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Mahmoud AM, Alsaied MA, Ragab SG, Abdelfattah YA, Farghaly OS, Shawky MA. Inter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trial. Anesth Pain Med 2024; 14:e143369. [PMID: 38725919 PMCID: PMC11078230 DOI: 10.5812/aapm-143369] [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] [Received: 11/25/2023] [Revised: 12/24/2023] [Accepted: 01/12/2024] [Indexed: 05/12/2024] Open
Abstract
Background Postoperative pain management is crucial for improving patient outcomes following posterior cervical spine surgery. Opioids are effective but carry a risk of respiratory depression. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used but may not provide adequate pain relief and have potential complications. The inter-semispinalis plane (ISPB) block is a novel technique for postoperative analgesia in cervical spine surgery. Objectives This study aims to evaluate and compare the efficacy of the ISPB with general anesthesia in terms of analgesia, postoperative Visual Analog Scale (VAS) pain scores, patient-surgeon satisfaction levels, and the occurrence of postoperative complications. Methods This double-blind, randomized controlled trial was blinded to both the patient and the assessor. Fifty adult patients (18 - 60 years old) undergoing elective posterior cervical spine surgery were enrolled. The participants were divided into 2 groups: The ISPB group (receiving bilateral ultrasound-guided ISPB at the C5 level) and the control group (receiving general anesthesia only), with each group comprising 25 patients. The study assessed intraoperative fentanyl use, postoperative VAS pain levels, the need for rescue analgesia, and complications. Results The ISPB group showed significantly lower intraoperative fentanyl consumption (median 100 vs. 100 - 150 μg, P = 0.022) and lower postoperative pain scores at 1, 8, 12, and 48 hours (P = 0.016, 0.009, 0.005, 0.016). Additionally, the ISPB group required less postoperative pethidine (20% vs. 64%, P = 0.002) and had a longer delay before requesting pethidine (hazard ratio 0.215, P = 0.001). Surgeon satisfaction was significantly higher in the ISPB group (P = 0.003). These results suggest that the ISPB can effectively reduce pain and analgesic requirements. Conclusions The ISPB is an effective analgesic technique for posterior cervical spine surgery, reducing opioid consumption, providing better pain control, and enhancing surgeon satisfaction without increasing complications. This approach has the potential to improve postoperative care and patient outcomes in this surgical population.
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Mostafa SF, Abu Elyazed MM, Eid GM, Belal AM. Inter-semispinal plane (ISP) block for postoperative analgesia following cervical spine surgery: A prospective randomized controlled trial. J Clin Anesth 2022; 83:110974. [PMID: 36228453 DOI: 10.1016/j.jclinane.2022.110974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
STUDY OBJECTIVE We evaluated the perioperative analgesic effects of the inter-semispinal plane (ISP) block in patients undergoing posterior cervical spine surgery. DESIGN Prospective, randomized, controlled, double-blinded trial. SETTING Operating room and surgical ward. PATIENTS 60 patients aged 18-60 years of either gender, ASA I-II, undergoing elective posterior cervical spine surgery. INTERVENTIONS Patients were randomly assigned into a control group (general anesthesia only), ISP group received bilateral ultrasound guided ISP block at the level of C5 using 20 ml bupivacaine 0.25% on each side. MEASUREMENTS Visual analog scale (VAS), intraoperative fentanyl and 24 h postoperative pethidine consumptions and time to first rescue analgesic request were documented. MAIN RESULTS The median (quartiles) of 24 h postoperative rescue pethidine consumption was significantly lower in the ISP group [0 (0-46.25) mg] compared to that of the control group [143 (116.75-169.00) mg]; P < 0.001). VAS was significantly lower in the ISP group at 30 min, 1 h, 2 h,4 h, 6 h, 8 h and 12 h postoperative compared to control group (P < 0.05). At 18 and 24 h, VAS was not significantly different between groups. The median (quartiles) of intraoperative fentanyl consumption in the ISP group [0 (0-40.75) μg] was significantly lower compared to that of the control group [63.5 (39.5-90.25) μg]; P < 0.001]. The time to first rescue analgesic administration was significantly longer in the ISP group compared to the control group (P < 0.001). CONCLUSION Bilateral ultrasound-guided ISP block can provide decreased 24 h postoperative analgesic consumption as well as lower pain scores in the first 12 postoperative hours in patients undergoing posterior cervical spine surgery.
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Affiliation(s)
- Shaimaa F Mostafa
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Mohamed M Abu Elyazed
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Gehan M Eid
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Aliaa M Belal
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
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Shlobin NA, Rosenow JM. Nonopioid Postoperative Pain Management in Neurosurgery. Neurosurg Clin N Am 2022; 33:261-273. [DOI: 10.1016/j.nec.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dong H, Liu H, Zhu D, Ruan B, Yu H, Xu X, Wang Y. Wound infiltration of dexmedetomidine as an adjunct to local anesthesia in postoperative analgesia for lumbar surgery: a systematic review and meta-analysis. Minerva Anestesiol 2021; 87:1034-1041. [PMID: 33982988 DOI: 10.23736/s0375-9393.21.15469-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The vast majority of patients undergoing lumbar surgery experience varying degrees of incision pain, leading to prolonged postoperative recovery and poor satisfaction with treatment. The objective of this meta-analysis was to evaluate the efficacy and safety of dexmedetomidine as an adjunct to local anesthesia for postoperative pain control after lumbar surgery. EVIDENCE ACQUISITION Two authors independently searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), CBM (The Chinese BioMedical database) using the search terms 'dexmedetomidine', 'infiltration', and 'lumbar'. The random-effect model was used to perform the meta-analysis based on deviance information criteria. EVIDENCE SYNTHESIS Six trials evaluating a total of 330 patients were included in this review. Wound infiltration with dexmedetomidine significantly reduced the postoperative VAS scores (4th hour static VAS scores (MD=-1.03; 95% CI: -1.58 to -0.47; p=0.0003); 24th hour static VAS scores (MD=-0.66; 95% CI: -0.91 to -0.40; p<0.00001); 6th hour dynamic VAS scores (MD=-1.84; 95% CI: -2.23 to -1.45; p<0.00001)) and total supplemental analgesic consumption (SMD=-2.01; 95% CI: -3.04 to -0.98; p<0.00001), prolonged the median time to first rescue analgesia (SMD=3.53; 95% CI:2.31 to 4.76; p<0.00001), and reduced the incidence of nausea or vomiting (RR=0.40; 95% CI: 0.17 to 0.93; P<0.05). CONCLUSIONS Dexmedetomidine infiltration appears to be a promising and safe adjunct for postoperative pain control after lumbar surgery. However, more studies are needed to assess the prevalence of other side effects.
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Affiliation(s)
- Hui Dong
- Department of Graduate School, Dalian Medical University, Dalian, China.,Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hongtao Liu
- Department of Graduate School, Dalian Medical University, Dalian, China.,Department of Urology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Dongming Zhu
- Department of Graduate School, Dalian Medical University, Dalian, China.,Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Binjia Ruan
- Department of Graduate School, Dalian Medical University, Dalian, China.,Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hang Yu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xiaohang Xu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yongxiang Wang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China -
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Bodendorfer BM, Shu HT, Lee CS, Ivey J, Mo FF, Wall RT. Unintentional Epidural Anesthesia Mimicking Cauda Equina Syndrome from Suprafascial Injection of Liposomal Bupivacaine After Lumbar Foraminotomy: A Case Report. JBJS Case Connect 2020; 10:e1900605. [PMID: 32649143 DOI: 10.2106/jbjs.cc.19.00605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE This case report describes a 46-year-old woman undergoing right-sided L5 to S1 decompression who received liposomal bupivacaine (LB) for postoperative analgesia and developed unintentional epidural anesthesia with symptoms mimicking cauda equina syndrome. The patient's symptoms resolved 72 hours postoperatively, approximately the length that LB typically lasts. At the 16-month follow-up, the patient demonstrated complete neurological function with no lower extremity strength or sensation deficits. CONCLUSIONS Tracking of LB into the epidural space after lumbar surgery may cause transient epidural anesthesia with symptoms that mimic cauda equina syndrome.
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Affiliation(s)
- Blake M Bodendorfer
- 1Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, District of Columbia 2Department of Anesthesiology, Georgetown University Medical Center, Washington, District of Columbia
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Rogobete AF, Bedreag OH, Sărăndan M, Păpurică M, Preda G, Dumbuleu MC, Vernic C, Stoicescu ER, Săndesc D. Liposomal bupivacaine – New trends in Anesthesia and Intensive Care Units. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2014.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Alexandru Florin Rogobete
- Emergency County Hospital, Clinic of Anesthesia and Intensive Care , Bd. Iosif Bulbuca Nr. 10 , 300736 Timişoara, Romania
- “Victor Babeş” University of Medicine and Pharmacy, Faculty of Medicine , Piata E. Murgu 2 , 300041 Timişoara, Romania
- West University of Timişoara, Faculty of Chemistry, Biology, Geography , Str. Pestalozzi 16A , 300115 Timişoara, Romania
| | - Ovidiu Horea Bedreag
- Emergency County Hospital, Clinic of Anesthesia and Intensive Care , Bd. Iosif Bulbuca Nr. 10 , 300736 Timişoara, Romania
- “Victor Babeş” University of Medicine and Pharmacy, Faculty of Medicine , Piata E. Murgu 2 , 300041 Timişoara, Romania
| | - Mirela Sărăndan
- Emergency County Hospital, Clinic of Anesthesia and Intensive Care , Department Anesthesia and Intensive Care “Casa Austria” , Bd. Iosif Bulbuca Nr. 10 , 300736 Timişoara, Romania
| | - Marius Păpurică
- Emergency County Hospital, Clinic of Anesthesia and Intensive Care , Bd. Iosif Bulbuca Nr. 10 , 300736 Timişoara, Romania
- “Victor Babeş” University of Medicine and Pharmacy, Faculty of Medicine , Piata E. Murgu 2 , 300041 Timişoara, Romania
| | - Gabriela Preda
- West University of Timişoara, Faculty of Chemistry, Biology, Geography , Str. Pestalozzi 16A , 300115 Timişoara, Romania
| | - Maria Corina Dumbuleu
- Emergency County Hospital, Clinic of Anesthesia and Intensive Care , Bd. Iosif Bulbuca Nr. 10 , 300736 Timişoara, Romania
| | - Corina Vernic
- “Victor Babeş” University of Medicine and Pharmacy, Faculty of Medicine , Piata E. Murgu 2 , 300041 Timişoara, Romania
| | - Emil Robert Stoicescu
- “Victor Babeş” University of Medicine and Pharmacy, Faculty of Medicine , Piata E. Murgu 2 , 300041 Timişoara, Romania
| | - Dorel Săndesc
- Emergency County Hospital, Clinic of Anesthesia and Intensive Care , Bd. Iosif Bulbuca Nr. 10 , 300736 Timişoara, Romania
- “Victor Babeş” University of Medicine and Pharmacy, Faculty of Medicine , Piata E. Murgu 2 , 300041 Timişoara, Romania
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Moradkhani MR, Karimi A, Negahdari B. Nanotechnology application to local anaesthesia (LA). ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2017; 46:355-360. [PMID: 28395522 DOI: 10.1080/21691401.2017.1313263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Several advancements have been made on the exact release of local anaesthetics formulation and its efficiency at inducing motor and sensory block for an extended time has been harnessed in clinical practice. The use of sustained release formulations delivers analgesia for a lengthier period of time with one administration, thereby reducing complications that usually arise with administration of conventional analgesia. In addition, controlled release of an anaesthetic drug is said to prevent overdosing, reduced side effects, especially cardiotoxicity, neurotoxicity and tissue lesions. The use of nanotechnology knowledge via liposomal formulation has recorded high successful results in pain control and quick patient recovery.
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Affiliation(s)
- Mahmoud Reza Moradkhani
- a Department of Anesthesiology , Lorestan University of Medical Sciences , Khorramabad , Iran
| | - Arash Karimi
- a Department of Anesthesiology , Lorestan University of Medical Sciences , Khorramabad , Iran
| | - Babak Negahdari
- b Department of Medical Biotechnology , School of Advanced Technologies in Medicine, Tehran University of Medical Sciences , Tehran , Iran
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