1
|
Aldape-Rivas DE, Padilla-Medina JR, Espinosa-Galindo AM, de la Garza-Castro S, Palacios-Ríos D, Peña-Martínez VM, Morales-Avalos R. Epidural administration of ropivacaine and midazolam is superior to intra-articular administration as postoperative analgesia after isolated arthroscopic anterior cruciate ligament reconstruction with hamstrings autograft: a randomized controlled clinical trial. J ISAKOS 2024; 9:334-340. [PMID: 38460601 DOI: 10.1016/j.jisako.2024.03.002] [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: 12/01/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE Reconstructive surgery of the anterior cruciate ligament (ACL) is quite common, previous studies have documented that adequate pain control in the early phases of the postoperative period translates into early mobility and a rapid start of rehabilitation. Therefore, the search for new strategies for postoperative pain control is justified. The aim of this study was to compare intra-articular to the epidural administration of ropivacaine and midazolam as postoperative analgesia after arthroscopic ACL reconstruction with hamstring autograft (HA). MATERIAL AND METHODS Double-blinded, prospective randomized clinical trial included 108 consecutive patients aged from 18 to 50 years that had undergone arthroscopic ACL reconstruction with HA. The patients were randomly assigned to 2 groups. The first group received intraarticular ropivacaine and midazolam. The second group received epidural ropivacaine and midazolam. The need for rescue analgesia, the postoperative pain experienced, side effects and complications of the analgesic drugs were evaluated. RESULTS The intra-articular group received statistically significantly higher mean doses of rescue analgesia on the first two days (2.8 ± 1.0 vs. 1.3 ± 0.6 in the epidural group; p = 0.001). Visual Analogue Scale scores at flexion were statistically significantly higher in the intra-articular group over the entire study period. The intra-articular group also reported a statistically significantly lower range-of-motion 87 ± 15 vs. 102 ± 11 in the epidural group (p = 0.001). CONCLUSIONS Epidural administration of ropivacaine combined with midazolam in patients undergoing primary ACL reconstruction with HA was clinically and significantly better relative to rescue analgesia and the intensity of pain in the first 48 postoperative hours when compared to intraarticular administration. There was no difference in terms of adverse effects and complications. LEVEL OF EVIDENCE: 2
Collapse
Affiliation(s)
- Dareny Esmeralda Aldape-Rivas
- Department of Anesthesiology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, 64460, Mexico
| | - José Ramón Padilla-Medina
- Department of Orthopedic Surgery and Traumatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, 64460, Mexico
| | - Ana María Espinosa-Galindo
- Department of Anesthesiology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, 64460, Mexico
| | - Santiago de la Garza-Castro
- Department of Orthopedic Surgery and Traumatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, 64460, Mexico
| | - Dionisio Palacios-Ríos
- Department of Anesthesiology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, 64460, Mexico
| | - Víctor M Peña-Martínez
- Department of Orthopedic Surgery and Traumatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, 64460, Mexico
| | - Rodolfo Morales-Avalos
- Department of Physiology, School of Medicine, Universidad Autónoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, 64460, Mexico.
| |
Collapse
|
2
|
Zeng Y, Jiang H. Letter: Integrative review of non-pharmacological intervention and multidimensional evaluation for intraoperative anxiety under spinal anaesthesia. J Clin Nurs 2024; 33:1226-1227. [PMID: 38062583 DOI: 10.1111/jocn.16938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Ying Zeng
- Department of Anesthesiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Hong Jiang
- Department of Anesthesiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| |
Collapse
|
3
|
Osman BM, Tieu TG, Caceres YG, Hernandez VH. Current Trends and Future Directions for Outpatient Total Joint Arthroplasty: A Review of the Anesthesia Choices and Analgesic Options. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202309000-00001. [PMID: 37669101 PMCID: PMC10481314 DOI: 10.5435/jaaosglobal-d-22-00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/11/2023] [Indexed: 09/06/2023]
Abstract
The aging population and the obesity epidemic have led to an increased rate of joint arthroplasty procedures, specifically total knee arthroplasty and total hip arthroplasty. These surgeries are associated with increased hospital length of stay and, consequently, higher costs. Despite the benefits of outpatient surgery, only a small percentage of total joint arthroplasties (TJAs) are done in this manner. We reviewed the most up-to-date trends for outpatient TJA and discussed essential factors for a successful outpatient program, including the proper patient selection process and best available anesthetic and analgesic options, along with their risks and benefits. Risk stratification tools, such as the Outpatient Arthroplasty Risk Assessment, are helpful for predicting outcomes regarding outpatient TJA, and neuraxial anesthesia should be considered to minimize complications and facilitate early discharge. A multimodal analgesia regimen could be effective for pain management in outpatient TJA, and the currently recommended peripheral nerve blocks for total hip arthroplasty and total knee arthroplasty are the fascia iliaca compartment block and adductor canal block, respectively. However, blocks should be carefully considered for outpatient procedures. Enhanced recovery after surgery (ERAS) protocols help to guide perioperative care teams and allow for improved patient recovery, decreased length of stay, and increased patient satisfaction.
Collapse
Affiliation(s)
- Brian M. Osman
- From the Perioperative Medicine and Pain Management, University of Miami Health System, University of Miami Miller School of Medicine, Miami, FL (Dr. Osman, Dr. Caceres, and Dr. Hernandez); Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL (Dr. Tieu)
| | - Tuan G. Tieu
- From the Perioperative Medicine and Pain Management, University of Miami Health System, University of Miami Miller School of Medicine, Miami, FL (Dr. Osman, Dr. Caceres, and Dr. Hernandez); Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL (Dr. Tieu)
| | - Yosira Guevara Caceres
- From the Perioperative Medicine and Pain Management, University of Miami Health System, University of Miami Miller School of Medicine, Miami, FL (Dr. Osman, Dr. Caceres, and Dr. Hernandez); Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL (Dr. Tieu)
| | - Victor H. Hernandez
- From the Perioperative Medicine and Pain Management, University of Miami Health System, University of Miami Miller School of Medicine, Miami, FL (Dr. Osman, Dr. Caceres, and Dr. Hernandez); Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL (Dr. Tieu)
| |
Collapse
|
4
|
Ge L, Zhang P, Kong L, Wang W, Tong Q, Fan Q, Han X. Comparison of Efficacy and Safety of Different Doses of Dexmedetomidine for Epidural Labor Analgesia. Emerg Med Int 2023; 2023:2358888. [PMID: 37057296 PMCID: PMC10089781 DOI: 10.1155/2023/2358888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/30/2023] [Accepted: 03/03/2023] [Indexed: 04/15/2023] Open
Abstract
Objective To explore the efficacy and safety of different doses of dexmedetomidine (DEX) for epidural labor analgesia (ELA). Methods From June 2021 to June 2022, 147 parturients who underwent ELA in our hospital were selected and divided into low- (0.5 μg/kg DEX), medium- (0.75 μg/kg DEX), and high-dose (1.0 μg/kg DEX) groups (n = 49 for each) according to the random number table method. The analgesic effect was assessed using the Ramsay sedation score and Visual Analogue Scale (VAS), and the labor duration, mean arterial pressure (MAP), and heart rate (HR) before and after analgesia, vaginal bleeding within 2 h postpartum, and delivery outcomes (the cesarean section conversion rate and the neonatal Apgar score) were statistically analyzed. Furthermore, the incidence of adverse reactions was calculated, and maternal satisfaction with delivery was investigated. Results After analgesia, the the Ramsay and labor duration were higher in the high-dose group than those in the low- and medium-dose groups, and the VAS scores was lowerin the high-dose group than those in the low- and medium-dose groups(P < 0.05), while no difference was identified among the three groups in terms of the cesarean section conversion rate and the neonatal Apgar score (P > 0.05). The high-dose group had the greatest fluctuations in MAP and HR levels before and after analgesia than the other two groups, with a higher incidence of adverse reactions (P < 0.05). Finally, the survey of delivery satisfaction showed no significant difference in delivery satisfaction among the three groups (P > 0.05). Conclusion DEX has excellent performance in ELA, which can effectively relieve the pain of puerperae and shorten the labor process. Among them, low-dose DEX has higher safety and is recommended as the first choice. Trial Registrations. This trial is registered with ML2021073.
Collapse
Affiliation(s)
- Liang Ge
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Peng Zhang
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Lingguo Kong
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Wei Wang
- The Reproductive Medicine Special Hospital of the 1st Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu 730000, China
| | - Qian Tong
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Quanlong Fan
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Xudong Han
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| |
Collapse
|
5
|
Midazolam versus Dexmedetomidine in Patients at Risk of Obstructive Sleep Apnea during Urology Procedures: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11195849. [PMID: 36233716 PMCID: PMC9571182 DOI: 10.3390/jcm11195849] [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: 08/22/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
Benzodiazepines are the most commonly used sedatives for the reduction of patient anxiety. However, they have adverse intraoperative effects, especially in obstructive sleep apnea (OSA) patients. This study aimed to compare dexmedetomidine (DEX) and midazolam (MDZ) sedation considering intraoperative complications during transurethral resections of the bladder and prostate regarding the risk for OSA. This study was a blinded randomized clinical trial, which included 115 adult patients with a mean age of 65 undergoing urological procedures. Patients were divided into four groups regarding OSA risk (low to medium and high) and choice of either MDZ or DEX. The doses were titrated to reach a Ramsay sedation scale score of 4/5. The intraoperative complications were recorded. Incidence rates of desaturations (44% vs. 12.7%, p = 0.0001), snoring (76% vs. 49%, p = 0.0008), restlessness (26.7% vs. 1.8%, p = 0.0044), and coughing (42.1% vs. 14.5%, p = 0.0001) were higher in the MDZ group compared with DEX, independently of OSA risk. Having a high risk for OSA increased the incidence rates of desaturation (51.2% vs. 15.7%, p < 0.0001) and snoring (90% vs. 47.1%, p < 0.0001), regardless of the sedative choice. DEX produced fewer intraoperative complications over MDZ during sedation in both low to medium risk and high-risk OSA patients.
Collapse
|