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Kochhar A, Banday J, Ahmad Z, Panjiar P, Vajifdar H. Cervical epidural analgesia combined with general anesthesia for head and neck cancer surgery: A randomized study. J Anaesthesiol Clin Pharmacol 2020; 36:182-186. [PMID: 33013032 PMCID: PMC7480315 DOI: 10.4103/joacp.joacp_72_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 12/09/2019] [Accepted: 12/27/2019] [Indexed: 12/03/2022] Open
Abstract
Background and Aims: The role of cervical epidural analgesia in head and neck cancer surgery is not fully explored. The aim of this study was to evaluate cervical epidural analgesia in terms of opioid and anesthetic requirements and stress response in patients undergoing head and neck cancer surgery. Material and Methods: After institutional ethical committee approval and written informed consent, 30 patients undergoing elective head and neck cancer surgery were randomized into two groups: Group E (cervical epidural analgesia with general anesthesia), and group G (general anesthesia alone). In group E, an 18 gauge epidural catheter was placed at cervical (C) 6 – thoracic (T) 1 level. After test dose, a bolus of 10 ml of 0.2% ropivacaine was given followed by continuous infusion. Technique of general anesthesia and post-operative management was standardized in both the groups. Opioid and anesthetic drug requirement was observed. Blood glucose and serum cortisol levels were measured at baseline; post-incision and after surgery. Results: There was significant reduction in the requirement of morphine (P < 0.001), isoflurane (P = 0.004) and vecuronium (P = 0.001) in group E. Post-operative, blood glucose and serum cortisol levels were significantly reduced (P = 0.0153 and 0.0074, respectively). Early post-operative pain was reduced with the lesser requirement of post-operative morphine. Conclusions: The use of combined cervical epidural analgesia with general anesthesia reduces opioid, anesthetic drug requirement and stress response as compared to general anesthesia alone in patients undergoing head and neck cancer surgery.
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Affiliation(s)
- Anjali Kochhar
- Department of Anesthesia, Critical Care and Pain Medicine, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Jahanara Banday
- Department of Anesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Zainab Ahmad
- Department of Anesthesia, Critical Care and Pain Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Pratibha Panjiar
- Department of Anesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Homay Vajifdar
- Department of Anesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Kumar A, Kumar N, Kumar A, Naaz S. Cervical epidural anaesthesia an alternative for combined neck and thorax surgery. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kumar A, Sinha C, Kumar A, Kumari P, Mukul SK. Ultrasound-guided trigeminal nerve block and its comparison with conventional analgesics in patients undergoing faciomaxillary surgery: Randomised control trial. Indian J Anaesth 2018; 62:871-875. [PMID: 30532323 PMCID: PMC6236796 DOI: 10.4103/ija.ija_256_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Ultrasound (USG)-guided injection in pterygopalatine fossa is an indirect approach to block the trigeminal nerve. Trigeminal nerve block for maxillofacial surgeries may provide preemptive analgesia, reduce opioid consumption and opioid-related adverse effects. Methods: In this randomised, prospective double-blind study, 60 American Society of Anesthesiologists I/II patients, within the age group of 18–60 years scheduled for faciomaxillary surgery (fracture/pathological lesion of maxilla or mandible and cleft lip), were recruited. The patients were allocated in either of the two groups: group I: general anaesthesia (FENT group) and group II: general anaesthesia + trigeminal nerve (TNB group). Perioperative opioid consumption and postoperative pain scores were recorded. Any adverse effects like respiratory depression and nausea were also looked for. Results: Patients in group II required less intraoperative fentanyl top ups (1.17 ± 0.53 vs 2.70 ± 0.53) (P < 0.05). Postoperative opioid consumption was also less in this group (0.93 ± 0.69 vs 3.53 ± 0.68) (P < 0.05). Conclusion: USG-guided TNB reduces perioperative opioid consumption in patients undergoing faciomaxillary surgery with better patient pain scores.
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Affiliation(s)
- Amarjeet Kumar
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Chandni Sinha
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Ajeet Kumar
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Poonam Kumari
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
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Shanthanna H, Mendis N, Goel A. Cervical epidural analgesia in current anaesthesia practice: systematic review of its clinical utility and rationale, and technical considerations. Br J Anaesth 2016; 116:192-207. [PMID: 26787789 DOI: 10.1093/bja/aev453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cervical epidural analgesia (CEA) is an analgesic technique, potentially useful for surgeries involving the upper body. Despite the inherent technical risks and systemic changes, it has been used for various surgeries. There have been no previously published systematic reviews aimed at assessing its clinical utility. This systematic review was performed to explore the perioperative benefits of CEA. The review was also aimed at identifying the rationale of its use, reported surgical indications and the method of use. We performed a literature search involving PubMed and Embase databases, to identify studies using CEA for surgical indications. Out of 467 potentially relevant articles, 73 articles were selected. Two independent investigators extracted data involving 5 randomized controlled trials, 17 observational comparative trials, and 51 case reports (series). The outcomes studied in most comparative studies were on effects of local anaesthetics and other agents, systemic effects, and feasibility of CEA. In one randomized controlled study, CEA was observed to decrease the resting pain scores after pharyngo-laryngeal surgeries. In a retrospective study, CEA was shown to decrease the cancer recurrence after pharyngeal-hypopharyngeal surgeries. The limited evidence, small studies, and the chosen outcomes do not allow for any specific recommendations based on the relative benefit or harm of CEA. Considering the potential for significant harm, in the face of better alternatives, its use must have a strong rationale mostly supported by unique patient and surgical demands. Future studies must aim to assess analgesic comparator effectiveness for clinically relevant outcomes.
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Affiliation(s)
- H Shanthanna
- Department of Anaesthesiology, St Joseph's Hospital, McMaster University, Hamilton, ON, Canada
| | - N Mendis
- Resident, Department of Anaesthesiology, University of Ottawa, Ottawa, ON, Canada
| | - A Goel
- Resident, Department of Anesthesiology, University of Toronto, Toronto, ON, Canada
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Cervical epidural anesthesia is associated with increased cancer-free survival in laryngeal and hypopharyngeal cancer surgery: a retrospective propensity-matched analysis. Reg Anesth Pain Med 2014; 38:398-402. [PMID: 23881179 DOI: 10.1097/aap.0b013e31829cc3fb] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Regional anesthesia preserves perioperative immune competence and may reduce the risk of recurrence and metastasis after cancer surgery. Cervical epidural anesthesia provides adequate analgesia for head and neck cancer surgery, but its impact on cancer recurrence is unknown. METHODS This study was a single-center retrospective cohort study of patients undergoing larynx or hypopharynx cancer surgery between January 1984 and December 2008. One hundred eleven patients had general anesthesia combined with intraoperative and postoperative cervical epidural; 160 had general anesthesia alone with postoperative morphine. From this cohort, matched pairs were selected using a propensity score to balance potential confounders of receiving epidural anesthesia. The primary end point was the length of cancer-free survival after surgery until September 2009. RESULTS Propensity-based matching produced 65 pairs. Matching was effective in achieving balance between groups for each of the preoperative variables collected. Combined epidural and general anesthesia (68% 5-year cancer-free survival; 95% confidence interval [CI], 57%-82%) was associated with significantly increased cancer-free survival compared with general anesthesia alone (37% 5-year cancer-free survival; 95% CI, 25%-54%) with a corresponding adjusted hazard ratio of 0.49 (95% CI, 0.25-0.96; P = 0.04). Patients in the epidural group had an increased overall survival compared with the non-epidural group (P = 0.03). CONCLUSIONS The association between cervical epidural anesthesia and increased cancer-free survival found in this retrospective study should be an important hypothesis to further investigate in head and neck cancer surgery.
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Kim JY, Park SY, Chang HS, Nam SK, Min SK. The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia. Korean J Anesthesiol 2013; 65:544-51. [PMID: 24427461 PMCID: PMC3888848 DOI: 10.4097/kjae.2013.65.6.544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intravenous fentanyl has been used for acute postoperative pain management, but has not always provided reliable adequate analgesia, including patient-controlled analgesia (PCA). The purpose of this study was to investigate the efficacy of time-scheduled decremental infusion of fentanyl for postoperative analgesia. METHODS Ninety-nine patients, aged 20-65 years, undergoing laparoscopic-assisted hysterectomy using total intravenous anesthesia (TIVA) were randomly assigned into one of the three groups. Their background infusions of fentanyl diluent (2 ml/hr of diluent was equivalent with 0.5 µg/kg/hr of fentanyl) with PCA were maintained at the fixed-rate of 2 ml/hr until the postoperative 24 hr (FX2-2-2), or at the decremental rates of 6.0, 4.0, 2.0 ml/hr (D6-4-2) and 8.0, 4.0, 2.0 ml/hr (D8-4-2). The visual analogue score (VAS), incidence of inadequate analgesia, frequency of PCA intervention, and side effects were evaluated. RESULTS VAS was significantly higher in FX2-2-2 than in D6-4-2 and D8-4-2 until postoperative 3 hr (P < 0.05). After postoperative 4 hr, VAS was significantly higher in FX2-2-2 than D8-4-2 (P < 0.05). The incidence of inadequate analgesia of FX2-2-2 was significantly greater than D6-4-2 (P = 0.038) and D8-4-2 (P < 0.001) until postoperative 1 hr. None of the patients had ventilatory depression, and postoperative nausea and vomiting were not significant among the groups. CONCLUSIONS The time-scheduled decremental background infusion regimens of fentanyl, based on the pharmacokinetic model, could provide more effective postoperative pain management after TIVA, and the side effects and the risk for morbidity were not different from the fixed-rate infusion regimen.
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Affiliation(s)
- Jong-Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sung-Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Hyuk Soo Chang
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Si-Kwon Nam
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Kee Min
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
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Trotter PB, Norton LA, Loo AS, Munn JI, Voge E, Ah-See KW, Macfarlane TV. Pharmacological and other interventions for head and neck cancer pain: a systematic review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2013; 3:e1. [PMID: 24422019 PMCID: PMC3886097 DOI: 10.5037/jomr.2012.3401] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 12/20/2012] [Indexed: 01/03/2023]
Abstract
Objectives Pain is a common complication in head and neck cancer. The aim of this paper
is to evaluate the evidence from randomised control trials investigating
pharmacological and non-pharmacological methods of pain management in head
and neck cancer. Material and Methods Medline, Embase and the Cochrane library databases were searched. Squamous
cell carcinomas of the head and neck excluding nasopharyngeal and salivary
gland cancers were included. The limits were "human" and
"randomised clinical trials". A quality assessment was carried
out. Results 13 studies were included with a total of 644 participants. The primary
outcome for most of these papers was pain control post-treatment. Levels of
bias varied between the studies. Majority (12 out of the 13 studies)
reported intervention to be superior to the control or standard therapy in
pain management. Only 46% of the studies were carried out on an intention to
treat basis. Two studies reported high dropout rates, with one at 66%. Conclusions There is insufficient evidence from randomised clinical trials to suggest an
optimal pharmacological intervention for head and neck cancer pain
post-treatment. Further high quality randomised clinical trials should be
conducted to develop an optimal management strategy for head and neck cancer
pain.
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Affiliation(s)
- Patrick B Trotter
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
| | - Lindsey A Norton
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
| | - Ann S Loo
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
| | - Jonathan I Munn
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
| | - Elena Voge
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom. ; University of Bremen Bremen Germany
| | - Kim W Ah-See
- Department of Otolaryngology, Aberdeen Royal Infirmary Aberdeen United Kingdom
| | - Tatiana V Macfarlane
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
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Saracoglu KT, Saracoglu A, Cakar K, Fidan V, Ay B. Comparative study of intravenous opioid consumption in the postoperative period. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156:48-51. [PMID: 22580860 DOI: 10.5507/bp.2011.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Intravenous patient-controlled analgesia (IV PCA) using opiods is an accepted method for delivering postoperative analgesia. The aim of this study was to compare fentanyl and tramadol with IV PCA after spinal anesthesia (SA) and general anesthesia (GA) following cesarean section (C/S). METHODS Ninety women were randomly assigned to three groups (n=30). Group 1 was treated with IV fentanyl PCA after SA. Groups 2 and 3 were treated with IV fentanyl PCA and IV tramadol PCA after GA. Outcome measures were recorded for the first 24 h post-anesthesia. RESULTS PCA use was significantly lower after SA (P<0.05). Eighteen patients in the SA Group and 27 patients and 24 patients from the GA groups required additional opioid. Opioid consumption and patient satisfaction were similar for groups after GA (P>0.05). 638.4 ± 179.1 μg fentanyl was consumed by patients of Group 2, 356.3 ± 87.0 μg fentanyl and 559.5 ± 207.0 mg tramadol was consumed by Group 1 and Group 3 respectively. There was no significant difference in the overall severity and incidence of nausea, drowsiness or pruritus. CONCLUSION Our study shows that analgesic consumption and post-operative pain scores after SA in C/S decreased, without increase in adverse reactions.
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Affiliation(s)
- Kemal Tolga Saracoglu
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey.
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Yamauchi M, Asano M, Watanabe M, Iwasaki S, Furuse S, Namiki A. Continuous Low-Dose Ketamine Improves the Analgesic Effects of Fentanyl Patient-Controlled Analgesia After Cervical Spine Surgery. Anesth Analg 2008; 107:1041-4. [DOI: 10.1213/ane.0b013e31817f1e4a] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Plantevin F, Pascal J, Morel J, Roussier M, Charier D, Prades JM, Auboyer C, Molliex S. Effect of mandibular nerve block on postoperative analgesia in patients undergoing oropharyngeal carcinoma surgery under general anaesthesia. Br J Anaesth 2007; 99:708-12. [PMID: 17884802 DOI: 10.1093/bja/aem242] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Postoperative analgesia after oropharyngeal carcinoma surgery remains poorly studied. This study investigates the effects of mandibular nerve block (MNB) with ropivacaine 10 mg ml(-1) in conjunction with general anaesthesia (GA) on postoperative analgesia after partial glossectomy or transmandibular lateral pharyngectomy. METHODS In a randomized double-blind study, 42 patients (21 in each group) received an MNB by the lateral extra-oral approach (MNB group) or a deep s.c. injection of normal saline (control group). Both groups received a standardized general anaesthetic. Postoperative analgesia included fixed dose of i.v. acetaminophen and morphine via a patient-controlled analgesia device. Consumption of morphine and supplemental analgesics and pain scores at rest were measured. RESULTS The mean cumulative morphine consumption was reduced by 56 and 45% at 12 and 24 h after operation in the MNB group. The administration of analgesic rescue medications was delayed in the MNB group. The visual analogue scale (VAS) pain scores were comparable in the two groups during the first 24 h. Adequate analgesia (mean VAS < or = 3) was observed throughout the study period in the MNB group, but only from 4 h after operation onwards in the control group. The number of patients who experienced severe pain (VAS > 7) during the first postoperative day was lower in the MNB group than in the control group (3 vs 10. respectively, P < 0.05). CONCLUSIONS In this study, MNB performed before GA for oropharyngeal carcinoma surgery improved postoperative analgesia, resulting in reduced morphine consumption at 24 h and severe pain in fewer patients.
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Affiliation(s)
- F Plantevin
- Département d'Anesthésie-Réanimation, CHU Hôpital Bellevue, bd Pasteur, 42055 Saint-Etienne Cedex 2, France
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:388-94. [PMID: 17620851 DOI: 10.1097/aco.0b013e3282c3a878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laser literature watch. Photomed Laser Surg 2006; 24:424-53. [PMID: 16875454 DOI: 10.1089/pho.2006.24.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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