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Selvamani BJ, Kalagara H, Volk T, Narouze S, Childs C, Patel A, Seering MS, Benzon HT, Sondekoppam RV. Infectious complications following regional anesthesia: a narrative review and contemporary estimates of risk. Reg Anesth Pain Med 2024:rapm-2024-105496. [PMID: 38839428 DOI: 10.1136/rapm-2024-105496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Infectious complications following regional anesthesia (RA) while rare, can be devastating. The objective of this review was to estimate the risk of infectious complications following central neuraxial blocks (CNB) such as epidural anesthesia (EA), spinal anesthesia (SA) and combined spinal epidural (CSE), and peripheral nerve blocks (PNB). MATERIALS AND METHODS A literature search was conducted in PubMed, Embase and Cochrane databases to identify reference studies reporting infectious complications in the context of RA subtypes. Both prospective and retrospective studies providing incidence of infectious complications were included for review to provide pooled estimates (with 95% CI). Additionally, we explored incidences specifically associated with spinal anesthesia, incidences of central nervous system (CNS) infections and, the incidences of overall and CNS infections following CNB in obstetric population. RESULTS The pooled estimate of overall infectious complications following all CNB was 9/100 000 (95% CI: 5, 13/100 000). CNS infections following all CNB was estimated to be 2/100 000 (95% CI: 1, 3/100 000) and even rarer following SA (1/100 000 (95% CI: 1, 2/100 000)). Obstetric population had a lower rate of overall (1/100 000 (95% CI: 1, 3/100 000)) and CNS infections (4 per million (95% CI: 0.3, 1/100 000)) following all CNB. For PNB catheters, the reported rate of infectious complications was 1.8% (95% CI: 1.2, 2.5/100). DISCUSSION Our review suggests that the risk of overall infectious complications following neuraxial anesthesia is very rare and the rate of CNS infections is even rarer. The infectious complications following PNB catheters seems significantly higher compared with CNB. Standardizing nomenclature and better reporting methodologies are needed for the better estimation of the infectious complications.
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Affiliation(s)
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Samer Narouze
- Western Reserve Hospital Partners, Cuyahoga Falls, Ohio, USA
| | | | - Aamil Patel
- University of Iowa Health Care, Iowa City, Iowa, USA
| | | | - Honorio T Benzon
- Departments of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa, USA
- Department of Anesthesia and Pain Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Hewson DW, Tedore TR, Hardman JG. Impact of spinal or epidural anaesthesia on perioperative outcomes in adult noncardiac surgery: a narrative review of recent evidence. Br J Anaesth 2024:S0007-0912(24)00261-7. [PMID: 38811298 DOI: 10.1016/j.bja.2024.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
Spinal and epidural anaesthesia and analgesia are important anaesthetic techniques, familiar to all anaesthetists and applied to patients undergoing a range of surgical procedures. Although the immediate effects of a well-conducted neuraxial technique on nociceptive and sympathetic pathways are readily observable in clinical practice, the impact of such techniques on patient-centred perioperative outcomes remains an area of uncertainty and active research. The aim of this review is to present a narrative synthesis of contemporary clinical science on this topic from the most recent 5-year period and summarise the foundational scholarship upon which this research was based. We searched electronic databases for primary research, secondary research, opinion pieces, and guidelines reporting the relationship between neuraxial procedures and standardised perioperative outcomes over the period 2018-2023. Returned citation lists were examined seeking additional studies to contextualise our narrative synthesis of results. Articles were retrieved encompassing the following outcome domains: patient comfort, renal, sepsis and infection, postoperative cancer, cardiovascular, and pulmonary and mortality outcomes. Convincing evidence of the beneficial effect of epidural analgesia on patient comfort after major open thoracoabdominal surgery outcomes was identified. Recent evidence of benefit in the prevention of pulmonary complications and mortality was identified. Despite mechanistic plausibility and supportive observational evidence, there is less certain experimental evidence to support a role for neuraxial techniques impacting on other outcome domains. Evidence of positive impact of neuraxial techniques is best established for the domains of patient comfort, pulmonary complications, and mortality, particularly in the setting of major open thoracoabdominal surgery. Recent evidence does not strongly support a significant impact of neuraxial techniques on cancer, renal, infection, or cardiovascular outcomes after noncardiac surgery in most patient groups.
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Affiliation(s)
- David W Hewson
- Department of Anaesthesia and Critical Care, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Tiffany R Tedore
- Department of Anesthesiology, Weill Cornell Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Jonathan G Hardman
- Department of Anaesthesia and Critical Care, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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Domagalska M, Ciftsi B, Janusz P, Reysner T, Daroszewski P, Kowalski G, Wieczorowska-Tobis K, Kotwicki T. Effectiveness of the Bilateral and Bilevel Erector Spinae Plane Block (ESPB) in Pediatric Idiopathic Scoliosis Surgery: A Randomized, Double-Blinded, Controlled Trial. J Pediatr Orthop 2024:01241398-990000000-00549. [PMID: 38689466 DOI: 10.1097/bpo.0000000000002707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND This study aimed to compare the effect of the ultrasound-guided bilateral and bilevel erector spinae plane block (ESPB) on pain scores, opioid requirement, intraoperative motor-evoked potentials (MEPs), and stress response to surgery expressed by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) versus standard analgesia methods following idiopathic scoliosis surgery. METHODS This was a prospective, double-blinded, randomized controlled trial. Sixty patients aged 10 to 18 years and physical status ASA 1 or 2 were randomized into 2 equal groups, each receiving an ESPB or sham block. The primary outcome was the pain scores (Numerical Rating Scale, NRS) within 48 hours after spinal correction and fusion surgery for idiopathic thoracic scoliosis. The secondary outcomes were total opioid consumption, NLR, and PLR levels at 12 and 24 hours postoperatively and intraoperative MEPs. RESULTS ESPB patients presented lower NRS scores, signifying less pain, at all time points (30, 60, 90, 120 min; and 6, 12, 24, and 48 h after surgery), all P<0.0001. The total opioid consumption, the incidence of nausea or vomiting, and the need for remifentanil and propofol during surgery were significantly lower in the ESPB group. The surgery-induced stress response expressed by NLR and PLR was considerably lower in the ESPB group. ESPB did not affect the intraoperative MEP's amplitude. CONCLUSIONS ESPB is effective for postoperative analgesia, can reduce opioid consumption in patients undergoing scoliosis surgery, and reduces the stress response to surgery. ESPB does not interfere with neuromonitoring. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | - Bahadir Ciftsi
- Departments of Spine Disorders and Pediatric Orthopedics
| | - Piotr Janusz
- Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
| | - Tomasz Reysner
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences
| | - Przemysław Daroszewski
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
| | - Grzegorz Kowalski
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences
| | | | - Tomasz Kotwicki
- Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
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Ganesh A, Maher J, Record S, Welsby I, Lidsky ME. Thoracic Epidural Analgesia for Hepatic Arterial Infusion Pump Implantation. Anesth Analg 2024; 138:692-693. [PMID: 38109846 DOI: 10.1213/ane.0000000000006800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Arun Ganesh
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - James Maher
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Sydney Record
- Duke University School of Medicine, Durham, North Carolina
| | - Ian Welsby
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Michael E Lidsky
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Oostvogels L, Weibel S, Meißner M, Kranke P, Meyer-Frießem CH, Pogatzki-Zahn E, Schnabel A. Erector spinae plane block for postoperative pain. Cochrane Database Syst Rev 2024; 2:CD013763. [PMID: 38345071 PMCID: PMC10860379 DOI: 10.1002/14651858.cd013763.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Acute and chronic postoperative pain are important healthcare problems, which can be treated with a combination of opioids and regional anaesthesia. The erector spinae plane block (ESPB) is a new regional anaesthesia technique, which might be able to reduce opioid consumption and related side effects. OBJECTIVES To compare the analgesic effects and side effect profile of ESPB against no block, placebo block or other regional anaesthetic techniques. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Web of Science on 4 January 2021 and updated the search on 3 January 2022. SELECTION CRITERIA Randomised controlled trials (RCTs) investigating adults undergoing surgery with general anaesthesia were included. We included ESPB in comparison with no block, placebo blocks or other regional anaesthesia techniques irrespective of language, publication year, publication status or technique of regional anaesthesia used (ultrasound, landmarks or peripheral nerve stimulator). Quasi-RCTs, cluster-RCTs, cross-over trials and studies investigating co-interventions in either arm were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all trials for inclusion and exclusion criteria, and risk of bias (RoB), and extracted data. We assessed risk of bias using the Cochrane RoB 2 tool, and we used GRADE to rate the certainty of evidence for the primary outcomes. The primary outcomes were postoperative pain at rest at 24 hours and block-related adverse events. Secondary outcomes were postoperative pain at rest (2, 48 hours) and during activity (2, 24 and 48 hours after surgery), chronic pain after three and six months, as well as cumulative oral morphine requirements at 2, 24 and 48 hours after surgery and rates of opioid-related side effects. MAIN RESULTS We identified 69 RCTs in the first search and included these in the systematic review. We included 64 RCTs (3973 participants) in the meta-analysis. The outcome postoperative pain was reported in 38 out of 64 studies; block-related adverse events were reported in 40 out of 64 studies. We assessed RoB as low in 44 (56%), some concerns in 24 (31%) and high in 10 (13%) of the study results. Overall, 57 studies reported one or both primary outcomes. Only one study reported results on chronic pain after surgery. In the updated literature search on 3 January 2022 we found 37 new studies and categorised these as awaiting classification. ESPB compared to no block There is probably a slight but not clinically relevant reduction in pain intensity at rest 24 hours after surgery in patients treated with ESPB compared to no block (visual analogue scale (VAS), 0 to 10 points) (mean difference (MD) -0.77 points, 95% confidence interval (CI) -1.08 to -0.46; 17 trials, 958 participants; moderate-certainty evidence). There may be no difference in block-related adverse events between the groups treated with ESPB and those receiving no block (no events in 18 trials reported, 1045 participants, low-certainty evidence). ESPB compared to placebo block ESPB probably has no effect on postoperative pain intensity at rest 24 hours after surgery compared to placebo block (MD -0.14 points, 95% CI -0.29 to 0.00; 8 trials, 499 participants; moderate-certainty evidence). There may be no difference in block-related adverse events between ESPB and placebo blocks (no events in 10 trials reported; 592 participants; low-certainty evidence). ESPB compared to other regional anaesthetic techniques Paravertebral block (PVB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to PVB (MD 0.23 points, 95% CI -0.06 to 0.52; 7 trials, 478 participants; low-certainty evidence). There is probably no difference in block-related adverse events (risk ratio (RR) 0.27, 95% CI 0.08 to 0.95; 7 trials, 522 participants; moderate-certainty evidence). Transversus abdominis plane block (TAPB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to TAPB (MD -0.16 points, 95% CI -0.46 to 0.14; 3 trials, 160 participants; low-certainty evidence). There may be no difference in block-related adverse events (RR 1.00, 95% CI 0.21 to 4.83; 4 trials, 202 participants; low-certainty evidence). Serratus anterior plane block (SAPB) The effect on postoperative pain could not be assessed because no studies reported this outcome. There may be no difference in block-related adverse events (RR 1.00, 95% CI 0.06 to 15.59; 2 trials, 110 participants; low-certainty evidence). Pectoralis plane block (PECSB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to PECSB (MD 0.24 points, 95% CI -0.11 to 0.58; 2 trials, 98 participants; low-certainty evidence). The effect on block-related adverse events could not be assessed. Quadratus lumborum block (QLB) Only one study reported on each of the primary outcomes. Intercostal nerve block (ICNB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to ICNB, but this is uncertain (MD -0.33 points, 95% CI -3.02 to 2.35; 2 trials, 131 participants; very low-certainty evidence). There may be no difference in block-related adverse events, but this is uncertain (RR 0.09, 95% CI 0.04 to 2.28; 3 trials, 181 participants; very low-certainty evidence). Epidural analgesia (EA) We are uncertain whether ESPB has an effect on postoperative pain intensity at rest 24 hours after surgery compared to EA (MD 1.20 points, 95% CI -2.52 to 4.93; 2 trials, 81 participants; very low-certainty evidence). A risk ratio for block-related adverse events was not estimable because only one study reported this outcome. AUTHORS' CONCLUSIONS ESPB in addition to standard care probably does not improve postoperative pain intensity 24 hours after surgery compared to no block. The number of block-related adverse events following ESPB was low. Further research is required to study the possibility of extending the duration of analgesia. We identified 37 new studies in the updated search and there are three ongoing studies, suggesting possible changes to the effect estimates and the certainty of the evidence in the future.
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Affiliation(s)
- Lisa Oostvogels
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Stephanie Weibel
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Meißner
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Peter Kranke
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christine H Meyer-Frießem
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, BG-Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Alexander Schnabel
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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Omanik P, Funakova M, Babala J, Beder I. Devastating neurological complication after pectus excavatum surgery. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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Isaza E, Santos J, Haro GJ, Chen J, Weber DJ, Deuse T, Singer JP, Golden JA, Hays S, Trinh BN, Brzezinski M, Kukreja J. Intercostal Nerve Cryoanalgesia Versus Thoracic Epidural Analgesia in Lung Transplantation: A Retrospective Single-Center Study. Pain Ther 2023; 12:201-211. [PMID: 36274081 PMCID: PMC9845479 DOI: 10.1007/s40122-022-00448-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/07/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The optimal pain management strategy after lung transplantation is unknown. This study compared analgesic outcomes of intercostal nerve blockade by cryoanalgesia (Cryo) versus thoracic epidural analgesia (TEA). METHODS Seventy-two patients who underwent bilateral lung transplantation via clamshell incision at our center from 2016 to 2018 were managed with TEA (N = 43) or Cryo (N = 29). We evaluated analgesic-specific complications, opioid use in oral morphine equivalents (OME), and pain scores (0-10) through postoperative day 7. Adjusted linear regression was used to assess for non-inferiority of Cryo to TEA. RESULTS The overall mean pain scores (Cryo 3.2 vs TEA 3.8, P = 0.21), maximum mean pain scores (Cryo 4.7 vs TEA 5.5, P = 0.16), and the total opioid use (Cryo 484 vs TEA 705 OME, P = 0.12) were similar in both groups, while the utilization of postoperative opioid-sparing analgesia, measured as use of lidocaine patches, was lower in the Cryo group (Cryo 21% vs TEA 84%, P < 0.001). Analgesic outcomes remained similar between the cohorts after adjustment for pertinent patient and analgesic characteristics (P = 0.26), as well as after exclusion of Cryo patients requiring rescue TEA (P = 0.32). There were no Cryo complications, with four patients requiring subsequent TEA for pain control. Two TEA patients experienced hemodynamic instability following a test TEA bolus requiring code measures. Additionally, TEA placement was delayed beyond postoperative day 1 in 33% owing to need for anticoagulation or clinical instability. CONCLUSIONS In lung transplantation, Cryo was found to be safe with analgesic effectiveness similar to TEA. Cryo may be advantageous in this complex patient population, as it can be used in all clinical scenarios and eliminates risks and delays associated with TEA.
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Affiliation(s)
- Erin Isaza
- grid.266102.10000 0001 2297 6811School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jesse Santos
- grid.266102.10000 0001 2297 6811Department of Surgery, University of California, San Francisco, East Bay, San Francisco, USA
| | - Greg J. Haro
- grid.266102.10000 0001 2297 6811Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, 500 Parnassus Ave, Suite MUW-405, San Francisco, CA 94143-0118 USA
| | - Joy Chen
- grid.266102.10000 0001 2297 6811Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, 500 Parnassus Ave, Suite MUW-405, San Francisco, CA 94143-0118 USA
| | - Daniel J. Weber
- grid.266102.10000 0001 2297 6811Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, 500 Parnassus Ave, Suite MUW-405, San Francisco, CA 94143-0118 USA
| | - Tobias Deuse
- grid.266102.10000 0001 2297 6811Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, 500 Parnassus Ave, Suite MUW-405, San Francisco, CA 94143-0118 USA
| | - Jonathan P. Singer
- grid.266102.10000 0001 2297 6811Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jeffrey A. Golden
- grid.266102.10000 0001 2297 6811Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Steven Hays
- grid.266102.10000 0001 2297 6811Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Binh N. Trinh
- grid.266102.10000 0001 2297 6811Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, 500 Parnassus Ave, Suite MUW-405, San Francisco, CA 94143-0118 USA
| | - Marek Brzezinski
- grid.266102.10000 0001 2297 6811Department of Anesthesia, University of California, San Francisco, San Francisco, USA
| | - Jasleen Kukreja
- grid.266102.10000 0001 2297 6811Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, 500 Parnassus Ave, Suite MUW-405, San Francisco, CA 94143-0118 USA
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Pöpping DM, Wenk M. [Epidural anesthesia : Clinical application and current developments]. DIE ANAESTHESIOLOGIE 2022; 71:893-906. [PMID: 36264325 DOI: 10.1007/s00101-022-01209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Epidural anesthesia has been an established procedure in anesthesia for many years. Possibly due to its invasiveness, the associated fear of serious complications and the proliferation of alternative methods, an overall decline in its use can be observed. Several alternative procedures have been developed, especially the introduction of ultrasound into anesthesia, which are increasingly being used in clinical practice. The aim of this continuing medical education (CME) article is to shed light on the remaining range of indications for epidural anesthesia, to present the approaches and possible clinical benefits as well as to evaluate the effects that go beyond pure analgesia, according to the current evidence. In addition, potential complications and preventive approaches are discussed. This article is based on a literature search in PubMed and Google Scholar.
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Affiliation(s)
- Daniel M Pöpping
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Deutschland.
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Alte Landstraße 179, 40489, Düsseldorf, Deutschland
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Li Y, Zhang Q, Wang Y, Yin C, Guo J, Qin S, Zhang Y, Zhu L, Hou Z, Wang Q. Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial. BMC Musculoskelet Disord 2021; 22:735. [PMID: 34452610 PMCID: PMC8400756 DOI: 10.1186/s12891-021-04619-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/13/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives The aim of this study was to evaluate the postoperative analgesia effect of ultrasound-guided single popliteal sciatic nerve block for calcaneal fracture. Methods A total of 120 patients scheduled for unilateral open reduction and internal fixation of calcaneal fracture were enrolled in this prospective randomized study. Patients in group B received ultrasound-guided single popliteal sciatic nerve block after operation, but Patients in group A did not. All patients received patient-controlled intravenous analgesia (PCIA) after operation. The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use and the total number of times the patient pressed the analgesia pump were recorded. The time of rescue analgesia and the adverse reactions were recorded. Pain magnitude of the patients immediately after discharge from operating room (T1), and at 4th (T2), 8th (T3), 12th (T4), 16th (T5), 24th (T6) and 48th (T7) h after the operation were assessed with visual analog scale (VAS). In addition, patient, surgeon and nurse satisfaction were recorded. Results The VAS scores at T2 ~ T5, the time of rescue analgesia and the adverse reactions, the total number of times the patient pressed the analgesia pump were significantly declined in group B (p < 0.001). The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use were prolonged and patient surgeon and nurse satisfaction were improved in group B (p < 0.05). Conclusion Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture. Trial registration ChiCTR, ChiCTR2100042340. Registered 19 January 2021, URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=66526.
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Affiliation(s)
- Yanan Li
- Department of Anesthesiology, the Third Hospital of Hebei Medical University, NO.139, Ziqiang Road, Shijiazhuang, Hebei Province, China
| | - Qi Zhang
- Department of Anesthesiology, the Third Hospital of Hebei Medical University, NO.139, Ziqiang Road, Shijiazhuang, Hebei Province, China.,Department of Anesthesiology, Children's Hospital of Hebei province Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ying Wang
- Department of Anesthesiology, the Third Hospital of Hebei Medical University, NO.139, Ziqiang Road, Shijiazhuang, Hebei Province, China
| | - Chunping Yin
- Department of Anesthesiology, the Third Hospital of Hebei Medical University, NO.139, Ziqiang Road, Shijiazhuang, Hebei Province, China
| | - Junfei Guo
- Department of Orthopaedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Shiji Qin
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yahui Zhang
- Department of Nursing, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lian Zhu
- Department of Orthopaedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Zhiyong Hou
- Department of Orthopaedics, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Qiujun Wang
- Department of Anesthesiology, the Third Hospital of Hebei Medical University, NO.139, Ziqiang Road, Shijiazhuang, Hebei Province, China.
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Bos EM, van der Lee K, Haumann J, de Quelerij M, Vandertop WP, Kalkman CJ, Hollmann MW, Lirk P. Intracranial hematoma and abscess after neuraxial analgesia and anesthesia: a review of the literature describing 297 cases. Reg Anesth Pain Med 2021; 46:337-343. [PMID: 33441431 PMCID: PMC7982926 DOI: 10.1136/rapm-2020-102154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Besides spinal complications, intracranial hematoma or abscess may occur after neuraxial block. Risk factors and outcome remain unclear. OBJECTIVE This review evaluates characteristics, treatment and recovery of patients with intracranial complications after neuraxial block. EVIDENCE REVIEW We systematically searched MEDLINE, Embase and the Cochrane Library from their inception to May 2020 for case reports/series, cohort studies and reviews of intracranial hematoma or abscess associated with neuraxial block. Quality of evidence was assessed using the critical appraisal of a case study checklist by Crombie. FINDINGS We analyzed 232 reports, including 291 patients with hematoma and six patients with abscess/empyema. The major part of included studies comprised single case reports with a high risk of bias. Of the patients with hematoma, 48% concerned obstetric patients, the remainder received neuraxial block for various perioperative indications or pain management. Prior dural puncture was reported in 81%, either intended (eg, spinal anesthesia) or unintended (eg, complicated epidural catheter placement). Headache was described in 217 patients; in 101 patients, symptoms resembled postdural puncture headache (PDPH). After treatment, 11% had partial or no recovery and 8% died, indicating the severity of this complication. Intracranial abscess after neuraxial block is seldom reported; six reports were found. CONCLUSION Diagnosis of intracranial hematoma is often missed initially, as headache is assumed to be caused by cerebrospinal hypotension due to cerebrospinal fluid leakage, known as PDPH. Prolonged headache without improvement, worsening symptoms despite treatment or epidural blood patch, change of headache from postural to non-postural or new neurological signs should alert physicians to alternative diagnoses.
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Affiliation(s)
- Elke Me Bos
- Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Koen van der Lee
- Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - Marcel de Quelerij
- Anesthesiologie, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - W Peter Vandertop
- Neurosurgical Center Amsterdam, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Cor J Kalkman
- Anesthesiology, UMC Utrecht, Utrecht, The Netherlands
| | - Markus W Hollmann
- Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Philipp Lirk
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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11
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Schnabel A, Weibel S, Meißner M, Reichl SU, Kranke P, Meyer-Frießem CH, Zahn PK, Pogatzki-Zahn E. Erector spinae plane block for postoperative pain. Hippokratia 2020. [DOI: 10.1002/14651858.cd013763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Alexander Schnabel
- Department of Anesthesiology, Intensive Care and Pain Medicine; University Hospital Münster; Münster Germany
| | - Stephanie Weibel
- Department of Anesthesiology and Critical Care; University Hospital Wuerzburg; Wuerzburg Germany
| | - Michael Meißner
- Department of Anesthesiology, Intensive Care and Pain Medicine; University Hospital Münster; Münster Germany
| | - Sylvia U Reichl
- Department of Anesthesiology, Perioperative and Intensive Care Medicine; Paracelsus Medical University; Salzburg Austria
| | - Peter Kranke
- Department of Anesthesiology and Critical Care; University Hospital Wuerzburg; Wuerzburg Germany
| | - Christine H Meyer-Frießem
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management; BG-Universitätsklinikum Bergmannsheil gGmbH; Bochum Germany
| | - Peter K Zahn
- Department of Anaesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management; BG-Universitätsklinikum Bergmannsheil gGmbH; Bochum Germany
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine; University Hospital Münster; Münster Germany
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12
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Manassero A, Bossolasco M, Carrega M, Coletta G. Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients. Local Reg Anesth 2020; 13:111-119. [PMID: 32982397 PMCID: PMC7490049 DOI: 10.2147/lra.s272410] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications. Patients and Methods Patients received continuous infusion TEA (0.2% ropivacaine and 2 µg ml−1 fentanyl) to control postoperative pain. Every 8 hours, the acute pain service recorded the analgesia regimen and occurrence of side effects. The initial infusion rate was tapered daily in response to improvement in pain symptoms or occurrence of side effects. Results A total of 3126 patients received TEA. The median age was 65 years (range, 18–94) and the duration of catheter placement was 3.5 days (range, 2–8). Three major complications were identified (1:1042): two subarachnoid blocks and one epidural abscess which led to permanent sequela (1:3126). Minor complications were hypotension (4.8%), pruritus (4.4%), accidental catheter removal (3.7%), insertion site inflammation (2.5%), motor weakness (2.0%), postoperative nausea and vomiting (1.8%), catheter disconnection (1.9%), catheter occlusion (0.3%), post-dural puncture headache (0.5%), and catheter fragment retention (0.06%), which were the reasons for a 7.4% rate of early discontinuation of epidural analgesia. No occurrence of epidural hematoma, local anesthetic systemic toxicity, and cardiovascular/respiratory depression was recorded. Conclusion Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique.
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Affiliation(s)
- Alberto Manassero
- Department of Emergency and Critical Care, Division of Operating Room Management, S. Croce e Carle Hospital, Cuneo, Italy
| | - Matteo Bossolasco
- Department of Emergency and Critical Care, Division of Operating Room Management, S. Croce e Carle Hospital, Cuneo, Italy
| | - Mattia Carrega
- Department of Emergency and Critical Care, Division of Operating Room Management, S. Croce e Carle Hospital, Cuneo, Italy
| | - Giuseppe Coletta
- Department of Emergency and Critical Care, Division of Operating Room Management, S. Croce e Carle Hospital, Cuneo, Italy
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13
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Cata JP, Corrales G, Speer B, Owusu-Agyemang P. Postoperative acute pain challenges in patients with cancer. Best Pract Res Clin Anaesthesiol 2019; 33:361-371. [DOI: 10.1016/j.bpa.2019.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
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