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Eldadamony Mohammed Z, Nashaat Mohammed M, Gad Mostafa M, Bahy O, Elsaid Rashad A. The efficacy of the ultrasound-guided retrolaminar block versus the classic paravertebral block in patients undergoing unilateral inguinal hernioplasty: a randomized controlled study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:584-591. [PMID: 38552956 DOI: 10.1016/j.redare.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND In daily surgical practice, inguinal hernioplasty is a frequent procedure that is frequently accompanied by severe postoperative pain. Multiple regional blocks have been described for analgesia after such operations. Retrolaminar block (RLB) is a paravertebral block (PVB) variant that provides excellent analgesia and reduces the risk of complications. This prospective trial compared the analgesic efficacy of PVB and RLB in the inguinal hernioplasty. METHODS The 56 patients included were randomly assigned into two equal groups according to the block performed under ultrasound guidance at the T12 level: PVB group (28 patients) and RLB (28 patients). Time until the first rescue analgesia was our primary outcome. Other outcomes included the time to perform the block, changes in intraoperative hemodynamic parameters, postoperative VAS, 24-h morphine consumption, the level of patient satisfaction, and the incidence of block-related complications. RESULTS Demographic data were comparable in the two groups. However, the time needed for the block was significantly shortened with the RLB (p < 0.001). Patients in the PVB groups expressed better pain scores and lower opioid consumption. Additionally, the time to the first call for opioid analgesia showed a significant prolongation in association with the PVB. There was no discernible difference in the frequency of adverse events and recorded MAP and HR. CONCLUSION The PVB has a superior perioperative analgesic profile compared to the RLB, which manifested in the prolonged duration to the first rescue analgesics, better pain scores, and less opioid consumption, with no significant increase in block-related complications.
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Affiliation(s)
- Z Eldadamony Mohammed
- Lecturer of Anaesthesia, Pain Medicine and Surgical ICU, Mansoura University, Mansoura, Egypt
| | - M Nashaat Mohammed
- Lecturer of Anaesthesia, Pain Medicine and Surgical ICU, Mansoura University, Mansoura, Egypt.
| | - M Gad Mostafa
- Assistant Professor of Anaesthesia, Pain Medicine and Surgical ICU, Mansoura University, Egypt
| | - O Bahy
- Lecturer of Surgical Oncology, Mansoura University, Mansoura, Egypt
| | - A Elsaid Rashad
- Lecturer of Anaesthesia, Pain Medicine and Surgical ICU, Mansoura University, Mansoura, Egypt
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Kol E, Ince S, Erdoğan A, Karsli B, Keskin H, Özgür N. The Effectiveness of Active External Warming of Patient Concurrently With Ice Application on the Incision Site on Post-Thoracotomy Pain and Analgesic Consumption. Clin Nurs Res 2023; 32:323-336. [PMID: 35726475 DOI: 10.1177/10547738221101729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of study is to investigate the effects of active external warming of patient concurrently with application of ice to incision site on thoracotomy pain and analgesic consumption. The research is a quasi-experimental design with control and study groups. The study was conducted in 2018 and 2019. A total of 70 patients were included in the study: 35 in the control group and 35 in the study group. The mean verbal pain scale values were significantly lower in the intervention group (2.85 point) than in the control group (4.57 point; p < .001). Opioid consumption rate was high in control group patients (77.1% tramadol 30 mg; 45.7% morphine sulfate 5 mg) In contrast, the rate of opioid consumption was lower in patients in the intervention group (40% tramadol 30 mg; 17% morphine sulfate 5 mg). Active external warming and ice application on the incision area, could reduce the intensity of thoracotomy pain.
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Affiliation(s)
- Emine Kol
- Department of Fundamentals Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
| | - Serpil Ince
- Department of Fundamentals Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
| | - Abdullah Erdoğan
- Department of Thoracic Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Bilge Karsli
- Department of Anesthesiology and Reanimation, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Hakan Keskin
- Department of Thoracic Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nazmiye Özgür
- Department of surgical medicine, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Kim SH, Kim S, Kim YS, Song MK, Kang JY. Application of sequential multimodal analgesia before and after impacted mandibular third molar extraction: Protocol for a randomized controlled trial. Contemp Clin Trials Commun 2023; 32:101078. [PMID: 36762120 PMCID: PMC9905937 DOI: 10.1016/j.conctc.2023.101078] [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: 05/08/2022] [Revised: 11/26/2022] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Background Several analgesics have been applied under various protocols to control the moderate-to-severe postoperative pain caused by the surgical extraction of an impacted mandibular third molar. However, a consensus on optimal pain management while minimizing side effects is yet to be reached. Methods This multi-center, prospective, double-blind, randomized controlled trial aims to evaluate the efficacy and safety of sequential multimodal analgesia combined with postoperative zaltoprofen along with multiple preemptive analgesics. A total of 80 participants with bilateral impacted mandibular third molar from two hospitals were randomized into two groups. Two surgical extractions were performed at one-month intervals, and in a crossover design, celecoxib or tramadol/acetaminophen was administered before one extraction and placebo before the other extraction. Following extraction, all subjects took zaltoprofen for 5 days. The outcome measures included pain at specific times, time and intensity of the first pain onset after extraction, need of rescue drugs, and occurrence and frequency of side effects. Conclusions This ongoing clinical trial was designed to provide evidence regarding a new protocol for effective postoperative pain management of a commonly performed surgical extraction. The results of this study will provide guidance to clinicians regarding the timing and combination of oral analgesics in various oral surgeries performed under local anesthesia. Trial registration KCT0005450, registered on October 7, 2020.
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Affiliation(s)
- Soo-Ho Kim
- Department of Dentistry, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Somi Kim
- Department of Dentistry, Chungnam National University Sejong Hospital, 407, Dodam-dong, Sejong-si, 30099, South Korea
| | - Yoon-Seon Kim
- Department of Dentistry, Chungnam National University Sejong Hospital, 407, Dodam-dong, Sejong-si, 30099, South Korea
| | - Mi-Kyoung Song
- Department of Dentistry, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Ji-Yeon Kang
- Department of Dentistry, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea,Department of Oral & Maxillofacial Surgery, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea,Corresponding author. Department of Dentistry, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.
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Kanna RM, Ramachandran K, Subramanian JB, Shetty AP, Rajasekaran S. Perioperative analgesic efficacy and safety of erector spinae plane block in posterior cervical spine surgery-a double blinded, randomized controlled study. Spine J 2023; 23:6-13. [PMID: 35470087 DOI: 10.1016/j.spinee.2022.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTENT Posterior cervical spine surgery (PCSS) are typically open surgeries and entail significant postoperative pain. Current perioperative pain management in PCSS is reliant on multimodal analgesia. While perioperative epidural anesthetic infusion can be used in lumbar surgeries, this is not an option in the cervical spine. Pre-emptive regional analgesia through erector spinae plane block (ESPB) has shown significant perioperative analgesic benefits in lumbar spine surgeries. There are no such clinical studies in PCSS. PURPOSE To assess the safety and efficacy of ultrasound-guided ESPB for perioperative analgesia in PCSS. STUDY DESIGN Prospective, randomized controlled, double-blinded study. PATIENT SAMPLE Eighty-six patients requiring sub-axial PCSS with or without instrumentation were randomized into two groups, those who underwent ESPB with multimodal analgesia (case) and those with only multimodal analgesia (control). OUTCOME MEASURES Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization and complications were recorded. METHODS After anesthesia and prone position, case patients received ultrasound-guided ESPB at the T1 level using 15 ml of 0.25% bupivacaine and 8 mg Dexamethasone bilaterally while the control patients received only standard postoperative multimodal analgesia. RESULTS There were 43 patients in each group; the two groups were identical in demographic and surgical profile. The intraoperative opioid consumption (119.53±40.35 vs. 308.6±189.78; p<.001) in mcg), muscle relaxant usage (50.00±0.00 mg vs. 59.53±3.75 mg, p<.001), surgical duration (124.77±26.63/ 156.74±37.01 min; p<.01) and intraoperative blood loss (310.47±130.73 ml vs. 429.77±148.50 ml; p<.05) were significantly less in the ESPB group. In the postoperative period, the control group's pain score was significantly higher (p<.001). The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores also showed significant differences between the case and control groups (p<.001). The mean time required to ambulate (sitting/walking) was statistically less in cases (15.81±6.15/20.72±4.02 h) when compared to controls (16.86±6.18/ 23.05±8.88 h; p<.001). CONCLUSION In patients undergoing PCSS, ESPB is a safe and effective technique with better outcomes than standard multimodal analgesia alone, in terms of reduced intraoperative opioid requirements and blood loss, better postoperative analgesia and early mobilization.
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Affiliation(s)
- Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
| | - Karthik Ramachandran
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | | | - Ajoy P Shetty
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Rajasekaran
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Pallu I, Boscoli SDES, Zaleski T, Andrade DPDE, Cherubini GRL, Czepula AIDS, Souza JMDE. Evaluation of pain and opioid consumption in local preemptive anesthesia and the erector spine plane block in thoracoscopic surgery: A randomized clinical trial. Rev Col Bras Cir 2022; 49:e20223291. [PMID: 36074392 PMCID: PMC10578843 DOI: 10.1590/0100-6991e-20223291-en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/14/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE assess pain and opioid consumption in patients undergoing anesthetic techniques of spinal erector plane block and local anesthetic block in video-assisted thoracic surgery in the immediate postoperative period. METHODS ninety-two patients undergoing video assisted thoracic surgery were randomized to receive ESPB or BAL before starting the surgical procedure. Using the numerical verbal scale, the primary outcome assessed was the patient's pain in the immediate postoperative period (POI). The secondary outcome comprises the assessment of opioid consumption in the IPP by quantifying the medication used in an equianalgesic dose of morphine expressed in milligrams, in the immediate post-anesthetic recovery period, 6h, 12h, and 24h after surgery. RESULTS the EVN scores in the LBA and ESPB group in the POI had a mean of 0,8 (±1,89) vs 0,58 (±2,02) in the post-anesthesia care room (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) in 6 hours of POI, 0,84 (±1,74) vs 1,19 (±2,01) within 12 hours of POI and 0,95 (±1,88) vs 1 ( ±1,66) within 24 hours of POI, all with p>0.05. Mean opioid consumption in the BAL and ESPB groups in the POI was 12.9 (± 10.4) mg vs 14.9 (±10.2) mg, respectively, with p = 0.416. Sixteen participants in the ESPB group and seventeen in the BAL group did not use opioids during the first 24 hours of the PO analyzed. CONCLUSION local anesthesic block and ESP block techniques showed similar results in terms of low pain scores and opioid consumption during the period evaluated.
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Affiliation(s)
- Ighor Pallu
- - Faculdades Pequeno Principe, Curso de Medicina - Curitiba - PR - Brasil
| | | | - Tania Zaleski
- - Faculdades Pequeno Principe, Curso de Medicina - Curitiba - PR - Brasil
| | | | | | | | - Juliano Mendes DE Souza
- - Faculdades Pequeno Principe, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Nossa Senhora das Graças, Departamento de Cirurgia Torácica - Curitiba - PR - Brasil
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Wang YQ, Jiang R, Pan J. Effect of Foot and Hand Massage on Abdominal Pain of Cesarean Section Incision under Ultrasound Guidance. SCANNING 2022; 2022:8356256. [PMID: 35950090 PMCID: PMC9348944 DOI: 10.1155/2022/8356256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
In order to relieve the pain of incision after cesarean section, a method of foot and hand massage for abdominal pain of cesarean section incision under ultrasound guidance was proposed in this paper. In this paper, the experimental control method and retrospective analysis were used to relax the patients through massage, so that the pregnant women could focus on the reaction caused by hand and foot massage, distract their attention, and reduce the pain. The results showed that 60 cases of puerpera after cesarean section were divided into two groups with 30 cases in each group. The control group was only given routine care. The intervention group received 20 min hand and foot massage on the basis of routine care. The visual analog scale (VAS) of pain before, immediately after, 30 min after, and 60 min after massage in the intervention group was evaluated and recorded, and the VAS scores of the control group at the corresponding time points were recorded. The VAS score of the intervention group at each time point after massage was significantly lower than that before massage (P < 0.05), and the VAS score of the intervention group at each time point was significantly lower than that of the control group (P < 0.01). Hand and foot massage can effectively relieve incision pain after cesarean section.
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Affiliation(s)
- Yu Qing Wang
- Pregnant Women School, Changyi People's Hospital, Weifang, Shandong 261300, China
| | - Rongrong Jiang
- Delivery Room, Changyi People's Hospital, Weifang, Shandong 261300, China
| | - Jianmin Pan
- Delivery Room, Changyi People's Hospital, Weifang, Shandong 261300, China
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PALLU IGHOR, BOSCOLI SOFIADESOUZA, ZALESKI TANIA, ANDRADE DIANCARLOSPEREIRADE, CHERUBINI GUILHERMERODRIGOLOBO, CZEPULA ALEXANDRAINGRIDDOSSANTOS, SOUZA JULIANOMENDESDE. Avaliação da dor e consumo de opioides em anestesia preemptiva local e do plano eretor da espinha em cirurgia torácica videotoracoscópica: Um ensaio clínico randomizado. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: avaliar a dor e o consumo de opioides dos pacientes submetidos a técnicas anestésicas de bloqueio do plano eretor da espinha (ESPB) e bloqueio anestésico local (LBA) em cirurgia torácica vídeo assistida no período pós-operatório imediato (POI). Métodos: noventa e dois pacientes submetidos a cirurgia torácica videotoracoscópica foram randomizados aleatoriamente para receberem ESPB ou LBA antes do início do procedimento cirúrgico. O desfecho primário avaliado foi a dor do paciente no POI através da escala verbal numérica. O desfecho secundário avaliou o consumo de opioides através da quantificação da medicação usada em dose equianalgésica de morfina expressa em miligramas, no período de recuperação pós-anestésica imediata, 6h, 12h e 24h após a cirurgia. Resultados: os escores da Escala Verbal Numérica de dor (EVN) no grupo LBA e ESPB no POI, respectivamente, tiveram média de 0,8 (±1,89) vs 0,58 (±2,02) na sala de recuperação pós anestesia (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) em 6 horas do POI, 0,84 (±1,74) vs 1,19 (±2,01) em 12 horas do POI e 0,95 (±1,88) vs 1 ( ±1,66) em 24 horas do POI, todos com p>0,05. O consumo médio de opioides no grupo LBA e ESPB foi de 12,9 (±10,4) mg vs 14,9 (±10.2) mg, respectivamente, com p=0.416. Dezesseis participantes do grupo ESPB e dezessete do grupo LBA não utilizaram opioides durante as primeiras 24 horas do PO. Conclusões: as técnicas de bloqueio LBA e ESPB apresentaram resultados semelhantes em termos de baixos escores de dor e consumo de opioides durante o período avaliado.
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Yamazaki S, Koike S, Eguchi T, Matsuoka S, Takeda T, Miura K, Hamanaka K, Shimizu K. Preemptive Intercostal Nerve Block as an Alternative to Epidural Analgesia. Ann Thorac Surg 2021; 114:257-264. [PMID: 34389301 DOI: 10.1016/j.athoracsur.2021.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/27/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The necessity of thoracic epidural analgesia (TEA) during minimally invasive surgery remains unclear. We investigated TEA efficacy in minimally invasive surgery vs. thoracotomy and the non-inferiority of a preemptive intercostal nerve block (ICNB) to TEA in minimally invasive surgery. METHODS We investigated 393 patients who underwent lung resection, with and without TEA, between 2014 and 2019 (242 minimally invasive surgery, 151 thoracotomy) and 93 patients who underwent minimally invasive surgery with ICNB between 2019 and 2020. To address selection bias, 70 TEA and 70 ICNB patients were propensity-score-matched. Endpoints were 1) pain score during hospitalization, 2) postoperative complications, 3) duration of operating room use, 4) analgesia-related adverse effects, and 5) use of supplemental pain medication. RESULTS One-third of patients with minimally invasive surgery discontinued TEA on postoperative day 1 or earlier; those with early TEA discontinuation reported worse pain the next day. TEA was associated with lower pain scores compared to non-TEA, regardless of surgical invasiveness, and a lower complication risk in patients with thoracotomy, but not minimally invasive surgery. For minimally invasive surgery, ICNB was associated with equivalent pain score on postoperative day 1, lower average pain score during hospitalization, shorter duration of operation room use, less frequent use of supplemental pain medication, and similar risk of postoperative complication and analgesia-related adverse effects compared to TEA after matching. CONCLUSIONS Given early TEA discontinuation after minimally invasive surgery and ICNB's non-inferior pain relief, preemptive ICNB can be an alternative for TEA in patients undergoing minimally invasive surgery.
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Affiliation(s)
- Shiori Yamazaki
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Sachie Koike
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsu Takeda
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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