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Ienello L, Byrne J, Tearney C, Franzen-Klein D, Ahlmann-Garcia A, Wendt-Hornickle E. Ultrasound-guided sciatic nerve block injections in barred owl (Strix varia) cadavers. Vet Anaesth Analg 2024; 51:558-565. [PMID: 39054197 DOI: 10.1016/j.vaa.2024.06.012] [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: 01/31/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To describe an ultrasound-guided approach to the sciatic nerve and the distribution of nerve staining using two injectate volumes of dye in barred owls. STUDY DESIGN Descriptive, randomized, assessor-blinded, cadaveric study. ANIMALS Twelve barred owl cadavers. METHODS The sciatic nerve was visualized with a 13-6 MHz linear ultrasound probe placed on the medial aspect of the proximal femur in barred owl cadavers. A needle was inserted at the proximal caudal thigh, and cranially advanced in-plane until the tip was immediately adjacent and ventral to the sciatic nerve. Eleven owls were injected bilaterally with a 1:1 solution of 1% methylene blue and 0.5% ropivacaine, with high-volume (HV; 0.4 mL kg-1) and low-volume (LV; 0.2 mL kg-1) treatments. Nerve staining ≥ 1 cm circumferentially was determined by dissection 15 minutes post-injection. The coelom was then opened to inspect for aberrant dye spread. In one barred owl cadaver, a 1:1 solution of 1% methylene blue and 74% ioversol contrast was injected, and computed tomography was performed immediately before and 15 minutes after injection for evaluation of injectate spread. RESULTS The HV treatment (0.4 mL kg-1) resulted in successful nerve staining in 100% of injections, whereas the LV treatment (0.2 mL kg-1) resulted in successful nerve staining in 91% of injections. There was no leakage of injectate into undesired locations (e.g. coelomic cavity) in any cadaver. CONCLUSIONS AND CLINICAL RELEVANCE In barred owls, the sciatic nerve can be visualized with ultrasound and injecting a ropivacaine/dye solution under ultrasound guidance successfully stained the sciatic nerve in the majority of cases. This technique holds potential for providing analgesia distal to the stifle joint; however, further investigations are necessary to evaluate its practical application in a clinical setting.
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Affiliation(s)
- Lauren Ienello
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA.
| | - Jessica Byrne
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Caitlin Tearney
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | | | | | - Erin Wendt-Hornickle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
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Sherazi AW, Zamir A, Rehman AU, Ashraf W, Imran I, Saeed H, Majeed A, Saleem Z, Aziz M, Alqahtani F, Rasool MF. A Systematic Critical Review of Clinical Pharmacokinetics of Torasemide. Ther Drug Monit 2024; 46:309-320. [PMID: 38176856 DOI: 10.1097/ftd.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/10/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Torasemide is a potassium-sparing loop diuretic used to treat fluid retention associated with congestive heart failure and kidney and hepatic diseases. This systematic review was conducted to combine all accessible data on the pharmacokinetics (PK) of torasemide in healthy and diseased populations, which may help clinicians avert adverse drug reactions and determine the correct dosage regimen. METHODS Four databases were systematically searched to screen for studies associated with the PK of torasemide, and 21 studies met the eligibility criteria. The review protocol was registered in the PROSPERO database (CRD42023390178). RESULTS A decrease in maximum plasma concentration (C max ) was observed for torasemide after administration of the prolonged-release formulation in comparison to that after administration of the immediate-release formulation, that is, 1.12 ± 0.17 versus 1.6 ± 0.2 mcg/mL. After administering an oral dose of torasemide, a 2-fold increase in the area under the concentration-time curve (AUC) was reported in patients with congestive heart failure compared with the healthy population. Moreover, the patients with renal failure (clearance < 30 mL/min) showed an increase in value of AUC 0-∞ that is, 42.9 versus 8.091 mcg.h -1 .mL -1 compared with healthy subjects. In addition, some studies have reported interactions with different drugs, in which irbesartan showed a slight increase in the AUC 0-∞ of torasemide, whereas losartan and empagliflozin did not. CONCLUSIONS The current review summarizes all available PK parameters of torasemide that may be beneficial for avoiding drug-drug interactions in subjects with renal and hepatic dysfunction and for predicting doses in patients with different diseases.
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Affiliation(s)
- Abdul Wasay Sherazi
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Ammara Zamir
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees Ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Waseem Ashraf
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Abdul Majeed
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; and
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Majid Aziz
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; and
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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Saleem T, Zamir A, Rasool MF, Imran I, Saeed H, Alqahtani F. Exploring the pharmacokinetics of second-generation cephalosporin, cefaclor: a systematic review in healthy and diseased populations. Xenobiotica 2024; 54:171-181. [PMID: 38517680 DOI: 10.1080/00498254.2024.2333009] [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: 01/01/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
Cefaclor is a bactericidal antibiotic recommended for treating diverse types of infections. This review aims to comprehensively assess the pharmacokinetic (PK) data on cefaclor in humans.Google Scholar, PubMed, Cochrane Library, and EBSCO databases were systematically performed to identify all the relevant studies containing at least one reported PK parameter of cefaclor.Cefaclor shows the linear PK profile as the area under the plasma concentration-time curve from 0 to t (AUC0-t) and maximum plasma concentration (Cmax) increase in a dose-dependent manner. The AUC0-t of cefaclor in the rice diet was found to be higher than that of bread food, i.e. 19.9 ± 2.6 ug/ml.hr vs 15.4 ± 4 ug/ml.hr. The AUC in paediatrics during the fed state was significantly higher compared to that in adults. Patients with renal impairments showed a Cmax 2.2 times higher than that of normal subjects. A significant increase in Cmax was depicted among individuals following a vegetarian diet in comparison with the non-vegetarian diet. Moreover, cefaclor exhibits time-dependent killing above the minimum inhibitory concentration (MIC < 2 ug), favouring its use in treating infections caused by specific pathogens.This systematic review summarises all the reported PK parameters of cefaclor in healthy and diseased subjects in the literature. This data can help practitioners in adjusting cefaclor doses among different diseases and populations to avoid drug interactions and adverse effects.
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Affiliation(s)
- Tahir Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Ammara Zamir
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, Allama Iqbal Campus, University of the Punjab, Lahore, Pakistan
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Hanif N, Zamir A, Imran I, Saeed H, Majeed A, Rehman AU, Ashraf W, Alqahtani F, Rasool MF. Clinical pharmacokinetics of nebivolol: a systematic review. Drug Metab Rev 2023; 55:428-440. [PMID: 37849071 DOI: 10.1080/03602532.2023.2271195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
Nebivolol is a beta-1 receptor blocker used to treat hypertension, heart failure, erectile dysfunction, vascular disease, and diabetes mellitus. This review investigated the data regarding pharmacokinetic (PK) parameters, drug-drug interactions, dextrorotatory (D), and levorotatory (L) stereoisomers of nebivolol. The articles related to the PK of nebivolol were retrieved by searching the five databases; Google Scholar, PubMed, Cochrane Library, ScienceDirect, and EBSCO. A total of 20 studies comprising plasma concentration-time profile data following the nebivolol's oral and intravenous (IV) administration were included. The area under the concentration-time curve from zero to infinity (AUC0-∞) was 15 times greater in poor metabolizers (PMs) than in extensive metabolizers (EMs). In hypertensive patients, L-nebivolol expressed a higher maximum plasma concentration (Cmax) than D-nebivolol, i.e. 2.5 ng/ml vs 1.2 ng/ml. The AUC0-∞ of nebivolol was 3-fold greater in chronic kidney disease (CKD). The clearance (CL) was increased in obese than in controls from 51.6 ± 11.6 L/h to 71.6 ± 17.4 L/h when 0.5 mg/ml IV solution was infused. Nebivolol showed higher Cmax, AUC0-∞ and half-life (t1/2) when co-administered with bupropion, duloxetine, fluvoxamine, paroxetine, lansoprazole, and fluoxetine. This concise review of nebivolol would be advantageous in assessing all PK parameters, which may be crucial for clinicians to avoid drug-drug interactions, prevent adverse drug events and optimize the dosage regimen in diseased patients diagnosed with hypertension and cardiovascular disorders.
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Affiliation(s)
- Nida Hanif
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Ammara Zamir
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, Allama Iqbal Campus, University of the Punjab, Lahore, Pakistan
| | - Abdul Majeed
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees Ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Waseem Ashraf
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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Wagner KJ, Beck JJ, Carsen S, Crepeau AE, Cruz AI, Ellis HB, Mayer SW, Niu E, Pennock AT, Stinson ZS, VandenBerg C, Ellington MD. Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction. J Pediatr Orthop 2023; 43:e278-e283. [PMID: 36728478 DOI: 10.1097/bpo.0000000000002344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The opioid epidemic in the United States is a public health crisis. Pediatric orthopaedic surgeons must balance adequate pain management with minimizing the risk of opioid misuse or dependence. There is limited data available to guide pain management for anterior cruciate ligament reconstruction (ACLR) in the pediatric population. The purpose of this study was to survey current pain management practices for ACLR among pediatric orthopaedic surgeons. METHODS A cross-sectional survey study was conducted, in which orthopaedic surgeons were asked about their pain management practices for pediatric ACLR. The voluntary survey was sent to members of the Pediatric Orthopaedic Society of North America. Inclusion criteria required that the surgeon perform anterior cruciate ligament repair or reconstruction on patients under age 18. Responses were anonymous and consisted of surgeon demographics, training, practice, and pain management strategies. Survey data were assessed using descriptive statistics. RESULTS Of 64 included responses, the average age of the survey respondent was 48.9 years, 84.4% were males, and 31.3% practiced in the southern region of the United States. Preoperative analgesia was utilized by 39.1%, 90.6% utilized perioperative blocks, and 89.1% prescribed opioid medication postoperatively. For scheduled non-narcotic medications postoperatively 82.8% routinely advocated and 93.8% recommended cryotherapy postoperatively.Acetaminophen was the most used preoperative medication (31.3%), the most common perioperative block was an adductor canal block (81.0%), and the most common postoperative analgesic medication was ibuprofen (60.9%). Prior training or experience was more frequently reported than published research as a primary factor influencing pain management protocols. CONCLUSIONS Substantial variability exists in pain management practices in pediatric ACLR. There is a need for more evidence-based practice guidelines regarding pain management. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | | | - Sasha Carsen
- Children's Hospital of Eastern Ontario, ON, Canada
| | | | | | - Henry B Ellis
- Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical School, Dallas, TX
| | | | - Emily Niu
- Children's National Medical Center, Washington DC
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Muacevic A, Adler JR. Peripheral Nerve Stimulator Versus Ultrasound-Guided Femoral Nerve Block for Knee Arthroscopy Procedures: A Randomized Controlled Trial. Cureus 2022; 14:e32043. [PMCID: PMC9710297 DOI: 10.7759/cureus.32043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
Background Femoral nerve block (FNB) provides effective analgesia and is a widely used technique for postoperative pain relief for orthopedic procedures on lower limbs. This study aims to compare the efficacy of ultrasonography (USG) versus peripheral nerve stimulator (PNS)-guided FNB in knee arthroscopic procedures. Methodology This randomized comparative study included two study groups with 30 participants in each group who were given FNB with either PNS or USG for knee arthroscopic procedures following spinal anesthesia. The study evaluated the number of needle repositioning, the time taken for performing the block, the efficacy of postoperative analgesia based on the duration of the block, and patient satisfaction. Results The number of needle repositioning and time taken to finish the procedure using USG was lower compared to the group using PNS (p < 0.001). The duration of the block was comparable in both groups (p = 0.584). Patients were satisfied with both techniques and responded as either very good or outstanding and chose neither as inferior (p = 0.310). Conclusions Both techniques have equal efficacy concerning the duration of the effect of the block and patient satisfaction. However, the procedural time and number of needle repositioning were significantly less in the group where USG was used for the block.
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Oliver JA, Oliver LA, Aggarwal N, Baldev K, Wood M, Makusha L, Vadivelu N, Lichtor L. Ambulatory Pain Management in the Pediatric Patient Population. Curr Pain Headache Rep 2022; 26:15-23. [PMID: 35129824 DOI: 10.1007/s11916-022-00999-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Outpatient surgery in the pediatric population has become increasingly common. However, many patients still experience moderate to severe postoperative pain. A poor understanding of the extent of pain after pediatric ambulatory surgery and the lack of randomized control studies of pain management of the outpatient necessitate this review of scientific evidence and multimodal analgesia. RECENT FINDINGS A multimodal approach to pain management should be applied to the ambulatory setting to decrease postoperative pain. These include non-pharmacological techniques, multimodal pharmacologics, and neuraxial and peripheral nerve blocks. Postoperative pain management in pediatric ambulatory surgical patients remains suboptimal at most centers due to limited evidence-based approach to postoperative pain control. Pediatric ambulatory pain management requires a multipronged approach to address this inadequacy.
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Affiliation(s)
- Jodi-Ann Oliver
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Lori-Ann Oliver
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Nitish Aggarwal
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA.
| | - Khushboo Baldev
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Melanie Wood
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Lovemore Makusha
- Department of Anesthesiology, Stanford University, Pao Alto, CA, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Lance Lichtor
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
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Ozen V. Comparison of the postoperative analgesic effects of US-guided caudal block and US-guided pudendal nerve block in circumcision. Int J Clin Pract 2021; 75:e14366. [PMID: 33993633 DOI: 10.1111/ijcp.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022] Open
Abstract
AIM To compare the postoperative analgesic efficacy and postoperative complications of the pudendal nerve block (PNB) and caudal block (CB) with ultrasound (US). STUDY DESIGN A prospective observational study. METHODS This study was included male patients aged between 4 and 12 years in the ASA I-II group and scheduled for circumcision. A low-dose CB or US-guided PNB was administered under general anaesthesia before the operation. Postoperative pain was evaluated using the Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Faces Pain Scale-Revised. Postoperative analgesic need was also noted. RESULTS The study was completed with a total of 100 patients consisting of 50 patients who received a CB and 50 who received a PNB. Intraoperative block failure was not seen in any patient. The mean CHEOPS score (P < .001) and the 6th (P = .003) and 12th hours (P < .001) CHEOPS scores were found to be statistically significantly higher in the CB group. There were no postoperative side effects in the PNB group with a statistically significant difference compared with the CB group (P = .027). CONCLUSION This first prospective study in the literature shows that US-guided PNB provided a more pronounced and longer analgesic effect and resulted in less requirement for postoperative analgesics than US-guided CB.
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Affiliation(s)
- Volkan Ozen
- Department of Anesthesiology and Reanimation, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Karim WA, Bathla S, Malik S, Arora D. Comparison of Ultrasoundguided Ilioinguinal Iliohypogastric Nerve Block with Wound Infiltration during Pediatric Herniotomy Surgeries. Anesth Essays Res 2020; 14:243-247. [PMID: 33487823 PMCID: PMC7819410 DOI: 10.4103/aer.aer_22_20] [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: 03/10/2020] [Revised: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: The purpose of this study was to compare the analgesic efficacy of the ilioinguinal-iliohypogastric nerve block (II/IH) with local wound infiltration in children undergoing herniotomy surgeries. Methods: After ethics committee approval and informed consent, 100 children aged 6 months–7 years posted for herniotomy surgeries were randomly divided into Group B and Group W. Local wound infiltration was performed in Group W by the surgeon at the time of port placement and the end of the surgery with 0.2 mL.kg−1 of 0.25% bupivacaine. Ipsilateral II/IH was performed in Group B at the end of the surgery, under ultrasonographic guidance with a Sonosite portable ultrasound unit and a linear 5–10 MHz probe with a 22G hypodermic needle, and 0.2 mL.kg−1 of 0.25% bupivacaine was used on each side. The parameters recorded were postoperative hemodynamics, paracetamol and opioid requirements, postoperative pain scores, postoperative nausea vomiting, and the need for rescue analgesia in the first 6 h postoperatively. Results: The median pain scores were significantly lower in the II/IH group than the local wound infiltration group at 10 min (2 [0–2.5] compared to 2 [3–4]; P = 0.011), 30 min (1.5 [0–3] compared to 3 [2–5]; P < 0.001), 1 h (1.5 [0–2] compared to 2 [2–3]; P < 0.001) and 2 h (2 [0–2] compared to 2 [1.5–2.5]; P = 0.010) postoperatively. The need for postoperative opioids and rescue analgesia was also significantly lower in the II/IH group (P < 0.001). Conclusion: II/IH is superior to local wound infiltration for postoperative analgesia in pediatric herniotomy surgeries.
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Affiliation(s)
- Wahaja A Karim
- Department of Anaesthesia, VMMC and Safdarjung Hospital, Delhi, India
| | - Sapna Bathla
- Department of Anaesthesia, VMMC and Safdarjung Hospital, Delhi, India
| | - Shraddha Malik
- Department of Anaesthesia, Rajiv Gandhi Super Speciality Hospital, Delhi, India
| | - Deep Arora
- Department of Anaesthesia, Medanta Medicity, Gurugram, Haryana, India
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Our Ultrasound Guided Brachial Plexus Block Experiences for Upper Extremity Surgeries in Pediatric Patients. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:231-235. [PMID: 32617065 PMCID: PMC7326672 DOI: 10.14744/semb.2018.98958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/26/2018] [Indexed: 11/20/2022]
Abstract
Objectives: Brachial plexus block is the most effective analgesia and anesthesia procedure for the upper extremity surgeries in pediatric patients. In recent years, ultrasound guidance for this procedure has reduced the fail and complications like pneumothorax, intravascular injection and nerve damage. However, the number of studies about brachial plexus block is not enough, particularly in pediatric patients, which remained under-researched. In our study, we aimed to discuss the efficacy and safety of the ultrasound-guided brachial plexus block in pediatric patients by retrospectively examining their data. Methods: We retrospectively reviewed the data of pediatric patients who underwent ultrasound-guided brachial block in our clinic between January 2015-January 2017. Demographic data, diagnosis, procedure and operation times, medications, motor and sensorial block times were recorded. Results: Between January 2015 and January 2017, the number of pediatric patients who underwent ultrasound-guided peripheral nerve block in our clinic was 24. In 15 of these patients, the supraclavicular block was applied in 15, and the infraclavicular block was applied in nine patients. The mean age of the patients was 9.6±3.12, with a male/female ratio 14/10. The mean duration of the procedure was 9.54±2.14 minutes in patients for the supraclavicular block and 12.9 ± 2.8 minutes for the infraclavicular block. The mean surgery time was 64±13.6 minutes. As a local anesthetic, bupivacaine was used in three patients; bupivacaine+lidocaine combination was used in 21 patients and adjuvants were added in eight patients. The block procedure was performed under general anesthesia in 12 patients and under sedation in 12 patients. The mean motor block time was 7.5±2 hours in patients who received supraclavicular block, and 7.4±1.5 hours in patients who received infraclavicular block. The mean sensorial block time was 10.5±1.7 hours in the supraclavicular block, and 10.45±1.15 hours in the infraclavicular block. The mean motor block period with added adjuvants was 7.7±0.5 hours, and the sensorial block period was 11.12±1.1 hours. No complications were seen during the procedure, intraoperative and postoperative follow-up. Conclusion: Ultrasound-guided brachial plexus block in pediatric patients is effective and safe, with longer analgesia duration and lower complication rates. Prospective studies with a larger number of patients are needed in this regard.
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Ozen V, Yigit D. A comparison of the postoperative analgesic effectiveness of low dose caudal epidural block and US-guided dorsal penile nerve block with in-plane technique in circumcision. J Pediatr Urol 2020; 16:99-106. [PMID: 31759904 DOI: 10.1016/j.jpurol.2019.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/22/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Circumcision can be performed under sedo-analgesia, general anesthesia, or regional anesthesia. It may cause serious postoperative pain and patients often require additional analgesia. Dorsal penile nerve block (DPNB) and caudal epidural block are commonly used regional anesthesia methods to provide effective postoperative pain control in circumcision. OBJECTIVE In this prospective observational study, we aimed to investigate the postoperative analgesic efficiency of DPNB with the ultrasound (US)-guided in-plane technique and single-dose caudal epidural block in circumcision. STUDY DESIGN Male patients aged 4-12 years in the ASA I-II group, who were scheduled for circumcision, were included in the study. A caudal epidural block or US-guided DPNB with the in-plane technique was administered under general anesthesia before the operation. Postoperative pain was evaluated using the Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Faces Pain Scale-Revised (FPS-R). Postoperative analgesic need and parental satisfaction were also noted. RESULTS There were 140 patients in our study. The number of patients receiving a caudal block (n = 70) and DPNB block (n = 70) was equal. Side effects were only seen in five patients in the caudal group. No side effects were seen in patients in the DPNB group. Analgesics were required in 3.6% of the patients in the caudal group and none of the patients in the DPNB group postoperatively. CHEOPS mean scores in the caudal block group were found to be statistically significantly higher than in the penile block group. FPS-R 24th. hour mean score was statistically significantly higher in the caudal block group (P < 0.001). Postoperative parental satisfaction in the penile block group was found to be statistically significantly better than in the caudal block group (P = 0.028). DISCUSSION This study demonstrated that DPNB conducted with the US-guided in-plane technique was more effective than caudal block in providing postoperative analgesia. The parental satisfaction was also higher, and no side effect was seen in the DPNB group. CONCLUSION DPNB conducted with the US-guided in-plane technique is a simple and safe regional anesthesia method used to provide effective postoperative analgesia for male circumcision. Complications related to DPNB can be prevented with the help of the real-time imaging provided by ultrasound.
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Affiliation(s)
- Volkan Ozen
- Okmeydanı Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Dogakan Yigit
- Okmeydanı Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey.
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Mori T, Nomura O, Ihara T. Ultrasound-guided peripheral forearm nerve block for digit fractures in a pediatric emergency department. Am J Emerg Med 2019; 37:489-493. [DOI: 10.1016/j.ajem.2018.11.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/20/2018] [Accepted: 11/23/2018] [Indexed: 11/25/2022] Open
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Hecht S, Piñeda J, Bayne A. Ultrasound-guided Pudendal Block Is a Viable Alternative to Caudal Block for Hypospadias Surgery: A Single-Surgeon Pilot Study. Urology 2018; 113:192-196. [DOI: 10.1016/j.urology.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
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15
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Abstract
Effective perioperative pain control in pediatric patients undergoing orthopedic surgery remains a challenge. Developing a successful pain control regimen begins preoperatively with assessment of the patient and discussion with the patient and family regarding expectations. Perioperative pain control regimens are customized based on the type of surgery, patient characteristics, and anticipated severity and duration of the postoperative pain. Recent study focuses on multimodal strategies and regional anesthesia options, allowing for decreased opioid use. This article provides an evidence-based overview of preoperative, intraoperative, and postoperative pain control for the pediatric orthopedic patient.
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Can we use lower volume of local anesthetic for infraclavicular brachial plexus nerve block under ultrasound guidance in children? J Clin Anesth 2017; 41:132-136. [DOI: 10.1016/j.jclinane.2016.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 12/04/2016] [Accepted: 12/27/2016] [Indexed: 11/22/2022]
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Wroe P, O'Shea R, Johnson B, Hoffman R, Nagdev A. Ultrasound-guided forearm nerve blocks for hand blast injuries: case series and multidisciplinary protocol. Am J Emerg Med 2016; 34:1895-7. [PMID: 27461885 DOI: 10.1016/j.ajem.2016.06.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Peter Wroe
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
| | - Ryan O'Shea
- Department of Orthopedics, Alameda Health System, Highland Hospital, Oakland, CA
| | - Brian Johnson
- University of Washington Medicine-Valley Medical Center, Renton, WA
| | - Robert Hoffman
- Department of Orthopedics, Alameda Health System, Highland Hospital, Oakland, CA
| | - Arun Nagdev
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA
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18
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Ríos-Medina AM, Caicedo-Salazar J, Vásquez-Sadder MI, Aguirre-Ospina OD, González MP. Regional anesthesia in pediatrics – Non-systematic literature review. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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19
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Anestesia regional en pediatría – Revisión no sistemática de la literatura. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Shah RD, Cappiello D, Suresh S. Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence. Pain Pract 2015; 16:359-69. [DOI: 10.1111/papr.12285] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 12/09/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Ravi D. Shah
- Department of Pediatric Anesthesiology; Ann & Robert H. Lurie Children's Hospital; Northwestern University Feinberg School of Medicine; Chicago Illinois U.S.A
| | - Dario Cappiello
- Department of Anesthesiology; Pain and Intensive Care Medicine; University School of Medicine Campus Bio-Medico of Rome; Rome Italy
| | - Santhanam Suresh
- Department of Pediatric Anesthesiology; Ann & Robert H. Lurie Children's Hospital; Northwestern University Feinberg School of Medicine; Chicago Illinois U.S.A
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21
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Regional anesthesia in pediatrics - Non-systematic literature review☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543030-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Bosenberg AT. Regional anaesthesia in children: an update. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- AT Bosenberg
- Department Anesthesiology and Pain Management, Faculty Health Sciences University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
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23
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Brasher C, Gafsous B, Dugue S, Thiollier A, Kinderf J, Nivoche Y, Grace R, Dahmani S. Postoperative pain management in children and infants: an update. Paediatr Drugs 2014; 16:129-40. [PMID: 24407716 DOI: 10.1007/s40272-013-0062-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many factors contribute to suboptimal pain management in children. Current evidence suggests that severe pain in children has significant long-lasting effects, even more so than in adults. In particular, recent evidence suggests a lack of optimal postoperative pain management in children, especially following ambulatory surgery. This review provides simple guidelines for the management of postoperative pain in children. It discusses the long-term effects of severe pain and how to evaluate pain in both healthy and neurologically impaired children, including neonates. Currently available treatment options are discussed with reference to the efficacy and side effects of opioid and non-opioid and regional analgesic techniques. The impact of preoperative anxiety on postoperative pain, and the efficacy of some nonpharmacological techniques such as hypnosis or distraction, are also discussed. Finally, basic organizational strategies are described, aiming to promote safer and more efficient postoperative pain management in children.
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Affiliation(s)
- Christopher Brasher
- Department of Anesthesiology, Intensive Care, Robert Debré Hospital, 48 Bd Sérurier, 75019, Paris, France
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24
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Ultrasound for the anesthesiologists: present and future. ScientificWorldJournal 2013; 2013:683685. [PMID: 24348179 PMCID: PMC3856172 DOI: 10.1155/2013/683685] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/26/2013] [Indexed: 12/13/2022] Open
Abstract
Ultrasound is a safe, portable, relatively inexpensive, and easily accessible imaging modality, making it a useful diagnostic and monitoring tool in medicine. Anesthesiologists encounter a variety of emergent situations and may benefit from the application of such a rapid and accurate diagnostic tool in their routine practice. This paper reviews current and potential applications of ultrasound in anesthesiology in order to encourage anesthesiologists to learn and use this useful tool as an adjunct to physical examination. Ultrasound-guided peripheral nerve blockade and vascular access represent the most popular ultrasound applications in anesthesiology. Ultrasound has recently started to substitute for CT scans and fluoroscopy in many pain treatment procedures. Although the application of airway ultrasound is still limited, it has a promising future. Lung ultrasound is a well-established field in point-of-care medicine, and it could have a great impact if utilized in our ORs, as it may help in rapid and accurate diagnosis in many emergent situations. Optic nerve sheath diameter (ONSD) measurement and transcranial color coded duplex (TCCD) are relatively new neuroimaging modalities, which assess intracranial pressure and cerebral blood flow. Gastric ultrasound can be used for assessment of gastric content and diagnosis of full stomach. Focused transthoracic (TTE) and transesophageal (TEE) echocardiography facilitate the assessment of left and right ventricular function, cardiac valve abnormalities, and volume status as well as guiding cardiac resuscitation. Thus, there are multiple potential areas where ultrasound can play a significant role in guiding otherwise blind and invasive interventions, diagnosing critical conditions, and assessing for possible anatomic variations that may lead to plan modification. We suggest that ultrasound training should be part of any anesthesiology training program curriculum.
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Yoo SH, Lee DH, Moon DE, Song HK, Jang Y, Kim JB. Anatomical investigations for appropriate needle positioning for thoracic paravertebral blockade in children. J Int Med Res 2013; 40:2370-80. [PMID: 23321195 DOI: 10.1177/030006051204000636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Clinicians hesitate to perform thoracic paravertebral blockade (TPVB) in children due to the potential high risk of adverse effects. No paediatric anatomical guidelines for TPVB exist. This study aimed to estimate the appropriate depth and distance for safe needle positioning in children. METHODS The depth (D) from the skin to the paravertebral space and the distance (A) from the spinous process to the needle entry point on the skin were measured using chest computed tomography (CT) in children aged between 1 and 9 years. Correlations between age, gender, weight, height, body mass index (BMI) and each of the anatomical measurements were analysed. RESULTS Each measurement correlated significantly with age, weight and height, but not with BMI (n = 373 children). Measurements A and D could be calculated by: A = 13.56 + (0.33 × age [years]) + (0.06 × weight [kg]) + 0.47 × (gender [female = 0, male = 1]); and D = 17.49 - (0.35 × age [years]) + (0.55 × weight [kg]). CONCLUSION These anatomical guidelines for TPVB are recommended to help prevent anaesthetic complications such as pneumothorax, when ultrasonography and CT are unavailable.
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Affiliation(s)
- S H Yoo
- Department of Anaesthesia and Pain Medicine, Soonchunhyang University Hospital Cheonan, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
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26
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Axillary block as the sole anesthetic for peripherally inserted central catheter placement in an infant with goldenhar syndrome. Case Rep Anesthesiol 2013; 2013:956807. [PMID: 24371529 PMCID: PMC3859214 DOI: 10.1155/2013/956807] [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: 09/19/2013] [Accepted: 10/20/2013] [Indexed: 11/17/2022] Open
Abstract
The use of peripheral nerve block as the sole anesthetic in infants is not very common. Studies have demonstrated that ultrasound guided (USG) peripheral nerve block is associated with higher overall success rate when compared with nerve stimulation (Rubin et al., 2009, and Gelfand et al., 2011). Described below is a medically complex infant who had an USG axillary brachial plexus block for peripherally inserted central catheter (PICC) placement.
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27
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Marhofer P, Ivani G, Suresh S, Melman E, Zaragoza G, Bosenberg A. Everyday regional anesthesia in children. Paediatr Anaesth 2012; 22:995-1001. [PMID: 22967158 DOI: 10.1111/pan.12003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Regional anesthesia in children is an evolving technique with many advantages in perioperative management. Although most regional anesthesia techniques are sufficiently described in the literature, the implementation of these techniques into daily clinical practice is still lacking. The main problems associated with pediatric regional anesthesia (PRA) include the appropriate selection of blockade, the management around the block, and how to teach these techniques in an optimal manner. This review article provides an overview of these 'hot' topics in PRA.
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Affiliation(s)
- Peter Marhofer
- Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria.
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28
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Moore DL, Ding L, Sadhasivam S. Novel real-time feedback and integrated simulation model for teaching and evaluating ultrasound-guided regional anesthesia skills in pediatric anesthesia trainees. Paediatr Anaesth 2012; 22:847-53. [PMID: 22612411 DOI: 10.1111/j.1460-9592.2012.03888.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess, teach, and improve core competencies and skills sets associated with ultrasound-guided regional anesthesia (UGRA) of pediatric anesthesia trainees. AIM To effectively assess and improve UGRA-associated cognitive and technical skills and proficiency of pediatric anesthesia trainees using simulators and real-time feedback. BACKGROUND Ultrasound usage has been increasingly adopted by anesthesiologists to perform regional anesthesia. Pediatric UGRA performance significantly lags behind adult UGRA practice. Lack of effective UGRA training is the major reason for this unfortunate lag. Integration of ultrasound imaging, target location, and needling skills are crucial in safely performing UGRA. However, there are no standards to ensure proficiency in practice, nor in training. METHODS We implemented an UGRA instructional program for all trainees, in two parts. First, we used a unique training model for initial assessment and training of technical skills. Second, we used an instructional program that encompasses UGRA and equipment-associated cognitive skills. After baseline assessment at 0 months, we retested these trainees at 6 and 12 months to identify progression of proficiency over time. RESULTS Cognitive and technical UGRA skills of trainees improved significantly over the course of time. UGRA performance average accuracy improved to 79% at 12 months from the baseline accuracy of 57%. Cognitive UGRA-related skills of trainees improved from baseline results of 52.5-79.2% at 12 months. CONCLUSIONS Implementing a multifaceted assessment and real-time feedback-based training has significantly improved UGRA-related cognitive and technical skills and proficiency of pediatric anesthesia trainees.
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Affiliation(s)
- David L Moore
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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29
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Abstract
Pediatric regional anesthesia continues to evolve. Education and attention to anatomical detail remain key elements to successful outcomes. New techniques, some adapted from adult practice, provide analgesia for pediatric surgical procedures such cleft palate or congenital hip dysplasia. Despite technological advances a number of controversial issues remain unresolved.
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Affiliation(s)
- Adrian Bosenberg
- Department Anesthesiology and Pain Management, Faculty Health Sciences, University Washington, Seattle, WA 98105, USA.
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30
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Abstract
The use of regional anesthesia is increasingly common in pediatric practice. This review reports the complications and risks in pediatric regional anesthesia. Few large studies reported incidence of complications. However, the different studies have shown that regional anesthesia, when performed properly, carried a very low risk of morbidity in appropriately selected infants and children. In addition, the use of ultrasound-guided peripheral nerve blockade has shown some promise toward increasing the safety profile of these already safe techniques.
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Affiliation(s)
- Claude Ecoffey
- Service d'Anesthésie-Réanimation 2, Hôpital Pontchaillou, Université Rennes 1, Rennes, France.
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31
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Affiliation(s)
- Adrian Bosenberg
- Faculty Health Sciences, Department Anesthesiology and Pain Management, Seattle Children's Hospital, University Washington, Seattle, WA 98105, USA.
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32
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Abstract
The use of regional anesthetics, whether as adjuncts, primary anesthetics or postoperative analgesia, is increasingly common in pediatric practice. Data on safety remain limited because of the paucity of very large-scale prospective studies that are necessary to detect low incidence events, although several studies either have been published or have reported preliminary results. This paper will review the data on complications and risk in pediatric regional anesthesia. Information currently available suggests that regional blockade, when performed properly, carries a very low risk of morbidity and mortality in appropriately selected infants and children.
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Affiliation(s)
- David M Polaner
- Department of Pediatric Anesthesiology, The Children's Hospital Denver, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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33
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Amiri HR, Espandar R. Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case series. J Child Orthop 2011; 5:5-9. [PMID: 22295045 PMCID: PMC3024489 DOI: 10.1007/s11832-010-0303-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 10/16/2010] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Supraclavicular brachial plexus block is considered to be one of the most effective anesthetic procedures for upper extremity surgeries. Its major drawback is placement of the needle, with inaccurate placement, especially in children, being a risk factor for pneumothorax and vascular puncture and failure of the procedure. Ultrasound-guided needle placement may reduce the risk of complications and increase the accuracy of the block, particularly in pediatric patients. Little has been published on the efficacy and safety of ultrasound-guided supraclavicular block in children based on practical experience, and there has been no published report on its usage in younger children (<6 years old). METHODS Seventeen patients between the ages of 6 months and 6 years were randomly selected to test the efficacy of ultrasound-guided supraclavicular block in younger children. The ultrasound probe was used for proper placement of the needle. After confirmation of the needle location using a nerve locator, the anesthetic agent was injected. The procedure time, establishment time, duration of analgesia, any complications related to the procedure, and surgeon's satisfaction were recorded and assessed. RESULTS The length of the procedure was 10.35 ± 1.22 min, establishment time was 89.59 + 18 s, and the duration of the analgesia was between 6 and 16 h (mean 9.76 ± 2.57 h). The recovery time was 24.4 + 6.5 min (range 15-37 min), and the duration of surgeries was 61.3 ± 25.9 min (range 15-110 min). Not one procedure failed, and there was not one complication related to the procedure. The surgeon's satisfaction during surgery was good or excellent. CONCLUSIONS The results of this study demonstrate the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block for orthopedic upper extremity surgeries in patients less than 6 years of age.
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Affiliation(s)
- Hamid Reza Amiri
- />Department of Anesthesiology, Imam University Hospital, Tehran University of Medical Sciences, Keshavarz Blvd., 1419733141 Tehran, Iran
| | - Ramin Espandar
- />Department of Orthopedic Surgery, Imam University Hospital, Tehran University of Medical Sciences, Keshavarz Blvd., 1419733141 Tehran, Iran
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Faraoni D, Gilbeau A, Lingier P, Barvais L, Engelman E, Hennart D. Does ultrasound guidance improve the efficacy of dorsal penile nerve block in children? Paediatr Anaesth 2010; 20:931-6. [PMID: 20849498 DOI: 10.1111/j.1460-9592.2010.03405.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penile nerve block (PNB) is a well-established technique used for circumcision; it requires the injection of local anesthetics close to the dorsal nerve of the penis. The goal of this study was to compare the efficacy of ultrasound-guided PNB versus the classical landmark-based technique (LBT) in children undergoing circumcision. METHODS Forty boys, aged 1-14 years old that were scheduled for circumcision were randomly assigned to ultrasound-guided and landmark-based groups. All patients were placed under standard anesthesia with sevoflurane. In each group, patients received the penile block with ropivacaine, 0.75 mg·kg(-1) per side, and 0.05 mg·kg(-1) at the penis base. Groups were compared for intraoperative failure rate of the block, anesthesia time, postoperative pain scale, time of first required dose of paracetamol, time to first micturition, and average duration of stay in the postanesthesia care unit. RESULTS The failure rate of dorsal PNB was not statistically different between groups (P = 0.5). Ultrasound guidance improved the efficacy of the PNB compared to the LBT in terms of postoperative pain scores on arrival in the PACU (P < 0.01) and after 30 min (P < 0.01). The ultrasound-guided technique also delayed the time to the first paracetamol dose administration (P < 0.0001), but the duration of the procedure, defined as the time between anesthesia induction and the end of surgery, was increased by 10 min in the US-guided group (P = 0.001). CONCLUSION Ultrasound-guided PNB improved the efficacy of the block compared with the LBT in terms of the postoperative pain during the first postoperative hour and the time to the first requirement for postoperative analgesia.
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Affiliation(s)
- David Faraoni
- Department of Anesthesia, CUB-Erasme Hospital, Brussels, Belgium.
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35
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Walker FO, Alter KE, Boon AJ, Cartwright MS, Flores VH, Hobson-Webb LD, Hunt CH, Primack SJ, Shook SJ. Qualifications for practitioners of neuromuscular ultrasound: position statement of the American Association of Neuromuscular and Electrodiagnostic Medicine. Muscle Nerve 2010; 42:442-4. [PMID: 20806399 DOI: 10.1002/mus.21760] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Francis O Walker
- Department of Neurology Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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36
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Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case series. J Child Orthop 2010; 4:315-9. [PMID: 21804893 PMCID: PMC2908336 DOI: 10.1007/s11832-010-0264-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 04/16/2010] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Supraclavicular brachial plexus block is considered as one of the most effective anesthetic methods for upper extremity surgeries. Its major drawback, especially in children, is the risk of pneumothorax, vascular puncture, and failure of the procedure due to inaccurate placement of the needle. Ultrasound-guided needle placement may reduce the risk of complications and increase the accuracy of block, particularly in pediatric patients. There are few published experiences about the efficacy and safety of ultrasound-guided supraclavicular block in children and to our knowledge, it seems that there is no published report about its usage in younger children (less than 6 years of age). METHODS In order to consider the efficacy of ultrasound in younger children, 17 patients aged between 6 months and 6 years were randomly selected. The ultrasound probe was used for proper placement of the needle. After confirmation of the needle location using a nerve locator, the anesthetic agent was injected. The procedure time, establishment time, duration of analgesia, any complications related to the procedure, and the surgeon's satisfaction were recorded and analyzed. RESULTS The procedure time was 10.35 ± 1.22 min, the establishment time was 89.59 ± 18 s, and the duration of analgesia was between 6 and 16 h (mean 9.76 ± 2.57 h). The recovery time was 24.4 ± 6.5 min (range 15-37 min) and the duration of surgeries was 61.3 ± 25.9 min (range 15-110 min). There was no failure of the procedure. Also, there were no complications related to the procedure and the surgeon's satisfaction during surgery was good or excellent. CONCLUSIONS This study demonstrates the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block for orthopedic upper extremity surgeries in patients younger than 6 years of age.
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Mottard N, James I, Duflo F. [Interest of ultrasound guidance for ulnar and median nerve block in the mid forearm in children]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2010; 29:406-407. [PMID: 20483559 DOI: 10.1016/j.annfar.2010.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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38
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McKiernan S, Chiarelli P, Warren-Forward H. Diagnostic ultrasound use in physiotherapy, emergency medicine, and anaesthesiology. Radiography (Lond) 2010. [DOI: 10.1016/j.radi.2009.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Oberndofer U, Weintraud M, Redl G. The use of ultrasound-guided regional anesthesia in a rural developing area in India for plastic and orthopedic operations. Paediatr Anaesth 2010; 20:198-9. [PMID: 20078818 DOI: 10.1111/j.1460-9592.2009.03228.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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