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Duarte-Medrano G, Nuño-Lámbarri N, Minnuti-Palacios M, Dominguez-Franco A, Dominguez-Cherit JG, Zamora-Meraz R. Navigating challenges in anesthesia for robotic urological surgery: a comprehensive guide. J Robot Surg 2024; 18:300. [PMID: 39073629 DOI: 10.1007/s11701-024-02055-w] [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: 04/17/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
Robotic surgery has emerged as a cornerstone in urological interventions, offering effectiveness and safety for patients. For anesthesiologists, this technological advancement presents a myriad of new challenges, spanning from patient selection and assessment to intraoperative dynamics and post-surgical pain management. This article aims to elucidate these challenges and provide guidance for anesthesiologists in navigating the complexities of anesthesia administration in robotic urological procedures. Through a detailed exploration of patient optimization, team coordination, intraoperative adjustments, and post-surgical care, this article serves as a valuable resource for ensuring the success of such interventions.
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Affiliation(s)
- Gilberto Duarte-Medrano
- Anesthesiology Department, Hospital Medica Sur, Puente de Piedra 150, Toriello Guerra Tlalpan, Ciudad de México, CDMX, 14050, Mexico, Mexico.
| | - Natalia Nuño-Lámbarri
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, 14050, Mexico, Mexico.
- Department of Surgery, Faculty of Medicine, The National Autonomous University of Mexico (UNAM), Escolar 411A, Copilco Universidad, Coyoacán, Mexico, Mexico.
| | - Marissa Minnuti-Palacios
- Anesthesiology Department, Hospital Medica Sur, Puente de Piedra 150, Toriello Guerra Tlalpan, Ciudad de México, CDMX, 14050, Mexico, Mexico
| | - Analucia Dominguez-Franco
- Anesthesiology Department, Hospital Medica Sur, Puente de Piedra 150, Toriello Guerra Tlalpan, Ciudad de México, CDMX, 14050, Mexico, Mexico
| | - Jose Guillermo Dominguez-Cherit
- Anesthesiology Department, Hospital Medica Sur, Puente de Piedra 150, Toriello Guerra Tlalpan, Ciudad de México, CDMX, 14050, Mexico, Mexico
- Escuela de Medicina, Tecnológico de Monterrey, CDMX, Mexico
| | - Rafael Zamora-Meraz
- Anesthesiology Department, Hospital Medica Sur, Puente de Piedra 150, Toriello Guerra Tlalpan, Ciudad de México, CDMX, 14050, Mexico, Mexico
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Js Medeiros H, Gee E, Pak A, Hu V, Crawford L, Razavi S, Anderson TA, Sabouri AS. The Analgesic Effects of the Thoracic Paravertebral Block on Post-percutaneous Nephrolithotripsy: A Retrospective Study. Cureus 2024; 16:e60272. [PMID: 38872686 PMCID: PMC11170241 DOI: 10.7759/cureus.60272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Percutaneous nephrolithotripsy (PCNL) is a minimally invasive procedure for treating large and complex kidney stones, often resulting in significant post-operative pain and increased opioid use. This study aims to compare pain scores between patients undergoing PCNL who did and did not receive a preoperative single-shot thoracic paravertebral block (PVB) at the post-anesthesia care unit (PACU) as the primary outcome. Secondary outcomes were patient-controlled analgesia (PCA) usage on post-operative day 1 (POD 1), total opioid consumption on PACU and POD 1, and post-operative nausea and vomiting (PONV). METHODS A retrospective cohort study was conducted on the medical records of 341 patients who underwent PCNL from July 2014 to April 2016 in a single major academic center. PVB was administered at thoracic levels T7-9 using a volume of 20 cc of bupivacaine, ranging from 0.25% to 0.5%, to achieve the desired analgesic effect. RESULTS After excluding 34 patients, the study included 123 in the no block (NB) group and 149 in the regional anesthesia (RA) group. There were no differences in demographics, including age, sex, weight and height, BMI, and indication for PCNL. The results revealed that the RA group experienced a statistically significant reduction in PCA usage in both crude and adjusted models (adjusted logistic regression analysis: OR = 0.19, 95% CI = 0.05-0.60; p = 0.008). However, there were no significant changes in total opioid consumption, pain scores, or incidents of PONV. CONCLUSION The retrospective analysis did not reveal any discernible advantage in pain management associated with the use of PVB for post-PCNL analgesia, except for reducing the percentage of PCA narcotics used. Future investigations with larger sample sizes and meticulous control for surgical indications and complexity are imperative to accurately assess the efficacy of this block in the context of post-PCNL surgery.
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Affiliation(s)
- Heitor Js Medeiros
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Erica Gee
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Aimee Pak
- Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Vivian Hu
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Lane Crawford
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Sarah Razavi
- Urology, Massachusetts General Hospital, Boston, USA
| | | | - A Sassan Sabouri
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
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Scholzen EA, Silva JB, Schroeder KM. Unique considerations in regional anesthesia for emergency department and non-or procedures. Int Anesthesiol Clin 2024; 62:43-53. [PMID: 38063037 DOI: 10.1097/aia.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Elizabeth A Scholzen
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Zhao Y, Kan Y, Huang X, Wu M, Luo W, Nie J. The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and meta-analysis of randomized controlled trials. Front Surg 2022; 9:865362. [PMID: 35923436 PMCID: PMC9339658 DOI: 10.3389/fsurg.2022.865362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Paravertebral block (PVB) has been widely used in postoperative analgesia, especially in thoracic and breast surgery. However, the efficacy and safety of PVB for analgesia after renal surgery remains uncertain. Therefore, this study aimed to determine the postoperative analgesic efficacy and safety of PVB in renal surgery. Methods PubMed, Web of Science, Embase, and the Cochrane Library databases were systematically searched up to December 20, 2021. All randomized controlled trials (RCTs) evaluating the postoperative analgesic efficacy of PVB in renal surgery were collected. The meta-analysis was performed using RevMan 5.4 and Stata/MP 14.0 software. Results A total of 16 RCTs involving 907 patients were included in the meta-analysis. Ten studies investigated patients under percutaneous nephrolithotomy (PCNL), and six studies were done for patients under other renal surgery (nephrectomy or pyeloplasty). Compared with control groups (no block, sham block, or other nerve blocks), meta-analysis showed that PVB reduced 24-hour postoperative opioid consumption significantly (SMD = −0.99, 95%CI: −1.60–0.38, p = 0.001, I2 = 92%) and reduced pain scores at various time points within 24 h at rest and 1 h, 4 h, and 24 h at movement after renal surgery, furthermore, PVB prolonged the time to first postoperative analgesic requirement (SMD = 2.16, 95%CI: 0.94–3.39, p = 0.005, I2 = 96%) and reduced the incidence of postoperative additional analgesia (OR = 0.14, 95%CI: 0.06∼0.33, p < 0.00001, I2 = 50%). Subgroup analysis revealed that the postoperative analgesia effect of PVB was more significant in PCNL, and the use of bupivacaine for PVB seemed to have a better performance. Besides, there was no difference in the incidence of postoperative nausea, vomiting, and itching between PVB and control groups. Conclusion This study indicates that PVB may provide effective postoperative analgesia in patients under renal surgery, especially PCNL patients. Moreover, PVB is a safe analgesic method without significant analgesia-related complications.
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Affiliation(s)
- You Zhao
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
| | - Yanan Kan
- Department of Orthopedic, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xin Huang
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
| | - Ming Wu
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
| | - Weiping Luo
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
- Correspondence: Weiping Luo Jun Nie
| | - Jun Nie
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
- Correspondence: Weiping Luo Jun Nie
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Pani N, Sahu P, Swain D, Biswal C, Pradhan A, Routray SS. Effects of fentanyl and dexmedetomidine as adjuvants to bupivacaine in paravertebral block for postoperative analgesia in patients undergoing modified radical mastectomy: A prospective randomised double-blind study. Indian J Anaesth 2022; 66:S193-S199. [PMID: 35874488 PMCID: PMC9298934 DOI: 10.4103/ija.ija_745_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/17/2022] [Accepted: 02/12/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND AIMS Paravertebral block (PVB) is an established method, indicated for postoperative analgesia after modified radical mastectomy (MRM). Although many additives to bupivacaine in PVB have been tried to prolong the analgesia in postoperative period, no additive has been found without any adverse effects. We have compared the duration of analgesia in PVB using adjuvants like dexmedetomidine and fentanyl with bupivacaine after MRM. METHODS A total of 60 female patients enroled for MRM were divided into two groups of 30 patients each. Group BF received PVB with 20 ml bupivacaine 0.25% with fentanyl 1 mg/kg and group BD received 20 ml bupivacaine 0.25% with dexmedetomidine 1 mg/kg for PVB. After confirming successful PVB, surgery was done under general anaesthesia. Time for first rescue analgesic request was the primary outcome of the study. The secondary outcome was comparison of visual analogue scale scores for pain and total analgesic consumption. Side effects like sedation, nausea, vomiting, bradycardia and hypotension in the postoperative period till 24 h were also assessed. RESULTS The time for first rescue analgesic request was 6.32 ± 1.75 h in the BD group contrary to 3.94 ± 2.12 h in group BF (P < 0.05). Total paracetamol consumed as rescue analgesia in the first 24 h of postoperative period was remarkably reduced in group BD (1.7 ± 0.94 gm) in contrary to group BF (2.6 ± 0.98 gm) (P < 0.05). There was no significant difference in the incidence of complications between the groups. CONCLUSION Dexmedetomidine provides prolonged postoperative analgesia compared with fentanyl when used as an adjuvant to bupivacaine in PVB after MRM.
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Affiliation(s)
- Nibedita Pani
- Department of Anaesthesiology and Critical Care, SCB Medical College, Hospital, Cuttack, Odisha
| | - Padmalaya Sahu
- Department of Anaesthesiology and Critical Care, SCB Medical College, Hospital, Cuttack, Odisha
| | - Deepti Swain
- Department of Anaesthesiology and Critical Care, SCB Medical College, Hospital, Cuttack, Odisha
| | - Chetna Biswal
- Department of Anaesthesiology and Critical Care, SCB Medical College, Hospital, Cuttack, Odisha
| | - Amit Pradhan
- Department of Anaesthesiology and Critical Care, KIMS, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Sidharth Sraban Routray
- Department of Anaesthesiology and Critical Care, SCB Medical College, Hospital, Cuttack, Odisha,Address for correspondence: Dr. Sidharth Sraban Routray, Department of Anaesthesiology and Critical Care, SCB Medical College, Hospital, Cuttack, Odisha-753 001, India. E-mail:
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Fu S, Mo Z, He S, Che X, Wu T. The effect of nonpharmacological interventions on pain and sleep quality after percutaneous nephrolithotomy: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e28898. [PMID: 35451382 PMCID: PMC8913122 DOI: 10.1097/md.0000000000028898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Various nonpharmacological interventions have been applied to alleviate pain and improve sleep quality after percutaneous nephrolithotomy. However, evidence to compare their efficacy is scant. This study aims to evaluate the efficacy of different nonpharmacological interventions on alleviating pain and improving sleep quality in patients after percutaneous nephrolithotomy through a network meta-analysis . METHODS Randomized controlled trials reporting the efficacy of nonpharmacological interventions on alleviating pain and improving sleep quality in patients after percutaneous nephrolithotomy will be searched in online databases, including the Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, China Biomedical Literature Database, Pubmed, Web of Science, Embase, and Cochrane Library. After quality assessment and date extraction, network meta-analysis will be performed using Stata 14.0 and R software. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSIONS This study will provide systematic and comprehensive evidence-based support for the effects of nonpharmacological interventions on alleviating pain and improving sleep quality after percutaneous nephrolithotomy. ETHICS AND DISSEMINATION Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. REGISTRATION NUMBER DOI 10.17605/OSF.IO/B4DHW.
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Xu XJ, Zhang J, Li M, Hou JQ. Clinical study on the minimally invasive percutaneous nephrolithotomy treatment of upper urinary calculi. World J Clin Cases 2022; 10:1198-1205. [PMID: 35211553 PMCID: PMC8855199 DOI: 10.12998/wjcc.v10.i4.1198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/02/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Upper urinary tract stones are very common in my country, with an incidence of 1% to 5% in the North and an even higher incidence of 5% to 10% in the south. The incidence rate in the south is higher than that in the north, mainly due to the water quality, climate and eating habits of the region. From the perspective of sex, incidence is more likely in males than females. In the high-incidence population, young adults are most prone to stones. Men in the age range of 25 to 40 years are more likely to have stones.
AIM To observe the therapeutic effect of minimally invasive percutaneous nephrolithotomy (mPCNL) on upper urinary tract stones and its influence on the renal function of patients.
METHODS Patients with upper urinary tract stones who were treated in our hospital from February 2017 to March 2018 were selected as research subjects and were divided into the PCNL group and the mPCNL group according to the random number table method. The general conditions of the two groups of patients were observed during the perioperative period, and the differences in stone clearance, pain, renal function indicators and complication rates were compared between the two groups to determine which were statistically significant (P < 0.05).
RESULTS The operation time of the mPCNL group was longer than that of the PCNL group (t = -34.392, P < 0.001), and the intraoperative blood loss of the mPCNL group was more than that of the PCNL group (t = 34.090, P < 0.001). There was no difference in renal function indices between the two groups of patients before treatment, and there was no difference in the levels of serum creatinine, β2 microglobulin or retinol binding protein in the mPCNL group after treatment. The visual analog scale score of patients in the mPCNL group was lower than that of the PCNL group (t = 12.191, P < 0.001), and there was no significant difference in the stone clearance rate between the two groups (χ2 value = 1.013, P = 0.314). There was no significant difference in the incidence of urine extravasation, dyspnea and peripheral organ damage between the two groups (χ2 value = 1.053, P = 0.305). At 1 mo after treatment and 3 mo after treatment, the quality of life of the mPCNL group was lower than that of the PCNL group, and the Qmax level of the mPCNL group was higher than that of the PCNL group.
CONCLUSION mPCNL has a good therapeutic effect on upper urinary tract stones, with a high stone clearance rate without causing kidney damage or increasing the incidence of complications, and thus has good application value.
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Affiliation(s)
- Xiao-Jian Xu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jun Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Miao Li
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jian-Quan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Winoker JS, Koo K, Alam R, Matlaga B. Opioid-sparing analgesic effects of peripheral nerve blocks in percutaneous nephrolithotomy: a systematic review. J Endourol 2021; 36:38-46. [PMID: 34314232 DOI: 10.1089/end.2021.0402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Multimodal analgesia regimens incorporating peripheral nerve blocks (PNB) have demonstrated reduced postoperative pain, opioid use, and recovery time in various disease states. However, this remains a subject of limited investigation in the percutaneous nephrolithotomy (PCNL) domain. In the face of an ongoing opioid epidemic and collective push to enhance prescribing stewardship, we sought to examine the potential opioid-sparing effect of PNB in PCNL. METHODS A systematic review of Embase and PubMed was performed to identify all randomized controlled trials evaluating the use of a PNB with general anesthesia (GA) versus GA alone for pain control following PCNL. Studies evaluating neuraxial (epidural and spinal) anesthesia and those without GA as the control arm were excluded. RESULTS Seventeen trials evaluating 1012 procedures were included. Five different blocks were identified and evaluated: paravertebral (n=8), intercostal nerve (n=3), quadratus lumborum (n=2), transversus abdominis plane (n=1), and erector spinae (n=3). 9/16 (56%) studies observed lower pain scores with PNB use throughout the 24-hour postop period. By comparison, improved pain scores with PNB were limited to the early (<6 hours) recovery period in 5 studies and 2 found no difference. Total analgesia and opioid requirements were significantly higher in the GA control arm in nearly all studies (12/14, 86%). Operative times were similar and there were no differences in rates of intercostal access or nephrostomy tube insertion between study arms in any trial. CONCLUSION While greater analgesic use with GA alone likely minimizes or obscures differences in patient-reported pain scores, PNB may offer a significant opioid-sparing analgesic effect during postoperative recovery after PCNL.
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Affiliation(s)
- Jared S Winoker
- Johns Hopkins University School of Medicine, 1500, 600 N. Wolfe Street, Baltimore, MD, Baltimore, Maryland, United States, 21205-2105;
| | - Kevin Koo
- Mayo Clinic, 6915, 200 First St SW, Rochester, Minnesota, United States, 55905;
| | - Ridwan Alam
- Johns Hopkins University James Buchanan Brady Urological Institute, 117539, 600 N. Wolfe St., Marburg 134, Baltimore, Maryland, United States, 21287;
| | - Brian Matlaga
- Johns Hopkins University, Brady Urological Institute, Baltimore, Maryland, United States;
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