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Simonin M, Delsuc C, Meuret P, Caruso L, Deleat-Besson R, Lamblin A, Huriaux L, Abraham P, Bidon C, Giai J, Riche B, Rimmelé T. Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial. Anesth Analg 2022; 135:1262-1270. [PMID: 36135347 DOI: 10.1213/ane.0000000000006208] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hypotension during surgery is frequent in the elderly population and is associated with acute kidney and myocardial injury, which are, themselves, associated with increased 30-day mortality. The present study compared the hemodynamic effects of hypobaric unilateral spinal anesthesia (HUSA) to general anesthesia (GA) in patients ≥70 years of age undergoing hip fracture surgery. METHODS We conducted a single-center, prospective, randomized study. In the HUSA group, patients were positioned with the operated hip above, and the hypobaric anesthetic solution was composed of 9 mg ropivacaine, 5 µg sufentanil, and 1 mL of sterile water. Anesthesia was adjusted for the GA group. Mean arterial pressure (MAP) was measured with a noninvasive blood pressure upper arm cuff every 3 minutes. Hypotension was treated with a bolus of ephedrine and then a continuous intravenous of norepinephrine to obtain a MAP ≥65 mm Hg. Primary outcome was the occurrence of severe hypotension, defined as a MAP <65 mm Hg for >12 consecutive minutes. RESULTS A total of 154 patients were included. Severe hypotension was more frequent in the GA group compared to the HUSA group (odds ratio, 5.6; 95% confidence interval, 2.7-11.7; P < .001). There was no significant difference regarding the short-term outcomes between the HUSA and GA groups: acute kidney injury (respectively, 5.1% vs 11.3%; P = .22), myocardial injury (18.0% vs 14.0%; P = .63), and 30-day mortality (2.4% vs 4.7%; P = .65). CONCLUSIONS HUSA leads to fewer episodes of severe intraoperative hypotension compared to GA in an elderly population undergoing hip fracture surgery.
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Affiliation(s)
- Marine Simonin
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Claire Delsuc
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Pascal Meuret
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Liana Caruso
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Robert Deleat-Besson
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Antoine Lamblin
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Laetitia Huriaux
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Paul Abraham
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Cyril Bidon
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Joris Giai
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
- Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Benjamin Riche
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
- Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Thomas Rimmelé
- From the Département d'Anesthésie-Réanimation, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
- Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Hôpital Édouard Herriot, Lyon, France
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Effects of Different Concentrations of Ropivacaine Lumbar Plexus-Sciatic Nerve Block on Recovery from Anesthesia, Postoperative Pain and Cognitive Function in Elderly Patients with Femoral Neck Fracture. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4096005. [PMID: 36062177 PMCID: PMC9436580 DOI: 10.1155/2022/4096005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/30/2022] [Indexed: 12/02/2022]
Abstract
Objective To investigate the effects of lumbar plexus-sciatic nerve block with different concentrations of ropivacaine on recovery from anesthesia, postoperative pain, and cognitive function in elderly patients with femoral neck fracture. Method A total of 110 elderly patients with femoral neck fractures who were treated in our hospital from January 2020 to January 2022 were selected as the research objects. According to the concentration of ropivacaine, they were divided into low-, medium-, and high-concentration groups (concentrations of ropivacaine were 0.15%, 0.25%, and 0.40%, respectively), with 36, 37, and 37 cases, respectively. Extubation time, anesthesia recovery time, and hospitalization time were recorded. Cognitive symptoms were assessed by the spatial cognitive ability, working memory ability, simple computing ability, and picture recognition ability test. The pain degree of patients was assessed by visual analogue scale (VAS). The occurrence of adverse reactions in patients was recorded. Result There was no significant difference in extubation time, anesthesia recovery time, and hospitalization time among the three groups (P > 0.05). The PCA time of the patients in the high-concentration group was significantly longer than that in the low- and medium-concentration groups. The dosage of sufentanil within 24 hours and total sufentanil in the high-concentration group were significantly lower than those in the low- and medium-concentration groups, and the dosage of sufentanil within 24 hours and total sufentanil in the medium-concentration group was significantly less than that in the low-concentration group (P < 0.05). The cognitive function score for each entry of the three groups 1 d after surgery was lower than that before surgery (P < 0.05); On the 1 day after operation, the cognitive function score for each entry of the patients in the low-concentration group was significantly higher than that in the middle- and high-concentration groups, and the cognitive function score for each entry in the middle-concentration group was significantly higher than that in the high-concentration group (P < 0.05). There was no significant difference in VAS scores between the three groups at 2 h and 8 h after surgery (P > 0.05); 16 h and 24 h after operation, the VAS score of patients in the high-concentration group was significantly lower than that in the low- and medium-concentration groups, and the VAS score in the medium-concentration group was significantly lower than that in the low-concentration ropivacaine group (P < 0.05). The incidence of adverse reactions in the high-concentration ropivacaine group was significantly higher than that in the low- and medium-concentration groups (P < 0.05). Conclusion The middle concentration of ropivacaine has good analgesic and nerve block effects and has less influence on cognitive function and less adverse reactions in elderly patients.
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Wang Y, Zha H, Fang X, Shen T, Pan K, Zhang J, He K, Wang S, Hu L. Dose Selection of Ropivacaine for Spinal Anesthesia in Elderly Patients with Hip Fracture: An Up-Down Sequential Allocation Study. Clin Interv Aging 2022; 17:1217-1226. [PMID: 35982942 PMCID: PMC9379111 DOI: 10.2147/cia.s371219] [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: 04/18/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The dose selection of ropivacaine for spinal anesthesia in clinical work mainly depends on the experience of the anesthesiologist. In this study, a prospective and modified up-down sequential allocation design was used to provide the optimal dose selection of ropivacaine for spinal anesthesia. Patients and methods This study was divided into two stages, and a total of 164 elderly patients with elective hip fractures were included. In stage I, the dose of ropivacaine was selected using the up-down sequential method of height correction, and the 50% effective dose (ED50) and 95% effective dose (ED95) were obtained. A nomogram for predicting satisfactory anesthesia and a formula for predicting the optimal dose was also given in this stage. In stage II, the dose of ropivacaine was calculated by using the optimal dose prediction formula, so as to evaluate the efficacy and safety of the model. Results The ED50 and ED95 of the stage I were 7.036 mg (95%CI 6.549–7.585 mg) and 8.709 mg (95%CI 7.902–14.275 mg), respectively. And provided a nomogram predicting satisfactory anesthesia with a C-index of 0.847 (95%CI 0.774–0.92). The optimal dose prediction formula of ropivacaine was calculated, including variables for age, gender, height, and weight. This formula was found to be 90% efficient. It is worth mentioning that the incidence of direct transfer to the ward in the two stages was as high as 86.84% and 93.33%, respectively, and no patients were transferred to the ICU in stage II. Conclusion The ED50 and ED95 of ropivacaine were 7.036 mg and 8.709 mg, respectively, and the nomograms are sufficiently accurate to predict satisfactory anesthesia. Beyond that, the dose prediction equation provided in this study has high efficacy and safety, and can guide the dose selection of spinal anesthesia in elderly patients with hip fracture in clinical practice. Clinical trials registration ChiCTR2100046982
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Affiliation(s)
- Yu Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Hanning Zha
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Xiang Fang
- Department of Anesthesiology, Hefei BOE Hospital, Hefei, Anhui, People's Republic of China
| | - Tianjiao Shen
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Kunyun Pan
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Jianping Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Keqiang He
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Sheng Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Liguo Hu
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
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Messina A, La Via L, Milani A, Savi M, Calabrò L, Sanfilippo F, Negri K, Castellani G, Cammarota G, Robba C, Morenghi E, Astuto M, Cecconi M. Spinal anesthesia and hypotensive events in hip fracture surgical repair in elderly patients: a meta-analysis. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:19. [PMID: 37386657 DOI: 10.1186/s44158-022-00047-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/20/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND Spinal anesthesia (SA) is widely used for anesthetic management of patients undergoing hip surgery, and hypotension is the most common cardiovascular side effect of SA. This paper aims to assess the lowest effective dose of SA that reduces the occurrence of intraoperative hypotension in elderly patients scheduled for major lower limb orthopedic surgery. METHODS We conducted a systematic review of randomized controlled trials (RCTs) performed in elderly patients scheduled for surgical hip repair and a meta-analysis with meta-regression on the occurrence of hypotensive episodes at different effective doses of anesthetics. We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials registered. RESULTS Our search retrieved 2085 titles, and after screening, 6 were finally included in both the qualitative and quantitative analysis, including 344 patients [15% (10-28) males], with a median (25th to 75th interquartile) age of 82 (80-85). The risk of bias assessment reported "low risk" for 5 (83.3%) and "some concerns" for 1 (16.7%) of the included RCTs. The low dose of SA of [mean 6.5 mg (1.9)] anesthetic was associated with a lower incidence of hypotension [OR = 0.09 (95%CI 0.04-0.21); p = 0.04; I2 = 56.9%], as compared to the high-dose of anesthetic [mean 10.5 mg (2.4)]. CONCLUSIONS In the included studies of this meta-analysis, a mean dose of 6.5 mg of SA was effective in producing intraoperative comfort and motor block and associated with a lower incidence of hypotension as compared to a mean dose of 10.5 mg. TRIAL REGISTRATION CRD42020193627.
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Affiliation(s)
- Antonio Messina
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Angelo Milani
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | - Marzia Savi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | - Lorenzo Calabrò
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Katerina Negri
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | | | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Emanuela Morenghi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Wan CF, Meng QZ, Wang YW, Qi L, Ai CL, Sui X, Song T. Patient-controlled subcutaneous analgesia using sufentainil or morphine in home care treatment in patients with stage III-IV cancer: A multi-center randomized controlled clinical trial. Cancer Med 2020; 9:5345-5352. [PMID: 32500675 PMCID: PMC7402833 DOI: 10.1002/cam4.3194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose Patient‐controlled subcutaneous analgesia (PCSA) with sufentanil is an alternative analgesia strategy in patients with stage III‐IV cancer; however, its efficacy and safety have not been fully investigated. Methods From May 10, 2017 to November 10, 2017, 120 patients with stage III‐IV cancer suffering from moderate to severe pain were prospectively enrolled from six hospitals and randomized to receive PCSA with morphine (control group) or sufentanil (intervention group). Before the PCSA and on days 1, 3, 7, 14, 28, and 56 after treatment, the numeric rating scale (NRS) and 36‐item Short Form health survey (SF‐36) were completed for each patient and the side effects were also recorded. RESULTS No significant differences (P > .05) were observed in the preoperative NRS score and the SF‐36 parameters between the two groups. Patients in the intervention group achieved better pain relief, as indicated by lower NRS scores at days 14 (P = .040), 28 (P < .001), and 56 (P < .001) after PCSA device implantation (vs control group). Furthermore, the patients in the intervention group also achieved a better life quality, as indicated by the physical role, general health, social function body pain, and mental health scores. Finally, the patients receiving sufentanil showed lower levels of nausea and somnolence than those in the control group. Conclusion PCSA with sufentanil achieves better pain control and life quality as well as fewer adverse reactions in stage III‐IV cancer patients with pain and may be a promising pain management in these patients. Trial registration This study was registered at chictr.org.cn with the trial number: ChiCTR‐IPR‐17011280.
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Affiliation(s)
- Cheng-Fu Wan
- Pain Department of the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Qing-Zhu Meng
- Pain Department of the Central Hospital of Haicheng city, Anshan, China
| | - Yan-Wei Wang
- Pain Department of the Third People's Hospital of Anshan city, Anshan, China
| | - Liang Qi
- Pain Department of the Central Hospital of Fuxin city, Fuxin, China
| | - Chang-Liang Ai
- Pain Department of the Women and Children's Hospital of Dandong city, Dandong, China
| | - Xin Sui
- Pain Department of the Central Hospital of Kuandian city, Dandong, China
| | - Tao Song
- Pain Department of the First Affiliated Hospital, China Medical University, Shenyang, China
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Zhao XY, Zhang EF, Bai XL, Cheng ZJ, Jia PY, Li YN, Guo Z, Yang JX. Ultrasound-Guided Continuous Femoral Nerve Block with Dexmedetomidine Combined with Low Concentrations of Ropivacaine for Postoperative Analgesia in Elderly Knee Arthroplasty. Med Princ Pract 2019; 28:457-462. [PMID: 30995645 PMCID: PMC6771060 DOI: 10.1159/000500261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 04/09/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This study aims to investigate the clinical effect of dexmedetomidine (DEX) combined with low concentrations of ropivacaine in ultrasound-guided continuous fem-oral nerve block for postoperative analgesia in elderly patients with total knee arthroplasty (TKA). MATERIALS AND METHODS Patients were divided into three groups: group C, group D1, and group D2. For postoperative analgesia, patients in group C were given 0.15% ropivacaine, patients in group D1 were given 0.15% ropivacaine + 0.02 μg × kg-1 × h-1 DEX, and patients in group D2 were given 0.15% ropivacaine + 0.05 μg × kg-1 × h-1 DEX. The visual analogue scores in the resting state, active state (AVAS), and passive functional exercise state (PVAS), degree of joint bending, and Ramsay scores were recorded. RESULTS The Ramsay scores were significantly higher, AVAS scores were significantly lower, PVAS scores were significantly decreased, the degree of joint bending was significantly higher, and the time to the first postoperative ambulation was shorter in groups D1 and D2 than group C. Furthermore, the time to the first postoperative ambulation was shorter in group D2 than in group D1, patients in groups D1 and D2 were more satisfied than patients in group C, and patients in group D2 were more satisfied than patients in group D1. CONCLUSION The protocol of 0.05 μg × kg-1 × h-1 of DEX combined with 0.15% ro-pivacaine in ultrasound-guided continuous femoral nerve block for postoperative analgesia in elderly patients with TKA provides a better analgesic effect than without DEX performance. UNLABELLED X.-Y.Z. and E.-F.Z. have contributed equally to this research.
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Affiliation(s)
- Xiao-Ying Zhao
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Er-Fei Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yan'an University, Yan'an, China
| | - Xiao-Li Bai
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zi-Jian Cheng
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Peng-Yun Jia
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan-Nan Li
- Shanxi Medical University, Taiyuan, China
| | - Zheng Guo
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian-Xin Yang
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China,
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Ke X, Li J, Liu Y, Wu X, Mei W. Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports. BMC Anesthesiol 2017. [PMID: 28651520 PMCID: PMC5483845 DOI: 10.1186/s12871-017-0358-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Anesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty is challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis successfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block. Case presentation Four patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe ankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12 paravertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional intravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort during the operations. Conclusions The combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all nerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a promising alternative for total hip arthroplasty in ankylosing spondylitis.
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Affiliation(s)
- Xijian Ke
- Department of anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China
| | - Ji Li
- Department of anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China
| | - Yong Liu
- Department of anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China
| | - Xi Wu
- Department of anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China
| | - Wei Mei
- Department of anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China.
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Qi Y, Yao X, Zhang B, DU X. Comparison of recovery effect for sufentanil and remifentanil anesthesia with TCI in laparoscopic radical resection during colorectal cancer. Oncol Lett 2016; 11:3361-3365. [PMID: 27123117 PMCID: PMC4841051 DOI: 10.3892/ol.2016.4394] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/30/2016] [Indexed: 12/26/2022] Open
Abstract
The aim of the present study was to compare the recovery of sufentanil and remifentanil anesthesia by target-controlled infusion (TCI) in elderly patients with laparoscopic-assisted radical resection of colorectal cancer. The effect of anesthesia on patient stress response and cellular immune function was also observed. Elderly patients (n=192) who underwent laparoscopic radical resection of colorectal cancer between July 2014 and October 2015 were randomly divided into the sufentanil and remifentanil groups (n=96 per group). The two groups used sufentanil- and remifentanil-based anesthesia by TCI. The wake-up time, extubation time, orientation recovery time, vital signs, stress response, distribution of T-cell subsets and incidence of adverse reactions were recorded and compared. The wake-up and extubation times of the remifentanil group were significantly shorter than those of the sufentanil group. The difference of orientation recovery time was not statistically significant. The differences in heart rate, mean arterial pressure, and arterial oxygen saturation following anesthesia and during surgery and those prior to anesthesia of the sufentanil group were not statistically significant. However, those of the remifentanil group significantly improved following anesthesia. The concentrations of glucose, cortisol (COR), and interleukin-6 and C-reactive protein were stable in the sufentanil group, whereas the indices in the remifentanil group had a tendency of increasing during the anesthesia and surgery, and had a longer postoperative recovery time. The decreasing degree of T-cell subsets in the sufentanil group was significantly lower than that in the remifentanil group, and had a short recovery of cellular immunity following surgery. The adverse reactions rate during anesthesia of the remifentanil group was significantly higher than that of the sufentanil group. In conclusion, sufentanil- and remifentanil-based anesthesia with TCI has certain advantages, including improved recovery effect, less stress response, less inhibition of cellular immunity and fewer adverse reactions. It has the potential to become the first choice of anesthetic in the clinic for elderly patients who undergo laparoscopic radical resection for colorectal cancer.
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Affiliation(s)
- Yanyan Qi
- Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Xiangyan Yao
- Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Beibei Zhang
- Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Xianhui DU
- Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
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Wu HH, Wang HT, Jin JJ, Cui GB, Zhou KC, Chen Y, Chen GZ, Dong YL, Wang W. Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis. PLoS One 2014; 9:e93114. [PMID: 24671181 PMCID: PMC3966844 DOI: 10.1371/journal.pone.0093114] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 03/01/2014] [Indexed: 12/13/2022] Open
Abstract
Background Neuraxial application of dexmedetomidine (DEX) as adjuvant analgesic has been invetigated in some randomized controlled trials (RCTs) but not been approved because of the inconsistency of efficacy and safety in these RCTs. We performed this meta-analysis to access the efficacy and safety of neuraxial DEX as local anaesthetic (LA) adjuvant. Methods We searched PubMed, PsycINFO, Scopus, EMBASE, and CENTRAL databases from inception to June 2013 for RCTs that investigated the analgesia efficacy and safety for neuraxial application DEX as LA adjuvant. Effects were summarized using standardized mean differences (SMDs), weighed mean differences (WMDs) or odds ratio (OR) with suitable effect model. The primary outcomes were postoperative pain intensity and analgesic duration, bradycardia and hypotension. Results Sixteen RCTs involving 1092 participants were included. Neuraxial DEX significantly decreased postoperative pain intensity (SMD, −1.29; 95% confidence interval (CI), −1.70 to −0.89; P<0.00001), prolonged analgesic duration (WMD, 6.93 hours; 95% CI, 5.23 to 8.62; P<0.00001) and increased the risk of bradycardia (OR, 2.68; 95% CI, 1.18 to 6.10; P = 0.02). No evidence showed that neuraxial DEX increased the risk of other adverse events, such as hypotension (OR, 1.54; 95% CI, 0.83 to 2.85; P = 0.17). Additionally, neuraxial DEX was associated with beneficial alterations in postoperative sedation scores and number of analgesic requirements, sensory and motor block characteristics, and intro-operative hemodynamics. Conclusion Neuraxial DEX is a favorable LA adjuvant with better and longer analgesia. The greatest concern is bradycardia. Further large sample trials with strict design and focusing on long-term outcomes are needed.
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Affiliation(s)
- Huang-Hui Wu
- Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China
- Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China
| | - Hong-Tao Wang
- Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China
- Department of Burn and Cutaneous Surgery, Xi’jing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Jun-Jie Jin
- Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China
- Department of Neurosurgery, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China
| | - Guang-Bin Cui
- Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China
- Department of Diagnostic Radiology, Tangdu Hospital, Fourth Military Medical University, Xi’an, PR China
| | - Ke-Cheng Zhou
- Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China
- China Pharmaceutical University, Nanjing, PR China
| | - Yu Chen
- Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China
| | - Guo-Zhong Chen
- Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China
- * E-mail: (GZC); (YLD); (WW)
| | - Yu-Lin Dong
- Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China
- * E-mail: (GZC); (YLD); (WW)
| | - Wen Wang
- Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China
- * E-mail: (GZC); (YLD); (WW)
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