1
|
Soulioti E, Pertsikapa M, Fyntanidou B, Limnaios P, Sidiropoulou T. Trauma Patients and Acute Compartment Syndrome: Is There an Ariadne's Thread That Can Safely Guide the Anesthesiologist/Emergency Physician Out of the Labyrinth? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1279. [PMID: 39202560 PMCID: PMC11356385 DOI: 10.3390/medicina60081279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 07/20/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024]
Abstract
Trauma patients in the emergency department experience severe pain that is not always easy to manage. The risk of acute compartment syndrome further complicates the analgesic approach. The purpose of this review is to discuss relevant bibliography and highlight current guidelines and recommendations for the safe practice of peripheral nerve blocks in this special group of patients. According to the recent bibliography, peripheral nerve blocks are not contraindicated in patients at risk of acute compartment syndrome, as long as there is surveillance and certain recommendations are followed.
Collapse
Affiliation(s)
- Eleftheria Soulioti
- Second Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.S.); (P.L.)
| | - Marianthi Pertsikapa
- Department of Emergency Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.P.); (B.F.)
| | - Barbara Fyntanidou
- Department of Emergency Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.P.); (B.F.)
| | - Pantelis Limnaios
- Second Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.S.); (P.L.)
| | - Tatiana Sidiropoulou
- Second Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.S.); (P.L.)
| |
Collapse
|
2
|
Jaramillo-Granada AM, Li J, Flores Villarreal A, Lozano O, Ruiz-Suárez JC, Monje-Galvan V, Sierra-Valdez FJ. Modulation of Phospholipase A 2 Membrane Activity by Anti-inflammatory Drugs. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2024; 40:7038-7048. [PMID: 38511880 DOI: 10.1021/acs.langmuir.4c00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The phospholipase A2 (PLA2) superfamily consists of lipolytic enzymes that hydrolyze specific cell membrane phospholipids and have long been considered a central hub of biosynthetic pathways, where their lipid metabolites exert a variety of physiological roles. A misregulated PLA2 activity is associated with mainly inflammatory-derived pathologies and thus has shown relevant therapeutic potential. Many natural and synthetic anti-inflammatory drugs (AIDs) have been proposed as direct modulators of PLA2 activity. However, despite the specific chemical properties that these drugs share in common, little is known about the indirect modulation able to finely tune membrane structural changes at the precise lipid-binding site. Here, we use a novel experimental strategy based on differential scanning calorimetry to systematically study the structural properties of lipid membrane systems during PLA2 cleavage and under the influence of several AIDs. For a better understanding of the AIDs-membrane interaction, we present a comprehensive and comparative set of molecular dynamics (MD) simulations. Our thermodynamic results clearly demonstrate that PLA2 cleavage is hindered by those AIDs that significantly reduce the lipid membrane cooperativity, while the rest of the AIDs oppositely tend to catalyze PLA2 activity to different extents. On the other hand, our MD simulations support experimental results by providing atomistic details on the binding, insertion, and dynamics of each AID on a pure lipid system; the drug efficacy to impact membrane cooperativity is related to the lipid order perturbation. This work suggests a membrane-based mechanism of action for diverse AIDs against PLA2 activity and provides relevant clues that must be considered in its modulation.
Collapse
Affiliation(s)
- Angela M Jaramillo-Granada
- Centro de Investigación y de Estudios Avanzados-Monterrey, Parque de Investigación e Innovación Tecnológica, Apodaca, Nuevo León 66600, Mexico
| | - Jinhui Li
- Department of Chemical and Biological Engineering, State University of New York (SUNY) at Buffalo, Buffalo, New York 14260, United States
| | | | - Omar Lozano
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Nuevo León 64460, Mexico
- Institute for Obesity Research, Tecnologico de Monterrey, Monterrey, Nuevo León 64849, Mexico
| | - J C Ruiz-Suárez
- Centro de Investigación y de Estudios Avanzados-Monterrey, Parque de Investigación e Innovación Tecnológica, Apodaca, Nuevo León 66600, Mexico
| | - Viviana Monje-Galvan
- Department of Chemical and Biological Engineering, State University of New York (SUNY) at Buffalo, Buffalo, New York 14260, United States
| | | |
Collapse
|
3
|
Balsevicius L, Urbano PCM, Hasselager RP, Mohamud AA, Olausson M, Svraka M, Wahlstrøm KL, Oppermann C, Gögenur DS, Hølmich ER, Cappelen B, Sækmose SG, Tanggaard K, Litman T, Børglum J, Brix S, Gögenur I. Effect of anterior quadratus lumborum block with ropivacaine on the immune response after laparoscopic surgery in colon cancer: a substudy of a randomized clinical trial. Reg Anesth Pain Med 2023:rapm-2023-104896. [PMID: 37945063 DOI: 10.1136/rapm-2023-104896] [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: 09/06/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Surgery induces a temporal change in the immune system, which might be modified by regional anesthesia. Applying a bilateral preoperative anterior quadratus lumborum block has proven to be a safe and effective technique in pain management after abdominal and retroperitoneal surgery, but the effect on the immune response is not thoroughly investigated. METHODS This study is a substudy of a randomized, controlled, double-blinded trial of patients undergoing laparoscopic hemicolectomy due to colon cancer. Twenty-two patients were randomized to undergo either a bilateral anterior quadratus lumborum nerve block with a total of 60 mL ropivacaine 0.375% or placebo with corresponding isotonic saline injections. The main objective of this exploratory substudy was to investigate the systemic immune response in the first postoperative day by examining changes in blood transcript levels (n=750) and stimulated secretion of cytokines (n=17) on ex vivo activation with microbial ligands and anti-CD3/CD28. RESULTS Using unsupervised data analysis tools, we observed no effect of the bilateral anterior quadratus lumborum nerve block on gene expression in immune cells (permutational multivariate analysis of variance using distance matrices: F=0.52, p=0.96), abundances of major immune cell populations (Wilcoxon rank-sum test: p>0.05), and stimulated cytokine secretion (Wilcoxon rank-sum test: p>0.05). CONCLUSIONS Our study provides evidence that administration of bilateral anterior quadratus lumborum nerve block as a part of a multimodal analgesic regimen in an enhanced recovery after surgery for laparoscopic hemicolectomy in this cohort does not alter the systemic immune response.Trial registration number NCT03570541.
Collapse
Affiliation(s)
- Lukas Balsevicius
- Department of Surgery, Zealand University Hospital, Koge, Denmark
- Graduate School of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paulo C M Urbano
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - Rune Petring Hasselager
- Department of Surgery, Zealand University Hospital, Koge, Denmark
- Euro-Periscope, Onco-Anaesthesiology Research Group (RG), European Society of Anaesthesiology, Brussels, Belgium
| | | | - Maria Olausson
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - Melina Svraka
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | | | | | | | | | - Britt Cappelen
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | | | - Katrine Tanggaard
- Department of Anesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Thomas Litman
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Jens Børglum
- Department of Anesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, Koge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Vinyes D, Traverso PH, Murillo JH, Sánchez-Padilla M, Muñoz-Sellart M. Improvement in post-orthodontic chronic musculoskeletal pain after local anesthetic injections in the trigeminal area: a case series. J Int Med Res 2023; 51:3000605231214064. [PMID: 38017361 PMCID: PMC10686034 DOI: 10.1177/03000605231214064] [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: 07/26/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023] Open
Abstract
Orthodontic treatment has been associated with chronic extraoral pain that is often resistant to common treatments such as drugs or physiotherapy, adversely affecting patients' quality of life. In this case series, we discuss the potential impact of orthodontics on chronic cervical spine pain or gonalgia and explore the long-term effect of local anesthetic injections as a possible therapeutic intervention. Six orthodontic patients with chronic cervical spine pain or gonalgia that substantially affected their quality of life were treated with injections of 0.5% procaine into individual lesions and at palpable points of tissue tension in the oral mucosa and extraoral myofascial areas. All patients in this case series reported significant improvement in their chronic pain, with no residual pain recorded at the 6-month follow-up. Injecting local anesthetic at stress points in the oral mucosal and extraoral myofascial regions may be an effective treatment for post-orthodontic neck and knee pain. Further research is required to better understand the potential benefits of this intervention for patients experiencing orthodontic-related musculoskeletal pain.
Collapse
Affiliation(s)
- David Vinyes
- Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
- Master’s Degree in Continuing Education in Medical and Dental Neural Therapy, University of Barcelona, Barcelona, Spain
- Neural Therapy Research Foundation, Sabadell, Barcelona, Spain
| | - Paula Hermosilla Traverso
- Master’s Degree in Continuing Education in Medical and Dental Neural Therapy, University of Barcelona, Barcelona, Spain
- La Granja Family Health Center (CESFAM), La Granja Municipality, Santiago, Chile
| | - Julia Hartley Murillo
- Master’s Degree in Continuing Education in Medical and Dental Neural Therapy, University of Barcelona, Barcelona, Spain
| | - Maider Sánchez-Padilla
- Gimbernat University School, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Barcelona, Spain
| | - Montserrat Muñoz-Sellart
- Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
- Master’s Degree in Continuing Education in Medical and Dental Neural Therapy, University of Barcelona, Barcelona, Spain
- Neural Therapy Research Foundation, Sabadell, Barcelona, Spain
| |
Collapse
|
5
|
Sonawane K, Dhamotharan P, Dixit H, Gurumoorthi P. Coping With the Fear of Compartment Syndrome Without Compromising Analgesia: A Narrative Review. Cureus 2022; 14:e30776. [DOI: 10.7759/cureus.30776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
|
6
|
Lee IWS, Schraag S. The Use of Intravenous Lidocaine in Perioperative Medicine: Anaesthetic, Analgesic and Immune-Modulatory Aspects. J Clin Med 2022; 11:3543. [PMID: 35743617 PMCID: PMC9224677 DOI: 10.3390/jcm11123543] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022] Open
Abstract
This narrative review provides an update on the applied pharmacology of lidocaine, its clinical scope in anaesthesia, novel concepts of analgesic and immune-modulatory effects as well as the current controversy around its use in perioperative opioid-sparing multi-modal strategies. Potential benefits of intravenous lidocaine in the context of cancer, inflammation and chronic pain are discussed against concerns of safety, toxicity and medico-legal constraints.
Collapse
Affiliation(s)
- Ingrid Wing-Sum Lee
- School of Medicine, University of Glasgow, Wolfson Medical School Building, University Avenue, Glasgow G12 8QQ, UK;
| | - Stefan Schraag
- Department of Perioperative Medicine, Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| |
Collapse
|