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Zhaksylyk A, Abdildin YG, Sultangazin S, Zhumakanova A, Viderman D. The impact of ketamine on pain-related outcomes after thoracotomy: a systematic review with meta-analysis of randomized controlled trials. Front Med (Lausanne) 2024; 11:1394219. [PMID: 38919936 PMCID: PMC11196606 DOI: 10.3389/fmed.2024.1394219] [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] [Received: 03/01/2024] [Accepted: 05/15/2024] [Indexed: 06/27/2024] Open
Abstract
Objective This meta-analysis aims to examine how effective ketamine is in the management of acute and preventing chronic post-thoracotomy pain by synthesizing the available research. Method A systematic literature search was conducted across PubMed, Scopus, and Cochrane Library till May 2023. Randomized Controlled Trials (RCT) examining the influence of ketamine on post-thoracotomy pain in adults were included. The intervention group included ketamine plus morphine, while the control group included morphine only. The outcome measures were opioid intake and pain scores at rest and on moving/coughing. Evidence quality was evaluated using the Cochrane Risk of Bias and GRADE assessment. Results Nine articles comprising 556 patients were selected for meta-analysis. The intervention group had a significant decrease in pain at rest (Std. Mean Difference (SMD = -0.60 with 95% CI [-0.83, -0.37]) and on movement/cough (SMD = -0.73 [-1.27, -0.18]) in the first postoperative days. Also, the ketamine group had lower opioid consumption (mg) in comparison with controls (SMD = -2.75 [-4.14, -1.36], p-value = 0.0001) in postoperative days 1-3. There was no data to assess the long-term effect of ketamine on chronic pain. Conclusion This meta-analysis shows that ketamine use can lower acute pain levels and morphine use after thoracotomy. In the future, larger RCTs using standardized methods and assessing both short-term and long-term analgesic effects of ketamine are necessary to deepen the understanding of the issue.
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Affiliation(s)
- Aruzhan Zhaksylyk
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Yerkin G. Abdildin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Suienish Sultangazin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Aigerim Zhumakanova
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Dmitriy Viderman
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Department of Anesthesiology, Intensive Care and Pain Medicine, National Research Oncology Center, Astana, Kazakhstan
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Viderman D, Nabidollayeva F, Aubakirova M, Sadir N, Tapinova K, Tankacheyev R, Abdildin YG. The Impact of Transcutaneous Electrical Nerve Stimulation (TENS) on Acute Pain and Other Postoperative Outcomes: A Systematic Review with Meta-Analysis. J Clin Med 2024; 13:427. [PMID: 38256561 PMCID: PMC10816585 DOI: 10.3390/jcm13020427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
This study aimed to investigate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) in postoperative acute pain control. PubMed, Scopus, and Cochrane Library were searched on 1-8 December 2022, for randomized controlled trials on the analgesic effects of TENS. The outcomes were pain intensity and opioid use (primary), and postoperative (PO) adverse events, blood pressure, and the duration of hospital stay (secondary); PROSPERO CRD42022333335. A total of 40 articles were included in the meta-analysis. Pain intensity at rest and during coughing for all types of surgeries combined was lower in the TENS group (standardized mean difference (SMD) = -0.51 [-0.61, -0.41], p < 0.00001, 29 studies, and -1.28 [-2.46, -0.09], p-value = 0.03, six studies, respectively). There was a statistically significant decrease in morphine requirements, as well as in the incidence of postoperative nausea and vomiting, dizziness, and pruritus. There was no difference between the groups in postoperative pain intensity during walking, in blood pressure, and only a borderline difference in the length of hospital stay. The subgroup analysis by surgery type did not show significant differences between the groups in pain severity at rest. Thus, TENS has a potential for pain control and postoperative recovery outcomes.
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Affiliation(s)
- Dmitriy Viderman
- Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (M.A.); (N.S.); (K.T.)
- Department of Anesthesiology, Intensive Care and Pain Medicine, National Research Oncology Center, Astana 010000, Kazakhstan
| | - Fatima Nabidollayeva
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (F.N.); (Y.G.A.)
| | - Mina Aubakirova
- Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (M.A.); (N.S.); (K.T.)
| | - Nurzhamal Sadir
- Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (M.A.); (N.S.); (K.T.)
| | - Karina Tapinova
- Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (M.A.); (N.S.); (K.T.)
| | - Ramil Tankacheyev
- Department of Minimally Invasive Surgery, National Research Neurosurgery Center, Astana 010000, Kazakhstan;
| | - Yerkin G. Abdildin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (F.N.); (Y.G.A.)
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Nair A, Saxena P, Borkar N, Rangaiah M, Arora N, Mohanty PK. Erector spinae plane block for postoperative analgesia in cardiac surgeries- A systematic review and meta-analysis. Ann Card Anaesth 2023; 26:247-259. [PMID: 37470522 PMCID: PMC10451138 DOI: 10.4103/aca.aca_148_22] [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: 08/28/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 07/21/2023] Open
Abstract
Ultrasound-guided erector spinae plane block (ESPB) has been used in many studies for providing opioid-sparing analgesia after various cardiac surgeries. We performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of ESPB in cardiac surgeries. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar to identify the studies in which ESPB was compared with the control group/sham block in patients undergoing cardiac surgeries. The primary outcomes were postoperative opioid consumption and postoperative pain scores. The secondary outcomes were intraoperative opioid consumption, ventilation time, time to the first mobilization, length of ICU and hospital stay, and adverse events. Out of 607 studies identified, 16 studies (n = 1110 patients) fulfilled inclusion criteria and were used for qualitative and quantitative analysis. Although, 24-hr opioid consumption were comparable in both groups group (MD, -18.74; 95% CI, -46.85 to 9.36, P = 0.16), the 48-hr opioid consumption was significantly less in ESPB group than control ((MD, -11.01; 95% CI, -19.98 to --2.04, P = 0.02). The pain scores at various time intervals and intraoperative opioid consumption were significantly less in ESPB group. Moreover, duration of ventilation, time to the first mobilization, and length of ICU and hospital were also less in ESPB group (P < 0.00001, P < 0.00001, P < 0.00001, and P < 0.0001, respectively). This systematic review and meta-analysis demonstrated that ESPB provides opioid-sparing perioperative analgesia, facilitates early extubation and mobilization, leads to early discharge from ICU and hospital, and has lesser pruritus when compared to control in patients undergoing cardiac surgeries.
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Affiliation(s)
- Abhijit Nair
- Department of Anaesthesiology, Ibra Hospital, Ministry of Health-Oman, Ibra-414, Sultanate of Oman, Oman
| | - Praveen Saxena
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | - Nitin Borkar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Manamohan Rangaiah
- Department of Anaesthetics and Pain Management, Walsall Manor Hospital, Moat Rd, Walsall WS2 9PS, United Kingdom
| | - Nishant Arora
- Department of Anaesthesiology, Kings College Hospital, NHS Foundation Trust, London, United Kingdom
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Abdildin YG, Salamat A, Omarov T, Sultanova M, Krassavina Y, Viderman D. Thoracolumbar Interfascial Plane Block in Spinal Surgery: A Systematic Review with Meta-Analysis. World Neurosurg 2023; 174:52-61. [PMID: 36894001 DOI: 10.1016/j.wneu.2023.02.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE As the thoracolumbar interfascial plane (TLIP) block may be a promising alternative in spinal surgery, there is a need for timely meta-analysis of this method's effectiveness in different medical outcomes. METHODS The meta-analysis of 6 randomized controlled studies on the application of TLIP block in spinal surgery was performed under the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The primary outcome used for comparison was the mean difference (MD) of pain intensity scores at rest/in motion between patients receiving TLIP block and those receiving no block care. RESULTS Our analysis favors TLIP block over no block (control group) for pain intensity at rest (MD with 95% confidence interval [CI] is -1.14 [-1.29, -0.99], P value <0.00001, I2 = 99%) and pain intensity in motion (MD with 95% CI is -1.49 [-1.73, -1.24], P value <0.00001, I2 = 99%) on postoperative day 1. Analysis also favors TLIP block in terms of cumulative fentanyl consumption on postoperative day 1 (MD is -166.64 mcg with 95% CI [-204.48, -128.80], P value <0.00001, I2 = 89%), postoperative side effects (risk ratio with 95% CI is 0.63 [0.44, 0.91], P value = 0.01, I2 = 0%), requests for supplementary/rescue analgesia (risk ratio with 95% CI is 0.36 [0.23, 0.49], P value <0.00001, I2 = 0%). The results are statistically significant. CONCLUSIONS The TLIP block reduces postoperative pain intensity, opioid consumption, side effects, and requests for rescue analgesia after spinal surgery more than the no-block alternative.
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Affiliation(s)
- Yerkin G Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Azamat Salamat
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Temirlan Omarov
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Madina Sultanova
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Yuliya Krassavina
- Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan
| | - Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan; Department of Anesthesiology and Intensive Care, National Research Oncology Center, Astana, Kazakhstan.
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Abdildin Y, Tapinova K, Salamat A, Shaimakhanov R, Aitbayev A, Viderman D. Rectus Sheath Block in Abdominal Surgery: A Systematic Review with Meta-Analysis. Rom J Anaesth Intensive Care 2023; 30:43-50. [PMID: 37635853 PMCID: PMC10448445 DOI: 10.2478/rjaic-2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Background and aims With the development of ultrasound-guided and laparoscopic techniques of rectus sheath block (RSB), regional analgesia promises to be efficient and safe. However, studies show controversial results. Our systematic review with meta-analysis aims to evaluate the effect of rectus sheath block in abdominal surgery. Method We searched PubMed, Google Scholar, and the Cochrane Library from inception to October 2021 for randomised controlled trials written in English. We included studies on adult populations undergoing abdominal surgery. The primary outcomes of our meta-analysis were postoperative pain intensity and postoperative opioid consumption. Data analysis was conducted using the Review Manager software (RevMan, v. 5.4). Statistical heterogeneity was estimated by the I2 statistic. The methodological quality of the included studies was assessed using the Oxford quality scoring system (Jadad Scale). Results Eight randomised controlled trials (RCTs) in English with a total of 386 patients were included in this meta-analysis. Patients in the RSB group did not consume fewer anaesthetics and opioids after abdominal surgery when compared with patients in the control group. In addition, postoperative pain intensity (out of 10) was not lower in the RSB group when compared with the control group. Finally, RSB did not improve the time to the first opioid/analgesic (min) compared with the non-RSB option. Conclusion There is no statistically significant evidence in favour of RSB over non-RSB in reducing anaesthetics and opioid consumption, postoperative pain intensity, and increasing time to first opioid/analgesic.
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Affiliation(s)
- Yerkin Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Karina Tapinova
- Nazarbayev University School of Medicine (NUSOM), Department of Biomedical Sciences, Astana, Kazakhstan
| | - Azamat Salamat
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Ramazan Shaimakhanov
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Alisher Aitbayev
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), Department of Anaesthesiology and Intensive Care, University Medical Centre, Astana, Kazakhstan
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Abdildin YG, Tapinova K, Nabidollayeva F, Viderman D. Epidural dexamethasone for acute postoperative pain management: a systematic review with meta-analysis. Pain Manag 2023; 13:129-141. [PMID: 36718798 DOI: 10.2217/pmt-2022-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Aim: To study the effect of epidural dexamethasone in postoperative pain management. Methods: Random-effects meta-analysis was conducted in RevMan 5.4. Results: We included nine randomized-controlled trials (RCT) with 657 patients. Dexamethasone demonstrated longer analgesia duration (mean difference 266.18 minutes, 95% CI [3.21,529.14]; p 0.05), lower incidence of nausea and vomiting during the first postoperative day (risk ratio 0.36, 95% CI [0.18,0.71]; p 0.004), and lower antiemetic requirements (risk ratio 0.33, 95% CI [0.14,0.79]; p 0.01). No difference in pain reduction and the length of hospital stay was observed between the groups. Conclusion: Dexamethasone was associated with a longer analgesic effect, a lower number of patients requiring antiemetics, and lower incidences of nausea and vomiting.
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Affiliation(s)
- Yerkin G Abdildin
- School of Engineering & Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, 010000, Kazakhstan
| | - Karina Tapinova
- Nazarbayev University School of Medicine (NUSOM), 5/1 Kerei & Zhanibek Khans Str., Astana, 020000, Kazakhstan
| | - Fatima Nabidollayeva
- School of Engineering & Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, 010000, Kazakhstan
| | - Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), 5/1 Kerei & Zhanibek Khans Str., Astana, 020000, Kazakhstan.,Department of Anesthesiology, Intensive Care & Pain Medicine, National Research Oncology Center, 5/1 Kerei & Zhanibek Khans Str., Astana, 020000, Kazakhstan
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Hochberg U, Brill S, Ofir D, Salame K, Lidar Z, Regev G, Khashan M. Is the Erector Spinae Plane Block Effective for More than Perioperative Pain? A Retrospective Analysis. J Clin Med 2022; 11:jcm11164902. [PMID: 36013141 PMCID: PMC9410308 DOI: 10.3390/jcm11164902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction: The thoracic Erector Spinae Plane Block (ESPB) is an ultrasound-guided block that has gained popularity and is widely used in acute pain setups. However, data regarding its role in chronic and cancer-related pain are anecdotal. Material and Methods: The study is a retrospective analysis of patients who underwent ESPB. The cohort was divided into subgroups based on three determinants: etiology, pain type, and chronicity. Results: One hundred and ten patients were included, and genders were affected equally. The average age was 61.2 ± 16.1 years. The whole group had a statistically significant reduction in a numerical rating scale (NRS) (7.4 ± 1.4 vs. 5.0 ± 2.6, p-value > 0.001). NRS reduction for 45 patients (41%) exceeded 50% of the pre-procedural NRS. The mean follow-up was 7.9 ± 4.6 weeks. Baseline and post-procedure NRS were comparable between all subgroups. The post-procedural NRS was significantly lower than the pre-procedural score within each group. The proportion of patients with over 50% improvement in NRS was lower for those with symptom duration above 12 months (p-value = 0.02). Conclusions: Thoracic ESPB is a simple and safe technique. The results support the possible role of ESPB for chronic as well as cancer-related pain.
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Affiliation(s)
- Uri Hochberg
- Division of Anesthesiology, Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-6974477
| | - Silviu Brill
- Division of Anesthesiology, Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dror Ofir
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Khalil Salame
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Zvi Lidar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Gilad Regev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Morsi Khashan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Spine Surgery Unit, Neurosurgical Department, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
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Viderman D, Aubakirova M, Umbetzhanov Y, Kulkaeva G, Shalekenov SB, Abdildin YG. Ultrasound-Guided Erector Spinae Plane Block in Thoracolumbar Spinal Surgery: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:932101. [PMID: 35860731 PMCID: PMC9289466 DOI: 10.3389/fmed.2022.932101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Neurosurgical spinal surgeries such as micro- discectomy and complex fusion surgeries remain the leading causes of disability-adjusted life-year. Major spinal surgeries often result in severe postprocedural pain due to massive dissection of the underlying tissues. While opioids offer effective pain control, they frequently lead to side effects, such as post-operative nausea and vomiting, pruritus, constipation, and respiratory depression. ESPB was successfully used in spinal surgery as a component of a multimodal analgesic regimen and it eliminated the requirements for opioids. The primary purpose of this systematic review and meta-analysis was to compare post-operative opioid consumption between ESPB and placebo. Methods To conduct this systematic review, we used the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines. We conducted a search for relevant articles available in the following databases: Google Scholar, PubMed, and the Cochrane Library published up to March 2022. Results The total morphine consumption within 24 h after surgery was lower in the ESPB group, the mean difference (in mg of morphine) with 95% CI is −9.27 (−11.63, −6.91). The pain intensity (0–10) at rest measured 24 h after surgery was lower in the ESPB group, the MD with 95% CI is −0.47 (−0.77, −0.17). The pain intensity during movement measured 24 h after surgery was lower in the ESPB group, the MD with 95% CI is −0.73 (−1.00, −0.47). Post-operative nausea and vomiting were significantly lower in the ESPB group, the risk ratio with 95% CI is 0.32 (0.19, 0.53). Conclusion Ultrasound-guided ESPB was superior to placebo in reducing post-operative opioid consumption, pain intensity, post-operative nausea and vomiting, and prolonging the time to first rescue analgesia. There were no ESPB-related serious complications reported.
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Affiliation(s)
- Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), Nur-Sultan, Kazakhstan
- National Research Oncology Center, Nur-Sultan, Kazakhstan
- *Correspondence: Dmitriy Viderman,
| | - Mina Aubakirova
- Nazarbayev University School of Medicine (NUSOM), Nur-Sultan, Kazakhstan
| | | | | | | | - Yerkin G. Abdildin
- Nazarbayev University School of Engineering and Digital Sciences, Nur-Sultan, Kazakhstan
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Torrano V, Zadek F, Bugada D, Cappelleri G, Russo G, Tinti G, Giorgi A, Langer T, Fumagalli R. Simulation-Based Medical Education and Training Enhance Anesthesia Residents' Proficiency in Erector Spinae Plane Block. Front Med (Lausanne) 2022; 9:870372. [PMID: 35463012 PMCID: PMC9024057 DOI: 10.3389/fmed.2022.870372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Advances in regional anesthesia and pain management led to the advent of ultrasound-guided fascial plane blocks, which represent a new and promising route for the administration of local anesthetics. Both practical and theoretical knowledge of locoregional anesthesia are therefore becoming fundamental, requiring specific training programs for residents. Simulation-based medical education and training (SBET) has been recently applied to ultrasound-guided regional anesthesia (UGRA) with remarkable results. With this in mind, the anesthesia and intensive care residency program of the University of Milano-Bicocca organized a 4-h regional anesthesia training workshop with the BlockSim® (Accurate Srl, Cesena) simulator. Our study aimed to measure the residents' improvement in terms of reduction in time required to achieve an erector spinae plane (ESP) block. Methods Fifty-two first-year anesthesia residents were exposed to a 4-h training workshop focused on peripheral blocks. The course included an introductory theoretical session held by a locoregional anesthetist expert, a practical training on human models and mannequins using Onvision® (B. Braun, Milano) technologies, and two test performances on the BlockSim simulator. Residents were asked to perform two ESP blocks on the BlockSim: the first without previous practice on the simulator, the second at the end of the course. Trainees were also also asked to complete a self-assessment questionnaire. Results The time needed to achieve the block during the second attempt was significantly shorter (131 [83, 198] vs. 68 [27, 91] s, p < 0.001). We also observed a reduction in the number of needle insertions from 3 [2, 7] to 2 [1, 4] (p = 0.002), and an improvement aiming correctly at the ESP from 30 (58%) to 46 (88%) (p < 0.001). Forty-nine (94%) of the residents reported to have improved their regional anesthesia knowledge, 38 (73%) perceived an improvement in their technical skills and 46 (88%) of the trainees declared to be “satisfied/very satisfied” with the course. Conclusions A 4-h hands-on course based on SBET may enhance first-year residents' UGRA ability, decrease the number of punctures and time needed to perform the ESP block, and improve the correct aim of the fascia.
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Affiliation(s)
- Vito Torrano
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Francesco Zadek
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Dario Bugada
- Department of Emergency and Critical Care Medicine, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gianluca Russo
- Department of Emergency and Urgency, Azienda Socio Sanitaria Territoriale Lodi, Lodi, Italy
| | - Giulia Tinti
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Antonio Giorgi
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
- *Correspondence: Thomas Langer
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
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Viderman D, Aubakirova M, Abdildin YG. Erector Spinae Plane Block in Abdominal Surgery: A Meta-Analysis. Front Med (Lausanne) 2022; 9:812531. [PMID: 35280917 PMCID: PMC8904394 DOI: 10.3389/fmed.2022.812531] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/03/2022] [Indexed: 12/25/2022] Open
Abstract
Background Abdominal surgery is one of the most definitive and mainstay treatment options for abdominal pathologies in clinical practice. Acute postoperative pain is a major challenge in the postoperative period. Although opioids are commonly used for analgesia after major abdominal surgeries, they can lead to side effects, such as nausea and vomiting, constipation, pruritus, and life-threatening respiratory depression. Regional anesthetic techniques are commonly used to prevent or minimize these side effects. The objective of this meta-analysis is to assess the effectiveness of erector spinae plane block (ESPB) and standard medical (no block) pain management after major abdominal surgeries. Methods We searched for articles reporting the results of randomized controlled trials on ESPB and no block in pain control published before May 2021. Results The systematic search initially yielded 56 publications, 49 articles were excluded, and seven randomized clinical trials were included and analyzed. We extracted the data on postoperative opioid consumption, the efficacy of pain relief, time to the first opioid demand, and the rate of postoperative complications in the ESPB group and no block group. Conclusions Opioid requirement and time to first analgesic request were significantly reduced in the ultrasound-guided ESPB group, but pain scores, nausea, and vomiting did not differ significantly after pooling the results of the block and no block studies. There were no reports on serious complications related to ESPB.
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Affiliation(s)
- Dmitriy Viderman
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
| | - Mina Aubakirova
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
| | - Yerkin G Abdildin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
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Effects of Nalbuphine Combined with Anterior Serratus Plane Block in Elderly Patients Undergoing Thoracoscopic Surgery. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7408951. [PMID: 35186237 PMCID: PMC8853809 DOI: 10.1155/2022/7408951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 02/03/2023]
Abstract
Postoperative pain in elderly patients with lung cancer after thoracoscopic surgery is still an important factor affecting the prognosis of patients. In this study, 200 elderly patients with lung cancer who were positive and planned to undergo video-assisted thoracoscopic surgery were randomly divided into four groups: control group, SAPB (serratus anterior plane block) group, Nalbuphine group and Nalbuphine + SAPB group. The effects of drugs and nerve block on the perioperative indexes of elderly patients were observed. The results showed that ① The VAS and SAS scores of postoperative analgesia in the Nalbuphine + SAPB group were lower than those in the single group and the control group. ② The postoperative spontaneous respiratory recovery time, extubation time, resuscitation room stay time, extubation cough, restlessness and respiratory depression in the Nalbuphine + SAPB group were lower than those in the single group and the control group. ③ The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and blood oxygen saturation (SpO2) of patients in Nalbuphine + SAPB group before induction, T2 after intubation, T3 before skin incision, T4 after skin incision, T5 after chest closure and T6 after extubation were lower than those in single group and control group. Therefore, this study concluded that Nabufine combined with SAPB can make the vital signs of intraoperative patients more stable, which is worthy of clinical promotion.
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