1
|
Bullock WM, Kumar AH, Manning E, Jones J. Perioperative Analgesia in Spine Surgery: A Review of Current Data Supporting Future Direction. Orthop Clin North Am 2023; 54:495-506. [PMID: 37718088 DOI: 10.1016/j.ocl.2023.05.007] [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: 09/19/2023]
Abstract
This Clinical Research discusses the diverse nature of spine surgery procedures and the use of multimodal analgesia within enhanced recovery after surgery (ERAS) protocols to improve patient outcomes. Spine surgeries range from minor decompressions to extensive tumor resections, performed by neurosurgeons or orthopedic spine surgeons on adults and children. To manage perioperative pain effectively, various methods have been employed, including multimodal analgesia within ERAS protocols. Incorporating ERAS protocols into spine surgery has shown benefits such as reduced pain scores, decreased opioid use, shorter hospital stays, and improved functionality. ERAS protocols help to enhance patient outcomes, focusing on deconstructing these protocols for surgeons and anesthesiologists.
Collapse
Affiliation(s)
- William Michael Bullock
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Road, 5672C HAFS, Durham, NC 27710, USA. https://twitter.com/wmbullockMDPhD
| | - Amanda H Kumar
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Road, 5672C HAFS, Durham, NC 27710, USA. https://twitter.com/amandakumarMD
| | - Erin Manning
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Road, 5672C HAFS, Durham, NC 27710, USA. https://twitter.com/ukmdphd2006
| | - Jerry Jones
- East Memphis Anesthesia Services, 5545 Murray Avenue, Suite 130, Memphis, TN 38119, USA; Department of Anesthesiology, University of Tennessee Health Science Center, 877 Jefferson Avenue, Chandler Building, Suite 600, Memphis, TN, USA.
| |
Collapse
|
2
|
Kwon HJ, Kim YJ, Kim Y, Kim S, Cho H, Lee JH, Kim DH, Jeong SM. Complications and Technical Consideration of Ultrasound-Guided Rectus Sheath Blocks: A Retrospective Analysis of 4033 Patients. Anesth Analg 2023; 136:365-372. [PMID: 36638514 DOI: 10.1213/ane.0000000000006282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although the ultrasound-guided rectus sheath block (RSB) is usually regarded as an easy and safe procedure in clinical settings, there is currently no report on complications incidence. Therefore, the present study investigated complications in a large cohort and described the technical considerations to minimize complications of real-time ultrasound-guided RSBs. METHODS This was a retrospective cohort study of patients who underwent real-time ultrasound-guided RSBs for perioperative pain control in laparoscopic surgery with an umbilical port between February 1, 2017, and February 28, 2021, at the Asan Medical Center in South Korea. All RSBs were performed bilaterally using a 23-gauge Quincke needle, and a bilateral 2-block placement was regarded as 1 RSB. Patient data, including demographics, preoperative laboratory data, preoperative antiplatelet or anticoagulant medication with the duration of discontinuation, and type of surgery, were collected to show the study population characteristics and explore potential factors associated with adverse events such as hematoma. Ultrasound images of patients and adverse events of RSBs, including extrarectus sheath injections, vascular injuries, bowel injury, or local anesthetic systemic toxicity, were also analyzed accordingly. RESULTS A total of 4033 procedures were analyzed. The mean body mass index of the patients was 24.1 (21.8-26.5) kg/m2. The preoperative laboratory data were within normal range in 4028 (99.9%) patients. Preoperative antiplatelets or anticoagulants were administered in 17.3% of the patients. Overall, 96 complications (2.4%) were observed. Among them, extrarectus sheath injection occurred in 88 cases (2.2%), which included preperitoneal injection (0.9%) and intraperitoneal injection (1.3%). Vascular injuries constituted 8 cases (0.2%) and all vascular injuries resulted in hematoma: 7 cases of inferior epigastric artery injury with rectus sheath hematoma and 1 of inferior mesenteric artery injury with retroperitoneal hematoma. Bowel injury or local anesthetic systemic toxicity was not reported. CONCLUSIONS In this study of RSBs performed on 4033 patients using a 23-gauge Quincke needle in patients with low body mass index, there were 8 cases (0.2%) of vascular injury, all of which accompanied hematoma.
Collapse
Affiliation(s)
- Hyun-Jung Kwon
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeon Ju Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Youngmu Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seonjin Kim
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Hakmoo Cho
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jong-Hyuk Lee
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Doo-Hwan Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Moon Jeong
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
3
|
Muacevic A, Adler JR, Gabriel RA. Ultrasound-Guided Percutaneous Cryoneurolysis for Post-Thoracotomy Pain Syndrome: A Case Report. Cureus 2022; 14:e32888. [PMID: 36699749 PMCID: PMC9867988 DOI: 10.7759/cureus.32888] [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: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
Post-thoracotomy pain syndrome (PTPS) is a post-operative thoracotomy complication that is difficult to treat. We describe the first-time use of ultrasound-guided percutaneous cryoneurolysis of the intercostal nerves to successfully treat PTPS refractory to conventional medications and interventions. We report a case of a 40-year-old male with two years of severe PTPS sustained after undergoing a thoracotomy. Treatment with intercostal cryoneurolysis resulted in an immediate 75% improvement in pain for six weeks followed by sustained 50% pain relief for eight weeks. This highlights the potential of this intervention as a radiation-free, safe, and efficacious therapy for chronic PTPS.
Collapse
|
4
|
McEvoy MD, Raymond BL, Krige A. Opioid-Sparing Perioperative Analgesia Within Enhanced Recovery Programs. Anesthesiol Clin 2022; 40:35-58. [PMID: 35236582 DOI: 10.1016/j.anclin.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Opioid-based analgesia in the perioperative period can provide excellent pain control, but this approach exposes the patient to avoidable side effects and possible harm. Optimal analgesia, an approach that targets the fastest functional recovery with adequate pain control while minimizing side effects, can be achieved with opioid minimization. Many different options for nonopioid multimodal analgesia exist and have been shown to be efficacious, with certain modalities being more beneficial for specific surgeries. This review will present the evidence and practical tips for these management strategies.
Collapse
Affiliation(s)
- Matthew D McEvoy
- Department of Anesthesiology, Vanderbilt University School of Medicine, 1301 Medical Center Drive, TVC 4619, Nashville, TN 37221, USA; Perioperative Medicine Fellowship, Hi-RiSE Perioperative Optimization Clinic, Perioperative Consult Service, VUMC ERAS Executive Steering Committee, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC 4648, Nashville, TN 37232, USA.
| | - Britany L Raymond
- Department of Anesthesiology, Vanderbilt University School of Medicine, 1301 Medical Center Drive, TVC 4619, Nashville, TN 37221, USA; Perioperative Medicine Fellowship, Hi-RiSE Perioperative Optimization Clinic, Perioperative Consult Service, VUMC ERAS Executive Steering Committee, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC 4648, Nashville, TN 37232, USA
| | - Anton Krige
- Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital, Haslingden Road, Blackburn BB2 3HH, UK
| |
Collapse
|
5
|
Sethi D, Garg G. Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial. Anesth Pain Med (Seoul) 2022; 17:67-74. [PMID: 34991187 PMCID: PMC8841257 DOI: 10.17085/apm.21030] [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: 04/08/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries. Methods Eighty patients with the American Society of Anesthesiologists status I/II undergoing laparoscopic gynecology surgery were enrolled for this randomized control trial. After general anesthesia was administered, patients in group C received LAI at each port site, and patients in group T received bilateral ultrasound-guided TAP block. Postoperative pain was assessed at time intervals of 1/2, 2, 4, 6, 8, and 24 h using the numeric rating scale (NRS). Clinical metrics such as postoperative analgesic diclofenac consumption, need for rescue fentanyl, nausea-vomiting scores, and antiemetic requirements were also recorded. Results Seventy-four patients were included in the final analysis. Postoperatively, patients in group T had significantly lower NRS than those in group C (P < 0.05). The highest difference in the postoperative NRS was observed at 2 h (median [1Q, 3Q]; group C = 3 [2, 4]; group T = 1 [0, 2]; P < 0.001). A statistically significant difference was observed in the frequency of diclofenac (75 mg intravenous) requirement between the groups (P = 0.010). No significant difference was observed between the groups in need of rescue fentanyl or antiemetic and the nausea-vomiting scores. Conclusions In patients undergoing laparoscopic gynecological surgery, ultrasound-guided TAP block provided greater postoperative analgesic benefits in terms of lower NRS and reduced analgesic requirements than port site LAI.
Collapse
Affiliation(s)
- Divya Sethi
- Department of Anesthesia and Critical Care, Employees' State Insurance Cooperation Postgraduate Institute of Medical Sciences and Research (ESIC-PGIMSR), New Delhi, India
| | - Garima Garg
- Department of Anesthesia and Critical Care, Employees' State Insurance Cooperation Postgraduate Institute of Medical Sciences and Research (ESIC-PGIMSR), New Delhi, India
| |
Collapse
|
6
|
Kwon HM, Kim DH, Jeong SM, Choi KT, Park S, Kwon HJ, Lee JH. Does Erector Spinae Plane Block Have a Visceral Analgesic Effect?: A Randomized Controlled Trial. Sci Rep 2020; 10:8389. [PMID: 32439926 PMCID: PMC7249264 DOI: 10.1038/s41598-020-65172-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/17/2020] [Indexed: 11/16/2022] Open
Abstract
The visceral analgesic efficacy of erector spinae plane block (ESPB) is still a matter of debate. This study attempted to investigate the visceral analgesic efficacy of ESPB in clinical setting. After randomized, we performed ultrasound-guided bilateral rectus sheath block (RSB), which was aimed to prevent postoperative somatic pain on all patients who underwent laparoscopic cholecystectomy (LC). Ultrasound-guided bilateral ESPB at T7 level was performed only to the intervention group to provide the visceral analgesic block. The intraoperative requirement for remifentanil (P = 0.021) and the cumulative fentanyl consumption at postoperative 24-hours was significantly lower in the ESPB group (206.5 ± 82.8 μg vs.283.7 ± 102.4 μg, respectively; P = 0.004) compared to non-ESPB group. The ESPB group consistently showed lower accumulated analgesic consumption compared with those in the non-ESPB group at all observed time-points (all P < 0.05) after 2 hours and the degree of the accumulated analgesic consumption reduction was greater (P = 0.04) during the 24-hour postoperative period. Pain severity was lower in the ESPB group at 6-hours postoperatively. The significantly reduced opioid consumption in ESPB group may imply that while preliminary and in need of confirmation, ESPB has potential visceral analgesic effect. Therefore, performing ESPB solely may be feasible in inducing both somatic and visceral analgesia.
Collapse
Affiliation(s)
- Hye-Mee Kwon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Sung-Moon Jeong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Kyu Taek Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Sooin Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Hyun-Jung Kwon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea
| | - Jong-Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea.
| |
Collapse
|
7
|
Rotstein D, Park C, Khaitov S, Dickstein E. Rectus sheath catheters-a novel approach to perioperative analgesia for colorectal surgery in an enhanced recovery after surgery (ERAS) protocol: a case series. Int J Colorectal Dis 2019; 34:1345-1348. [PMID: 31089874 DOI: 10.1007/s00384-019-03309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Opioids have played a critical role in the management of perioperative pain following abdominal surgery. Increasing attention is being paid to the deleterious side effects and limitations of this practice. This case report offers a novel alternative to opioid-based analgesia in the form of rectus sheath catheters (RSCs) which we employed as part of an enhanced recovery after surgery (ERAS) protocol. METHODS Three patients underwent laparoscopic- assisted colorectal surgery and were treated intra- and postoperatively with local anesthesia administered via bilateral rectus sheath catheters as well as by multimodal adjuncts. Evaluations of the patients' pain scores, opioid usage, and abdominal sensitivity to sharp stimuli were conducted daily. RESULTS The patients demonstrated a substantially lessened opioid requirement over their hospital stay with two of them requiring no opioid analgesic medications postoperatively. DISCUSSION We suggest that the incorporation of these catheters into an ERAS protocol can play an important role in further reducing perioperative opioid usage for procedures in which pain control can be especially challenging.
Collapse
Affiliation(s)
- David Rotstein
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY, 10029, USA.
| | - Chang Park
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY, 10029, USA
| | - Sergey Khaitov
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elisha Dickstein
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY, 10029, USA
| |
Collapse
|