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Gupta A, Barik AK, Mohanty CR, Radhakrishnan RV, Das G, Ray A. Response to "Regional anesthesia is safe for use in intramedullary nailing of low-energy tibial shaft fractures". Injury 2024:111798. [PMID: 39155207 DOI: 10.1016/j.injury.2024.111798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 08/03/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Anju Gupta
- Department of Anesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Amiya Kumar Barik
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, India.
| | | | - Gurudip Das
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ananya Ray
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
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Schwartz G, Gadsden JC, Gonzales J, Hutchins J, Song J, Brady O, DiGiorgi M, Winston R. A phase 3 active-controlled trial of liposomal bupivacaine via sciatic nerve block in the popliteal fossa after bunionectomy. J Clin Anesth 2024; 94:111402. [PMID: 38340677 DOI: 10.1016/j.jclinane.2024.111402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/22/2023] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
STUDY OBJECTIVE To investigate the efficacy, safety, pharmacodynamics, and pharmacokinetics of liposomal bupivacaine (LB) administered via ultrasound-guided sciatic nerve block in the popliteal fossa in participants undergoing bunionectomy. DESIGN Two-part, randomized, double-blind, active-controlled trial (NCT05157841). SETTING Operating room, postanesthesia care unit, and health care facility (6 sites). PATIENTS Adults with American Society of Anesthesiologists physical status classification ≤3 and body mass index ≥18 to <40 kg/m2 undergoing elective distal metaphyseal osteotomy. INTERVENTIONS Part A participants were randomized 1:1:1 to LB 266 mg, LB 133 mg, or bupivacaine hydrochloride 50 mg (BUPI). Part B participants were randomized 1:1 to LB (at the dose established by part A) or BUPI. MEASUREMENTS The primary endpoint was area under the curve (AUC) of numerical rating scale (NRS) pain intensity scores 0-96 h after surgery. Secondary endpoints included total postsurgical opioid consumption, opioid-free status 0-96 h after surgery, and pharmacokinetic endpoints. MAIN RESULTS Part A enrolled 22 participants per group. In part B, additional participants were randomized to LB 133 mg (n = 59) and BUPI (n = 60) (185 total). LB 133 mg had significant reductions versus BUPI in the AUC of NRS pain intensity score (least squares mean [LSM], 207.4 vs 371.4; P < 0.00001) and total opioid consumption 0-96 h after surgery (LSM, 17.7 [95% confidence interval (CI), 13.7, 22.8] morphine milligram equivalents [MMEs] vs 45.3 [95% CI, 35.1, 58.5] MMEs; P < 0.00001) and an increased proportion of opioid-free participants (24.4% vs 6%; odds ratio, 5.04 [95% CI, 2.01, 12.62]; P = 0.0003) in parts A + B. Adverse events were similar across groups. CONCLUSIONS LB 133 mg administered via sciatic nerve block in the popliteal fossa after bunionectomy demonstrated superior and long-lasting postsurgical pain control versus BUPI. The clinical relevance of these findings is supported by concurrent reductions in pain and opioid consumption over 4 days after surgery and a significantly greater percentage of participants remaining opioid-free.
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Affiliation(s)
| | - Jeffrey C Gadsden
- Duke University Medical Center, 2301 Erwin Rd, Durham 27710, NC, USA.
| | - Jeffrey Gonzales
- Guardian Anesthesia Services and Enhanced Recovery Anesthetic Consultants, 9395 Crown Crest Blvd, Parker 80138, CO, USA.
| | - Jacob Hutchins
- University of Minnesota Medical Center, 420 Delaware St SE, Minneapolis 55455, MN, USA.
| | - Jia Song
- Pacira BioSciences, Inc., 5401 West Kennedy Blvd, Lincoln Center Ste 890, Tampa 33609, FL, USA.
| | - O'Dane Brady
- Pacira BioSciences, Inc., 5401 West Kennedy Blvd, Lincoln Center Ste 890, Tampa 33609, FL, USA.
| | - Mary DiGiorgi
- Pacira BioSciences, Inc., 5401 West Kennedy Blvd, Lincoln Center Ste 890, Tampa 33609, FL, USA.
| | - Roy Winston
- Pacira BioSciences, Inc., 5401 West Kennedy Blvd, Lincoln Center Ste 890, Tampa 33609, FL, USA.
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Hu J, Li X, Wang Q, Yang J. Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744461. [PMID: 37657517 DOI: 10.1016/j.bjane.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE This trial aimed to identify the Minimum Effective Concentration (MEC90, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). METHODS A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC90, MEC95 and MEC99 were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method. RESULTS Based on the analysis of 52 patients, MEC90, MEC95, and MEC99 of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334-0.372%), 0.363% (95% CI 0.351-0.383%), and 0.373% (95% CI 0.363-0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients. CONCLUSIONS For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.
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Affiliation(s)
- Jian Hu
- Sichuan University, West China Hospital, Department of Anesthesiology, Chengdu, China
| | - Xingcheng Li
- Sichuan University, West China School of Nursing, West China Tianfu Hospital, Department of Urology, Chengdu, China
| | - Qiuru Wang
- Sichuan University, West China Hospital, Department of Orthopedic Surgery, Chengdu, China
| | - Jing Yang
- Sichuan University, West China Hospital, Department of Anesthesiology, Chengdu, China.
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Castro D, Ishihara T, Hofmeister E, Clark-Price S, Portela DA. Ultrasound-guided sciatic nerve block in Wistar rat cadavers: Relevant anatomy and injection distribution. Vet Anaesth Analg 2024; 51:173-180. [PMID: 38233268 DOI: 10.1016/j.vaa.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To investigate the feasibility of an ultrasound-guided sciatic nerve block by describing the sonoanatomy and comparing the distribution of two volumes of bupivacaine dye solution for nerve staining. STUDY DESIGN Randomized, experimental, assessor-blinded cadaveric study. ANIMALS A total of 40 adult female Wistar rat cadavers. METHODS After studying the sonoanatomy of the sciatic nerve and adjacent structures using a high-resolution linear transducer (19-5 MHz), rat cadavers were randomly divided into two groups that were administered either 0.1 mL (group 0.1) or 0.2 mL (group 0.2) of bupivacaine dye solution per nerve, delivered via an in-plane technique. The extent of nerve staining was subsequently evaluated following dissection. Statistical analysis consisted of assessing data distribution using the Shapiro-Wilk test, followed by paired t-tests for continuous data, Mann-Whitney U test and McNemar's test for categorical data. Statistical significance was defined as p < 0.05. RESULTS The sciatic nerve was identified bilaterally as a double ellipsoid-shaped image, surrounded by a hyperechoic fascia separating the biceps femoris from the adductor muscle. The hypoechoic structure formed by the bupivacaine dye solution around the nerve was effectively visualized using ultrasound imaging. Sciatic nerve staining was successfully achieved in all pelvic limbs, with dye spread of 4.82 ± 1.55 mm and 5.47 ± 2.18 mm in groups 0.1 and 0.2, respectively (p = 0.128). CONCLUSIONS AND CLINICAL RELEVANCE This study achieved a detailed understanding of the sonoanatomy of the sciatic nerve and its adjacent structures, highlighting the feasibility of the ultrasound-guided technique for injection in Wistar rats. Furthermore, the results show a comparable distribution of dye solution in both groups. Use of the ultrasound-guided sciatic nerve block technique in rats not only exhibits substantial potential for regional anesthesia but also opens avenues for translational studies.
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Affiliation(s)
- Douglas Castro
- Department of Clinical Science, Auburn University College of Veterinary Medicine, Auburn, AL, USA.
| | - Toshitsugu Ishihara
- Department of Clinical Science, Auburn University College of Veterinary Medicine, Auburn, AL, USA
| | - Erik Hofmeister
- Department of Clinical Science, Auburn University College of Veterinary Medicine, Auburn, AL, USA
| | - Stuart Clark-Price
- Department of Clinical Science, Auburn University College of Veterinary Medicine, Auburn, AL, USA
| | - Diego A Portela
- Department of Comparative, Diagnostic & Population Medicine, University of Florida College of Veterinary Medicine, Gainesville, FL, USA
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Hu J, Wang Q, Hu J, Gong C, Yang J. Analgesic efficacy of anterior iliopsoas muscle space block combined with local infiltration analgesia after total hip arthroplasty: A prospective, double-blind, placebo-controlled study. Anaesth Crit Care Pain Med 2023; 42:101282. [PMID: 37506766 DOI: 10.1016/j.accpm.2023.101282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The present study aimed to evaluate the efficacy of ultrasound-guided anterior iliopsoas muscle space block (AIMSB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach. METHODS In this prospective, double-blind, placebo-controlled study, 80 patients undergoing primary THA under general anesthesia were included in the final analysis between March 22, 2022, and June 1, 2022. All patients were randomly assigned to receive AIMSB combined with LIA (AIMSB group, n = 40) or sham AIMSB and LIA (Sham group, n = 40). The primary outcome was cumulative morphine consumption (mg) within 24 h after surgery. Secondary outcomes were pain scores on a visual analog scale (VAS) at rest or during motion after surgery, time to first rescue analgesia, cumulative morphine consumption during hospitalization, intraoperative consumption of opioids, postoperative recovery, and postoperative adverse effects. RESULTS Patients in the AIMSB group consumed significantly less morphine than the Sham group within the first 24 h and throughout hospitalization, as well as smaller amounts of intraoperative opioids. Also, significantly lower pain scores were recorded at rest or during motion within 24 h after surgery in AIMSB patients. Patients in the AIMSB group recovered more quickly than Sham patients. No significant difference was observed in quadriceps strength and postoperative complications between the two groups. CONCLUSIONS Compared to treatment with LIA alone, ultrasound-guided AIMSB combined with LIA can provide better postoperative pain relief, decrease opioid consumption, promote motor sparing, and enhance the recovery of THA patients.
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Affiliation(s)
- Jian Hu
- Department of Anaesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041 Sichuan, China.
| | - Qiuru Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041 Sichuan, China.
| | - Jie Hu
- Department of Anaesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041 Sichuan, China.
| | - Chunyu Gong
- Department of Surgery, No. 4 West China Teaching Hospital, Sichuan University, No. 18 Renmin South Road, Chengdu, 610041 Sichuan, China.
| | - Jing Yang
- Department of Anaesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041 Sichuan, China.
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Azizoğlu M, Özdemir L, Bilgin M, Rumeli Ş. Awake femoral fracture surgery with suprainguinal fascia iliaca compartment and sciatic nerve blocks under dual antiplatelet therapy after coronary stent: A case report. J Orthop Sci 2023; 28:1436-1438. [PMID: 34140209 DOI: 10.1016/j.jos.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/28/2021] [Accepted: 04/11/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Mustafa Azizoğlu
- Mersin University Faculty of Medicine, Department of Anesthesiology and Reanimation, Mersin, Turkey.
| | - Levent Özdemir
- Mersin University Faculty of Medicine, Department of Anesthesiology and Reanimation, Mersin, Turkey
| | - Merve Bilgin
- Mersin University Faculty of Medicine, Department of Anesthesiology and Reanimation, Mersin, Turkey
| | - Şebnem Rumeli
- Mersin University Faculty of Medicine, Department of Anesthesiology and Reanimation, Mersin, Turkey
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Li X, Li Q, Song S, Stevens AO, Broemmel Z, He Y, Wesselmann U, Yaksh T, Zhao C. Emulsion-induced polymersomes taming tetrodotoxin for prolonged duration local anesthesia. ADVANCED THERAPEUTICS 2023; 6:2200199. [PMID: 36819711 PMCID: PMC9937052 DOI: 10.1002/adtp.202200199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 11/06/2022]
Abstract
Injectable local anesthetics that can provide a continuous nerve block approximating the duration of a pain state would be a life-changing solution for patients experiencing post-operative pain or chronic pain. Tetrodotoxin (TTX) is a site 1 sodium channel blocker that is extremely potent compared to clinically used local anesthetics. Challengingly, TTX doses are limited by its associated systemic toxicity, thus shortening the achievable duration of nerve blocks. Here, we explore emulsion-induced polymersomes (EIP) as a drug delivery system to safely use TTX for local anesthesia. By emulsifying hyperbranched polyglycerol-poly (propylene glycol)-hyperbranched polyglycerol (HPG-PPG-HPG) in TTX aqueous solution, HPG-PPG-HPG self-assembled into micrometer-sized polymersomes within seconds. The formed polymersomes have microscopically visible internal aqueous pockets that encapsulate TTX with an encapsulation efficiency of up to 94%. Moreover, the polymersomes are structurally stable, enabling sustained TTX release. In vivo, the freshly prepared EIP/TTX formulation can be directly injected and increased the tolerated dose of TTX in Sprague-Dawley rats to 11.5 μg without causing any TTX-related systemic toxicity. In the presence of the chemical penetration enhancer (CPE) sodium octyl sulfate (SOS), a single perineural injection of EIP/TTX/SOS formulation produced a reliable sciatic nerve block for 22 days with minimal local toxicity.
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Affiliation(s)
- Xiaosi Li
- Department of Chemical and Biological Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Qi Li
- Department of Chemical and Biological Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Shenghan Song
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Amy O. Stevens
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Zach Broemmel
- Department of Chemical and Biological Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Yi He
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM 87131, USA
- Translational Informatics Division, Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Ursula Wesselmann
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, and Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Tony Yaksh
- Department of Anesthesiology, University of California at San Diego, La Jolla, CA 92093, USA
| | - Chao Zhao
- Department of Chemical and Biological Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
- Center for Convergent Biosciences and Medicine, University of Alabama, Tuscaloosa AL 35487
- Alabama Life Research Institute, University of Alabama, Tuscaloosa AL 35487
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Hu J, Wang Q, Hu J, Kang P, Yang J. Efficacy of Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined With Local Infiltration Analgesia on Postoperative Pain After Total Hip Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial. J Arthroplasty 2022; 38:1096-1103. [PMID: 36529195 DOI: 10.1016/j.arth.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study examined whether pericapsular nerve group (PENG) block combined with local infiltration analgesia (LIA) could improve pain management and functional recovery after total hip arthroplasty. METHODS All patients were randomly assigned to receive PENG block combined with LIA (PENG group) or sham PENG block and LIA (Sham group). The primary outcome was cumulative morphine consumption within 24 hours after surgery. Secondary outcomes were pain scores on a visual analog scale (VAS); time to first rescue analgesia; cumulative morphine consumption during hospitalization; intraoperative consumption of opioids; postoperative recovery; and postoperative complications. RESULTS PENG patients consumed significantly less morphine within the first 24 hours and throughout hospitalization and smaller amounts of intraoperative opioids. There were significantly lower pain scores at rest and during motion within 24 hours in PENG patients. PENG patients took significantly longer until the first rescue analgesia and showed significantly better postoperative rehabilitation. However, the absolute change in morphine consumption and VAS scores did not exceed the reported minimal clinically important differences (morphine consumption: 10 mg; VAS scores: 1.5 at rest and 1.8 during movement). The two groups showed no difference in quadriceps muscle strength and postoperative complications. CONCLUSION PENG block combined with LIA could improve postoperative pain relief, reduce opioid use, and enhance recovery in total hip arthroplasty patients, without weakening the quadriceps muscle strength. This work justifies further trials to examine the safety and efficacy of this block and to explore maximal effective volume of local anesthetic for motor-sparing PENG block.
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Affiliation(s)
- Jian Hu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
| | - Qiuru Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Hu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
| | - Pengde Kang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
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Carella M, Beck F, Piette N, Denys S, Kurth W, Lecoq JP, Bonhomme VL. Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial. Reg Anesth Pain Med 2022; 47:rapm-2021-103427. [PMID: 35705263 DOI: 10.1136/rapm-2021-103427] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/05/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Posterolateral-approached total hip arthroplasty (PLTHA) is followed by moderate to severe postoperative pain. Suprainguinal fascia iliaca compartment block (SFICB) has been proposed as a promising analgesia technique. METHODS Data from 86 patients scheduled for PLTHA with spinal anesthesia were analyzed in this prospective randomized controlled trial. Patients were randomly divided into two groups of 43 patients each. As opposed to the control group (group C), ropivacaine group (group R) received additional SFICB using 40 mL of 0.375% ropivacaine. As primary endpoint, blind observers noted total morphine consumption at postoperative 48 hours. Secondary endpoints were pain at rest and mobilization on 0-10 Numeric Rating Scale (rest and dynamic NRS) at fixed time points (1 hour and 6 hours after surgery, and at day 1 and day 2 at 8:00, 13:00 and 18:00 hours), walking performance at day 1 and day 2; postoperative complications including morphine-related side effects or orthostatic intolerance symptoms such as dizziness, nausea, blurred vision or vasovagal syncope. RESULTS A 48-hour morphine consumption (mg; median (IQR)) was significantly lower in group R than in group C (11 (8.5-15.5)) vs 26 (21-33.5), p<0001), as well as incidence of morphine-related side effects such as nausea at day 1 (p=0.04) and day 2 (p<0.01). Rest and dynamic NRS were globally significantly lower in group R than in group C (p<0.01). Group R showed less orthostatic intolerance at day 1 (p<0.001) and day 2 (p<0.01) and better functional walking performance at day 1 (<0.001) and day 2 (<0.001). DISCUSSION In PLTHA, SFICB provides opioid sparing, improved postoperative pain control, and enhanced functional recovery. TRIAL REGISTRATION NUMBER NCT04574479.
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Affiliation(s)
- Michele Carella
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
| | - Florian Beck
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
| | - Nicolas Piette
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
| | - Sébastien Denys
- Department of Physical Medicine, Rehabilitation and Sports Traumatology, Central University Hospital of Liege, Liege, Belgium
| | - William Kurth
- Department of Locomotor System Surgery, Central University Hospital of Liege, Liege, Belgium
| | - Jean-Pierre Lecoq
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
| | - Vincent L Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
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Das S, Mohanty CR, Singh N, Radhakrishnan RV. Re to: ‘‘Ultrasound-Guided Subgluteal Sciatic Nerve Block for Pain Management during Endovascular Treatment for Below-the-Knee Arterial Occlusions”. J Vasc Interv Radiol 2022; 33:1001. [DOI: 10.1016/j.jvir.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/26/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022] Open
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Dexmedetomidine as an adjunct to peripheral nerve blocks in pediatric patients. World J Pediatr 2022; 18:251-262. [PMID: 35006581 DOI: 10.1007/s12519-021-00507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Combining local anesthetics with dexmedetomidine (DEX) for nerve blocks has been tested and confirmed as an alternative technique to strengthen analgesia in adults, but the evidence supported this proposal in pediatrics was not convincing enough. Thus, we intend to conduct a meta-analysis to make an appraisal of the effects of DEX as a local anesthetic adjuvant on peripheral nerve blocks in children. METHODS The analysis has been registered on https://www.crd.york.ac.uk/prospero/ with the registration number CRD42021254029 on June 10th, 2021. PubMed, Ovid MEDLINE, Embase and Cochrane central register were searched for the randomized controlled trials (RCTs) that are relevant to child/pain/DEX or block up to April 30, 2021. RESULTS Eight RCTs were included for data analysis. The pooled results showed a significantly reduced number of patients who required postoperative analgesics within DEX groups [odds ratio = 0.1, 95% confidence interval (CI) 0.03-0.32, P < 0.001]. And DEX significantly prolonged the duration of analgesia of local anesthetics in the meantime [standardized mean difference (SMD) = 4.93, 95% CI 3.02-6.83, P < 0.001]. Nevertheless, adding DEX as an adjunct to local anesthetics would significantly decrease heart rate (SMD = - 0.95, 95% CI - 1.45 to - 0.45, P < 0.001) and increase sedation score (SMD = 1.6, 95% CI 0.53-2.66, P = 0.003) simultaneously. CONCLUSIONS Adding DEX as an adjunct to peripheral nerve blocks can prolong analgesia until postoperative 8 hours in pediatric patients. However, the benefits should be weighed against the increasing risk of bradycardia and sedation in critical children.
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Hu J, Wang Q, Zeng Y, Xu M, Gong J, Yang J. The impact of ultrasound-guided transmuscular quadratus lumborum block combined with local infiltration analgesia for arthroplasty on postoperative pain relief. J Clin Anesth 2021; 73:110372. [PMID: 34098394 DOI: 10.1016/j.jclinane.2021.110372] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE This study aimed to evaluate the efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach. DESIGN This was a prospective, randomized controlled trial. SETTING We collected data in the preoperative area, operating room, and bed ward. PATIENTS A total of 80 patients with American Society of Anesthesiology functional status scores of II-III were included and assigned to two groups, and all 80 patients were included in the final analysis. INTERVENTIONS All included patients were randomly assigned to the nerve block (group N) or the control group (group C). Patients in the group N received transmuscular QLB combined with LIA, while patients in the group C received only LIA. MEASUREMENTS The primary outcome was postoperative pain during the first active motion: it was measured at six hours after surgery and assessed using a visual analog scale (VAS). Secondary outcomes were the resting VAS scores in the post-anesthesia care unit (PACU) and at 2, 6, 12, 24, 48, and 72 h after surgery; VAS scores during motion at 12, 24, 48, and 72 h after surgery; intraoperative consumption of opioids; postoperative consumption of morphine hydrochloride; frequency of sleep interruption due to pain on the night of surgery; time until the first "walk out of the bed" after surgery; muscle strength of the quadriceps femoris; and postoperative adverse effects. MAIN RESULTS Compared to the group C, patients in the group N had significantly lower VAS scores during motion at 6, 12, and 24 h after surgery, as well as lower resting VAS scores in the PACU and at 2, 6, 12, and 24 h after surgery. Patients in the group N also consumed significantly smaller amounts of intraoperative opioids and morphine after surgery. Patients in the group N reported significantly fewer interruptions in sleep due to pain on the night of surgery and were able to "walk out of the bed" significantly earlier than those in the group C. There was no significant difference between the two groups in muscle strength of the quadriceps femoris or incidence of postoperative adverse effects. CONCLUSIONS Compared to treatment with LIA alone, ultrasound-guided transmuscular QLB combined with LIA can provide better postoperative pain relief and enhance the recovery of THA patients, since it does not cause quadriceps femoris muscle weakness and is associated with significantly lower need for intraoperative opioids.
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Affiliation(s)
- Jian Hu
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, China
| | - Qiuru Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, China
| | - Yan Zeng
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, China
| | - Min Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, China
| | - Jingxuan Gong
- Department of Biomedical Engineering, Northwestern University, 633 Clark Street, Evanston 60201, IL, USA
| | - Jing Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, China.
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Christiansen CB, Madsen MH, Rothe C, Andreasen AM, Lundstrøm LH, Lange KHW. Volume of ropivacaine 0.2% and sciatic nerve block duration: A randomized, blinded trial in healthy volunteers. Acta Anaesthesiol Scand 2020; 64:238-244. [PMID: 31605392 DOI: 10.1111/aas.13489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/22/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sciatic nerve blocks are used for many orthopaedic procedures on the knee, lower leg, foot and ankle. However, as nerve block durations vary considerably, the timing of supplemental analgesia is challenging. Therefore, knowledge on the effect of local anaesthetic (LA) dose on block duration is important to outweigh the benefits of increasing LA dose against the risk of LA systemic toxicity. In this randomized, double-blind trial, we aimed to explore the relationship between the volume of ropivacaine 0.2% and sciatic nerve block duration. We hypothesized that increasing LA volume would prolong block duration. METHODS We randomized 60 healthy volunteers to receive one of five volumes of ropivacaine 0.2%: 5, 10, 15, 20, or 30 mL. We used an ultrasound-guided, catheter-based technique targeting the sciatic nerve in the infragluteal region. The primary outcome was sensory block duration defined as the time of insensitivity to a cold stimulus. Intergroup differences were tested using one-way ANOVA. RESULTS Mean (SD) sensory block durations for the tibial nerve (TN) with increasing volume were: 9.3 hours (1.7), 10.4 hours (1.6), 9.7 hours (2.9), 10.7 hours (2.8) and 9.9 hours (2.6). Mean (SD) sensory block durations for the common peroneal nerve (CPN) were: 10.6 hours (2.7), 11.9 hours (1.5), 11.0 hours (3.3), 13.2 hours (3.7), and 13.5 hours (6.1). There were no intergroup differences (P = .67 [TN]; P = .25 [CPN]). CONCLUSION We found no effect of increasing the volume of ropivacaine 0.2% from 5 to 30 mL on sensory sciatic nerve block duration.
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Affiliation(s)
- Claus B. Christiansen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Mikkel H. Madsen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Christian Rothe
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Asger M. Andreasen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Lars H. Lundstrøm
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
| | - Kai H. W. Lange
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
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Hendriksen E, Slagt C. Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures [Letter]. Local Reg Anesth 2019; 12:109-110. [PMID: 31807062 PMCID: PMC6850673 DOI: 10.2147/lra.s233411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/31/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eva Hendriksen
- Department Anaesthesia, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
| | - Cornelis Slagt
- Department Anaesthesia, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
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15
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Schnepper GD, Kightlinger BI, Jiang Y, Wolf BJ, Bolin ED, Wilson SH. A Retrospective Study Evaluating the Effect of Low Doses of Perineural Dexamethasone on Ropivacaine Brachial Plexus Peripheral Nerve Block Analgesic Duration. PAIN MEDICINE 2019; 19:1485-1493. [PMID: 29036728 DOI: 10.1093/pm/pnx205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective Examination of the effectiveness of perineural dexamethasone administered in very low and low doses on ropivacaine brachial plexus block duration. Design Retrospective evaluation of brachial plexus block duration in a large cohort of patients receiving peripheral nerve blocks with and without perineural dexamethasone in a prospectively collected quality assurance database. Setting A single academic medical center. Methods A total of 1,942 brachial plexus blocks placed over a 16-month period were reviewed. Demographics, nerve block location, and perineural dexamethasone utilization and dose were examined in relation to block duration. Perineural dexamethasone was examined as none (0 mg), very low dose (2 mg or less), and low dose (greater than 2 mg to 4 mg). Continuous catheter techniques, local anesthetics other than ropivacaine, and block locations with fewer than 15 subjects were excluded. Associations between block duration and predictors of interest were examined using multivariable regression models. A subgroup analysis of the impact of receiving dexamethasone on block duration within each block type was also conducted using a univariate linear regression approach. Results A total of 1,027 subjects were evaluated. More than 90% of brachial plexus blocks contained perineural dexamethasone (≤4 mg), with a median dose of 2 mg. Increased block duration was associated with receiving any dose of perineural dexamethasone (P < 0.0001), female gender (P = 0.022), increased age (P = 0.048), and increased local anesthetic dose (P = 0.01). In a multivariable model, block duration did not differ with very low- or low-dose perineural dexamethasone after controlling for other factors (P = 0.420). Conclusion Perineural dexamethasone prolonged block duration compared with ropivacaine alone; however, duration was not greater with low-dose compared with very low-dose perineural dexamethasone.
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Affiliation(s)
| | | | - Yunyun Jiang
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bethany J Wolf
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eric D Bolin
- Departments of Anesthesia and Perioperative Medicine
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16
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Carles M, Beloeil H, Bloc S, Nouette-Gaulain K, Aveline C, Cabaton J, Cuvillon P, Dadure C, Delaunay L, Estebe JP, Hofliger E, Martinez V, Olivier M, Robin F, Rosencher N, Capdevila X. Anesthésie loco-régionale périnerveuse (ALR-PN). ANESTHÉSIE & RÉANIMATION 2019. [DOI: 10.1016/j.anrea.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Local Anesthetic Injection Speed and Common Peroneal Nerve Block Duration: A Randomized Controlled Trial in Healthy Volunteers. Reg Anesth Pain Med 2019; 43:467-473. [PMID: 29570501 DOI: 10.1097/aap.0000000000000759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The speed of local anesthetic (LA) injections in peripheral regional anesthesia ranges from slow continuous infusions (3-12 mL/h) to rapid manual injections (>7500 mL/h). Optimizing injection speed could augment the spread of LA toward the targeted nerves and influence nerve block characteristics. The objective of this study was to investigate whether injection speed of a single dose of LA affects peripheral nerve block duration. METHODS After approval from the Danish Regional Scientific Ethics Committee, we enrolled 60 healthy adult volunteers. We used an ultrasound-guided catheter-based technique to perform a common peroneal nerve block. Participants were randomized to receive 4.0 mL of ropivacaine 0.2% with 1 of 5 injection speeds: 12, 60, 300, 600, or 1800 mL/h. Investigators and participants were blinded to group assignment and intervention. Primary outcome was duration of sensory nerve block defined by insensitivity toward cold. Secondary outcomes were duration of motor nerve block, time to onset of sensory nerve block, and grades of sensory and motor nerve block.Intergroup differences were tested by one-way analysis of variance. RESULTS We found no differences in sensory block duration between the 5 groups. Durations were median [range]: 11 [6-14], 12 [9-14], 10.5 [2-15], 11 [8-17], and 12 [9-18] hours, respectively (P = 0.294). In addition, we found no differences in secondary outcomes. CONCLUSIONS Injection speed of LA in the range of 12 to 1800 mL/h did not affect common peroneal nerve block duration. CLINICAL TRIAL REGISTRATION This study was registered at ClinicalTrials.gov, identifier NCT02801799.
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18
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Christiansen CB, Madsen MH, Rothe C, Andreasen AM, Lundstrøm LH, Lange KHW. Volume of ropivacaine 0.2% and common peroneal nerve block duration: a randomised, double‐blind cohort trial in healthy volunteers. Anaesthesia 2018; 73:1361-1367. [DOI: 10.1111/anae.14400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2018] [Indexed: 01/10/2023]
Affiliation(s)
- C. B. Christiansen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - M. H. Madsen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - C. Rothe
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - A. M. Andreasen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - L. H. Lundstrøm
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - K. H. W. Lange
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
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19
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Kang DH, Kang C, Hwang DS, Song JH, Jang MG. The Efficacy of Different Ropivacaine Concentrations (0.5%, 0.6%, vs . 0.75%) for Regional Nerve Block in Lower Extremity: A Prospective Randomized Controlled Trial. ACTA ACUST UNITED AC 2018. [DOI: 10.4055/jkoa.2018.53.3.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dong Hun Kang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chan Kang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Deuk Soo Hwang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Hwang Song
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min Gu Jang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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20
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Scurrah A, Shiner CT, Stevens JA, Faux SG. Regional nerve blockade for early analgesic management of elderly patients with hip fracture - a narrative review. Anaesthesia 2017; 73:769-783. [DOI: 10.1111/anae.14178] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/27/2022]
Affiliation(s)
- A. Scurrah
- Department of Anaesthetics; St Vincent's Hospital Sydney; NSW Australia
| | - C. T. Shiner
- Department of Rehabilitation and Pain Medicine; St Vincent's Hospital Sydney; NSW Australia
| | - J. A. Stevens
- Department of Anaesthetics; St Vincent's Hospital Sydney; NSW Australia
| | - S. G. Faux
- Department of Rehabilitation and Pain Medicine; St Vincent's Hospital Sydney; NSW Australia
- University of New South Wales; Sydney NSW Australia
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21
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Walter WR, Burke CJ, Adler RS. Ultrasound-guided therapeutic injections for neural pathology about the foot and ankle: a 4 year retrospective review. Skeletal Radiol 2017; 46:795-803. [PMID: 28303298 DOI: 10.1007/s00256-017-2624-7] [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: 11/29/2016] [Accepted: 03/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe a 4-year clinical experience with ultrasound-guided therapeutic perineural injections of peripheral nerves about the foot and ankle. MATERIALS AND METHODS Retrospective analysis of foot and ankle perineural injections performed between January 2012 and August 2016. Demographics, clinical indications, presence of structural pathology, immediate and interval pain relief, as well as complications were recorded. RESULTS Fifty-nine therapeutic injections were performed among 46 patients, accounting for multiple injections in a single visit or multiple visits [mean age = 43 years (range 18-75), 31 female (67%) and 15 male (33%)]. Most commonly, perineural injections involved the hallux branch of the medial plantar nerve (n = 17, 22%). Least commonly, perineural injections involved the saphenous nerve (n = 3, 4%). Other injections in our series include sural (10), superficial (11) and deep (7) peroneal, medial (5) and lateral (3) plantar nerves, and the posterior tibial nerve (3). Ultrasound evaluation revealed structural abnormality associated with the nerve in 30 cases (51%)-most commonly thickening with perineural scarring (n = 14). Of 45 injections with complete documentation, immediate relief of symptoms was reported in 43 (96%) cases. Interval symptom relief was achieved in 23 injections [short term (n = 12), intermediate (n = 6), and long term (n = 5)] out of 38 for which follow-up was available (61%). Complications are rare, occurring in only one case. CONCLUSION Ultrasound-guided perineural injections about the foot and ankle are safe and provide lasting symptomatic relief for many indications. Concomitant sonographic evaluation identifies structural abnormalities that may contribute to neuropathic symptoms, allowing targeting of injection or clinical therapy.
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Affiliation(s)
- William R Walter
- Hospital for Joint Diseases, New York University Langone Medical Center, 301 E 17th St, New York, NY, 10003, USA.
| | - Christopher J Burke
- Hospital for Joint Diseases, New York University Langone Medical Center, 301 E 17th St, New York, NY, 10003, USA
| | - Ronald S Adler
- Center for Musculoskeletal Care, New York University Langone Medical Center, New York, NY, USA
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22
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Carles M, Beloeil H, Bloc S, Nouette-Gaulain K, Aveline C, Cabaton J, Cuvillon P, Dadure C, Delaunay L, Estebe JP, Hofliger E, Martinez V, Olivier M, Robin F, Rosencher N, Capdevila X. Anesthésie locorégionale périnerveuse. ANESTHESIE & REANIMATION 2017. [DOI: 10.1016/j.anrea.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Jæger P, Koscielniak-Nielsen ZJ, Hilsted KL, Grevstad U, Siersma V, Fabritius ML, Dahl JB. Effect of Total Dose of Lidocaine on Duration of Adductor Canal Block, Assessed by Different Test Methods. Anesth Analg 2016; 123:1026-32. [DOI: 10.1213/ane.0000000000001517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Use of Peripheral Nerve Blocks with Sedation for Total Knee Arthroplasty in a Patient with Contraindication for General Anesthesia. Case Rep Anesthesiol 2015; 2015:950872. [PMID: 26587290 PMCID: PMC4637460 DOI: 10.1155/2015/950872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022] Open
Abstract
Although peripheral nerve blocks are commonly used to provide postoperative analgesia after total knee arthroplasty (TKA) and other lower extremity procedures, these blocks are rarely used for intraoperative anesthesia. Most TKAs are performed under general anesthesia (GA) or neuraxial anesthesia (NA). The knee has a complex sensory innervation that makes surgical anesthesia difficult with peripheral nerve blocks alone. Rarely are both GA and NA relatively contraindicated and alternatives are considered. We present a patient who underwent TKA performed under peripheral nerve block and sedation alone.
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26
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O'Donnell BD, Szűcs S. Peripheral nerve block and local anaesthetic dose, how much is enough? Anaesthesia 2014; 69:665-8. [DOI: 10.1111/anae.12629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. D. O'Donnell
- Department of Anaesthesia; Cork University Hospital and University College Cork; Cork Ireland
| | - S. Szűcs
- Department of Anaesthesia; Mercy University Hospital; Cork Ireland
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Fiegel MJ. Noteworthy literature in regional anesthesia 2013. Semin Cardiothorac Vasc Anesth 2014; 18:29-35. [PMID: 24623805 DOI: 10.1177/1089253214522327] [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: 11/16/2022]
Abstract
The regional anesthesia literature was quite active in the calendar year 2013. In typical fashion, the literature was composed of articles representing neuraxial analgesia, peripheral nerve blocks, patient outcomes, regional anesthesia adjuvant medications, and patient safety. The goal of this article is to summarize and present the most relevant articles from each of these arenas.
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