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Anger JT, Case LK, Baranowski AP, Berger A, Craft RM, Damitz LA, Gabriel R, Harrison T, Kaptein K, Lee S, Murphy AZ, Said E, Smith SA, Thomas DA, Valdés Hernández MDC, Trasvina V, Wesselmann U, Yaksh TL. Pain mechanisms in the transgender individual: a review. FRONTIERS IN PAIN RESEARCH 2024; 5:1241015. [PMID: 38601924 PMCID: PMC11004280 DOI: 10.3389/fpain.2024.1241015] [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: 06/15/2023] [Accepted: 01/25/2024] [Indexed: 04/12/2024] Open
Abstract
Specific Aim Provide an overview of the literature addressing major areas pertinent to pain in transgender persons and to identify areas of primary relevance for future research. Methods A team of scholars that have previously published on different areas of related research met periodically though zoom conferencing between April 2021 and February 2023 to discuss relevant literature with the goal of providing an overview on the incidence, phenotype, and mechanisms of pain in transgender patients. Review sections were written after gathering information from systematic literature searches of published or publicly available electronic literature to be compiled for publication as part of a topical series on gender and pain in the Frontiers in Pain Research. Results While transgender individuals represent a significant and increasingly visible component of the population, many researchers and clinicians are not well informed about the diversity in gender identity, physiology, hormonal status, and gender-affirming medical procedures utilized by transgender and other gender diverse patients. Transgender and cisgender people present with many of the same medical concerns, but research and treatment of these medical needs must reflect an appreciation of how differences in sex, gender, gender-affirming medical procedures, and minoritized status impact pain. Conclusions While significant advances have occurred in our appreciation of pain, the review indicates the need to support more targeted research on treatment and prevention of pain in transgender individuals. This is particularly relevant both for gender-affirming medical interventions and related medical care. Of particular importance is the need for large long-term follow-up studies to ascertain best practices for such procedures. A multi-disciplinary approach with personalized interventions is of particular importance to move forward.
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Affiliation(s)
- Jennifer T. Anger
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Laura K. Case
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Andrew P. Baranowski
- Pelvic Pain Medicine and Neuromodulation, University College Hospital Foundation Trust, University College London, London, United Kingdom
| | - Ardin Berger
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States
| | - Rebecca M. Craft
- Department of Psychology, Washington State University, Pullman, WA, United States
| | - Lyn Ann Damitz
- Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC, United States
| | - Rodney Gabriel
- Division of Regional Anesthesia, University of California San Diego, San Diego, CA, United States
| | - Tracy Harrison
- Department of OB/GYN & Reproductive Sciences, University of California San Diego, San Diego, CA, United States
| | - Kirsten Kaptein
- Division of Plastic Surgery, University of California San Diego, San Diego, CA, United States
| | - Sanghee Lee
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Anne Z. Murphy
- Neuroscience Institute, Georgia State University, Atlanta, GA, United States
| | - Engy Said
- Division of Regional Anesthesia, University of California San Diego, San Diego, CA, United States
| | - Stacey Abigail Smith
- Division of Infection Disease, The Hope Clinic of Emory University, Atlanta, GA, United States
| | - David A. Thomas
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, United States
| | - Maria del C. Valdés Hernández
- Department of Neuroimaging Sciences, Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Victor Trasvina
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Ursula Wesselmann
- Departments of Anesthesiology and Perioperative Medicine/Division of Pain Medicine, Neurology and Psychology, and Consortium for Neuroengineering and Brain-Computer Interfaces, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tony L. Yaksh
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
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Hu X, Jiao B, Zhou R, Zhu T. The postoperative analgesia of retrolaminar block in patients undergoing surgery with general anesthesia: a systematic review. Minerva Anestesiol 2023; 89:1127-1133. [PMID: 37851415 DOI: 10.23736/s0375-9393.23.17466-9] [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: 10/19/2023]
Abstract
INTRODUCTION Postoperative pain has always been a difficult problem in anesthesia management. The neurological block technique has been used for postoperative analgesia management, but compared with the traditional block method, the effect of postoperative analgesia after layer block is still controversial, and a clear literature review is needed. This systematic review's goal was to investigate RLB's impact on postoperative analgesia. EVIDENCE ACQUISITION The literature search was performed using the PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Patients aged 18 years who underwent retrolaminar block were considered eligible. The article must report the results of the original study related to postoperative analgesia. The characteristics of the study sample and evaluating the RLB for postoperative analgesia were extracted from each included article and concluded. EVIDENCE SYNTHESIS Eleven randomized controlled trials (726 patients) were included. After summarizing the analysis of the results of RLB on changing postoperative analgesia indexes in different surgeries, we concluded that PVB is better used for postoperative analgesia compared with RLB. The analgesic effect of RLB provides advantages compared with EPSB, SCPB, etc. CONCLUSIONS Based on the results of this review, RLB can be applied to thoracic surgery, abdominal surgery and parotid surgery, but its analgesic effect is not significant enough, and further research is needed in the future to provide stronger evidence for postoperative analgesia in surgical patients.
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Affiliation(s)
- Xialian Hu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Jiao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruihao Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China -
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Mohan SC, Siegel E, Tran H, Ozcan L, Alban R, Shariff S, Mirocha J, Chung A, Giuliano A, Dang C, Anand K, Shane R, Amersi F. Effects of paravertebral blocks versus liposomal bupivacaine on hospital utilization after mastectomy with reconstruction. Am J Surg 2022; 224:938-942. [DOI: 10.1016/j.amjsurg.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
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Williams L, Iteld L. Moving Toward Opioid-Free Breast Surgery: Regional Blocks and a Novel Technique. Clin Plast Surg 2020; 48:123-130. [PMID: 33220899 DOI: 10.1016/j.cps.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Perioperative pain control is of increasing importance as awareness regarding the risks of under-controlled pain and opioid abuse rise. Enhanced recovery protocols and multimodal analgesia, including regional blocks, are useful tools for the plastic surgeon. The thoracic paravertebral block, pectoralis nerve I and pectoralis nerve II blocks, and proximal intercostal blocks are 3 described methods that provide regional anesthesia for breast surgery. The widespread use of these methods may be limited by the requirements for ultrasound equipment and anesthesiologists skilled in regional blocks. This article describes a novel technique of the intercostal field block under direct visualization that is safe and efficient.
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Affiliation(s)
- Lydia Williams
- Plastic & Reconstructive Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Lawrence Iteld
- Plastic & Reconstructive Surgery, University of Chicago Medicine, Chicago, IL, USA; Iteld Plastic Surgery, 939 West North Avenue, Suite 600, Chicago, IL 606042, USA.
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Hwang BY, Kim E, Kwon JY, Lee JY, Lee D, Park EJ, Kang T. The analgesic efficacy of a single injection of ultrasound-guided retrolaminar paravertebral block for breast surgery: a prospective, randomized, double-blinded study. Korean J Pain 2020; 33:378-385. [PMID: 32989202 PMCID: PMC7532298 DOI: 10.3344/kjp.2020.33.4.378] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/25/2020] [Accepted: 07/14/2020] [Indexed: 01/06/2023] Open
Abstract
Background The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.
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Affiliation(s)
- Boo-Young Hwang
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae-Young Kwon
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji-Youn Lee
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Dowon Lee
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Eun Ji Park
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Taewoo Kang
- Department of Busan Cancer Center (Breast Cancer Clinic), Pusan National University Hospital, Busan, Korea
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Seelam S, Nair AS, Christopher A, Upputuri O, Naik V, Rayani BK. Efficacy of single-shot ultrasound-guided erector spinae plane block for postoperative analgesia after mastectomy: A randomized controlled study. Saudi J Anaesth 2020; 14:22-27. [PMID: 31998015 PMCID: PMC6970350 DOI: 10.4103/sja.sja_260_19] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/21/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022] Open
Abstract
Background The aim of this study is to understand the effect of ultrasound (US) guided erector spinae plane block (ESPB) in improving the intraoperative and postoperative analgesia in patients undergoing mastectomies, decreasing the use of opioids and in reducing postoperative nausea and vomiting. Methods After local ethics committee approval, 100 patients were divided randomly into two groups. Group A with 50 patients received US guided ESPB with 30 ml of 0.25% of bupivacaine under US guidance. Group B with 50 patients received no block. Visual analogue scale (VAS) was used to assess pain postoperatively. All patients received 1 g intravenous intravenous paracetamol 8th hourly and morphine was used as rescue analgesia if VAS score is more than 4. Patients were monitored for VAS scores, postoperative nausea/ vomiting and total morphine consumption for a 24-hour period in a high dependency unit. Results Postoperative morphine consumption was found to be significantly less in patients who received US-guided ESPB compared to control group (0.12 mg ± 0.59 mg in ESPB group compared to 1.70 ± 2.29 mg which was statistically significant, p=0.000). Only 3 patients in ESP group received rescue analgesia in the form of morphine whereas 22 patients in the control group received morphine. There was no difference in PONV score in either groups. There were no complications like vascular puncture, pneumothorax, or respiratory depression in both groups. Conclusion US guided ESPB is quite effective in reducing perioperative pain in patients undergoing mastectomy. The trial was registered prospectively with CTRI with registration number: CTRI/2018/09/015668.
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Affiliation(s)
- Suresh Seelam
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Abhijit S Nair
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Asiel Christopher
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Omkar Upputuri
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Vibhavari Naik
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Basanth Kumar Rayani
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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Rivedal DD, Nayar HS, Israel JS, Leverson G, Schulz AJ, Chambers T, Afifi AM, Blake JM, Poore SO. Paravertebral block associated with decreased opioid use and less nausea and vomiting after reduction mammaplasty. J Surg Res 2018; 228:307-313. [DOI: 10.1016/j.jss.2018.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/22/2017] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
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8
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Yousef NK. Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Patients Undergoing Total Abdominal Hysterectomy: A Randomized Prospective Controlled Trial. Anesth Essays Res 2018; 12:742-747. [PMID: 30283187 PMCID: PMC6157234 DOI: 10.4103/aer.aer_108_18] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Abdominal hysterectomy is associated with sever postoperative pain. Quadratus lumborum (QL) block is a regional analgesic technique which has an evolving role in postoperative analgesia. Aims we aimed to compare ultrasound guided bilateral transverse abdominis plane (TAP) block versus bilateral QL block in patients undergoing total abdominal hysterectomy. Settings and Design This is a prospective randomized controlled double blinded study. Patients and Methods Sixty adult female patients (ASA I-II), scheduled for total abdominal hysterectomy were randomized into two equal groups (TAP group and QL group). Each patient received general anesthesia plus bilateral TAP block or bilateral QL block. We recorded postoperative total dose of morphine used / 24 hours, Visual Analuge Scales (VAS) for pain (at 30 min, 2, 4, 6, 12, and 24 hours postoperative), duration of postoperative analgesia, total dose of fentanyl use intraoperative, number of patients needed rescue analgesia and any side effects. Statistical Analysis Independent sample T test and Chi-Square (X2) test were used as appropriate. Results Patients in QL group consumed significantly less fentanyl and morphine than patients in TAP group, VAS for pain was significant higher in TAP group than in QL group at all times, the duration of postoperative analgesia was shorter in TAP group than in QL group, the number of patients requested analgesia was significantly higher in TAP group than in QL group. Conclusions Bilateral QL block provided better intraoperative and postoperative analgesia with less opioids consumption compared with bilateral TAP block, in patients undergoing total abdominal hysterectomy.
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Affiliation(s)
- Naglaa Khalil Yousef
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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9
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Onishi E, Murakami M, Nishino R, Ohba R, Yamauchi M. Analgesic Effect of Double-Level Retrolaminar Paravertebral Block for Breast Cancer Surgery in the Early Postoperative Period: A Placebo-Controlled, Randomized Clinical Trial. TOHOKU J EXP MED 2018; 245:179-185. [DOI: 10.1620/tjem.245.179] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eiko Onishi
- Department of Anesthesiology, Tohoku University Hospital
| | | | - Ryo Nishino
- Department of Anesthesiology, Tohoku Kosai Hospital
| | - Ruri Ohba
- Department of Anesthesiology, Tohoku University Hospital
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Intraoperative Techniques for the Plastic Surgeon to Improve Pain Control in Breast Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1522. [PMID: 29263948 PMCID: PMC5732654 DOI: 10.1097/gox.0000000000001522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/21/2017] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. In recent years, there has been a growing emphasis placed on reducing length of hospital stay and health costs associated with breast surgery. Adequate pain control is an essential component of enhanced recovery after surgery. Postoperative pain management strategies include use of narcotic analgesia, non-narcotic analgesia, and local anesthetics. However, these forms of pain control have relatively brief durations of action and multiple-associated side effects. Intraoperative regional blocks have been effectively utilized in other areas of surgery but have been understudied in breast surgery. The aim of this article was to review various intraoperative techniques for regional anesthesia and local pain control in breast surgery and to highlight areas of future technique development.
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11
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Cheng GS, Ilfeld BM. A review of postoperative analgesia for breast cancer surgery. Pain Manag 2016; 6:603-618. [DOI: 10.2217/pmt-2015-0008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
An online database search with subsequent article review was performed in order to review the various analgesic modalities for breast cancer surgery. Of 514 abstracts, 284 full-length manuscripts were reviewed. The effect of pharmacologic interventions is varied (NSAIDS, opioids, anticonvulsants, ketamine, lidocaine). Likewise, data from high-quality randomized, controlled studies on wound infiltration (including liposome encapsulated) and infusion of local anesthetic are minimal and conflicting. Conversely, abundant evidence demonstrates paravertebral blocks and thoracic epidural infusions provide effective analgesia and minimize opioid requirements, while decreasing opioid-related side effects in the immediate postoperative period. Other techniques with promising – but extremely limited – data include cervical epidural infusion, brachial plexus, interfascial plane and interpleural blocks. In conclusion, procedural interventions involving regional blocks are more conclusively effective than pharmacologic modalities in providing analgesia to patients following surgery for breast cancer.
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Affiliation(s)
- Gloria S Cheng
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian M Ilfeld
- University of California San Diego, San Diego, CA, USA
- Outcomes Research Consortium, Cleveland, OH, USA
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12
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Cheng GS, Ilfeld BM. An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery. PAIN MEDICINE 2016; 18:1344-1365. [DOI: 10.1093/pm/pnw172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Retrolaminar block: analgesic efficacy and safety evaluation. J Anesth 2016; 30:1003-1007. [PMID: 27518726 DOI: 10.1007/s00540-016-2230-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Retrolaminar block (RLB) is a thoracic truncal block that can produce analgesia for the thoracic and abdominal wall. However, the characteristics of RLB are not well known. The aim of this study was to determine analgesic efficacy by measuring postoperative consume of patient-controlled analgesia (PCA), additional nonsteroidal antiinflammatory drug (NSAID) rescue, and opioid rescue. Our secondary analysis included assessment of the chronological change in arterial levobupivacaine concentrations after the block. METHODS This prospective, randomized, double-blinded study included 30 patients scheduled for modified radical mastectomy under general anesthesia. The patients were randomized to receive either a landmark-guided RLB or paravertebral block (PVB) catheter placement on T4. Continuous infusion with 4 ml/h of 0.25 % levobupivacaine was started for 72 h, after initial injection of 20 ml 0.375 % levobupivacaine before surgery. Postoperative pain was compared using the amount of block PCA (3 ml 0.25 % levobupivacaine with 30-min lockout), NSAID, and opioid rescue. Arterial blood was sampled for 120 min after the initial injection. RESULTS The frequency of postoperative block PCA use was significantly high after RLB in 24 h [p = 0.01; 6 (3-12) vs. 2.5 (0.3-3) times, respectively]. There was no PCA use after 24 h in either group. There was no postoperative opioid rescue use throughout the study. After RLB and PVB, there was no significant difference in T max (p = 0.14; 15 ± 8 vs. 15 ± 8 min, respectively) and C max (p = 0.2; 0.9 ± 0.2 vs. 0.9 ± 0.3 µg/ml, respectively), and all the concentrations were below the threshold of local anesthetic systemic toxicity. CONCLUSION Continuous RLB was not inferior to PVB except for the first 24 h, and was satisfactory after mastectomy. RLB showed safe, low peak arterial levobupivacaine concentrations.
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Quadratus Lumborum Block: Analgesic Effects and Chronological Ropivacaine Concentrations After Laparoscopic Surgery. Reg Anesth Pain Med 2016; 41:146-50. [PMID: 26735154 DOI: 10.1097/aap.0000000000000349] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The quadratus lumborum block (QLB) is an abdominal truncal block, similar to transversus abdominis plane block (TAPB). However, the characteristics of QLB with regard to its duration and safety are not well known. The primary aim of this study was to determine the block duration and the cutaneous sensory block area. Our secondary analysis included assessment of the chronological change in arterial local anesthetic concentrations after QLB. METHODS This study included 11 patients scheduled for laparoscopic ovarian surgery under general anesthesia. The patients received bilateral single-injection QLBs (20 mL of 0.375% ropivacaine per side). Arterial blood was sampled at 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. The results were retrospectively compared with the results of our previous study on lateral TAPB. RESULTS The median duration of analgesia after QLB exceeded 24 hours and was significantly longer than the duration of lateral TAPB (P = 0.003). Quadratus lumborum block affected the T7-T12 dermatomes, whereas TAPB affected T10-T12. Arterial ropivacaine levels after block peaked at comparable time in the QLB and lateral TAPB groups (Tmax: 35 [SD, 13] vs 35 [SD, 11] minutes; P = 0.93). Peak ropivacaine concentrations were significantly lower in QLB than in lateral TAPB (Cmax: 1.0 [SD, 0.5] vs 1.8 [SD, 0.4] μg/mL; P = 0.0003). CONCLUSIONS Quadratus lumborum block resulted in a widespread and long-lasting analgesic effect after laparoscopic ovarian surgery and resulted in lower peak arterial ropivacaine concentrations as compared with those of lateral TAPB after 150 mg ropivacaine injection.
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Hansen CK, Dam M, Poulsen TD, Lönnqvist P, Bendtsen TF, Børglum J. Ultrasound‐guided parasternal Pecs block: a new and useful supplement to Pecs I and serratus anterior plane blocks. ACTA ACUST UNITED AC 2016. [DOI: 10.21466/ac.uppbana.2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Christian Kruse Hansen
- Clinical Research FellowDepartment of Anaesthesiolgy, Copenhagen University Hospital ‐ RoskildeRoskilde / CopenhagenDenmark
| | - Mette Dam
- Clinical Research FellowDepartment of Anaesthesia and Intensive Care Medicine, Copenhagen Universtity Hospital ‐ RoskildeRoskildeDenmark
| | - Troels Dirch Poulsen
- ConsultantDepartment of Anaesthesia and Intensive Care Medicine, Copenhagen Universtity Hospital ‐ RoskildeRoskildeDenmark
| | - Per‐Arne Lönnqvist
- ProfessorDepartment of Pediatric Anaesthesia and Intensive Care, Astrid Lindgren Children's Hospital/Karolinska University HospitalStockholmSweden
| | - Thomas Fichtner Bendtsen
- ConsultantDepartment of Anaesthesia and Intensive Care Medicine, Aarhus University HospitalAarhusDenmark
| | - Jens Børglum
- ConsultantDepartment of Anaesthesia and Intensive Care Medicine, Copenhagen Universtity Hospital ‐ RoskildeRoskildeDenmark
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Maheshwari P, Maheshwari P. Single-injection vs continuous thoracic paravertebral block for postoperative analgesia after mastectomy. J Clin Anesth 2015; 28:90-1. [PMID: 26388167 DOI: 10.1016/j.jclinane.2015.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Praveen Maheshwari
- Department of Anesthesiology, The University of Oklahoma Health Sciences Center, 750 N.E. 13th Street, Suite OAC200, Oklahoma City, OK 73014, USA.
| | - Parul Maheshwari
- Department of Anesthesiology, The University of Oklahoma Health Sciences Center, 750 N.E. 13th Street, Suite OAC200, Oklahoma City, OK 73014, USA.
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17
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Liu KP, Xue FS, Li CH, Liu GP. Assessing analgesic efficiency of single-injection thoracic paravertebral block after mastectomy. J Clin Anesth 2015; 27:702-3. [PMID: 26118311 DOI: 10.1016/j.jclinane.2015.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Kun-Peng Liu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Cheng Hui Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, China
| | - Gao-Pu Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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