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Serra S, Santonastaso DP, Romano G, Riccardi A, Nigra SG, Russo E, Angelini M, Agnoletti V, Guarino M, Cimmino CS, Spampinato MD, Francesconi R, Iaco FD. Efficacy and safety of the serratus anterior plane block (SAP block) for pain management in patients with multiple rib fractures in the emergency department: a retrospective study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02597-6. [PMID: 39020130 DOI: 10.1007/s00068-024-02597-6] [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: 02/01/2024] [Accepted: 07/02/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE Chest trauma is a severe and frequent cause of admission to the emergency department (ED). The serratus anterior plane (SAP) block seems to be an effective method of pain management; however, data on efficacy and safety of a single SAP block performed in the ED by emergency physicians (EP) are limited. This study aimed to compare SAP block performed by the EP in the ED plus standard therapy to standard therapy alone in terms of pain severity at 0-3-6-12-18 and 24 h, total opioid consumption (milligrams of morphine equivalents, MME), respiratory function (SpO2/FiO2 ratio), and adverse events (i.e. pneumothorax, infections in the site of injection, or Local Anaesthetic Systemic Toxicity syndrome due to SAP block) in the first 24 h. METHODS This retrospective, monocentric study included adult patients admitted to the Sub-intensive Care Unit (SICU) of the ED with multiple rib fractures between 01/2022 and 03/2023. RESULTS 156 patients (65.4% male; median age 62 years; median injury severity score 16; median thoracic trauma severity score 8) were included. 75 (48.2%) underwent SAP block. Patients undergoing SAP block showed significantly less pain 3-6-18 h after a single block, required less MME (0 [0-20] vs. 20 [0-40], p < 0.001), showed higher SpO2/FiO2 ratio, and no adverse events were reported. CONCLUSION The SAP block, in combination with standard therapy, appeared to be more effective in providing pain relief than standard therapy alone in patients admitted to the SICU for traumatic rib fractures.
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Affiliation(s)
- Sossio Serra
- Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | | | - Giuseppe Romano
- Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | - Alessandro Riccardi
- SC Pronto Soccorso e Medicina d'Urgenza, Ospedale Santa Corona, Pietra Ligure, Savona, 17027, Italy
| | | | - Emanuele Russo
- Anestesia and Intensive Care Unit, Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | - Mario Angelini
- Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | - Vanni Agnoletti
- Anestesia and Intensive Care Unit, Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | - Mario Guarino
- UOC MEU Ospedale CTO-AORN dei Colli Napoli, Napoli, 80131, Italy
| | | | - Michele Domenico Spampinato
- Department of Translational Medicine and for Romagna, University of Ferrara, Via A. Moro 8, Ferrara, 44124, Italy.
| | - Raffella Francesconi
- Struttura Complessa di Medicina di Emergenza Urgenza Ospedale Maria Vittoria, ASL Città di Torino, Torino, 10144, Italy
| | - Fabio De Iaco
- Department of Translational Medicine and for Romagna, University of Ferrara, Via A. Moro 8, Ferrara, 44124, Italy
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Bhushan S, Liu X, Jiang F, Wang X, Mao L, Xiao Z. A progress of research on the application of fascial plane blocks in surgeries and their future direction: a review article. Int J Surg 2024; 110:3633-3640. [PMID: 38935829 PMCID: PMC11175748 DOI: 10.1097/js9.0000000000001282] [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: 07/21/2023] [Accepted: 02/22/2024] [Indexed: 06/29/2024]
Abstract
Fascial plane blocks (FPBs) are gaining popularity in clinical settings owing to their improved analgesia when combined with either traditional regional anesthesia or general anesthesia during the perioperative phase. The scope of study on FPBs has substantially increased over the past 20 years, yet the exact mechanism, issues linked to the approaches, and direction of future research on FPBs are still up for debate. Given that it can be performed at all levels of the spine and provides analgesia to most areas of the body, the erector spinae plane block, one of the FPBs, has been extensively studied for chronic rational pain, visceral pain, abdominal surgical analgesia, imaging, and anatomical mechanisms. This has led to the contention that the erector spinae plane block is the ultimate Plan A block. Yet even though the future of FPBs is promising, the unstable effect, the probability of local anesthetic poisoning, and the lack of consensus on the definition and assessment of the FPB's success are still the major concerns. In order to precisely administer FPBs to patients who require analgesia in this condition, an algorithm that uses artificial intelligence is required. This algorithm will assist healthcare professionals in practicing precision medicine.
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Affiliation(s)
- Sandeep Bhushan
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Xian Liu
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Fenglin Jiang
- Department of Anesthesia and Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, People’s Republic of China
| | - Xiaowei Wang
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Long Mao
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Zongwei Xiao
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
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Capuano P, Sepolvere G, Toscano A, Scimia P, Silvetti S, Tedesco M, Gentili L, Martucci G, Burgio G. Fascial plane blocks for cardiothoracic surgery: a narrative review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:20. [PMID: 38468350 PMCID: PMC10926596 DOI: 10.1186/s44158-024-00155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
In recent years, there has been a growing awareness of the limitations and risks associated with the overreliance on opioids in various surgical procedures, including cardiothoracic surgery.This shift on pain management toward reducing reliance on opioids, together with need to improve patient outcomes, alleviate suffering, gain early mobilization after surgery, reduce hospital stay, and improve patient satisfaction and functional recovery, has led to the development and widespread implementation of enhanced recovery after surgery (ERAS) protocols.In this context, fascial plane blocks are emerging as part of a multimodal analgesic in cardiac surgery and as alternatives to conventional neuraxial blocks for thoracic surgery, and there is a growing body of evidence suggesting their effectiveness and safety in providing pain relief for these procedures. In this review, we discuss the most common fascial plane block techniques used in the field of cardiothoracic surgery, offering a comprehensive overview of regional anesthesia techniques and presenting the latest evidence on the use of chest wall plane blocks specifically in this surgical setting.
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Affiliation(s)
- Paolo Capuano
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (IRCCS-ISMETT), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy.
| | - Giuseppe Sepolvere
- Department of Anesthesia and Cardiac Surgery Intensive Care Unit, Casa Di Cura San Michele, Maddaloni, Caserta, Italy
| | - Antonio Toscano
- Department of Anesthesia, Critical Care and Emergency, "Città Della Salute E Della Scienza" Hospital, Turin, Italy
| | - Paolo Scimia
- Intensive Care Unit, Department of Anesthesia, G. Mazzini Hospital, Teramo, Italy
| | - Simona Silvetti
- Department of Cardioanesthesia and Intensive Care, Policlinico San Martino IRCCS Hospital - IRCCS Cardiovascular Network, Genoa, Italy
| | - Mario Tedesco
- Department of Anesthesia and Intensive Care Unit and Pain Therapy, Mater Dei Hospital, Bari, Italy
| | - Luca Gentili
- Intensive Care Unit, Department of Anesthesia, S. Maria Goretti Hospital, Latina, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (IRCCS-ISMETT), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy
| | - Gaetano Burgio
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (IRCCS-ISMETT), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy
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Ander M, Mugve N, Crouch C, Kassel C, Fukazawa K, Isaak R, Deshpande R, McLendon C, Huang J. Regional anesthesia for transplantation surgery - A White Paper Part 2: Abdominal transplantation surgery. Clin Transplant 2024; 38:e15227. [PMID: 38289879 DOI: 10.1111/ctr.15227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 02/01/2024]
Abstract
Transplantation surgery continues to evolve and improve through advancements in transplant technique and technology. With the increased availability of ultrasound machines as well as the continued development of Enhanced Recovery after Surgery (ERAS) protocols, regional anesthesia has become an essential component of providing analgesia and minimizing opioid use perioperatively. Many centers currently utilize peripheral and neuraxial blocks during transplantation surgery, but these techniques are far from standardized practices. The utilization of these procedures is often dependent on transplantation centers' historical methods and perioperative cultures. To date, no formal guidelines or recommendations exist which address the use of regional anesthesia in transplantation surgery. In response, the Society for the Advancement of Transplant Anesthesia (SATA) identified experts in both transplantation surgery and regional anesthesia to review available literature concerning these topics. The goal of this task force was to provide an overview of these publications to help guide transplantation anesthesiologists in utilizing regional anesthesia. The literature search encompassed most transplantation surgeries currently performed and the multitude of associated regional anesthetic techniques. Outcomes analyzed included analgesic effectiveness of the blocks, reduction in other analgesic modalities-particularly opioid use, improvement in patient hemodynamics, as well as associated complications. The findings summarized in this systemic review support the use of regional anesthesia for postoperative pain control after transplantation surgeries. Part 1 of the manuscript focused on regional anesthesia performed in thoracic transplantation surgeries, and part 2 in abdominal transplantations. Specifically, regional anesthesia in liver, kidney, pancreas, intestinal, and uterus transplants or applicable surgeries are discussed.
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Affiliation(s)
- Michael Ander
- Department of Anesthesiology & Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Neal Mugve
- Department of Anesthesiology & Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Cara Crouch
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cale Kassel
- Department of Anesthesiology, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kyota Fukazawa
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Robert Isaak
- Department of Anesthesiology, UNC Hospitals, N2198 UNC Hospitals, Chapel Hill, North Carolina, USA
| | - Ranjit Deshpande
- Department of Anesthesiology, Yale University/Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Charles McLendon
- Department of Anesthesiology & Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
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Huang X, Zeng Y, Sandeep B, Yang J. Clinical impact of fascial plane blocks: defining the research agenda. Br J Anaesth 2023; 131:e180-e183. [PMID: 37770253 DOI: 10.1016/j.bja.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Xin Huang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Yan Zeng
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Sichuan, Chengdu, China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, China.
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Zheng J, Mi Y, Liang J, Li H, Shao P, Wen H, Wang Y. Circum-Psoas Block versus Supra-Inguinal Fascia Iliaca Block for Postoperative Analgesia in Patients Undergoing Total Hip Arthroplasty: A Randomized Clinical Trial. J Pain Res 2023; 16:3961-3970. [PMID: 38026457 PMCID: PMC10675663 DOI: 10.2147/jpr.s435159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Total hip arthroplasty (THA) is often associated with moderate to severe pain. The present study compared the efficacy of circum-psoas block (CPB) with supra-inguinal fascia iliaca block (SIFIB) for postoperative analgesia in patients undergoing THA. Patients and Methods In this randomized trial, sixty-four patients undergoing THA were allocated randomly to the CPB group or SIFIB group with 40 mL of 0.3% ropivacaine. The primary outcome was dynamic pain score at 6 h postoperatively. Secondary outcomes included dynamic pain scores at 12, 24 and 48 h; static pain scores; sensory and motor block; opioid consumption; time to first opioid request; length of hospital stay; patient satisfaction; and adverse events. Results CPB patients showed significantly lower dynamic pain scores at 6 (3.11 ± 0.66 vs 4.47 ± 0.74, respectively; P = 0.000), 12 (2.52 ± 0.73 vs 3.53 ± 0.85, respectively; P = 0.000) and 24 h (2.30 ± 0.57 vs 2.87 ± 0.71, respectively; P = 0.001) after surgery, as well as lower static pain scores at 6 and 12h (P = 0.001 and P = 0.033 respectively) than SIFIB patients. Lower opioid consumption was observed in the CPB group at 24 and 48 h (P = 0.000, both) than in the SIFIB group. Patients in the CPB group reported improved quadriceps strength at 6 and 12 h (P = 0.000, both), as well as better muscle strength of hip flexion at 6, 12 and 24 h (P = 0.000, P = 0.000 and P = 0.025 respectively). Compared with SIFIB, CPB was associated with increased sensory block coverage at 6, 12 and 24 h (P = 0.000, P = 0.000, and P =0.022, respectively). Conclusion CPB has a greater potential to alleviate postoperative pain and improve recovery in THA patients than SIFIB.
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Affiliation(s)
- Junwei Zheng
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Yan Mi
- Department of Anesthesiology, Tumour Hospital, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Jinghan Liang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Huili Li
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Peiqi Shao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hong Wen
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
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Nair A, Thakre M, Rangaiah M, Dudhedia U, Borkar N. Analgesic efficacy and safety of duloxetine premedication in patients undergoing hysterectomy - A systematic review. Indian J Anaesth 2023; 67:770-777. [PMID: 37829772 PMCID: PMC10566655 DOI: 10.4103/ija.ija_170_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 10/14/2023] Open
Abstract
Background and Aims Patients undergoing hysterectomy by open or laparoscopic approach experience moderate to severe postoperative pain. A multimodal analgesic approach is recommended for these patients. This study reviews the analgesic efficacy of duloxetine, a selective serotonin and norepinephrine reuptake inhibitor used as an adjuvant for opioid-sparing postoperative analgesia. Methods After registering the protocol in the international prospective register of systematic reviews (PROSPERO), databases like PubMed, Ovid, Scopus, Cochrane Library and clinicaltrials.gov were searched for randomised controlled trials using relevant keywords to find studies in which duloxetine premedication was compared to a placebo in patients undergoing hysterectomy. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of evidence. Results The qualitative systematic review included five of the 88 studies identified. The overall risk of bias in the included studies was very high. In all the studies, 60 mg oral duloxetine was used, and the control group was placebo. In two studies, duloxetine premedication was administered 2 h before and 24 h after surgery. In the other three studies, a single dose of 60 mg duloxetine was only administered 2 h before surgery. A pooled meta-analysis was not performed due to fewer studies that fulfilled the inclusion criteria and even fewer studies with consistent reporting of various outcomes. Conclusion The evidence is insufficient to advocate routine duloxetine premedication in patients undergoing hysterectomy.
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Affiliation(s)
- Abhijit Nair
- Department of Anaesthesiology, Ibra Hospital, Ministry of Health-Oman, Ibra-414, Sultanate of Oman
| | - Manish Thakre
- Department of Psychiatry, Government Medical College, Nagpur, Maharashtra, India
| | - Manamohan Rangaiah
- Department of Anaesthetics and Pain Management, Walsall Manor Hospital, Moat Rd, Walsall WS2 9PS, United Kingdom
| | - Ujjwalraj Dudhedia
- Department of Anaesthesiology and Pain Management, DR. L.H. Hiranandani Hospital, Powai Mumbai, Maharashtra, India
| | - Nitinkumar Borkar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Ander M, Mugve N, Crouch C, Kassel C, Fukazawa K, Izaak R, Deshpande R, McLendon C, Huang J. Regional anesthesia for transplantation surgery - A white paper part 1: Thoracic transplantation surgery. Clin Transplant 2023; 37:e15043. [PMID: 37306898 PMCID: PMC10834230 DOI: 10.1111/ctr.15043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Transplantation surgery continues to evolve and improve through advancements in transplant technique and technology. With the increased availability of ultrasound machines as well as the continued development of enhanced recovery after surgery (ERAS) protocols, regional anesthesia has become an essential component of providing analgesia and minimizing opioid use perioperatively. Many centers currently utilize peripheral and neuraxial blocks during transplantation surgery, but these techniques are far from standardized practices. The utilization of these procedures is often dependent on transplantation centers' historical methods and perioperative cultures. To date, no formal guidelines or recommendations exist which address the use of regional anesthesia in transplantation surgery. In response, the Society for the Advancement of Transplant Anesthesia (SATA) identified experts in both transplantation surgery and regional anesthesia to review available literature concerning these topics. The goal of this task force was to provide an overview of these publications to help guide transplantation anesthesiologists in utilizing regional anesthesia. The literature search encompassed most transplantation surgeries currently performed and the multitude of associated regional anesthetic techniques. Outcomes analyzed included analgesic effectiveness of the blocks, reduction in other analgesic modalities-particularly opioid use, improvement in patient hemodynamics, as well as associated complications. The findings summarized in this systemic review support the use of regional anesthesia for postoperative pain control after transplantation surgeries. Part 1 of the manuscript focuses on regional anesthesia performed in thoracic transplantation surgeries, and part 2 in abdominal transplantations.
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Affiliation(s)
- Michael Ander
- Department of Anesthesiology & Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Neal Mugve
- Department of Anesthesiology & Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Cara Crouch
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cale Kassel
- Department of Anesthesiology, Nebraska Medical Center, 984455 Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kyota Fukazawa
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Robert Izaak
- Department of Anesthesiology, UNC Hospitals, N2198 UNC Hospitals, North Carolina, USA
| | - Ranjit Deshpande
- Department of Anesthesiology, Yale University/Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Charles McLendon
- Department of Anesthesiology & Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
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Coppens S, Hoogma D, Rex S, Wolmarans M, Merjavy P. Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair: a randomised clinical trial. Comment on Br J Anaesth 2023; 130: 786-794. Br J Anaesth 2023:S0007-0912(23)00236-2. [PMID: 37271722 DOI: 10.1016/j.bja.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Affiliation(s)
- Steve Coppens
- University Hospitals of Leuven, Department of Anesthesiology, Leuven, Belgium; University of Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
| | - Danny Hoogma
- University Hospitals of Leuven, Department of Anesthesiology, Leuven, Belgium; University of Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Steffen Rex
- University Hospitals of Leuven, Department of Anesthesiology, Leuven, Belgium; University of Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Morne Wolmarans
- Norwich Medical School, University of East Anglia, Norwich, UK; Department of Anaesthesia, Norfolk & Norwich University Hospital, Norwich, UK
| | - Peter Merjavy
- Department of Anaesthesia, Craigavon Area University Teaching Hospital, Craigavon, Northern Ireland, UK; Norwich Medical School, University of East Anglia, Norwich, UK
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Bilge A, Başaran B, Altıparmak B, Et T, Korkusuz M, Yarımoğlu R. Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial. BMC Anesthesiol 2023; 23:139. [PMID: 37106319 PMCID: PMC10134575 DOI: 10.1186/s12871-023-02106-z] [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: 10/27/2022] [Accepted: 04/23/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy(LC) causes significant postoperative pain. Oblique subcostal transversus abdominis plane(OSTAP) block was described for postoperative analgesia, especially for upper abdominal surgeries. Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA) block is a new technique defined by the modification of the thoracoabdominal nerves through perichondrial approach (TAPA) block, in which local anesthetics are delivered only to the underside of the perichondral surface. The primary aim of this study was to evaluate the effect of M-TAPA and OSTAP blocks as part of multimodal analgesia on postoperative opioid consumption in patients undergoing LC. METHOD The present study was designed as a randomized, controlled, prospective study. Seventy-six adult patients undergoing LC were randomly assigned to receive either bilaterally M-TAPA or OSTAP block after the induction of anesthesia and before surgery using bupivacaine 0.25%, 25 ml. The primary outcome was assessed as postoperative 24 h opioid consumption, between groups were compared. Secondary outcomes were Numerical Rational scale(NRS) scores, time to first opioid analgesia, patient recovery, using the Quality of Recovery-15 (QoR-15) scale, nausea and vomiting, sedation score, metoclopramide consumption, and evaluating the analgesic range of dermatome. RESULTS The mean tramadol consumption at the postoperative 24th hour was higher in the group OSTAP than in group M-TAPA (P = 0.047). NRS movement score at 12th hour was statistically significantly lower in group M-TAPA than in group OSTAP (P = 0.044). Dermatomes showed intense sensory analgesia between T7-11 in both groups, and it was determined that there was proportionally more involvement in the group M-TAPA. There were no differences between the groups in terms of other results. CONCLUSIONS After the LC surgery, ultrasound-guided M-TAPA block effectively reduced opioid consumption, postoperative pain, and QoR-15 scores similar to OSTAP block. CLINICAL TRIAL REGISTRATION The study was registered prospectively at clinicaltrials.gov (trial ID: NCT05108129 on 4/11/2021).
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Affiliation(s)
- Ayşegül Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey.
| | - Betül Başaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey
| | - Başak Altıparmak
- Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University, Menteşe Muğla, Turkey
| | - Tayfun Et
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey
| | - Muhammet Korkusuz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey
| | - Rafet Yarımoğlu
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, Karaman, Turkey
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Korgvee A, Veskimae E, Huhtala H, Koskinen H, Tammela T, Junttila E, Kalliomaki ML. Posterior quadratus lumborum block versus epidural analgesia for postoperative pain management after open radical cystectomy: A randomized clinical trial. Acta Anaesthesiol Scand 2023; 67:347-355. [PMID: 36547262 DOI: 10.1111/aas.14188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In open abdominal surgery, continuous epidural analgesia is commonly used method for postoperative analgesia. However, ultrasound (US)-guided fascial plane blocks may be a reasonable alternative. METHODS In this randomized controlled trial, we compared posterior quadratus lumborum block (QLB) with epidural analgesia for postoperative pain after open radical cystectomy (ORC). Adult patients aged 18-85 with bladder cancer (BC) scheduled for open RC were randomized in two groups. Exclusion criteria were complicated diabetes mellitus type I, lack of cooperation, and persistent pain for reasons other than BC. In one group, a bilateral US-guided single injection posterior QLB was performed with 3.75 mg/ml ropivacaine 20 ml/side. In the other group, continuous epidural analgesia with ropivacaine was used. Basic analgesia was oral paracetamol 1000 mg three times daily, and long-acting opioid twice daily in both groups. All patients had patient-controlled rescue analgesia with oxycodone. Postoperative cumulative rescue opioid consumption was recorded for the day of surgery, and the following 2 postoperative days (POD 0-2). Secondary outcomes were postoperative pain and nausea and vomiting. RESULTS In total, 20 patients (QLB), and 19 patients (epidural analgesia) groups, were included in the analyses. Cumulative rescue opioid consumption on POD 0, being of duration 9-12 h, was 14 mg (7.6-33.3) in the QLB group versus 6.1 mg (2.0-16.1) in the epidural analgesia group, p = 0.089, and as doses, 8 doses (3.6-15.7) versus 4 doses (1.3-8.5), p = .057. On POD 1 consumption was 25.3 mg (11.0-52.9) versus 18.0 mg (14.4-43.7), p = .749, and as doses 12 (5.5-23.0) versus 10 (8-20), p > .9, respectively. On POD 2 consumption was 19.1 mg (7.9-31.0) versus 18.0 mg (5.4-27.6) p = .749, and as doses 8.5 (5.2-14.7) versus 11 (3.0-18.0) p > .9, respectively. CONCLUSION Opioid consumption did not differ significantly between posterior QLB and an epidural infusion with ropivacaine for the first 2 postoperative days following RC. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03328988.
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Affiliation(s)
- Andrus Korgvee
- Department of Anesthesia, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Erik Veskimae
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology Tampere, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Heikki Koskinen
- Department of Anesthesia, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teuvo Tammela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology Tampere, Tampere University Hospital, Tampere, Finland
| | - Eija Junttila
- Department of Anesthesia, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Maija-Liisa Kalliomaki
- Department of Anesthesia, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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12
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Cavaliere F, Allegri M, Apan A, Brazzi L, Carassiti M, Cohen E, DI Marco P, Langeron O, Rossi M, Spieth P, Turnbull D, Weber F. A year in review in Minerva Anestesiologica 2022: anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2023; 89:239-252. [PMID: 36880326 DOI: 10.23736/s0375-9393.23.17281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Massimo Allegri
- Unit of Pain Therapy of Column and Athlete, Policlinic of Monza, Monza, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Türkiye
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University, Rome, Italy
| | - Edmond Cohen
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, New York, NY, USA
| | - Pierangelo DI Marco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Faculty of Medicine, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Assistance Publique - Hôpitaux de Paris (APHP), Henri Mondor University Hospital, University Paris-Est Créteil (UPEC), Paris, France
| | - Marco Rossi
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
| | - Frank Weber
- Department of Anesthesiology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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13
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Allen BFS, McEvoy MD. Regional Anesthesia for Thoracic and Abdominal Surgery: Tips and Tricks for the Surgeon. Am Surg 2023; 89:183-191. [PMID: 35798719 DOI: 10.1177/00031348221109499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The use of ultrasound-guided regional anesthesia (UGRA) has flourished over the past two decades with the description of many novel techniques and the incorporation of UGRA into patient care pathways for many types of surgery, including thoracic and abdominal surgery. Numerous facial plane blocks have been developed for analgesia of the chest and abdomen. Though analgesic efficacy varies based on the specific technique, it is important to be aware of the regional anesthesia techniques in common usage, their analgesic distributions, side effect profiles, and efficacy. In this review, we describe fascial plane blocks developed since 2010 as well as older regional anesthesia techniques and provide context for how and why they might be incorporated into patient care pathways. We will provide salient details on block coverage and briefly discuss evidence and relevant controversies around their use.
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Affiliation(s)
- Brian F S Allen
- Department of Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew D McEvoy
- Department of Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Belfar AL, Deng Y, Yu RC, Sabbagh A. Successful Use of Continuous Erector Spinae Plane Blocks in a Patient With Variant Angina After Large Ventral Hernia Repair. Tex Heart Inst J 2022; 49:489335. [PMID: 36534113 PMCID: PMC9809071 DOI: 10.14503/thij-21-7624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Coronary artery spasm constitutes the primary underlying pathology of variant angina. Because provocation of coronary artery spasm may occur with both excess sympathetic and excess parasympathetic stimulation, patients with this disorder have extremely limited options for perioperative pain control. This is especially true for procedures involving extensive abdominal incision/manipulation. Whereas neuraxial analgesia might otherwise be appropriate in these cases, several studies have demonstrated that coronary artery spasm can occur as a result of epidural placement, and therefore, that this may not be an optimal choice for patients with variant angina. This report discusses the case of a patient with a preexisting diagnosis of variant angina who underwent an exploratory laparotomy with large ventral hernia repair and for whom continuous erector spinae plane blocks were successfully used as analgesic adjuncts without triggering coronary artery spasm.
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Affiliation(s)
| | - Yi Deng
- Department of Anesthesiology, Baylor College of Medicine, Houston, Texas
| | - Raymond C. Yu
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Annas Sabbagh
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, Pennsylvania
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15
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Park JM, Lee J. Effect of transversus abdominis plane block on the quality of recovery in laparoscopic nephrectomy: A prospective double-blinded randomized controlled clinical trial. Medicine (Baltimore) 2022; 101:e31168. [PMID: 36253971 PMCID: PMC9575771 DOI: 10.1097/md.0000000000031168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Poorly controlled acute postoperative pain after laparoscopic nephrectomy may adversely affect surgical outcomes and increase morbidity rates. In addition, excessive use of opioids during surgery may slow postoperative endocrine and metabolic responses and cause opioid-related side effects and opioid-induced hyperalgesia. The purpose of this study was to evaluate the effect of ultrasound-guided transversus abdominis plane (TAP) block on the postoperative quality of recovery and intraoperative remifentanil requirement in laparoscopic nephrectomy. METHODS Sixty patients who underwent laparoscopic nephrectomy were randomly divided into 2 groups: TAP and Control groups. After induction of anesthesia and before awakening from anesthesia, the TAP group was administered 40 mL of 0.375% ropivacaine and the Control group was administered 40 mL of normal saline to deliver ultrasound-guided TAP block using 20 mL of each of the above drugs. The main objectives of this study were to evaluate the effect of the TAP block on quality of recovery using the Quality of Recovery 40 (QoR-40) questionnaire and assessments of intraoperative remifentanil requirement. In addition, to evaluate the postoperative analgesic effect of the TAP block, the total usage time for patient-controlled analgesia (PCA) and the number of PCA bolus buttons used in both groups were analyzed. RESULTS The QoR-40 score, measured when visiting the ward on the third day after surgery, was significantly higher in the TAP group (171.9 ± 23.1) than in the Control group (151.9 ± 28.1) (P = .006). The intraoperative remifentanil requirement was not significantly different between the groups (P = .439). In the TAP group, the frequency of bolus dose accumulation at 1, 2, 3, 6, 12, 24, 48, and 72 hours after surgery was low enough to show a significant difference, and the total usage time for PCA was long enough to show a significant difference. CONCLUSION In conclusion, we determined that ultrasound-guided TAP block during laparoscopic nephrectomy improves the quality of postoperative recovery and is effective for postoperative pain control but does not affect the amount of remifentanil required for adequate anesthesia during surgery.
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Affiliation(s)
- Jun-Mo Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
- *Correspondence: Jun-Mo Park, Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Bukgu, Daegu 41404, South Korea (e-mail: )
| | - Joonhee Lee
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
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16
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Campoy L. Development of Enhanced Recovery After Surgery (ERAS) protocols in veterinary medicine through a one-health approach: the role of anesthesia and locoregional techniques. J Am Vet Med Assoc 2022; 260:1751-1759. [DOI: 10.2460/javma.22.08.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Enhanced Recovery After Surgery (ERAS) is a new and emerging concept in human medicine that involves rethinking the preoperative, intraoperative, and postoperative periods. The ultimate, overarching aim is to improve patient outcome following surgery and, thus, return to a normal daily routine as soon as possible. The development and implementation of locoregional anesthetic techniques in humans is one of the key elements driving these protocols. In veterinary medicine, we are no exception: the rapidly growing interest, development, and refinement of these techniques in our veterinary species is changing the way we think of anesthesia and analgesia. The potential real benefits are yet to be determined, as this concept is implemented into our veterinary hospitals in general, and our surgical patients in particular, in a more systematic and routine way. In this article, we will introduce the reader to the concept of ERAS protocols and the role of regional anesthesia in some common surgical procedures.
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Affiliation(s)
- Luis Campoy
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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17
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de Barros GAM, Kraychete DC, Lineburger EB, Módolo NSP. Anesthesiology and pain medicine. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2022; 72:549-552. [PMID: 35914623 PMCID: PMC9515681 DOI: 10.1016/j.bjane.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Sag AA, Qadri YJ. Interventional Radiology Regional Anesthesia Approaches for Intra- and Postprocedural Pain Control. Semin Intervent Radiol 2022; 39:142-149. [PMID: 35781998 DOI: 10.1055/s-0042-1745799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Effective pain control enables procedural success and improved patient satisfaction in interventional radiology. Regional anesthesia techniques are now established for intraoperative and postoperative anesthesia during major surgery, and interventional radiologists (IRs) can readily apply these injections for intraprocedural nerve blocks that can reduce anesthetic requirements and ensure durable analgesia postprocedure. Moreover, IR is poised to advance this field with novel blocks unique to IR needs and by blocking deep plexi safely reachable with CT guidance (e.g., hepatic hilar plexus, aorticorenal plexus blocks). This report aims to provide a succinct IR-directed primer for image-guided nerve blocks usable in the interventional radiology suite.
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Affiliation(s)
- Alan Alper Sag
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Yawar Jamal Qadri
- Division of Pain Medicine, Department of Anesthesiology, Emory University, Atlanta, Georgia
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19
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Regional Nerve Block Decreases the Incidence of Postoperative Delirium in Elderly Hip Fracture. J Clin Med 2021; 10:jcm10163586. [PMID: 34441882 PMCID: PMC8397073 DOI: 10.3390/jcm10163586] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 12/19/2022] Open
Abstract
Postoperative delirium is common in elderly patients with hip fracture. Pain is a major risk factor for delirium, and regional nerve blocks (RNBs) effectively control pain in hip fractures. This study aimed to evaluate the effect of RNB on delirium after hip surgery in elderly patients. This retrospective comparative study was performed in a single institution, and the data were collected from medical records between March 2018 and April 2021. Patients aged ≥60 years who underwent proximal femoral fracture surgery were included, while those with previous psychiatric illness and cognitive impairment were excluded. Two hundred and fifty-two patients were enrolled and divided into an RNB or a control group according to RNB use. Delirium was assessed as the primary outcome and postoperative pain score, pain medication consumption, and rehabilitation assessment as the secondary outcomes. Between the RNB (n = 129) and control groups (n = 123), there was no significant difference in the baseline characteristics. The overall incidence of delirium was 21%; the rate was lower in the RNB group than in the control group (15 vs. 27%, respectively, p = 0.027). The average pain score at 6 h postoperatively was lower in the RNB group than in the control group (2.8 ± 1.5 vs. 3.3 ± 1.6, respectively, p = 0.030). There was no significant difference in the pain score at 12, 24, and 48 h postoperatively, amount of opioids consumed for 2 postoperative days, and time from injury to wheelchair ambulation. We recommend RNB as a standard procedure for elderly patients with hip fracture due to lower delirium incidence and more effective analgesia in the early postoperative period.
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