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Tankel J, Shay S, Wimpfheimer A, Neumann M, Berko R, Reissman P, Ben Haim M, Dagan A. The effect of longer epidural duration after open pancreaticoduodenectomy on pain and mobilisation: A retrospective single-centre analysis. J Perioper Pract 2024:17504589241265826. [PMID: 39104356 DOI: 10.1177/17504589241265826] [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: 08/07/2024]
Abstract
BACKGROUND The optimal length of epidural use following open pancreaticoduodenectomy has not been defined. The aim of this study was to investigate whether the length of patient-controlled epidural analgesia affected pain and ability to mobilise on epidural termination following open pancreaticoduodenectomy in the context of enhanced recovery after surgery. METHODS A retrospective single-centre cohort analysis was performed between November 2015 and December 2021 on patients who underwent open pancreaticoduodenectomy. As part of a continual review process of the enhanced recovery after surgery protocol, patient-controlled epidural analgesia duration changed allowing stratification of patients into either three- or five-day patient-controlled epidural analgesia groups. RESULTS Of the 196 patients identified, 157 were included with 80 (50.9%) and 77 (49.1%) allocated to the three-day and five-day patient-controlled epidural analgesia groups, respectively. Patient-controlled epidural analgesia termination on postoperative day 3 was associated with transiently higher pain and less mobilisation, although no greater rescue analgesia requirement. Conversely, longer patient-controlled epidural analgesia usage following open pancreaticoduodenectomy was associated with less pain and greater mobilisation in the immediate postoperative period. CONCLUSIONS Earlier patient-controlled epidural analgesia termination transiently leads to increased pain and decreased mobilisation following open pancreaticoduodenectomy. Ensuring appropriate analgesia requirements or longer patient-controlled epidural analgesia usage should be considered to avoid patient discomfort and enhance recovery.
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Affiliation(s)
- James Tankel
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Shahaf Shay
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Ariel Wimpfheimer
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Michael Neumann
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Robert Berko
- Department of Anesthesia, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Menahem Ben Haim
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Amir Dagan
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
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Elsharydah A, De La Cruz R, Horani SM, Xiao CY. Utilization of Truncal Fascial Plane Nerve Blocks for Chronic Pain Management: A Narrative Review. Curr Pain Headache Rep 2023; 27:149-155. [PMID: 37079259 DOI: 10.1007/s11916-023-01112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE OF REVIEW Nerve blocks constitute an integral portion in the management of chronic pain. The widespread use of ultrasound imaging opened the door to a flood of newer blocks especially truncal plane nerve blocks. We reviewed the current medical literature for studies and case reports utilizing the two most common truncal plane nerve blocks, transversus abdominis plane and erector spinae plane blocks, to manage chronic pain. RECENT FINDINGS We found some evidence, mostly in case reports and retrospective observational studies, that supports the use of transversus abdominis plane and erector spinae plane nerve blocks, usually with steroids, as a safe and valuable part of interdisciplinary management of chronic abdominal and chest walls pain. Ultrasound-guided truncal fascial plane nerve blocks are safe, easy to learn, and proven to help with post-operative acute pain management. Although limited, our current review provides evidence from the current medical literature regarding the utility of these blocks to manage some of the challenging chronic and cancer-related pain conditions of the trunk region.
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Affiliation(s)
- Ahmad Elsharydah
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390-9068, Dallas, TX, USA.
| | | | - Sami M Horani
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390-9068, Dallas, TX, USA
| | - Cindy Y Xiao
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390-9068, Dallas, TX, USA
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3
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Shukla U, Yadav U, Duggal J. A Comparative Study of Ultrasound-Guided Quadratus Lumborum Block and Transversus Abdominis Plane Block for Postoperative Analgesia Following Total Abdominal Hysterectomy. Cureus 2023; 15:e36412. [PMID: 37090304 PMCID: PMC10115150 DOI: 10.7759/cureus.36412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Total abdominal hysterectomy (TAH) results in remarkable postoperative pain. Truncal nerve blocks like the quadratus lumborum (QL) block and transversus abdominis plane (TAP) block are described to combat this pain. The aim of the present study was to compare the effectiveness of the QL block with the TAP block in terms of numeric rating scale (NRS) scores as the primary outcome for postoperative pain in TAH. The secondary outcome was time of the first analgesic demand, total analgesic demands required in 24 hr, and patient satisfaction level. METHODS Seventy patients of American Society of Anesthesiologists (ASA) physical status class I and II, aged 35-65 years with a body mass index (BMI) 18-30 kg/m2 planned for elective TAH under spinal anaesthesia were randomly allocated into two groups. Group Q received QL block and Group T received TAP block under ultrasound guidance with 40 ml of 0.25% bupivacaine of which 20 ml was injected on either side. RESULTS Demographic data of both groups was comparable. The NRS pain score was significantly lower in Group Q compared to Group T at the fourth and sixth hour. The mean first analgesic demand was significantly early in Group T compared to Group Q (5.69 ± 0.87 hr vs. 11.23 ± 2.22 hr) and total analgesic demands were significantly greater in Group T than Group Q. The mean patient satisfaction score was significantly high in Group Q compared to Group T (5.8 ± 0.41 vs. 4.74 ± 0.44). CONCLUSION The combined posterior and anterior approach of the QL block may represent a more efficacious alternative to the TAP block in patients after TAH. Further studies are recommended to evaluate the ideal dose, volume and approach for the QL block.
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Affiliation(s)
- Usha Shukla
- Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Urvashi Yadav
- Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Jasleen Duggal
- Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, IND
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Muacevic A, Adler JR, Gupta V, Verma S. Ultrasound-Guided Transversus Abdominis Plane Block Versus Single-Shot Epidural Block for Postoperative Analgesia in Patients Undergoing Inguinal Hernia Surgery. Cureus 2023; 15:e33876. [PMID: 36819433 PMCID: PMC9933787 DOI: 10.7759/cureus.33876] [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: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Background Transversus abdominis plane (TAP) block and epidural analgesia are two frequently used regional anaesthesia techniques that attenuate postoperative pain after inguinal hernia repair. Aim To compare the analgesic efficacy between the single-shot epidural block and TAP block for postoperative analgesia in patients undergoing inguinal hernia repair surgery. Methods Forty patients of either gender undergoing elective inguinal hernia surgery of American Society of Anesthesiologists (ASA) class Ⅰ and Ⅱ were randomly allocated into two groups. Group E received a single-shot epidural with 20 ml of 0.25% bupivacaine. Group T received a TAP block with 20 ml of 0.25% bupivacaine under ultrasound guidance. Postoperative pain was evaluated by the visual analog scale (VAS). Rescue analgesia was given on VAS score ≥ 4 or on-demand in the postoperative period. The primary outcome included VAS score at 15 min, 1st h, 2nd h, 6th h, 12th h, and 24th h after the block. The secondary outcome was the analgesia duration, the total rescue analgesia dose required, and the patient satisfaction level. Results The VAS pain scores were significantly lower in the epidural group compared to the TAP group at the 2nd, 6th, 12th, and 24th h postoperatively (p<0.0001). The mean duration of analgesia was significantly more in Group E (576.75±96.64 min) compared to Group T (276.75±105.56 min). The total analgesic consumption was seen significantly more in 24 h in Group T than in Group E. Patient satisfaction score was significantly higher with a mean value of 5.55±0.6 in group E compared to 4.75±0.72 in group T. Conclusion A single-shot epidural provides better postoperative pain control than a TAP block. The duration of the first analgesic demand was prolonged, with less analgesic consumption in the epidural group.
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Magdy M, Bakeer A, Hamimy W, Zaghloul A, Shaban A, Ahmed M. Analgesic efficacy of erector spinae plane block versus transversus abdominis plane block in laparotomies for cancer surgeries: A randomized blinded control study. BALI JOURNAL OF ANESTHESIOLOGY 2023. [DOI: 10.4103/bjoa.bjoa_229_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Araújo KMD, Ferraro LHC, Sun SY, Mattar R. Randomized Clinical Trial Comparing Quadratus Lumborum Block and Intrathecal Morphine for Postcesarean Analgesia. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1083-1089. [PMID: 36580935 PMCID: PMC9800151 DOI: 10.1055/s-0042-1759728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the efficacy of quadratus lumborum (QL) block and intrathecal morphine (M) for postcesarean delivery analgesia. METHODS Thirty-one pregnant women with ≥ 37 weeks of gestation submitted to elective cesarean section were included in the study. They were randomly allocated to either the QL group (12.5 mg 0.5% bupivacaine for spinal anesthesia and 0.3 ml/kg 0.2% bupivacaine for QL block) or the M group (12.5 mg bupivacaine 0.5% and 100 mcg of morphine in spinal anesthesia). The visual analog scale of pain, consumption of morphine and tramadol for pain relief in 48 hours, and side effects were recorded. RESULTS Median pain score and/or pain variation were higher in the morphine group than in the QL group (p = 0.02). There was no significant difference in the consumption of morphine or tramadol between groups over time. Side effects such as pruritus, nausea, and vomiting were observed only in the morphine group. CONCLUSION Quadratus lumborum block and intrathecal morphine are effective for analgesia after cesarean section. Patients undergoing QL block had lower postoperative pain scores without the undesirable side effects of opioids such as nausea, vomiting, and pruritus.
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Affiliation(s)
- Karoline Moura de Araújo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil,Address for correspondence Karoline Moura de Araújo Escola Paulista de Medicina, Universidade Federal de São PauloRua Napoleão de Barros, 715, 04024002, São Paulo, SPBrazil
| | | | - Sue Yasaki Sun
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rosiane Mattar
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Alsharari AF, Abuadas FH, Alnassrallah YS, Salihu D. Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review. J Clin Med 2022; 11:6896. [PMID: 36498471 PMCID: PMC9735918 DOI: 10.3390/jcm11236896] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Laparoscopic cholecystectomy (LC), unlike laparotomy, is an invasive surgical procedure, and some patients report mild to moderate pain after surgery. Transversus abdominis plane (TAP) block has been shown to be an appropriate method for postoperative analgesia in patients undergoing abdominal surgery. However, there have been few studies on the efficacy of TAP block after LC surgery, with unclear information on the optimal dose, long-term effects, and clinical significance, and the analgesic efficacy of various procedures, hence the need for this review. Five electronic databases (PubMed, Academic Search Premier, Web of Science, CINAHL, and Cochrane Library) were searched for eligible studies published from inception to the present. Post-mean and standard deviation values for pain assessed were extracted, and mean changes per group were calculated. Clinical significance was determined using the distribution-based approach. Four different local anesthetics (Bupivacaine, Ropivacaine, Lidocaine, and Levobupivacaine) were used at varying concentrations from 0.2% to 0.375%. Ten different drug solutions (i.e., esmolol, Dexamethasone, Magnesium Sulfate, Ketorolac, Oxycodone, Epinephrine, Sufentanil, Tropisetron, normal saline, and Dexmedetomidine) were used as adjuvants. The optimal dose of local anesthetics for LC could be 20 mL with 0.4 mL/kg for port infiltration. Various TAP procedures such as ultrasound-guided transversus abdominis plane (US-TAP) block and other strategies have been shown to be used for pain management in LC; however, TAP blockade procedures were reported to be the most effective method for analgesia compared with general anesthesia and port infiltration. Instead of 0.25% Bupivacaine, 1% Pethidine could be used for the TAP block procedures. Multimodal analgesia could be another strategy for pain management. Analgesia with TAP blockade decreases opioid consumption significantly and provides effective analgesia. Further studies should identify the long-term effects of different TAP block procedures.
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Affiliation(s)
| | | | | | - Dauda Salihu
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia
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8
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Attri J, Makhni R, Kaur H, Markam K. Comparison of ultrasound-guided transversus abdominis plane (TAP) block and quadratus lumborum (QL) block in inguinal hernia surgery. Indian J Anaesth 2022; 66:S122-S125. [PMID: 35601038 PMCID: PMC9116637 DOI: 10.4103/ija.ija_97_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
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9
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Zublena F, Briganti A, De Gennaro C, Corletto F. Ultrasound-guided parasternal injection in dogs: a cadaver study. Vet Anaesth Analg 2021; 48:563-569. [PMID: 34059462 DOI: 10.1016/j.vaa.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/09/2020] [Accepted: 12/30/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe the technique of performing an ultrasound-guided distal parasternal intercostal block and to determine the distribution of two volumes of methylene blue dye solution injected in canine cadavers. STUDY DESIGN Prospective cadaver study. ANIMALS A group of seven canine cadavers weighing 12-34 kg. METHODS The space between the transversus thoracic and the internal intercostal muscles is a virtual cavity. Ultrasound-guided injections in the distal (parasternal) intercostal space were performed using dye solution at 0.05 mL kg-1 in each intercostal space from the second to seventh (LV, low volume, six injections per dog) in one hemithorax, and 0.1 mL kg-1 in the third, fifth and seventh intercostal spaces (HV, high volume, three injections in each dog) on the contralateral side. Anatomical dissection was carried out to describe dye spread characteristics and staining of intercostal nerves. RESULTS The ultrasonographic landmarks for injection were identified in each cadaver. In the LV group the solution was found in every intercostal space (36/36), whereas the HV injection stained six intercostal spaces in two dogs, five in two, and in two dogs the solution was found in four and three spaces, respectively, demonstrating multisegmental distribution. Intrapleural staining was observed after two injections. CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided injection of 0.05 mL kg-1 at the distal intercostal space resulted in staining of the intercostal nerve in all dogs when performed in every space and may be an appropriate alternative to previously reported techniques. A single injection of 0.1 mL kg-1 may anaesthetize more than one intercostal nerve, but not consistently. Clinical investigations are warranted to better characterize and to refine this locoregional technique.
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Affiliation(s)
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Italy
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10
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Course of the thoracic nerves around the umbilicus within the posterior layer of the rectus sheath: a cadaver study. J Anesth 2020; 34:953-957. [PMID: 33064199 DOI: 10.1007/s00540-020-02863-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
Rectus sheath block is used to anesthetize thoracic nerves around the umbilicus. However, the appropriate point for anesthetic injection during rectus sheath block has not been determined anatomically. Here, we examined the course of thoracic nerve T10 at the posterior layer of the rectus sheath and the anatomical relationship between the nerve and the rectus abdominis and transversus abdominis muscles in formalin-fixed adult cadavers. The cranio-caudal distance from a horizontal line running through the umbilicus to where the thoracic nerve T10 passes through the posterior layer of the rectus sheath was 33.8 ± 14.4 (mean ± standard deviation) mm, while that from the horizontal line running through the umbilicus to the position where the lateral edge of the rectus abdominis muscle and the medial border of the transversus abdominis muscle cross was 33.1 ± 17.1 mm. The position where the lateral edge of the rectus abdominis muscle and the medial border of the transversus abdominis muscle cross approximates the position where thoracic nerves T10 passes through the posterior layer of the rectus sheath. Our results identify effective landmarks to guide the performance of rectus sheath block.
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Lu X, Yu P, Ou C, Wang J, Zhou Z, Lai R. The Postoperative Analgesic Effect of Ultrasound-Guided Bilateral Transversus Abdominis Plane Combined with Rectus Sheath Blocks in Laparoscopic Hepatectomy: A Randomized Controlled Study. Ther Clin Risk Manag 2020; 16:881-888. [PMID: 32982260 PMCID: PMC7509310 DOI: 10.2147/tcrm.s267735] [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: 06/15/2020] [Accepted: 08/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Our aim was to investigate the postoperative analgesic effect of ultrasound (US)-guided bilateral transversus abdominis plane (TAP) blocks combined with rectus sheath blocks (RSBs) in laparoscopic hepatectomy. Patients and Methods A total of 126 patients were allocated into two groups for analysis. Group 1 (n = 63) did not receive any local anesthetics. Group 2 (n = 63) received US-guided bilateral TAP blocks and RSBs using 20 mL 0.25% ropivacaine in each block. Postoperative pain scores, the dose of intraoperative remifentanil, 24 h consumption of oxycodone, adverse events such as postoperative dizziness, nausea and vomiting, and the length of postoperative hospital stay were recorded. Results In the postanesthesia care unit, patients in group 2 had significantly lower pain visual analog scale (VAS) scores at rest than those in group 1 (P < 0.001). The VAS scores both at rest and during movement were significantly lower in group 2 than in group 1 at 2, 4 and 6 h postoperatively (all P < 0.001). There was no difference in VAS scores between the two groups at rest 24 h postoperatively (P = 0.477). However, the VAS score during movement at 24 h in group 2 was significantly lower than that in group 1 (P < 0.001). No significant differences in the incidence of adverse events or the dose of intraoperative remifentanil were observed between the two groups (all P > 0.05). Patients in group 2 had a significantly lower 24 h consumption of oxycodone than patients in group 1 (P < 0.001). The mean length of postoperative hospital stay of group 2 was shorter than that of group 1 (P = 0.032). Conclusion US-guided bilateral TAP blocks combined with RSBs provide effective postoperative analgesia for laparoscopic hepatectomy, and they could shorten the postoperative hospital stay without increasing the incidence of adverse events from opioids.
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Affiliation(s)
- Xiaoyun Lu
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Ping Yu
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Chaopeng Ou
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Junchao Wang
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Zhongguo Zhou
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Renchun Lai
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
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Wardhan R, Kantamneni S. The Challenges of Ultrasound-guided Thoracic Paravertebral Blocks in Rib Fracture Patients. Cureus 2020; 12:e7626. [PMID: 32292684 PMCID: PMC7153808 DOI: 10.7759/cureus.7626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Thoracic paravertebral blocks (TPVBs) provide an effective pain relief modality in conditions where thoracic epidurals are contraindicated. Historically, TPVBs were placed relying solely on the landmark-based technique, but the availability of ultrasound imaging makes it a valuable and practical tool during the placement of these blocks. TPVBs also provide numerous advantages over thoracic epidurals, namely, minimal hypotension, absence of urinary retention, lack of motor weakness, and remote risk of an epidural hematoma. Utilization of both landmark-based and ultrasound-guided techniques may increase the successful placement of a TPVB. This article reviews relevant sonoanatomy as it pertains to TPVBs. However, certain patient-related issues, including pneumothoraces, surgical emphysema, body habitus, and transverse process fractures, all may make imaging with ultrasound challenging. The changes noted on ultrasound imaging as a result of these issues will be further described in this review.
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Affiliation(s)
- Richa Wardhan
- Anesthesiology, University of Florida, Gainesville, USA
| | - Sowmya Kantamneni
- Anesthesiology, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, USA
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Malawat A, Verma K, Jethava D, Jethava DD. Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study. J Anaesthesiol Clin Pharmacol 2020; 36:201-206. [PMID: 33013035 PMCID: PMC7480289 DOI: 10.4103/joacp.joacp_116_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/03/2019] [Accepted: 03/06/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Erector spinae plane (ESP) block is an interfascial plane block given at the paraspinal region and provides effective visceral and somatic analgesia. Transversus abdominis plane (TAP) block is also an interfascial block that provides adequate somatic pain control. We conducted this study to compare the analgesic efficacy of ESP and TAP blocks with ropivacaine for 48 h after the cesarean section. MATERIAL AND METHODS Sixty patients scheduled for elective cesarean section under spinal anesthesia, randomly divided into ESP block (n = 30) or TAP block (n = 30) groups. After completion of surgery, ultrasound-guided ESP or TAP block was given using 0.2% ropivacaine (0.2 ml/kg on either side). Postoperatively visual analogue scale (VAS) score and analgesic requirement of each patient was assessed at regular interval for 48 h by a blinded investigator. Statistical analysis was done using SPSS version 21. Student's t-test and Chi-square test were used for demographic and other data. RESULTS ESP block provided prolonged analgesia compared to the TAP block, andthe mean time to first rescue analgesia was 43.53 h and 12.07 h, respectively (P < 0.001). The requirement for total analgesic was also significantly less in the ESP group compared to the TAP group (P < 0.001). CONCLUSION ESP block provided prolonged analgesia with a significant decrease in analgesic requirement compared to TAP block and can be used as a standard technique for post-cesarean analgesia.
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Affiliation(s)
- Aman Malawat
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Kalpana Verma
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Durga Jethava
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Dharam Das Jethava
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
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Duggan EW, Vadlamudi R, Spektor B, Sharifpour M. Abdominal Surgery With Bilateral Rectus Sheath Block: A Case Report. A A Pract 2020; 13:278-280. [PMID: 31361662 DOI: 10.1213/xaa.0000000000001055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 44-year-old man, American Society of Anesthesiologists physical status class IV, presented for fulguration of anal condyloma and diverting colostomy. The patient's medical history includes World Health Organization (WHO) class I pulmonary hypertension (PH), right heart failure, and bilateral lower extremity paralysis due to Pott's disease. The patient was not a candidate for neuraxial anesthesia due to sacral decubitus ulcers, and alternative options to general anesthesia (GA) were considered to avoid the high risk of right ventricular (RV) failure and ensuing complications. The case was successfully performed under sedation with dexmedetomidine infusion and bilateral rectus sheath blocks for surgical anesthesia.
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Affiliation(s)
- Elizabeth W Duggan
- From the Department of Anesthesiology, Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia
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Sharma R, Agha M, Vyas R, Bhatia P, Sharma A. Prolonged analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in pediatric patients. INDIAN JOURNAL OF PAIN 2020. [DOI: 10.4103/ijpn.ijpn_8_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Klingensmith JD, Haggard AL, Ralston JT, Qiang B, Fedewa RJ, Elsharkawy H, Geoffrey Vince D. Tissue classification in intercostal and paravertebral ultrasound using spectral analysis of radiofrequency backscatter. J Med Imaging (Bellingham) 2019; 6:047001. [PMID: 31720315 DOI: 10.1117/1.jmi.6.4.047001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 10/14/2019] [Indexed: 12/23/2022] Open
Abstract
Paravertebral and intercostal nerve blocks have experienced a resurgence in popularity. Ultrasound has become the gold standard for visualization of the needle during injection of the analgesic, but the intercostal artery and vein can be difficult to visualize. We investigated the use of spectral analysis of raw radiofrequency (RF) ultrasound signals for identification of the intercostal vessels and six other tissue types in the intercostal and paravertebral spaces. Features derived from the one-dimensional spectrum, two-dimensional spectrum, and cepstrum were used to train four different machine learning algorithms. In addition, the use of the average normalized spectrum as the feature set was compared with the derived feature set. Compared to a support vector machine (SVM) (74.2%), an artificial neural network (ANN) (68.2%), and multinomial analysis (64.1%), a random forest (84.9%) resulted in the most accurate classification. The accuracy using a random forest trained with the first 15 principal components of the average normalized spectrum was 87.0%. These results demonstrate that using a machine learning algorithm with spectral analysis of raw RF ultrasound signals has the potential to provide tissue characterization in intercostal and paravertebral ultrasound.
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Affiliation(s)
- Jon D Klingensmith
- Southern Illinois University Edwardsville, Department of Electrical and Computer Engineering, Edwardsville, Illinois, United States
| | - Asher L Haggard
- Southern Illinois University Edwardsville, Department of Electrical and Computer Engineering, Edwardsville, Illinois, United States
| | - Jack T Ralston
- Southern Illinois University Edwardsville, Department of Electrical and Computer Engineering, Edwardsville, Illinois, United States
| | - Beidi Qiang
- Southern Illinois University Edwardsville, Department of Mathematics and Statistics, Edwardsville, Illinois, United States
| | - Russell J Fedewa
- Cleveland Clinic Foundation, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Hesham Elsharkawy
- Cleveland Clinic Foundation, Department of General Anesthesia and Pain Management, Outcomes Research, and Anesthesiology Institute, Cleveland, Ohio, United States
| | - David Geoffrey Vince
- Cleveland Clinic Foundation, Department of Biomedical Engineering, Cleveland, Ohio, United States
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Hagen JG, Barnett N, Kars MS, Padover A, Bunnell AM. Rectus sheath blocks in the extremes of body habitus. J Clin Anesth 2019; 57:55-56. [DOI: 10.1016/j.jclinane.2019.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/04/2019] [Accepted: 02/26/2019] [Indexed: 11/26/2022]
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Verma K, Malawat A, Jethava D, Jethava DD. Comparison of transversus abdominis plane block and quadratus lumborum block for post-caesarean section analgesia: A randomised clinical trial. Indian J Anaesth 2019; 63:820-826. [PMID: 31649394 PMCID: PMC6798627 DOI: 10.4103/ija.ija_61_19] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/03/2019] [Accepted: 08/11/2019] [Indexed: 02/04/2023] Open
Abstract
Background and Aims: Effective post-operative analgesia after caesarean section (CS) is important because it facilitates early amelioration, ambulation and expedites breastfeeding. Quadratus lumborum (QL) block is an interfascial block providing effective visceral and somatic analgesia. We conducted this study to compare the analgesic efficacy of QL block and transversus abdominis plane (TAP) block after CS. Methods: In this single hospital-based, prospective double-blind study, 60 patients scheduled for an elective CS between December 2018 and January 2019 were randomised to receive ultrasound-guided TAP block (n = 30) or QL block (n = 30) bilaterally with 0.2% ropivacaine postoperatively. The primary objective was to measure the time for rescue analgesic requirement and secondary objectives included the total number of analgesic dose required over a period of 72 hours and severity of post-operative pain assessment via visual analogue scale (VAS) score at rest and with movement. Statistical analysis was done using SPSS version 21. Data were compared using the Chi-square test and students' t-test. Results: Time for rescue analgesic requirement was higher in the QL group than the TAP group (mean ± SD: 68.77 ± 1.74 h vs. 13.3 ± 1.21 h) (P < 0.001). The QL group had significantly less analgesic demand (P < 0.001) at 2, 4, 6, 12, 24, 36, 48 and 72 h post-CS. The VAS at rest and movement was significantly reduced in the QL group at all times. Conclusion: The QL block provided prolonged and effective analgesia in comparison to TAP block up to 72 hours post-CS.
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Affiliation(s)
- Kalpana Verma
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Aman Malawat
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Durga Jethava
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Dharam Das Jethava
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
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Tammam TF. Transversus abdominis plane block: The analgesic efficacy of a new block catheter insertion method. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tarek F. Tammam
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt
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20
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Efficacy of combined ultrasound guided anterior and posterior rectus sheath block for postoperative analgesia following umbilical hernia repair: Randomized, controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Hausken J, Rydenfelt K, Horneland R, Ullensvang K, Kjøsen G, Tønnessen T, Haugaa H. First Experience With Rectus Sheath Block for Postoperative Analgesia After Pancreas Transplant: A Retrospective Observational Study. Transplant Proc 2019; 51:479-484. [DOI: 10.1016/j.transproceed.2019.01.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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22
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Klingensmith JD, Haggard A, Fedewa RJ, Qiang B, Cummings K, DeGrande S, Vince DG, Elsharkawy H. Spectral Analysis of Ultrasound Radiofrequency Backscatter for the Detection of Intercostal Blood Vessels. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1411-1422. [PMID: 29681422 DOI: 10.1016/j.ultrasmedbio.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/23/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Spectral analysis of ultrasound radiofrequency backscatter has the potential to identify intercostal blood vessels during ultrasound-guided placement of paravertebral nerve blocks and intercostal nerve blocks. Autoregressive models were used for spectral estimation, and bandwidth, autoregressive order and region-of-interest size were evaluated. Eight spectral parameters were calculated and used to create random forests. An autoregressive order of 10, bandwidth of 6 dB and region-of-interest size of 1.0 mm resulted in the minimum out-of-bag error. An additional random forest, using these chosen values, was created from 70% of the data and evaluated independently from the remaining 30% of data. The random forest achieved a predictive accuracy of 92% and Youden's index of 0.85. These results suggest that spectral analysis of ultrasound radiofrequency backscatter has the potential to identify intercostal blood vessels. (jokling@siue.edu) © 2018 World Federation for Ultrasound in Medicine and Biology.
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Affiliation(s)
- Jon D Klingensmith
- Department of Electrical and Computer Engineering, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA.
| | - Asher Haggard
- Department of Electrical and Computer Engineering, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
| | - Russell J Fedewa
- Department of Biomedical Engineering, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Beidi Qiang
- Department of Mathematics and Statistics, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
| | - Kenneth Cummings
- Anesthesiology Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sean DeGrande
- Anesthesiology Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - D Geoffrey Vince
- Department of Biomedical Engineering, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hesham Elsharkawy
- Anesthesiology Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Ammar A, Mahmoud K, Kasemy Z. Effect of adding midazolam to bupivacaine during rectus sheath block: a randomised controlled trial. Acta Anaesthesiol Scand 2018; 62:857-862. [PMID: 29446060 DOI: 10.1111/aas.13090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/08/2018] [Accepted: 01/24/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Various adjuvants have been tried to improve quality and increase duration of local anaesthetics during various nerve blocks. We aimed to evaluate the effect of adding midazolam to bupivacaine on rectus sheath (RS) block in patients undergoing umbilical or epigastric hernia repair. METHODS In all, 60 adult patients were divided into two equal groups, each group included 30 patients. Group I received 20 ml of bupivacaine hydrochloride 0.25% + midazolam 50 μg/kg in 2 ml saline 0.9% (Midazolam group, n = 30), whereas Group II received 20 ml of bupivacaine hydrochloride 0.25% + 2 ml saline (Control group, n = 30) for RS block on each side. The primary outcome was post-operative 48 h morphine consumption, whereas secondary outcomes included analgesia duration, post-operative pain, as evaluated by visual analogue scale (VAS) for pain scoring at 1, 2, 6, 12, 24 and 48 h post-operatively, reported post-operative nausea and or vomiting (PONV), somnolence or any adverse drug reactions. RESULTS The current study showed that addition of midazolam to bupivacaine for RS blockade provided good analgesia as evidenced by a statistically significant less morphine consumption in the post-operative 48 h [11.2 (5.3-18.3) vs. 25.9 (15.2-31.0) mg, P = 0.002], longer duration of analgesia, lower VAS during post-operative 48 h, lower incidence of PONV, somnolence and pruritus. CONCLUSION Midazolam addition to bupivacaine for RS blockade provided adjuvant analgesia as supported by less morphine consumption, longer duration of analgesia, and lower VAS score.
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Affiliation(s)
- A. Ammar
- Department of Anaesthesiology; Minoufiya Faculty of Medicine; Minoufiya University; Shebin Elkoam Egypt
| | - K. Mahmoud
- Department of Anaesthesiology; Minoufiya Faculty of Medicine; Minoufiya University; Shebin Elkoam Egypt
| | - Z. Kasemy
- Department of Public Health, Statistics and Community Medicine; Minoufiya Faculty of Medicine; Minoufiya University; Shebin Elkoam Egypt
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Jin F, Li Z, Tan WF, Ma H, Li XQ, Lu HW. Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels in patients with open midline incisions undergoing transabdominal gynecological surgery: a randomized-controlled trial. BMC Anesthesiol 2018; 18:19. [PMID: 29426287 PMCID: PMC5807824 DOI: 10.1186/s12871-018-0485-9] [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] [Received: 08/24/2017] [Accepted: 01/31/2018] [Indexed: 01/30/2023] Open
Abstract
Background Nerve block is usually performed before surgery because it inhibits reflection of the skin incision and reduces the amount of intraoperative anesthetic used. We hypothesized that performing rectus sheath block (RSB) after surgery would result in a longer duration of the analgesic effects and have a subtle influence on sleep time after surgery but that it would not decrease the perioperative cytokine levels of patients undergoing gynecological surgery. Methods A randomized, double-blinded, controlled trial was conducted from October 2015 to June 2016. Seventy-seven patients undergoing elective transabdominal gynecological surgery were randomly assigned to the following two groups: a general anesthesia group who received 0.5% ropivacaine hydrochloride RSB preoperatively and saline RSB postoperatively, and another group who received the opposite sequence. The objective of the trial was to evaluate the postoperative pain, sleep and changes in cytokine levels of patients during the postoperative 48 h. Results A total of 61 female patients (mean age: 50 years; range: 24–65 years) were included in the final study sample. There was no significant difference in the pain, consumption of oxycodone, or time to first administration of patient-controlled intravenous analgesia between the two groups. The postoperative sleep stages N2 and N3 were increased by 52.9 and 29.1 min per patient, respectively, in the preoperative RSB group compared with those in the postoperative group. The preoperative IL-6 concentration in the preoperative RSB group was lower than that in the same group at the end of surgery and 24 h postoperatively. Conclusions We concluded that preoperative RSB might preserve postoperative sleep by inhibiting the increase of IL-6 without shortening the analgesia time compared with postoperative RSB in female patients undergoing elective midline incision transabdominal gynecological surgery. Trial registration ClinicalTrials.gov, NCT02477098, registered on 15 June 2015.
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Affiliation(s)
- Feng Jin
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Zhe Li
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Wen-Fei Tan
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China.
| | - Hong Ma
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Xiao-Qian Li
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Huang-Wei Lu
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
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Ramkiran S, Jacob M, Honwad M, Vivekanand D, Krishnakumar M, Patrikar S. Ultrasound-guided Combined Fascial Plane Blocks as an Intervention for Pain Management after Laparoscopic Cholecystectomy: A Randomized Control Study. Anesth Essays Res 2018; 12:16-23. [PMID: 29628547 PMCID: PMC5872856 DOI: 10.4103/aer.aer_157_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Pain associated with laparoscopic cholecystectomy is most severe during the first 24 h and the port sites are the most painful. Recent multimodal approaches target incisional pain instead of visceral pain which has led to the emergence of abdominal fascial plane blocks. This study embraces a novel combination of two independently effective fascial plane blocks, namely rectus sheath block and subcostal transversus abdominis plane (TAP) block to alleviate postoperative pain. Study Objective The aim is to evaluate the effectiveness of the combination of rectus sheath block and subcostal TAP block, to compare its efficacy with that of subcostal TAP block alone and with conventional port site infiltration (PSI) in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy. Methodology This prospective, randomized control, pilot study included 61 patients scheduled for elective laparoscopic cholecystectomy and distributed among three groups, namely Group 1: Combined subcostal TAP block with rectus sheath block (n = 20); Group 2: Oblique subcostal TAP block alone (n = 21); and Group 3: PSI group as an active control (n = 20). Results Combined group had significantly lower pain scores, higher satisfaction scores, and reduced rescue analgesia both in early and late postoperative periods than the conventional PSI group. Conclusion Ultrasound-guided combined fascial plane blocks is a novel intervention in pain management of patients undergoing laparoscopic cholecystectomy and should become the standard of care.
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Affiliation(s)
- Seshadri Ramkiran
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Mathews Jacob
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Manish Honwad
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Desiraju Vivekanand
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Seema Patrikar
- Lecturer in Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
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Tammam TF, Kamhawy GA. Ultrasound-guided regional blockade for lipoma excision: a new approach to an old technique. Acta Anaesthesiol Scand 2017; 61:1325-1333. [PMID: 28832894 DOI: 10.1111/aas.12964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/28/2017] [Accepted: 07/29/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Local anesthesia for lipoma excision can be feasible with anesthetic injection in the fascial plane between the lipoma and the surrounding soft tissues under real-time ultrasonography [ultrasound- guided lipoma plane (ULP) block]. The advantage of targeting a single anesthetic injection plane under ultrasound guidance may allow for technically easier block placement and long-term analgesic effects. METHODS Forty-eight patients were randomly assigned to receive ULP block, group A (n = 24) or traditional block, group B (n = 24). Primary outcome measure was the number of needle passes required to perform the blockade. The level of procedure pain and the time to first request of analgesia were assessed. RESULTS Median (interquartile range) needle passes required to complete the blockade was significantly less in the group A 1(1, 1) in comparison with the group B 3 (2.5, 3); P = 0.0001. Group A required fewer needle redirections 1.5 (1, 2) than group B 2 (2, 2.5); P = 0.001. Group A showed significantly less procedure-related pain 2 (2, 3) when compared with group B 4 (3, 4); P = 0.0001. The time to first rescue analgesic was significantly longer in group A (21.3 ± 4.7 h) in comparison with group B (4.4 ± 1.2 h); P = 0.001. CONCLUSION Ultrasound-guided lipoma plane blockade reduces the number of needle passes required to complete the block and provides less procedure pain and longer pain relief compared with the traditional block in patients undergoing lipoma excision.
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Affiliation(s)
- T. F. Tammam
- Department of Anesthesia and Intensive Care; Faculty of Medicine; Suez Canal University Hospital; Ismailia Egypt
| | - G. A. Kamhawy
- Department of Anesthesia and Intensive Care; Faculty of Medicine; Suez Canal University Hospital; Ismailia Egypt
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27
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Transversus Abdominis Plane Block and Free Flap Abdominal Tissue Breast Reconstruction: Is There a True Reduction in Postoperative Narcotic Use? Ann Plast Surg 2017; 78:254-259. [PMID: 28118232 DOI: 10.1097/sap.0000000000000873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The use of the transversus abdominis plane (TAP) block is increasing in abdominally based autologous tissue breast reconstruction as a method to provide postoperative donor site analgesia. The purpose of this study was to evaluate the efficacy of the TAP block in the immediate postoperative period. METHODS A retrospective analysis of all patients who underwent autologous microsurgical breast reconstruction over a 2-year period (2013-2015) was conducted. Only patients with an abdominal donor site were included. Patients were grouped based on the presence or absence of TAP blocks. Primary endpoints included patient-reported pain score, daily and total narcotic use during the hospitalization, antiemetic use, as well as complications. RESULTS We identified 40 patients that had undergone abdominal-based free flap breast reconstruction and TAP block catheter placement for postoperative analgesia that met inclusion criteria. This group was then compared with a matched cohort of 40 patients without TAP blocks. There were no complications associated with using the TAP catheters. There was no statistically significant difference in postoperative pain scores, daily or total narcotic use during the hospitalization, or antiemetic use between the 2 groups. Although not statistically significant, linear regression analysis identified trends of improved donor site analgesia in select groups, such as unilateral immediate reconstructions, body mass index greater than 30 kg/m, and those without abdominal mesh placed at the time of donor site closure in the TAP block group. CONCLUSIONS Constant delivery of local anesthetic through the TAP block appears to be safe; however, it did not reduce narcotic requirements or postoperative pain scores in patients undergoing abdominal-based free flap breast reconstruction.
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Litz CN, Farach SM, Fernandez AM, Elliott R, Dolan J, Patel N, Zamora L, Colombani PM, Walford NE, Amankwah EK, Snyder CW, Danielson PD, Chandler NM. Percutaneous ultrasound-guided vs. intraoperative rectus sheath block for pediatric umbilical hernia repair: A randomized clinical trial. J Pediatr Surg 2017; 52:901-906. [PMID: 28377023 DOI: 10.1016/j.jpedsurg.2017.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/09/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Regional anesthesia is commonly used in children. Our hypothesis was that percutaneous ultrasound-guided (PERC) rectus sheath blocks would result in lower postoperative pain scores compared to intraoperative (IO) rectus sheath blocks following umbilical hernia repair. METHODS A single-institution randomized blinded trial was conducted in pediatric patients undergoing elective umbilical hernia repair. The primary outcome was mean postoperative Wong-Baker pain score. Secondary outcomes included narcotic requirements and length of postoperative stay. RESULTS Fifty-eight patients were included: 28 PERC and 30 IO. Operating room time was significantly longer in the PERC group (41 vs. 35min, p<0.01). Mean postoperative pain scores (PERC-2.6 vs. IO-3.3, p=0.11), morphine equivalents intraoperatively (PERC-0 vs. IO-0.04mg/kg, p=0.29) and postoperatively (PERC-0.04 vs. IO-0.09mg/kg, p=0.17), time to first postoperative narcotic dose (PERC-30 vs. IO-22min, p=0.33, log-rank test), and postoperative length of stay (PERC-76 vs. IO-80min, p=0.44) were similar. CONCLUSION Following umbilical hernia repair in children, percutaneous ultrasound-guided and intraoperative rectus sheath blocks resulted in similar mean postoperative pain scores. There were no differences in secondary outcomes such as time to first narcotic, narcotic requirements, and length of stay. The additional resources required to complete a percutaneous ultrasound-guided rectus sheath block may not be warranted. TYPE OF STUDY Randomized controlled trial. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Cristen N Litz
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Sandra M Farach
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Allison M Fernandez
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Richard Elliott
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Jenny Dolan
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Nikhil Patel
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Lillian Zamora
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Paul M Colombani
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Nebbie E Walford
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Ernest K Amankwah
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Christopher W Snyder
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
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Yassin HM, Abd Elmoneim AT, El Moutaz H. The Analgesic Efficiency of Ultrasound-Guided Rectus Sheath Analgesia Compared with Low Thoracic Epidural Analgesia After Elective Abdominal Surgery with a Midline Incision: A Prospective Randomized Controlled Trial. Anesth Pain Med 2017; 7:e14244. [PMID: 28856110 PMCID: PMC5561553 DOI: 10.5812/aapm.14244] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/19/2017] [Accepted: 03/12/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Ultrasound-guided rectus sheath blockade has been described to provide analgesia for midline abdominal incisions. We aimed to compare thoracic epidural analgesia (TEA) and rectus sheath analgesia (RSA) with respect to safety and efficacy. METHODS Sixty patients who underwent elective laparotomies through a midline incision were assigned randomly to receive either continuous TEA (TEA group, n = 31) or intermittent RSA (RSA group, n = 29). The number of patients who required analgesia, the time to first request analgesia, the interval and the cumulative morphine doses consumption during 72 hours postoperatively, and pain intensity using visual analog score (VAS) at rest and upon coughing were reported in addition to any side effects related to both techniques or administered drugs. RESULTS While 17 (54.84 %) patients were in the TEA group, 25 (86.21%) patients in the RSA group required analgesia postoperatively, P = 0.008. Cumulative morphine consumed during the early 72 hours postoperatively median (interquartile range) = 33 mg (27 - 39 mg), 95% confidence interval (28.63 - 37.37 mg) for the TEA group. While in the RSA group, it was 51 mg (45 - 57 mg), 95% CI (47.4 - 54.6 mg), P < 0.001. The time for the first request of morphine was 256.77 ± 73.45 minutes in the TEA group versus 208.82 ± 64.65 min in the RSA group, P = 0.031. VAS at rest and cough were comparable in both groups at all time points of assessment, P > 0.05. The time to the ambulation was significantly shorter in the RSA group (38.47 ± 12.34 hours) as compared to the TEA group (45.89 ± 8.72 hours), P = 0.009. Sedation scores were significantly higher in the RSA group, only at 12 hours and 24 hours postoperatively than in TEA group, with P = 0.041 and 0.013, respectively. The incidence of other morphine-related side effects, time to pass flatus, and patients satisfaction scores were comparable between both groups. CONCLUSIONS Continuous TEA had better opioid sparing effects markedly during the early 72 hours postoperatively than that of intermittent RSA with catheters inserted under real-time ultrasound guidance, both had comparable safety perspectives, and RSA had the advantage of early ambulation. RSA could be used as an effective alternative when TEA could not be employed in patients undergoing laparotomies with an extended midline incision, especially after the first postoperative day.
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Affiliation(s)
- Hany Mahmoud Yassin
- Department of Anesthesia, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | | | - Hatem El Moutaz
- Department of Anesthesia, Faculty of Medicine, Bani Sweif University, Egypt
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Epidural Versus Paravertebral Nerve Block for Postoperative Analgesia in Patients Undergoing Open Liver Resection: A Randomized Clinical Trial. Reg Anesth Pain Med 2017; 41:460-8. [PMID: 27281726 DOI: 10.1097/aap.0000000000000422] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Although many studies have found no difference between thoracic epidural block and unilateral thoracic paravertebral block after thoracotomy, no previous studies have compared epidural block with bilateral thoracic paravertebral block (bTPVB) in patients undergoing open liver resection. We aimed to investigate whether there was a significant analgesic advantage of thoracic epidural over bTPVB after liver resection. METHODS This randomized, prospective, open-label study included adult patients undergoing elective open liver resection. Patients were randomized to receive either thoracic epidural block or bTPVB, through which ropivacaine (0.2%) was infused for 3 days. The primary outcome was pain Verbal Rating Scale (VRS) score (0-10) at rest and with postoperative incentive spirometry. Secondary outcomes included VRS at rest, inspired volumes during incentive spirometry, patient-controlled analgesia hydromorphone utilization, measures of hemodynamic stability, and postoperative bowel function. RESULTS Eighty patients completed the study and received thoracic epidural block (n = 41) or bTPVBs (n = 39). No catheter-related complications were noted. The primary outcome, pain (VRS) with incentive spirometry, was significantly lower in the epidural group (epidural vs bTPVB, mean [SD]) (4.5 [2.7] vs 5.4 [2.7] at 24 hours postoperatively, and 3.2 [2.1] vs 4.6 [2.4] at 48 hours postoperatively). Maximal inspired volumes at 24 hours postoperatively (917 [379] vs 1042 [468] mL) and cumulative utilization of patient-controlled analgesia hydromorphone during the first 48 hours postoperatively (10.7 [7.9] vs 13.6 [8.5] mg) were not significantly different between groups. Decrease in mean arterial pressure from baseline at 24 hours postoperatively was greater for the epidural group (-12.6 [15.8] vs -3.8 [16.2]; P = 0.016). CONCLUSIONS This study suggests that there is a modest analgesic advantage of thoracic epidural over bTPVBs for patients after open liver resection.
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Tammam TF, Salama AF. Laparoscopic-guided psoas blockade as a novel analgesic method during inguinal herniorrhaphy: a clinical trial. Acta Anaesthesiol Scand 2017; 61:232-240. [PMID: 27900771 DOI: 10.1111/aas.12842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/22/2016] [Accepted: 11/01/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Under laparoscopic guidance, block of ilioinguinal, iliohypogastric, and genitofemoral nerves can be possible with anesthetic injection in the plane between psoas major and the fasciae covering its anterior aspects [laparoscopic-assisted psoas (LAP) blockade]. This observer-blinded trial aimed to compare the opioid-sparing effect of LAP block with transversus abdominis plane (TAP) block after laparoscopic inguinal herniorrhaphy. METHODS Forty-five male patients were randomly assigned to receive LAP block, group LAP (n = 23), or ultrasound-guided TAP block, group TAP (n = 22). Primary outcome measure was the analgesic requirements in the first 36 post-operative hours. Post-operative pain scores and sensory blockade were recorded. RESULTS Median (interquartile range) total morphine requirement was significantly less in patients who underwent LAP blockade 0 (0, 4) than in patients who underwent TAP blockade 21 (10, 27; P < 0.001). LAP group showed significantly less pain at rest and on coughing compared with TAP group. The median number of dermatomes blocked was 3 (2-4) in LAP group and 3 (3-4) in TAP group (P < 0.05). The highest sensory-level blockade was at T12 (T11-L1) in LAP group, while it was at T10 (T10-T11) in TAP group. The most distal dermatome involvement was at L2 (L2-L2) in LAP group and at L1 (T12-L1) in TAP group. CONCLUSION A single injection LAP blockade significantly reduces the post-operative analgesic requirements and provides longer pain relief compared with TAP block after laparoscopic inguinal herniorrhaphy.
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Affiliation(s)
- T. F. Tammam
- Department of Anesthesia and Intensive Care; Faculty of Medicine; Suez Canal University Hospital; Portsaid Egypt
| | - A. F. Salama
- Department of General and Digestive Surgery; TBRI (Theodor Bilharz Research Institute); Cairo Egypt
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Perineural dexamethasone does not enhance the analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2016; 15:540-545. [PMID: 27733325 DOI: 10.1016/s1499-3872(16)60086-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ultrasound-guided transversus abdominis plane (TAP) block is an adjunct therapy to provide effective postoperative analgesia in abdominal surgical procedures. Dexamethasone is a supplement agent that can improve the efficacy of local anesthesia. However, information about its additive effect is limited. This study aimed to compare the analgesic efficiency using ultrasound-guided TAP block with and without perineural dexamethasone for patients who underwent laparoscopic cholecystectomy. METHODS Sixty patients who underwent laparoscopic cholecystectomy were randomly divided into three groups: group I, controls; group II, TAP; and group III, TAP+perineural dexamethasone supplement. The requirement of additional analgesia and the first-time request of rescue-analgesia were recorded after operation and the numerical rating scale was evaluated at specific intervals. RESULTS Compared to group I, the first-time requirement of rescue-analgesia in groups II and III was significantly delayed (403.0+/-230.9, 436.0+/-225.3 vs 152.3+/-124.7, P<0.01). Compared with those in group I, patients in groups II and III were associated with lower numerical rating scale pain scores (P<0.01) and less postoperative analgesic consumption (P<0.01). There was no significant difference in the variables mentioned above between groups II and III (P>0.05). CONCLUSION Perineural dexamethasone has no additive/synergistic effect with subcostal TAP block on analgesic efficacy for the patients undergoing laparoscopic cholecystectomy.
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Ahmed A, Arora D, Kochhar AK. Ultrasound-guided alcohol neurolysis of lateral femoral cutaneous nerve for intractable meralgia paresthetica: a case series. Br J Pain 2016; 10:232-237. [PMID: 27867513 DOI: 10.1177/2049463716668811] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Meralgia paresthetica is a rare sensory entrapment neuropathy which leads to burning, tingling and numbness in the antero-lateral aspect of thigh. Mostly it runs a benign course, and responds to conservative measures. We present a case series of six patients with intractable meralgia paresthetica with severe pain over antero-lateral thigh along the distribution of lateral cutaneous nerve of thigh which was further confirmed by nerve conduction study. These patients did not respond to the oral anti-neuropathic medications. The two successive diagnostic lateral femoral cutaneous nerve block not only had confirmed the diagnosis but also provided pain relief for a few days. Then the ultrasound-guided lateral femoral cutaneous nerve neurolysis was done using 50% alcohol. In all the patients, there were more than 50% decrease in pain intensity and improvement in quality of life after the procedure, and the relief and improvement were maintained for up to 12 weeks. This case series shows ultrasound-guided lateral femoral cutaneous nerve neurolysis is a safe and effective treatment for intractable meralgia paresthetica and also provides prolonged pain relief and is a good option in avoiding the surgery. Summary points The literature on neurolysis is rare, with only few case reports. This is the first case series on this topic, and it will greatly improve the evidence that ultrasound-guided neurolysis can also be used for intractable meralgia paresthetica patients who do not respond to conservative measures before proceeding to surgery.
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Affiliation(s)
- Arif Ahmed
- Department of Anesthesiology and Pain Medicine, Asian Institute of Medical Sciences, Faridabad, India
| | - Divesh Arora
- Department of Anesthesiology and Pain Medicine, Asian Institute of Medical Sciences, Faridabad, India
| | - Amit Kumar Kochhar
- Department of Anesthesiology and Pain Medicine, Asian Institute of Medical Sciences, Faridabad, India
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Ahmed A, Bhatnagar S, Khurana D, Joshi S, Thulkar S. Ultrasound-Guided Radiofrequency Treatment of Intercostal Nerves for the Prevention of Incidental Pain Arising Due to Rib Metastasis. Am J Hosp Palliat Care 2016; 34:115-124. [PMID: 26656033 DOI: 10.1177/1049909115617933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Breakthrough pain (BTP) arising due to rib metastasis is very distressing and often very difficult to manage by titration of traditional analgesics. This study is undertaken to determine the efficacy of radiofrequency (RF) treatment of intercostal nerves for the prevention of BTP. METHODS The RF treatment of the intercostal nerves was carried out in 25 patients with uncontrolled BTP arising out of the rib metastasis. The intensity and episode of BTP, background pain, opioid dose, functional status (Karnofky score), and quality of life (Short-Form Health Survey [SF-36]) were noted at baseline visit and subsequently after the RF treatment. RESULTS After the RF treatment, there was more than 50% decrease in both intensity and frequency of BTP in more than 50% of patients for 3 months, and there was more than 50% decrease in BTP opioid dose in more than 50% of patients throughout the study period. There was also significant improvement in background pain, functional status, and the quality of life after the RF. Interestingly, pain relief, lowering of opioid dose, and functional status improvement were found mostly in patients with mixed and neuropathic type of pain and in patients in whom the metastasis were confined to the ribs only. CONCLUSION RF of the intercostal nerves is effective in preventing and deceasing the severity of BTP arising due to rib metastasis in selected group of patients with mixed and neuropathic type of pain and with the metastasis involving the ribs only.
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Affiliation(s)
- Arif Ahmed
- 1 Department of Anesthesia, Pain and palliative care, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- 1 Department of Anesthesia, Pain and palliative care, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Khurana
- 1 Department of Anesthesia, Pain and palliative care, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Joshi
- 1 Department of Anesthesia, Pain and palliative care, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- 2 Department of Radiology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Thomas KP, Sainudeen S, Jose S, Nadhari MY, Macaire PB. Ultrasound-Guided Parasternal Block Allows Optimal Pain Relief and Ventilation Improvement After a Sternal Fracture. Pain Ther 2016; 5:115-22. [PMID: 27001634 PMCID: PMC4912971 DOI: 10.1007/s40122-016-0050-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Indexed: 12/29/2022] Open
Abstract
Introduction Sternal fractures are a painful condition which can result in pulmonary morbidity if not treated promptly. The management of isolated fractures has changed from hospital to home-based treatment, provided other major injuries have been excluded. Pain management is the mainstay of treatment. In this case report, we describe how a parasternal block under ultrasound guidance for sternal fracture provided better analgesia thereby improving ventilation. Case report A 26-year-old man was admitted to the emergency department following a road traffic accident. His initial evaluation revealed a radio-cubital displaced fracture at the elbow level with severe tenderness over the sternum. Chest X-ray on admission did not reveal any abnormality. On preoperative checkup he was found to have altered chest mechanics with severe pain and tenderness over the sternum. Arterial blood gas (ABG) analysis showed respiratory acidosis. Pulmonary electrical impedance tomography showed hypoventilation of anterior portions of both lungs. An ultrasound examination of the sternum showed a fractured sternum with complete disjunction. An ultrasound-guided bilateral parasternal block was performed which resulted in efficient analgesia and thereby improved his ventilation as indicated by the improvement in ABG. Conclusion Timely and proper analgesia can reduce the pulmonary morbidity in sternal fractures. Of the various analgesic techniques, parasternal block under ultrasound guidance is a relatively simple, safe, and target-specific procedure that can provide efficient pain relief. Electronic supplementary material The online version of this article (doi:10.1007/s40122-016-0050-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kurian P Thomas
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | - Shaji Sainudeen
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | - Suraj Jose
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | - Mansour Y Nadhari
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | - Philippe B Macaire
- Department of Anesthesiology, Rashid Hospital-Trauma Centre, Dubai Health Authority, Dubai, United Arab Emirates.
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Abdelsalam K, Mohamdin OW. Ultrasound-guided rectus sheath and transversus abdominis plane blocks for perioperative analgesia in upper abdominal surgery: A randomized controlled study. Saudi J Anaesth 2016; 10:25-8. [PMID: 26955306 PMCID: PMC4760036 DOI: 10.4103/1658-354x.169470] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Regional anesthetic techniques can be used to alleviate postoperative pain in patients undergoing major upper abdominal surgery. Our aim was to evaluate the efficacy of bilateral ultrasound (US)-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks for better perioperative analgesia. Patients and Methods: It is a prospective, observer-blinded, randomized clinical study. 40 eligible patients undergoing elective liver resection or Whipple procedure were included. All patients received a standardized anesthetic technique. Group 1 (n = 20) received preincisional US-guided bilateral RS and TAP blocks using 20 ml volume of bupivacaine 0.25% for each, and group 2 (n = 20) received local wound infiltration at end of surgery with 40 ml of bupivacaine 0.25%. A standardized postoperative analgesic regimen composed of intravenous paracetamol and a morphine patient-controlled analgesia (PCA). The use of intraoperative fentanyl and recovery room morphine boluses, PCA-administered morphine, pain scores as well as number of patients’ experienced postoperative nausea and vomiting in the ward at 6 and 24 h were recorded. Results: Group 1 patients received a significantly lower cumulative intraoperative fentanyl, significantly lesser boluses of morphine in postanesthesia care unit, as well, significantly lower cumulative 24 h postoperative morphine dosage than the group 2 patients. Pain visual analog scale scores were significantly lower at both 6 and 24 h postoperatively in TAP group when compared with the no-TAP group. There were no complications related to the TAP block procedures. No signs or symptoms of local anesthetic systemic toxicity were detected. Conclusion: The combination of bilateral US-guided RS and TAP blocks provides excellent perioperative analgesia for major upper abdominal surgery.
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Affiliation(s)
- Khaled Abdelsalam
- Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Department of Anesthesia, Faculty of Medicine, King Fahd Specialist Hospital, Dammam, Saudi Arabia
| | - O W Mohamdin
- Department of Anesthesia, Faculty of Medicine, King Fahd Specialist Hospital, Dammam, Saudi Arabia
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The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia. Reg Anesth Pain Med 2016; 41:181-94. [DOI: 10.1097/aap.0000000000000331] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Jin F, Li XQ, Tan WF, Ma H, Lu HW. Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels of patients with open midline incisions undergoing transabdominal gynaecological operation: study protocol for a randomised controlled trial. Trials 2015; 16:568. [PMID: 26652009 PMCID: PMC4676186 DOI: 10.1186/s13063-015-1096-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/01/2015] [Indexed: 12/15/2022] Open
Abstract
Background Rectus sheath block (RSB) is used for postoperative pain relief in patients undergoing abdominal surgery with midline incision. Preoperative RSB has been shown to be effective, but it has not been compared with postoperative RSB. The aim of the present study is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively versus postoperatively. Methods/Design This study is a prospective, randomised, controlled (randomised, parallel group, concealed allocation), single-blinded trial. All patients undergoing transabdominal gynaecological surgery will be randomised 1:1 to the treatment intervention with general anaesthesia as an adjunct to preoperative or postoperative RSB. The objective of the trial is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively (n = 32) versus postoperatively (n = 32). All of the patients, irrespective of group allocation, will receive patient-controlled intravenous analgesia (PCIA) with oxycodone. The primary objective is to compare the interval between leaving the post-anaesthesia care unit and receiving the first PCIA bolus injection on the first postoperative night between patients who receive preoperative versus postoperative RSB. The secondary objectives will be to compare (1) cumulative oxycodone consumption at 24 hours after surgery; (2) postoperative sleep quality, as measured using a BIS-Vista monitor during the first night after surgery; and (3) cytokine levels (interleukin-1, interleukin-6, tumour necrosis factor-α and interferon-γ) during surgery and at 24 and 48 hours postoperatively. Discussion Clinical experience has suggested that RSB is a very effective postoperative analgesic technique, and we will answer the following questions with this trial. Do preoperative block and postoperative block have the same duration of analgesic effects? Can postoperative block extend the analgesic time? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays. Trial registration Current Controlled Trials NCT02477098 15 June 2015.
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Affiliation(s)
- Feng Jin
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Xiao-Qian Li
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Wen-Fei Tan
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Hong Ma
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Huang-Wei Lu
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
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Manassero A, Bossolasco M, Meineri M, Ugues S, Liarou C, Bertolaccini L. Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair. J Anaesthesiol Clin Pharmacol 2015; 31:349-53. [PMID: 26330714 PMCID: PMC4541182 DOI: 10.4103/0970-9185.161671] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS We conducted a prospective study to examine the local anesthetic (LA) spread and the effectiveness for surgical anesthesia of ultrasound (US)-guided rectus sheath block (RSB) in adult patients undergoing umbilical hernia repair. MATERIAL AND METHODS Thirty patients received at T-10 level a bilateral US-guided injection of 20 mL levobupivacaine 0.375% + epinephrine 5 μg/mL behind the rectus muscle to detach it from its sheath. Anesthetic spread into the rectus sheath was evaluated ultrasonographically at T-9 and T-11 levels and scored from 0 to 4. The RSB was defined effective for surgical anesthesia if it was able to guarantee an anesthetic level sufficient for surgery without any mepivacaine supplementation. RESULTS Overall, the block was effective for surgical anesthesia in 53.3% of patients (95% confidence interval, ±17.8). In the remaining patients, anesthesia supplementation was needed at cutaneous incision, whereas manipulation of the muscle and fascial planes was painless. No patients required general anesthesia. LA spreads as advocated (to T-9 and to T-11 bilaterally = spread score 4) in 8/30 patients (26.6%); in these cases, the block was 75% effective for surgery. The anesthetic spread was most negatively influenced by increased body mass index. Postoperative analgesia was excellent in 97% of patients. CONCLUSION Use of RSB as an anesthetic management of umbilical herniorrhaphy is recommended only with anesthetic supplementation at the incision site.
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Affiliation(s)
- Alberto Manassero
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Matteo Bossolasco
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Maurizio Meineri
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Susanna Ugues
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Chrysoula Liarou
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
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Ripollés J, Marmaña Mezquita S, Abad A, Calvo J. Eficácia analgésica do bloqueio ecoguiado do plano transverso do abdome – revisão sistemática. Braz J Anesthesiol 2015; 65:255-80. [DOI: 10.1016/j.bjan.2013.10.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/31/2013] [Indexed: 11/17/2022] Open
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Ripollés J, Mezquita SM, Abad A, Calvo J. Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane – a systematic review. Braz J Anesthesiol 2015; 65:255-80. [DOI: 10.1016/j.bjane.2013.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/19/2013] [Accepted: 10/31/2013] [Indexed: 12/11/2022] Open
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Kamei H, Ishibashi N, Nakayama G, Hamada N, Ogata Y, Akagi Y. Ultrasound-guided rectus sheath block for single-incision laparoscopic cholecystectomy. Asian J Endosc Surg 2015; 8:148-52. [PMID: 25720303 DOI: 10.1111/ases.12178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 09/14/2014] [Accepted: 09/24/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Single-incision laparoscopic cholecystectomy (SILC) is increasingly applied for cholecystectomy and has been reported as safe and feasible, with short-term operative outcomes equivalent to four-port cholecystectomy. Although many investigators in randomized studies have noted the cosmetic advantages of SILC, the benefit of decreased pain in SILC remains controversial. Therefore, this study aimed to assess the efficacy of the rectus sheath block in SILC with respect to subjective pain. METHODS From April 2010 to March 2012, 75 patients with symptomatic gallstone or gallbladder polyps were assigned to one of three groups: (i) four-port laparoscopic cholecystectomy (n = 29); (ii) SILC (n = 15); and (iii) rectus sheath block in SILC (n = 30). We evaluated the operative details, length of hospital stay, and the need and usage of analgesia. Postoperative pain was recorded at 2, 6, 12, and 24 h after surgery based on a visual analog scale. RESULTS There was no difference with regard to age, ASA score, BMI, duration of operation, or length of hospital stay among the three groups. A significantly lower pain score was observed in the rectus sheath block in SILC group than in the SILC group at 2 and 6 h after operation. The pain score and need for analgesia were similar between the SILC group and the four-port cholecystectomy group. CONCLUSION SILC using an ultrasound-guided rectus sheath block significantly reduces postoperative pain.
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Affiliation(s)
- Hideki Kamei
- Department of Surgery, Kurume University Medical Center, Kurume, Japan
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Quek KHY, Phua DSK. Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair. Singapore Med J 2015; 55:e39-41. [PMID: 24664392 DOI: 10.11622/smedj.2014042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present a case of an open surgical repair of an infraumbilical hernia, which was performed on a 45-year-old man categorised as American Society of Anesthesiologists class 4; he weighed 107 kg, and had a body mass index of 34.2 kg/m2 and nonischaemic cardiomyopathy (left ventricular ejection fraction of 20%). Due to the patient's significant perioperative risks, the surgery was performed with the patient under ultrasonography-guided bilateral rectus sheath blocks; 15 mL of 1% lignocaine and 10 mL of 0.5% bupivacaine were deposited in the space between the rectus abdominis and posterior rectus sheath. The patient tolerated the surgery with minimal further sedation and additional analgesia. Rectus sheath block is a useful regional technique for periumbilical surgery, allowing surgery in highrisk patients while avoiding general anaesthesia and central neuraxial blockade. The use of real-time ultrasonographic guidance may reduce risks of peritoneal puncture, bleeding and visceral injury, while potentially increasing the rate of success.
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Affiliation(s)
- Kelvin How Yow Quek
- Department of Anaesthesia, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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Bashandy GMN, Elkholy AHH. Reducing postoperative opioid consumption by adding an ultrasound-guided rectus sheath block to multimodal analgesia for abdominal cancer surgery with midline incision. Anesth Pain Med 2014; 4:e18263. [PMID: 25289373 PMCID: PMC4183078 DOI: 10.5812/aapm.18263] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/05/2014] [Accepted: 03/21/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Many multimodal analgesia techniques have been tried to provide adequate analgesia for midline incisions extending above and below the umbilicus aiming at limiting the perioperative use of morphine thus limiting side effects. Ultrasound (US) guidance made the anesthesiologist reconsider old techniques for wider clinical use. The rectus sheath block (RSB) is a useful technique under-utilized in the adult population. Objectives: Our study examined the efficacy of a preemptive single-injection rectus sheath block in providing better early postoperative pain scores compared to general anesthesia alone. Patients and Methods: Sixty patients were recruited in this randomized controlled trial. These patients were divided into two groups: RSB group had an RSB after induction of anesthesia and before surgical incision, and GA (general anesthesia) group had general anesthesia alone. Both groups were compared for verbal analogue scale (VAS) score, opioid consumption and hemodynamic variables in the post-anesthesia care unit (PACU). Analgesic requirements in surgical wards were recorded in postoperative days (POD) 0, 1 and 2. Results: The median VAS score was significantly lower in RSB group compared with GA group in all 5 time points in the PACU (P ˂ 0.05). Also PACU morphine consumption was lower in RSB group than GA group patients (95% confidence interval [CI] of the difference in means between groups, −4.59 to −2.23 mg). Morphine consumption was also less in the first 2 postoperative days (POD0 and POD1). Conclusions: Ultrasound-guided rectus sheath block is an easy technique to learn. This technique, when it is used with general anesthesia, will be more effective in reducing pain scores and opioid consumption compared with general anesthesia alone.
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Affiliation(s)
- Ghada Mohammad Nabih Bashandy
- Department of Anesthesiology and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
- Corresponding author: Ghada Mohammad Nabih Bashandy, Department of Anesthesiology and Pain Management, National Cancer Institute, Egypt-1 Fom Alkalij, Kasr Al-Einy St., Cairo, Egypt. Tel: +20-201125233337, E-mail:
| | - Abeer Hassan Hamed Elkholy
- Department of Anesthesiology and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
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Quintana Puerta JE. Applications of perioperative and critical care ultrasound. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Quintana Puerta JE. Aplicaciones de la ecografía perioperatoria y de cuidado crítico. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Mariano ER, Marshall ZJ, Urman RD, Kaye AD. Ultrasound and its evolution in perioperative regional anesthesia and analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:29-39. [DOI: 10.1016/j.bpa.2013.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/22/2013] [Indexed: 11/30/2022]
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Abstract
Ultrasound guidance has become the standard of care for many bedside procedures, owing to its portability, ease of use, and significant reduction in complications. This article serves as an introduction to the use of ultrasonography in several advanced procedures, including pericardiocentesis, thoracentesis, paracentesis, lumbar puncture, regional anesthesia, and peritonsillar abscess drainage.
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Affiliation(s)
- Nicholas Hatch
- Department of Emergency Medicine, Maricopa Medical Center, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA.
| | - Teresa S Wu
- EM Residency Program, Department of Emergency Medicine, Maricopa Medical Center, University of Arizona College of Medicine-Phoenix, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
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