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Webster A, Pezzanite L, Hendrickson D, Griffenhagen G. Review of intra-articular local anaesthetic administration in horses: Clinical indications, cytotoxicity, and outcomes. Equine Vet J 2024; 56:870-883. [PMID: 37940372 DOI: 10.1111/evj.14027] [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: 05/21/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
Equine practitioners frequently inject local anaesthetics (LA) intra-articularly in both diagnosis of lameness and for pain management intra- or post-operatively with synovial endoscopy. Recent reviews of the human and veterinary literature support the concept that chondrotoxicity of LA on joint tissues depends on the type of drug, dose administered, and duration of exposure. The purpose of this review is to summarise the current literature describing intra-articular local anaesthetic use, including both in vitro and in vivo studies, and to draw some comparisons to literature from other species where potential toxicity and duration of effect have been evaluated with the goal of advancing the field's understanding of intra-articular local anaesthetic use in horses, and indicating future directions for the field. The aggregate data available from all species, while generally sparse for horses, indicate that LA are rapidly cleared from the synovial fluid after injection, often within 30 min. In vitro data strongly suggest that lidocaine and bupivacaine are likely more chondrotoxic than other LA, although to what extent is still unknown, and cytotoxicity of LA may be mitigated through concurrent injection with HA, PRP, and drug combinations including nonsteroidal anti-inflammatories and opioids. The current body of in vitro research is not reflective of the in vivo environment, and further in vitro work, if performed, should focus on mimicking the native joint environment, utilising PK data and joint/injection volumes to replicate the native environment more accurately within the joint and the expected exposures to LA.
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Affiliation(s)
- Aaron Webster
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Lynn Pezzanite
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Dean Hendrickson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Gregg Griffenhagen
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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2
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Mojica JJ, Ocker A, Barrata J, Schwenk ES. Anesthesia for the Patient Undergoing Shoulder Surgery. Anesthesiol Clin 2024; 42:219-231. [PMID: 38705672 DOI: 10.1016/j.anclin.2023.11.007] [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] [Indexed: 05/07/2024]
Abstract
Shoulder surgery introduces important anesthesia considerations. The interscalene nerve block is considered the gold standard regional anesthetic technique and can serve as the primary anesthetic or can be used for postoperative analgesia. Phrenic nerve blockade is a limitation of the interscalene block and various phrenic-sparing strategies and techniques have been described. Patient positioning is another important anesthetic consideration and can be associated with significant hemodynamic effects and position-related injuries.
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Affiliation(s)
- Jeffrey J Mojica
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Suite 8290 Gibbon Building, Philadelphia, PA 19107, USA.
| | - Aaron Ocker
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Suite 8290 Gibbon Building, Philadelphia, PA 19107, USA
| | - Jaime Barrata
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Suite 8290 Gibbon Building, Philadelphia, PA 19107, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Suite 8290 Gibbon Building, Philadelphia, PA 19107, USA
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3
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Li Y, Li T. Enhancing patient comfort in varicose vein treatment through combined lidocaine and ropivacaine tumescent anesthesia. Front Surg 2024; 11:1359474. [PMID: 38783860 PMCID: PMC11111990 DOI: 10.3389/fsurg.2024.1359474] [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: 12/21/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To compare the analgesic effects of specific tumescent anesthetic solutions composed of lidocaine, ropivacaine, or a combination of lidocaine and ropivacaine during endovenous radiofrequency ablation for the treatment of great saphenous vein varicosities. Method This study included 149 patients with lower limb varicose veins who were admitted to our department between 2019 and 2023. The patients were randomly assigned to three groups: the lidocaine group (Group I), the ropivacaine group (Group II), and the lidocaine + ropivacaine group (Group III). Intraoperative vital signs, intraoperative and postoperative visual analog scale (VAS) pain scores, and long-term treatment outcomes were assessed using the venous clinical severity score (VCSS) based on clinical performance. Results There were no significant differences in age, body mass index, operative time, or blood loss among the three groups (P ≥ 0.05). The differences in the mean arterial pressure and heart rate during surgery in Group II were significantly greater than those in Groups I and III (P < 0.05). The intraoperative VAS scores in Group II were higher than those in Groups I and III (P < 0.05) and at 8 and 12 h postoperatively. There were no significant differences in VCSS among the groups (P ≥ 0.05). Conclusion The use of a tumescent anesthetic solution composed of lidocaine and ropivacaine significantly improved patient comfort during the perioperative period without affecting surgical outcomes. This formulation can be considered safe and reliable for preparing tumescent anesthesia solutions.
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Affiliation(s)
- Yubo Li
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tan Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Finneran JJ, Ilfeld BM. Continuous peripheral nerve blocks for analgesia following painful ambulatory surgery: a review with focus on recent developments in infusion technology. Curr Opin Anaesthesiol 2023; 36:525-532. [PMID: 37552018 DOI: 10.1097/aco.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW Continuous peripheral nerve blocks (cPNB) decrease pain scores and opioid consumption while improving patient satisfaction following ambulatory surgery. This review focuses on the history and evolution of ambulatory cPNBs, recent developments in infusion technology that may prolong the duration of analgesia, optimal choice of cPNB for various surgical procedures, and novel analgesic modalities that may prove to be alternatives or supplements to cPNBs. RECENT FINDINGS The primary factor limiting the duration of an ambulatory cPNB is the size of the local anesthetic reservoir. Recent evidence suggests the use of automated boluses, as opposed to continuous infusions, may decrease the rate of consumption of local anesthetic and, thereby, prolong the duration of analgesia. Utilizing a long-acting local anesthetic (e.g. ropivacaine) for initial block placement and an infusion start-delay timer may further increase this duration. SUMMARY Patients undergoing painful ambulatory surgery are likely to have less pain and require fewer opioid analgesics when receiving a cPNB for postoperative analgesia. Advances in electronic pumps used for cPNBs may increase the duration of these benefits.
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Affiliation(s)
- John J Finneran
- Department of Anesthesiology, University of California San Diego, San Diego, California
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, San Diego, California
- Outcomes Research Consortium, Cleveland, Ohio, USA
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Shah A, Cohen K, Patel B, Dahiya N, Fananapazir G. Optimizing anxiolysis and analgesia for percutaneous intervention by the abdominal radiologist. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2721-2729. [PMID: 35072783 DOI: 10.1007/s00261-022-03417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 01/18/2023]
Abstract
Abdominal radiologists perform a wide variety of image-guided interventions. Procedures performed by abdominal radiologists can be broadly categorized into paracentesis, thoracentesis, superficial and deep soft tissue biopsy, drain placement, and ablation. As these procedures continue to develop as an alternative to more invasive and potentially morbid interventions, and with continued improvements in minimally invasive technologies, it becomes increasingly important for abdominal radiologists to be familiar with options for peri-procedural analgesia and anxiolysis, as well as when to consult anesthesiology. In this review, we discuss analgesic, anxiolytic, and nonpharmacologic options available to the abdominal radiologist. We focus on practical agents that are relatively safe for general use, special populations, and considerations for post-procedural monitoring.
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Affiliation(s)
- Amar Shah
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Kevin Cohen
- Department of Anesthesia, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Bhavik Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
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Mojica JJ, Ocker A, Barrata J, Schwenk ES. Anesthesia for the Patient Undergoing Shoulder Surgery. Clin Sports Med 2022; 41:219-231. [PMID: 35300836 DOI: 10.1016/j.csm.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Shoulder surgery introduces important anesthesia considerations. The interscalene nerve block is considered the gold standard regional anesthetic technique and can serve as the primary anesthetic or can be used for postoperative analgesia. Phrenic nerve blockade is a limitation of the interscalene block and various phrenic-sparing strategies and techniques have been described. Patient positioning is another important anesthetic consideration and can be associated with significant hemodynamic effects and position-related injuries.
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Affiliation(s)
- Jeffrey J Mojica
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Suite 8290 Gibbon Building, Philadelphia, PA 19107, USA.
| | - Aaron Ocker
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Suite 8290 Gibbon Building, Philadelphia, PA 19107, USA
| | - Jaime Barrata
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Suite 8290 Gibbon Building, Philadelphia, PA 19107, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Suite 8290 Gibbon Building, Philadelphia, PA 19107, USA
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Saini S, Khattar N, Gautam D, Agrawal N, Gupta A. Comparison of combined adductor canal block with peri-hamstring infiltration versus adductor canal block for postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction surgery. JOURNAL OF ARTHROSCOPY AND JOINT SURGERY 2021; 8:282-287. [DOI: 10.1016/j.jajs.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
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Comparison of the Analgesic Duration of 0.5% Bupivacaine With 1:200,000 Epinephrine Versus 0.5% Ropivacaine Versus 1% Ropivacaine for Low-Volume Ultrasound-Guided Interscalene Brachial Plexus Block: A Randomized Controlled Trial. Anesth Analg 2021; 132:1129-1137. [PMID: 33464760 DOI: 10.1213/ane.0000000000005373] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Bupivacaine and ropivacaine are the preferred long-acting local anesthetics for peripheral nerve blocks as they provide prolonged analgesia in the postoperative period. No studies have directly compared the analgesic duration of these commonly used local anesthetics in the setting of low-volume ultrasound-guided interscalene block (US-ISB). This study was designed to determine which local anesthetic and concentration provides superior analgesia (duration and quality) for low-volume US-ISB. METHODS Sixty eligible patients scheduled for arthroscopic shoulder surgery were randomized (1:1:1) to receive US-ISB (5 mL) with 0.5% bupivacaine with 1:200,000 epinephrine, 0.5% ropivacaine, or 1% ropivacaine. All individuals were blinded including study participants, anesthesiologists, surgeons, research personnel, and statistician. All participants received a standardized general anesthetic and multimodal analgesia. The primary outcome was duration of analgesia defined as the time from the end of injection to the time that the patients reported a significant increase in pain (>3 numeric rating scale [NRS]) at the surgical site. RESULTS The mean duration of analgesia for 0.5% bupivacaine with 1:200,000 epinephrine, 0.5% ropivacaine, or 1% ropivacaine was 14.1 ± 7.4, 13.8 ± 4.5, and 15.8 ± 6.3 hours, respectively (analysis of variance [ANOVA], P = .51). There were no observed differences in analgesic duration or other secondary outcomes between the 3 groups with the exception of a difference in cumulative opioid consumption up to 20h00 on the day of surgery in favor of ropivacaine 0.5% over bupivacaine of minimal clinical significance. CONCLUSIONS In the context of single-injection low-volume US-ISB, we have demonstrated a similar efficacy between equal concentrations of ropivacaine and bupivacaine. In addition, increasing the concentration of ropivacaine from 0.5% to 1% did not prolong the duration of US-ISB.
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Breebaart MB, Branders J, Sermeus L, Termurziev S, Camerlynck H, Van Putte L, Van Putte Minelli M, De Hert S. Levobupivacaine Consumption in Automated Intermittent Bolus in Ultrasound Guided Subparaneural Sciatic Nerve Catheters: A Prospective Double-Blind Randomized Trial. Local Reg Anesth 2021; 14:43-50. [PMID: 33790643 PMCID: PMC8007557 DOI: 10.2147/lra.s299870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Continuous sciatic nerve blocks have proven benefits for postoperative analgesia after foot surgery. However, the optimal mode of administration remains a point of debate. Ultrasound guided subparaneural injection accelerates onset time and increases duration after a single shot sciatic nerve block. This double blind prospective randomized trial compares the 48-hour local anesthetic (LA) dose consumption of an automated intermittent bolus technique to a continuous infusion regimen in a subparaneural sciatic nerve catheter after hallux valgus surgery. Patients and Methods Patients scheduled for hallux valgus surgery were randomized to receive either a continuous infusion of levobupivacaine 0.125% at 5mL/h (group A) or an intermittent automated bolus of 9.8 mL every 2 hours with a background of 0.1 mL/h (group B), both with a PCA bolus of 6 mL and lockout of 30 minutes. The 48 hour LA consumption, PCA boluses, Numeric Rating Scale (NRS), satisfaction and return of normal sensation were recorded. Results Sixteen patients were excluded because of protocol violation or technical problems and 42 patients remained for analysis. The 48 hour ropivacaine consumption was higher in group A (293 ±60 mL) than group B (257±33 mL). The median and highest NRS scores and patient satisfaction were not statistically different between groups. Normal sensation returned after 75 ± 22 hours (group A) and 70 ± 17 hours (group B). Conclusion Programmed bolus administration in subparaneural sciatic nerve catheters reduces LA consumption 48 hours after surgery with equal analgesia and patient satisfaction. Return of sensation is variable and can last more than 75 hours.
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Affiliation(s)
- Margaretha B Breebaart
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.,Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium
| | - Jordi Branders
- Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium
| | - Luc Sermeus
- Department of Anesthesiology, St. Luc University Hospital, Brussels, Belgium
| | - Sultan Termurziev
- Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium
| | - Helene Camerlynck
- Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium
| | - Lennert Van Putte
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | | | - Stefan De Hert
- Department of Anesthesia and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
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Amorim KDS, Gercina AC, Ramiro FMS, Medeiros LDA, de Araújo JSM, Groppo FC, Souza LMDA. Can local anesthesia with ropivacaine provide postoperative analgesia in extraction of impacted mandibular third molars? A randomized clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:512-518. [PMID: 33223455 DOI: 10.1016/j.oooo.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/02/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the local anesthesia efficacy of ropivacaine 0.75% compared to lidocaine 2% with 1:100,000 epinephrine for postoperative analgesia following extraction of impacted mandibular third molars. STUDY DESIGN In this randomized, double-blind crossover clinical trial, 30 participants underwent surgical removal of bilateral impacted mandibular third molars under local anesthesia using ropivacaine 0.75% or lidocaine 2% with 1:100,000 epinephrine. The pain was recorded on a visual analog scale at 4, 8, 12, 24, and 48 h postoperatively. The use of analgesics and the presence of adverse effects were recorded. RESULTS The duration of soft tissue anesthesia in the ropivacaine group was significantly longer than that in the lidocaine group. The lidocaine group recorded significantly higher visual analog scale scores at all postoperative time intervals, except in the final 48-h period. Analgesic use was higher in the lidocaine group. Rescue medication was used by 2 patients in each group (6.7%). Significantly more postoperative bleeding was seen in the ropivacaine group. CONCLUSION Ropivacaine 0.75% injection before the surgical procedure may be associated with preventive analgesia for extraction of impacted mandibular third molars.
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Affiliation(s)
- Klinger de Souza Amorim
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, Piracibaba, São Paulo, Brazil.
| | - Anne Caroline Gercina
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, Piracibaba, São Paulo, Brazil
| | - Filipe Mazar Santos Ramiro
- Federal University of Sergipe, Oral Surgery and Anesthesiology Area of Dentistry Department, Aracaju, Sergipe, Brazil
| | - Leonardo de Araújo Medeiros
- Federal University of Sergipe, Oral Surgery and Anesthesiology Area of Dentistry Department, Aracaju, Sergipe, Brazil
| | - Jaiza Samara Macena de Araújo
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, Piracibaba, São Paulo, Brazil
| | - Francisco Carlos Groppo
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, Piracibaba, São Paulo, Brazil
| | - Liane Maciel de Almeida Souza
- Federal University of Sergipe, Oral Surgery and Anesthesiology Area of Dentistry Department, Aracaju, Sergipe, Brazil
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Kong DY, Oh JH, Choi WR, Ko YI, Choi CH. The Impact of Epinephrine in the Periarticular Injection Cocktail using Ropivacaine for Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind Comparison Study. J Arthroplasty 2020; 35:2439-2443. [PMID: 32444230 DOI: 10.1016/j.arth.2020.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Epinephrine is used in periarticular injection using ropivacaine to produce a synergistic effect when used with local anesthetic agents but the effect has not been proven yet. The purpose of this study is to evaluate how effective epinephrine is on postoperative clinical outcomes in primary total knee arthroplasty (TKA). METHODS One hundred sixteen cases (89 patients) who underwent primary TKA were randomized into 2 groups depending on whether epinephrine was mixed. Immediately after the operation, patient-controlled analgesia using fentanyl was initiated. The Numerical Rating Scale, the cumulative dose of fentanyl, active range of motion of the knee joint, and wound complications were evaluated postoperatively. RESULTS There were no significant differences in mean postoperative Numerical Rating Scale, cumulative dose of fentanyl, and active range of motion between the 2 groups. Neither skin necrosis nor wound dehiscence requiring operative management for skin care was required in either group. CONCLUSION The use of epinephrine in periarticular injection using ropivacaine after TKA did not have any effect on postoperative acute pain control and opioid usage. THE LEVEL OF EVIDENCE Therapeutic level I.
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Affiliation(s)
- Dong Yi Kong
- Department of Orthopaedic Surgery, Juan Nanoori Hospital, Incheon, South Korea
| | - Jeong Han Oh
- Department of Orthopaedic Surgery, HeeMyoung General Hospital, Seoul, South Korea
| | - Won Rak Choi
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Young-Il Ko
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Choong H Choi
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, South Korea
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Schumacher J, Boone L. Local anaesthetics for regional and intra‐articular analgesia in the horse. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. Schumacher
- Department of Clinical Sciences College of Veterinary Medicine Auburn University Auburn Alabama USA
| | - L. Boone
- Department of Clinical Sciences College of Veterinary Medicine Auburn University Auburn Alabama USA
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13
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Stiegelmar C, Li Y, Beaupre LA, Pedersen ME, Dillane D, Funabashi M. Perioperative pain management and chronic postsurgical pain after elective foot and ankle surgery: a scoping review. Can J Anaesth 2019; 66:953-965. [PMID: 31020631 DOI: 10.1007/s12630-019-01370-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/27/2019] [Accepted: 02/16/2019] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Chronic postsurgical pain (CPSP) can occur after elective mid/hindfoot and ankle surgery. Effective treatment approaches to prevent the development of CPSP in this population have not been extensively investigated. The impact of multimodal strategies to prevent CPSP following elective mid/hindfoot surgery is unknown because of both the heterogeneity of acute pain management and the lack of a recognized definition particular to this surgery. This review aimed to identify and evaluate current pain management strategies after elective mid/hindfoot and ankle surgery. SOURCES Manual and electronic searches (MEDLINE, Embase, and Cochrane Library) were conducted of literature published between 1990 and July 2017. Comparative studies of adults undergoing elective mid/hindfoot and ankle surgery were included. Two reviewers independently reviewed studies and assessed their methodological quality. PRINCIPAL FINDINGS We found seven randomized-controlled trials meeting our inclusion criteria. Interventions focused on regional anesthesia techniques such as continuous popliteal sciatic and femoral nerve blockade. Participants were typically followed up to 48 hr postoperatively. Only one study assessed pain six months following elective mid/hindfoot and ankle surgery. CONCLUSION There is an overwhelming lack of evidence regarding CPSP and its management for patients undergoing elective mid/hindfoot and ankle surgery. The lack of a recognized and standard definition of CPSP after this group of surgeries precludes accurate and consistent evaluation.
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Affiliation(s)
| | - Yibo Li
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lauren A Beaupre
- Faculty of Rehabilitation Medicine, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
| | - M Elizabeth Pedersen
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Derek Dillane
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - Martha Funabashi
- Collaborative Orthopaedic Research, Alberta Health Services, Edmonton, AB, Canada.,Division of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
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15
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Alvarez AV, Schumacher J, DeGraves FJ. Effect of the addition of epinephrine to a lidocaine solution on the efficacy and duration of palmar digital nerve blocks in horses with naturally occurring forefoot lameness. Am J Vet Res 2018; 79:1028-1034. [PMID: 30256149 DOI: 10.2460/ajvr.79.10.1028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether addition of epinephrine to a lidocaine solution would prolong and potentiate the efficacy of a palmar digital nerve block (PDNB) in horses. ANIMALS 6 adult horses with naturally occurring forefoot lameness. PROCEDURES Initially, a PDNB with a 2% lidocaine solution was performed on the affected foot of each horse. Three days later, the PDNB was repeated with a 1% lidocaine solution or a 1% lidocaine solution containing epinephrine (dilution, 1:200,000). After another 3-day washout period, the PDNB was repeated with the treatment opposite that administered for the second PDNB. Gait was analyzed with a computerized lameness analysis system and heart rate and extent of skin sensation between the heel bulbs of the blocked foot were evaluated at predetermined times for 2 hours after each PDNB. RESULTS Efficacy and duration of the PDNB did not differ significantly between the 2% and 1% lidocaine treatments. The addition of epinephrine to the 1% lidocaine solution improved the efficacy and prolonged the duration of the PDNB. It also resulted in a positive correlation between skin desensitization and amelioration of lameness. Median heart rate remained unchanged throughout the observation period for all 3 treatments. No adverse effects associated with the PDNBs were observed. CONCLUSIONS AND CLINICAL RELEVANCE Addition of epinephrine (dilution, 1:200,000) to a 1% lidocaine solution improved the efficacy and prolonged the duration of a PDNB in horses with naturally occurring lameness and might be clinically useful for lameness evaluations and standing surgery of the forefoot of horses.
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Christiansen CB, Madsen MH, Rothe C, Andreasen AM, Lundstrøm LH, Lange KHW. Volume of ropivacaine 0.2% and common peroneal nerve block duration: a randomised, double‐blind cohort trial in healthy volunteers. Anaesthesia 2018; 73:1361-1367. [DOI: 10.1111/anae.14400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2018] [Indexed: 01/10/2023]
Affiliation(s)
- C. B. Christiansen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - M. H. Madsen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - C. Rothe
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - A. M. Andreasen
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - L. H. Lundstrøm
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
| | - K. H. W. Lange
- Department of Anaesthesiology Nordsjællands Hospital University of Copenhagen HillerødDenmark
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Pushpanathan E, Setty T, Carvalho B, Sultan P. A Systematic Review of Postoperative Pain Outcome Measurements Utilised in Regional Anesthesia Randomized Controlled Trials. Anesthesiol Res Pract 2018; 2018:9050239. [PMID: 30151005 PMCID: PMC6087609 DOI: 10.1155/2018/9050239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/24/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Regional anesthesia is a rapidly growing subspecialty. There are few published meta-analyses exploring pain outcome measures utilised in regional anesthesia randomized controlled trials (RCTs), which may be due to heterogeneity in outcomes assessed. This systematic review explores postoperative pain outcomes utilised in regional anesthesia RCTs. METHODS A literature search was performed using three databases (Medline, Embase, and CINAHL). Regional anesthesia RCTs with postoperative pain as a primary outcome were included if written in English and published in one of the top 20 impact factor journals between 2005 and 2017. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS From the 31 included articles, 15 different outcome measures in total were used to assess postoperative pain. The most commonly (16/31) used outcome measures were verbal numerical grading of pain out of 10, total opioid consumption, and visual analogue scale 10 cm (VAS). The need for analgesia was used as an outcome measure where studies did not use a pain rating score. Ten studies reported pain scores on activity and 27/31 studies utilised ≥2 pain outcomes. Time of measurement of pain score also varied with a total of 51 different time points used in total. CONCLUSION Analysis of the articles demonstrated heterogeneity and inconsistency in choice of pain outcome and time of measurement within regional anesthesia studies. Identification of these pain outcomes utilised can help to create a definitive list of core outcomes, which may guide future researchers when designing such studies.
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Affiliation(s)
- E. Pushpanathan
- Department of Anaesthesia, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - T. Setty
- Department of Anaesthesia, University College Hospitals London NHS Foundation Trust, London, UK
| | - B. Carvalho
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - P. Sultan
- Department of Anaesthesia, University College Hospitals London NHS Foundation Trust, University College London, London, UK
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Tschopp C, Tramèr MR, Schneider A, Zaarour M, Elia N. Benefit and Harm of Adding Epinephrine to a Local Anesthetic for Neuraxial and Locoregional Anesthesia. Anesth Analg 2018; 127:228-239. [DOI: 10.1213/ane.0000000000003417] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kang DH, Kang C, Hwang DS, Song JH, Jang MG. The Efficacy of Different Ropivacaine Concentrations (0.5%, 0.6%, vs . 0.75%) for Regional Nerve Block in Lower Extremity: A Prospective Randomized Controlled Trial. ACTA ACUST UNITED AC 2018. [DOI: 10.4055/jkoa.2018.53.3.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dong Hun Kang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chan Kang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Deuk Soo Hwang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Hwang Song
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min Gu Jang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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