsese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Seth Greenspan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Christopher Seiter
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Yujie Jiang
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, 98195-6540, USA
| | - Michael B Huang
- Health Sciences Library, Stony Brook University, Stony Brook, NY, 11794-8034, USA
| | - Jun Lin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
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