1
|
Ma T, Yu Y, Cao H, Wang H, Wang M. Effect of Intermittent Thoracic Paravertebral Block on Postoperative Nausea and Vomiting Following Thoracoscopic Radical Resection of the Lung Cancer: A Prospective Randomized Trial. J Pain Res 2024; 17:931-939. [PMID: 38469556 PMCID: PMC10926915 DOI: 10.2147/jpr.s453615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
Purpose To explore the benefits of ultrasound-guided intermittent thoracic paravertebral block (TPVB) combined with intravenous analgesia (PCIA) in alleviating postoperative nausea and vomiting (PONV) during video-assisted thoracic surgery (VATS). Patients and Methods 120 patients with lung carcinoma undergoing VATS were included and divided into three groups: group S (single TPVB+PCIA), group I (intermittent TPVB+PCIA), and group P (PCIA). The patients' NRS scores, postoperative hydromorphone hydrochloride consumption, and intramuscular injection of bucinnazine hydrochloride were recorded. The incidence of PONV and complications were documented. Results Compared with the group P, both group I and group S had significantly lower static NRS scores from 1-48 hours after the operation (P <0.05), and the dynamic NRS score of group I at the 1-48 hours after the operation were significantly decreased (P <0.05). Compared with the group P, the proportion of patients with PONV in group I was significantly lower (P <0.05), while there was no significant difference in group S. Moreover, the hospitalization period of patients in group I was significantly reduced compared with the other two groups (P <0.01), and the patient satisfaction was significantly increased compared with the group P (P <0.05). Conclusion Intermittent TPVB combined with PCIA can reduce the postoperative pain and the occurrence of PONV.
Collapse
Affiliation(s)
- Ting Ma
- Anesthesia Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, 310000, People’s Republic of China
| | - Yulong Yu
- Anesthesia Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
| | - Haihua Cao
- Obstetrical Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
| | - Huiqin Wang
- Anesthesia Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
| | - Mingcang Wang
- Anesthesia Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
| |
Collapse
|
2
|
Gyawali S, Luitel BR, Bhattarai AS, Sharma UK. Comparison of efficacy of intercostal nerve block versus peritract infiltration with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial. Indian J Urol 2024; 40:37-43. [PMID: 38314072 PMCID: PMC10836456 DOI: 10.4103/iju.iju_276_23] [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: 07/19/2023] [Revised: 09/01/2023] [Accepted: 11/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Postoperative pain following percutaneous nephrolithotomy (PCNL) adds to the morbidity of patients requiring additional analgesia. Various modalities of pain control techniques, such as intercostal nerve block (ICNB) and peritract infiltration (PTI), are being studied for better pain management. This study compares the efficacy of ICNB with PTI for postoperative pain management. Methods A double-blinded, prospective, randomized control study was conducted, in which 0.25% bupivacaine, either ICNB or PTI, was given at the puncture site at the end of PCNL. The primary outcome was a comparison of postoperative pain score measured with resting Visual analogue Scale (r-VAS) and dynamic VAS (D-VAS) recorded at 2 h, 4 h, 8 h, 10 h, 12 h, 24 h, and at discharge. Injection ketorolac was given as rescue analgesia. Secondary outcomes include time to first rescue analgesia and total analgesic requirement (TAR). Results Sixty patients were randomized into two equal groups with 63.3% male and 36.6% female, with a mean age of 37.25 ± 13.09 years. In Group ICNB, 24 (40%) and 6 (10%) patients and in Group PTI, 21 (35%) and 9 (15%) patients underwent standard and mini PCNL, respectively, in each group. All cases were PCNL doen in prone position. The mean R-VAS and D-VAS scores at 2, 4, 8, 12, 24, and 48 h were similar in both groups. The mean TAR was 56.84 ± 0.33.00 mg and 55.54 ± 0.29.64 mg of injection ketorolac in Group ICNB and PTI, respectively (P < 0.894). The time to first rescue analgesic demand were 7.11 ± 4.898 h and 6.25 ± 3.354 h (P < 0.527). Both the groups were comparable in terms of length of hospital stay, stone clearance rate, and complication rate. Conclusion The ICNB was as efficacious as PTI for postoperative pain control with 0.25% bupivacaine following PCNL.
Collapse
Affiliation(s)
- Sushil Gyawali
- Department of General Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhoj Raj Luitel
- Department of Urology and Kidney Transplant Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Amit Sharma Bhattarai
- Department of Anesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Uttam Kumar Sharma
- Department of Urology and Kidney Transplant Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| |
Collapse
|
3
|
Wang L, Lu M, Wang S, Wu X, Tan B, Xu J, Zou J, He Y. Combined multiple regional anesthesia for microwave ablation of liver Tumors: Initial experience. Eur J Radiol 2023; 169:111147. [PMID: 37913695 DOI: 10.1016/j.ejrad.2023.111147] [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: 08/24/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aims to assess the feasibility and safety of combined multiple regional anesthesia (CMRA) as a potential strategy to decrease pain and reliance on intravenous analgesics during and after ultrasound-guided microwave ablation (US-guided-MWA) of liver tumors. METHODS A cohort of 75 patients with a total of 99 liver tumors who underwent US-guided-MWA of liver tumors were enrolled. These patients were randomly allocated into three groups: A, B, and C. Prior to the ablation procedure, Group A patients received a combination of hepatic hilar block (HHB), Transversus abdominis plane block (TAPB), and local anesthesia (LA). Patients in Group B were administered HHB in conjunction with LA, while those in Group C received TAPB and LA. Evaluative parameters included the Numerical Rating Scale (NRS) scores, consumption of morphine, incidence of complications, and factors influencing perioperative pain. RESULTS All patients successfully underwent US-guided-MWA. The peak NRS scores for pain during ablation across the three groups were 2.36 ± 1.19, 3.28 ± 1.59, and 4.24 ± 1.42 respectively (P < 0.01), while the count of patients requiring morphine were 4/25, 8/25, and 13/25 respectively (P < 0.01). Postoperative NRS scores for the three groups at 4, 8, 12, 24, and 36-hour intervals demonstrated a pattern of initial increase followed by a decrease, with the order at each interval being: Group A < Group C < Group B. Factors associated with increased pain included larger tumor size, greater number of tumors, and longer procedure and ablation time (P < 0.05). No major complications were recorded across the three groups. CONCLUSION CMRA offers an effective and safe modality to manage pain during and after US-guided-MWA of liver tumors.
Collapse
Affiliation(s)
- Lu Wang
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Man Lu
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Shishi Wang
- From the School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 China.
| | - Xiaobo Wu
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Bo Tan
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Jinshun Xu
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Jie Zou
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Yi He
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| |
Collapse
|
4
|
Lei J, Huang K, Dai Y, Yin G. Evaluating outcomes of patient-centered enhanced recovery after surgery (ERAS) in percutaneous nephrolithotomy for staghorn stones: An initial experience. Front Surg 2023; 10:1138814. [PMID: 37025266 PMCID: PMC10071039 DOI: 10.3389/fsurg.2023.1138814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Objective To evaluate the outcomes of patient-centered enhanced recovery after surgery (ERAS) in -percutaneous nephrolithotomy (PCNL) for staghorn stones. Patients and methods A retrospective analysis of 106 patients with staghorn calculi who underwent PCNL treatment at the Third Xiangya Hospital from October 01, 2018 to September 30, 2021 was performed. The patients were divided into the ERAS group (n = 56) and traditional group (n = 50). The ERAS program focused on a patient-centered concept, with elaboration on aspects, such as patient education, nutritional support, analgesia, body warming, early mobilization, nephrostomy tube removal, and strict follow-up. Results The total stone free rate and total complication rate were similar in both groups. The visual analogue scale (VAS) 6 h after surgery, ambulation off bed time, indwelling fistula time, indwelling catheter time, and postoperative hospital stays were lower in the ERAS group than in the traditional group (P < 0.05). The multiple session rate in the ERAS group (19, 28.57%) was lower than that in the traditional group (30, 60%) (P = 0.007). The 1-year stone recurrence rate in the ERAS group (7, 17.5%) was lower than that in the traditional group (14, 38.9%) (P = 0.037). Conclusion The patient-centered ERAS in PCNL for staghorn stones accelerated rehabilitation by relieving postoperative pain, shortening hospitalization time, accelerating early ambulation, and reducing multiple session rate and 1-year stone recurrence rate, which have socioeconomic benefits.
Collapse
Affiliation(s)
- Jun Lei
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Kai Huang
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yingbo Dai
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Guangming Yin
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Guangming Yin
| |
Collapse
|
5
|
Szamborski M, Janc J, Rosińczuk J, Janc JJ, Leśnik P, Łysenko L. Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8696. [PMID: 35886547 PMCID: PMC9320164 DOI: 10.3390/ijerph19148696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.
Collapse
Affiliation(s)
- Marek Szamborski
- Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (M.S.); (P.L.)
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (M.S.); (P.L.)
| | - Joanna Rosińczuk
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | | | - Patrycja Leśnik
- Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (M.S.); (P.L.)
| | - Lidia Łysenko
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-529 Wroclaw, Poland;
| |
Collapse
|
6
|
Wu H, Ding T, Yan S, Huang Z, Zhang H. Risk factors for moderate-to-severe postoperative pain after percutaneous nephrolithotomy: a retrospective cohort study. Sci Rep 2022; 12:8366. [PMID: 35589956 PMCID: PMC9120144 DOI: 10.1038/s41598-022-12623-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing renal calculi, while a large number of patients experience acute moderate-to-severe pain despite the analgesia provided. This study aimed to explore the risk factors for postoperative pain after PCNL, which may provide a novel perspective to refine the enhanced recovery after surgery (ERAS) program and to improve clinical outcomes. The clinical data of 331 patients who underwent PCNL in our hospital from September 2020 to February 2021 were retrospectively analyzed. The pain intensity was assessed every 4 h until 24 h post-surgery. According to the visual analog scale (VAS) score, patients were divided into two groups: mild or no pain group (VAS score, 0–3) and moderate-to-severe pain group (VAS score, 4–10). The pre-, peri-, and post-operative data were collected and analyzed. The indicators with statistically significant differences were selected, and multivariate logistic regression analysis was employed to determine the risk factors for postoperative pain after PCNL. Among 331 patients, 221 patients had moderate-to-severe pain and the incidence rate was 66.77%. Multivariate logistic regression analysis showed that the independent risk factors for moderate-to-severe pain after PCNL were the diameter of the renal calculus (odds ratio (OR) = 6.23, 95% confidence interval (CI) 2.50–15.56, P = 0.001), the number of renal calculi (OR = 15.892, 95% CI 7.721–32.711, P < 0.01), the presence of residual calculi (OR = 1.780, 95% CI 0.897–3.533, P = 0.01), and operation time (OR = 1.033, 95% CI 1.020–1.046, P < 0.01). The diameter of the renal calculus, the number of renal calculi, the presence of residual calculi, and operation time were significant predictors of postoperative pain after PCNL.
Collapse
Affiliation(s)
- Haotian Wu
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Tianfu Ding
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Siyi Yan
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China
| | - Zhongyue Huang
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huan Zhang
- School of Clinical Medicine, Tsinghua University, Beijing, China. .,Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, No.168 Litang Road, Changping District, Beijing, 102218, China.
| |
Collapse
|