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Somani S, Makhija N, Chauhan S, Bhoi D, Das S, Bandi SG, Rajashekar P, Bisoi AK. Comparison of Multiple Injection Costotransverse Block and Erector Spinae Plane Block for Post-Sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective Randomized Comparative Study. J Cardiothorac Vasc Anesth 2024; 38:974-981. [PMID: 38326195 DOI: 10.1053/j.jvca.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of ultrasound-guided multiple injection costotransverse block (MICB) and compare it with erector spinae plane block (ESPB) for poststernotomy pain relief in pediatric cardiac surgical patients. DESIGN A prospective, randomized, double-blind, comparative study. SETTING At a single institution tertiary referral cardiac center. PARTICIPANTS A total of 90 children with acyanotic congenital heart disease requiring surgery via sternotomy. INTERVENTIONS Children were allocated randomly to 1 of the 3 following groups: ESPB (group 1), MICB (group 2), or Control (group 3). Participants in groups 1 and 2 received 4 mg/kg of 0.2% ropivacaine for bilateral ultrasound-guided block after induction of anesthesia. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl/tramadol was used for rescue analgesia. MEASUREMENTS AND MAIN RESULTS The modified objective pain score (MOPS) was evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours postextubation. After all exclusions, 84 patients were analyzed. The MOPS score was found to be significantly lower in ESPB and MICB groups compared to the control group until 10 hours postextubation (p < 0.05), with no statistically significant difference at the 12th hour (p = 0.2198). The total intraoperative fentanyl consumption (p = 0.0005), need for fentanyl supplementation on incision (p < 0.0001), and need for rescue opioid requirement in the postoperative period (p = 0.034) were significantly lower in both the ESPB and MICB groups than the control group. There were no statistically significant differences in both primary and secondary outcomes between the ESPB and MICB groups. CONCLUSION Ultrasound-guided MICB was effective and comparable to ESPB for post-sternotomy pain management in pediatric cardiac surgical patients.
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Affiliation(s)
- Shruti Somani
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Sandeep Chauhan
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sambhunath Das
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sushama Gayatri Bandi
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Akshya Kumar Bisoi
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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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:S2341-1929(24)00061-1. [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] [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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Yang M, Cao L, Lu T, Xiao C, Wu Z, Jiang X, Wang W, Li H. Ultrasound-guided erector spinae plane block for perioperative analgesia in patients undergoing laparoscopic nephrectomy surgery: A randomized controlled trial. Heliyon 2024; 10:e26422. [PMID: 38434013 PMCID: PMC10906293 DOI: 10.1016/j.heliyon.2024.e26422] [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: 08/20/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
Study objective Kidney neoplasms have a high incidence, and radical nephrectomy or partial nephrectomy are the main treatment options. Our study aims to investigate the use of ultrasound-guided erector spinae plane block for perioperative analgesia in patients undergoing laparoscopic nephrectomy surgery. Design Prospective, randomized, double-blind. Setting University hospital. Patients Our study included 50 patients (ASA I-III) who underwent laparoscopic nephrectomy at the hospital of Second Affiliated Hospital of Army Medical University. Interventions The patients were divided into two groups: the ESPB group and the control group. In the ESPB group, a mixture of 10 mL of 1% lidocaine, 10 mL of 0.7% ropivacaine, 0.5 μg/kg dexmedetomidine, and 5 mg of dexamethasone was administered. In the control group, 20 mL of 0.9% saline was administered. Measurements The primary outcome measure was the total consumption of sufentanil during the intraoperative period. Secondary outcome measures included visual analogue scale (VAS) pain scores at rest and during coughing at 1 h, 6 h, 12 h, 24 h, and 48 h postoperatively, intraoperative consumption of remifentanil, frequency of rescue analgesic administration, consumption of rescue analgesia and incidence of postoperative nausea and vomiting within 48 h. Results The ESPB group exhibited lower intraoperative consumption of sufentanil, lower consumption of rescue analgesia, as well as VAS scores at rest and during coughing within the first 24 h postoperatively, compared to the control group. However, no significant differences were observed in VAS scores at 48 h postoperatively, postoperative nausea and vomiting, or the need for postoperative rescue analgesia. Conclusions Ultrasound-guided ESPB performed in patients who underwent laparoscopic nephrectomy demonstrated a substantial decrease in intraoperative opioid consumption, as well as lower VAS scores at rest and during coughing in the postoperative period.
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Affiliation(s)
- Ming Yang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Lei Cao
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Tong Lu
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Cheng Xiao
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Zhuoxi Wu
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Xuetao Jiang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Wei Wang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Hong Li
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
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Razak A, Corman B, Servider J, Mavarez-Martinez A, Jin Z, Mushlin H, Bergese SD. Postoperative analgesic options after spine surgery: finding the optimal treatment strategies. Expert Rev Neurother 2024; 24:191-200. [PMID: 38155560 DOI: 10.1080/14737175.2023.2298824] [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: 06/03/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Spine surgery is one of the most common types of surgeries performed in the United States; however, managing postoperative pain following spine surgery has proven to be challenging. Patients with spine pathologies have higher incidences of chronic pain and resultant opioid use and potential for tolerance. Implementing a multimodal plan for postoperative analgesia after spine surgery can lead to enhanced recovery and outcomes. AREAS COVERED This review presents several options for analgesia following spine surgery with an emphasis on multimodal techniques to best aid this specific patient population. In addition to traditional therapeutics, such as acetaminophen, non-steroidal anti-inflammatory medications, and opioids, we discuss intrathecal morphine administration and emerging regional anesthesia techniques. EXPERT OPINION Several adjuncts to improve analgesia following spine surgery are efficacious in the postoperative period. Intrathecal morphine provides sustained analgesia and can be instilled intraoperatively by the surgical team under direct visualization. Local anesthetics deposited under ultrasound guidance by an anesthesiologist trained in regional techniques also provide the opportunity for single injections or continuous analgesia via an indwelling catheter.
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Affiliation(s)
- Alina Razak
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Benjamin Corman
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - John Servider
- Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Ana Mavarez-Martinez
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Harry Mushlin
- Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
- Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY, USA
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Cho J, Kang KN, Lee MS, Kim YU. Surgical versus nonsurgical management of lumbar degenerative spondylolisthesis based on spinal canal cross-sectional area. Medicine (Baltimore) 2024; 103:e36874. [PMID: 38215145 PMCID: PMC10783222 DOI: 10.1097/md.0000000000036874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
Disability and pain associated with lumbar degenerative spondylolisthesis (LDS) result in a significant burden on both the healthcare costs and patients' quality of life. Currently, there exists controversy regarding employment of either nonsurgical management (NSM) or surgical management (SM) in a clinical setting. Spinal canal cross-sectional area (SCA) has been an important morphological parameter for the analysis of LDS. However, there is lack of research about the comparative value of NSM and SM according to SCA. Moreover, previous research have not yet evaluated the clinical most suitable cutoff values of SCA. The objective of this research was to evaluate the effective of NSM and SM for LDS using SCA as an objective morphological parameter. The axial T2 magnetic resonance imaging images were obtained from each patient. We collected SCA samples from 149 patients with LDS. 72 patients underwent SM and the rest did NSM. We measured SCA at the L4/5 LDS on magnetic resonance imaging using a picture archiving and communications system. We measured SCA at the intervertebral disk posterior border, turning down to reach the facet joint side on the opposite edge at the L4/5 level. The average SCA value was 114.34 ± 48.11 mm2 in the NSM group and 69.88 ± 27.87 mm2 in the SM group. Therefore, the SM group had considerably lower SCA (P < .001). In view of the effectiveness of SCA as a prediction factor of surgical option, Receiver Operating Characteristic curve analysis show the optimal cutoff value for SCA as 83.21 mm2, with 70.8% sensitivity, 71.4% specificity, and an area under the curve of 0.80 (95% CI, 0.73-0.87). The narrower the SCA, the higher the probability of SM. Thus, it is proposed that to evaluate surgical decision making, the pain physician should carefully inspect the SCA.
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Affiliation(s)
- Jaeho Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Min Sang Lee
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
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Yang M, Cao L, Lu T, Xiao C, Wu Z, Jiang X, Wang W, Li H. Ultrasound-guided erector spinae plane block for perioperative analgesia in patients undergoing laparoscopic nephrectomies surgery: a randomized controlled trial. Trials 2024; 25:10. [PMID: 38167138 PMCID: PMC10759534 DOI: 10.1186/s13063-023-07866-0] [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: 07/05/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Laparoscopic nephrectomy is a commonly utilized surgical approach for the management of renal cancer. Despite its widespread acceptance, postoperative pain management remains a significant challenge for many patients undergoing this procedure. Traditional pain management techniques, including opioid and nonsteroidal anti-inflammatory drug administration, may not provide adequate pain relief and may result in adverse effects. In recent years, erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique due to its simplicity, safety, and potential efficacy in reducing postoperative pain. ESPB has demonstrated effectiveness in reducing postoperative pain in various surgical procedures. However, the efficacy of ESPB in laparoscopic nephrectomy for renal cancer has not been extensively studied. As such, further investigation is necessary to determine the potential benefits of ESPB in this context. The addition of adjuvants such as dexmedetomidine and dexamethasone to nerve blocks has been shown to improve both the duration and quality of the block. Multiple studies have demonstrated the safety and efficacy of these adjuvants in reducing postoperative pain and opioid consumption and improving patient satisfaction. The use of dexmedetomidine and dexamethasone as adjuvants for nerve blocks represents a promising approach for enhancing regional anesthesia and analgesia. In light of these findings, we have incorporated dexmedetomidine and dexamethasone into our nerve block protocol. METHODS This study is a randomized controlled trial conducted at a single center, with 50 participants being randomized in a 1:1 ratio to either the ESPB group or the control group. The trial aims to investigate the efficacy of ESPB in patients diagnosed with kidney cancer who are scheduled for laparoscopic nephrectomy. The primary outcome measure is the total consumption of intraoperative sufentanil. Secondary outcomes include the VAS score at rest and during coughing at 1 h, 6 h, 12 h, 24 h, and 48 h after surgery; total intraoperative remifentanil consumption; the number of times rescue analgesia is required; and the incidence of nausea and vomiting in the first 24 h after surgery. This study is registered for a duration of 1 year and is being conducted in China. DISCUSSION The objective of our study is to evaluate the potential benefits of erector spinae plane block (ESPB) in patients undergoing laparoscopic nephrectomy, with a focus on the impact of dexmedetomidine and dexamethasone as adjuvants on the quality and duration of the block, as well as postoperative pain and opioid consumption. By investigating the effects of these adjuvants in the context of ESPB, we hope to contribute to the growing body of literature on the use of adjuvants in nerve blocks and provide further insight into the potential benefits of this approach for improving patient outcomes following laparoscopic nephrectomy. This trial was approved by the Ethics Committee of the Second Affiliated Hospital of Army Medical University. TRIAL REGISTRATION China Clinical Trial Register ChiCTR2300068578 . Registered on 20 February 2023.
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Affiliation(s)
- Ming Yang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Lei Cao
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Tong Lu
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Cheng Xiao
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Zhuoxi Wu
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Xuetao Jiang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Wei Wang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China
| | - Hong Li
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China.
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Sethuraman RM. Costotransverse block versus costotransverse foramen block: Long way to clarity on the difference in anatomy and techniques. Saudi J Anaesth 2024; 18:3-5. [PMID: 38313712 PMCID: PMC10833033 DOI: 10.4103/sja.sja_688_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Raghuraman M. Sethuraman
- Department of Anesthesiology, Sree Balaji Medical College and Hospital, BIHER, Chennai, Tamil Nadu, India
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Tanaka N, Kadoya Y, Suzuka T, Kawaguchi M. Reply to letter to the editor: Inter-transverse process blocks: caution about difference in methods. Anesth Pain Med (Seoul) 2024; 19:68-69. [PMID: 38311357 PMCID: PMC10847001 DOI: 10.17085/apm.23121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Yuma Kadoya
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, Nara, Japan
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Mostafa M, Nasr MA, Fawzy M, Awad AE, Waheeb MM. The analgesic effect of transmuscular quadratus lumborum block versus erector spinae plane block for women undergoing elective Caesarean section: A randomized controlled trial. Br J Pain 2023; 17:438-446. [PMID: 38107753 PMCID: PMC10722106 DOI: 10.1177/20494637231181513] [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: 12/19/2023] Open
Abstract
Background We aimed to compare the analgesic effect and quality of recovery of transmuscular quadratus lumborum block (QLB) and erector spinae plane block (ESPB) in the presence of multimodal analgesia following Caesarean section. Methods This randomised controlled trial included full-term pregnant women who underwent elective Caesarean section under spinal anaesthesia without intrathecal morphine. The included women were randomised to receive either bilateral QLB (n = 51) or bilateral thoracic ESPB (n = 51), in addition to the control group (n = 51) who did not receive any block. All participants received regular paracetamol (1 g/6h) and diclofenac (50 mg/8 h). Intravenous morphine was used as a rescue analgesic. The primary outcome was time to first morphine requirement. Secondary outcomes included total postoperative morphine consumption and total Obstetric Quality of Recovery-11 (ObsQoR-11) score. Results We analysed 51, 50 and 48 patients in the QLB, ESPB and control groups, respectively. The time to first morphine requirement in both QLB and ESPB groups was longer than that in the control group (median [quartiles] time: 6 [6,12] h, 6 [6,6] h and 4 [3,4] h, respectively; p-value <0.001), without significant differences between the two former groups. The total morphine consumption in both QLB and ESPB groups was lower than that in the control group (median [quartiles]:0 [0,5] mg, 0 [0,5] mg and 25 [25,30] mg, respectively; p-value <0.001), without significant differences between the two former groups. The QLB and ESPB groups had comparable ObsQoR-11 score, and both groups' scores were higher than the control group. Conclusion In patients undergoing elective Caesarean section under spinal anaesthesia without intrathecal morphine, both QLB and ESPB provided superior analgesia and quality of recovery compared to the standard care, without significant difference between the two blocks.
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Affiliation(s)
- Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Nasr
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Maher Fawzy
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Aya E Awad
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Mohsen M Waheeb
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
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Harbell MW, Langley NR, Seamans DP, Koyyalamudi V, Kraus MB, Carey FJ, Craner R. Evaluating two approaches to the erector spinae plane block: an anatomical study. Reg Anesth Pain Med 2023; 48:495-500. [PMID: 36797037 DOI: 10.1136/rapm-2022-104132] [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: 10/17/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Studies show variable spread with thoracic erector spinae plane (ESP) injections. Injection sites vary from lateral end of the transverse process (TP) to 3 cm from the spinous process, with many not describing the precise site of injection. This human cadaveric study examined dye spread of ultrasound-guided thoracic ESP block at two needle locations. METHODS Ultrasound-guided ESP blocks were performed on unembalmed cadavers. Methylene blue (20 mL, 0.1%) was injected in the ESP at the medial TP at level T5 (medial transverse process injection (MED), n=7) and the lateral end of the TP between T4 and T5 (injection between transverse processes (BTWN), n=7). The back muscles were dissected, and the cephalocaudal and medial-lateral dye spread documented. RESULTS Dye spread cephalocaudally from C4-T12 in the MED group and C5-T11 in the BTWN group, and laterally to the iliocostalis muscle in five MED injections and all BTWN injections. One MED injection reached serratus anterior. Dorsal rami were dyed in five MED and all BTWN injections. Dye spread to the dorsal root ganglion and dorsal root in most injections, though more extensively in the BTWN group. The ventral root was dyed in 4 MED and 6 BTWN injections. Epidural spread in BTWN injections ranged from 3 to 12 levels (median: 5 levels), with contralateral spread in two cases and intrathecal spread in five injections. Epidural spread in MED injections was less extensive (median (range): 1 (0-3) levels); two MED injections did not enter the epidural space. CONCLUSION An ESP injection administered between TPs exhibits more extensive spread than a medial TP injection in a human cadaveric model.
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Affiliation(s)
- Monica W Harbell
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Natalie R Langley
- Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - David P Seamans
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Molly B Kraus
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Frederick J Carey
- Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ryan Craner
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
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Pentsou J, Hoey S, Vagias M, Guy B, Huuskonen V. Comparison of Ultrasound-Guided Versus Anatomical Landmark-Guided Thoracolumbar Retrolaminar Techniques in Canine Cadavers. Animals (Basel) 2023; 13:3045. [PMID: 37835651 PMCID: PMC10571554 DOI: 10.3390/ani13193045] [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: 08/27/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
The retrolaminar block was developed in humans as an easier and safer alternative to the thoracic paravertebral block. This study aims to describe an ultrasound-guided thoracolumbar retrolaminar injection in canine cadavers and compare the injectate distribution between a landmark-guided and an ultrasound-guided thoracolumbar retrolaminar technique using computed tomography. Ten canine cadavers were randomised to receive two injections each of 0.6 mL/kg of iodinated contrast at the level of the twelfth thoracic vertebra (T12): a landmark-guided retrolaminar injection was performed on one hemithorax (group B, n = 10) and an ultrasound-guided on the other hemithorax (group U, n = 10). Groups were compared using the Mann-Whitney U test. The median (range) spread of the contrast in the paravertebral space was 0 (0-3) and 1 (0-5) vertebrae in groups B and U, respectively (p = 0.038). The median (range) extent of the spread surrounding the interverbal foramina was 4 (0-5) in group B and 4 (3-5) in group U. The median (range) spread along the retrolaminar space cranial and caudal to T12 was 3 (0-6) retrolaminar segments in group B and 3 (3-4) in group U. The potential of the ultrasound-guided retrolaminar injection to provide analgesia for dogs suffering from thoracolumbar pain should be further investigated.
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Affiliation(s)
- Julia Pentsou
- Department of Veterinary Anaesthesia and Analgesia, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK
| | - Séamus Hoey
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, UCD School of Veterinary Medicine, University College Dublin, D04W6F6 Dublin, Ireland; (S.H.); (V.H.)
| | - Michail Vagias
- Department of Small Animal Surgery, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK;
| | - Bethany Guy
- Department of Veterinary Medicine, Queen’s Veterinary School Hospital, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK;
| | - Vilhelmiina Huuskonen
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, UCD School of Veterinary Medicine, University College Dublin, D04W6F6 Dublin, Ireland; (S.H.); (V.H.)
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Toprak H, Başaran B, Toprak ŞS, Et T, Kumru N, Korkusuz M, Bilge A, Yarımoğlu R. Efficacy of the Erector Spinae Plane Block for Quality of Recovery in Bariatric Surgery: a Randomized Controlled Trial. Obes Surg 2023; 33:2640-2651. [PMID: 37488349 DOI: 10.1007/s11695-023-06748-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Postoperative pain management after bariatric surgery is difficult due to different physiological properties and high sensitivity toward opioids in patients with obesity. It has been reported that erector spinae plane block (ESPB) contributes to postoperative analgesia when applied together with multimodal analgesia. METHODS Eighty patients were randomized either bilateral ESPB (group E) each side or no block (group C). Our primary aim was to evaluate the effects of ESPB on the quality of recovery 24 h postoperatively in bariatric surgery by using 40-item Quality of Recovery-40 (QoR-40) questionnaire. Postoperative pain assessed using a numerical rating scale (NRS), time of additional analgesic requirement, analgesic consumption, side effects, sedation, mobilization time, and postoperative complications were evaluated as secondary outcomes. RESULTS Postoperative mean QoR-40 scores were found to be higher in group E (175.02 ± 11.25) than in group C (167.78 ± 18.59) at the postoperative 24th hour (P < 0.05). Pain scores at rest and during movement were higher in group C than in group E. At the postoperative 24th hour, NRS mean SD scores at rest for group C and group E were 3.25 ± 1.32 and 2.40 ± 0.96, respectively. NRS mean SD scores during movement for groups C and E were 3.88 ± 1.49 and 3.12 ± 1.30, respectively. The total amount of tramadol consumed in the first 24 h in group C and group E were mean SD: 86.40 ± 69.60 and 40.00 ± 46.96, respectively; P < 0.05. CONCLUSIONS ESPB improved postoperative quality of recovery, reduced NRS scores, and total analgesic consumption in patients with obesity undergoing bariatric surgery. CLINICAL TRIAL REGISTRATION NCT05020379.
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Affiliation(s)
- Hatice Toprak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey.
| | - Betül Başaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Şükrü S Toprak
- Department of General Surgery, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Tayfun Et
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Nuh Kumru
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, University Mh. Martyr Ömer Halis, Demir Caddesi Blok No: 7 No: 1, 70200, Karaman, Turkey
| | - Muhammet Korkusuz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Ayşegül Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Yunus Emre Campus, 70200, Karaman, Turkey
| | - Rafet Yarımoğlu
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, University Mh. Martyr Ömer Halis, Demir Caddesi Blok No: 7 No: 1, 70200, Karaman, Turkey
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Karmakar MK, Sivakumar RK, Sheah K, Pangthipampai P, Lönnqvist PA. Quest for the Elusive Mechanism of Action for the Thoracic Paraspinal Nerve Block Techniques. Are We Ignoring the Anatomy of the "Retro Superior Costotransverse Ligament Space?". Anesth Analg 2023; 137:458-465. [PMID: 37450909 DOI: 10.1213/ane.0000000000006462] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Manoj Kumar Karmakar
- From the Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Faculty of Medicine, Prince of Wales Hospital, Hong Kong, China
| | - Ranjith Kumar Sivakumar
- From the Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Faculty of Medicine, Prince of Wales Hospital, Hong Kong, China
| | - Kenneth Sheah
- Department of Radiology, Orthopedic and Hand MRI (OHM) Novena, Novena Specialist Centre, Singapore
| | - Pawinee Pangthipampai
- Department of Anesthesiology, Mahidol University, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailandand
| | - Per-Arne Lönnqvist
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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He Y, Xu M, Jiang X, Li Z, Du B. Comparing postoperative analgesia of bilateral serratus anterior plane block and thoracic paravertebral block for children following the Nuss procedure: protocol for a randomised, double-blind, non-inferiority clinical trial. BMJ Paediatr Open 2023; 7:e002128. [PMID: 37491133 PMCID: PMC10373708 DOI: 10.1136/bmjpo-2023-002128] [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] [Received: 06/12/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION The Nuss procedure, despite being a minimally invasive surgery, is regarded as one of the most painful surgical procedures in children, and postoperative pain control remains a major clinical issue in this population. Thoracic paravertebral nerve block (TPVB) is reported as excellent pain relief for the Nuss procedure despite its challenging performance and associated adverse effects. Serratus anterior plane block (SAPB) is a simplified and effective method for managing thoracic pain as an alternative to TPVB. However, whether SAPB can provide analgesia comparable with that provided by the TPVB approach in children undergoing the Nuss procedure is unknown. METHODS AND ANALYSIS This will be a prospective, randomised, double-blind, single-centre, non-inferiority trial that will enrol children aged 7-16 years subjected to the Nuss operation for pectus excavatum. In total, 74 paediatric patients will be randomly assigned to either the SAPB or TPVB group after general anaesthesia to receive ultrasound-guided regional nerve blocks (0.25% ropivacaine 2.5 mg/kg). The primary outcome will be the assessment of postoperative pain intensity at predetermined time points. The secondary outcomes will include assessing intraoperative opioid intake, consumption of analgesics within 24 hours postoperatively, time of first use of rescue analgesics, extubation time, perioperative adverse events and plasma ropivacaine concentrations across the block groups. Demographic and clinical characteristics (eg, pectus severity and the number of bars used) of the patients will be recorded. All data will be collected by investigators who are blinded to the treatment. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee on Biomedical Research of the West China Hospital of Sichuan University (2021-1275). During the period of the study, all procedures will be conducted following the principles of the Declaration of Helsinki. The results of the trial will be published in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER ChiCTR2200056596.
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Affiliation(s)
- Yi He
- Department of Anesthesiology & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Mingzhe Xu
- Department of Anesthesiology & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaojuan Jiang
- Department of Anesthesiology & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Zhi Li
- Department of Critical Care Medicine, Cheng Du Shang Jin Nan Fu Hospital, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Du
- Department of Anesthesiology & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Oh C, Chong Y, Kang MW, Bae J, Lee S, Jo Y, Lee J, Baek S, Jung J, Kim YH, Hong B. Comparison between costotransverse foramen block and thoracic paravertebral block for VATS pulmonary resection: A randomized noninferiority trial. J Clin Anesth 2023; 88:111127. [PMID: 37207551 DOI: 10.1016/j.jclinane.2023.111127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023]
Abstract
STUDY OBJECTIVE The present study assessed whether costotransverse foramen block (CTFB) is noninferior to thoracic paravertebral block (TPVB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS) pulmonary resection. DESIGN Single-center, double-blinded, randomized, non-inferiority trial. SETTING Operating room and intensive care unit or ward in a tertiary hospital. PATIENTS Patients aged 20 to 80 years with American Society of Anesthesiology physical status 1 to 3 scheduled for elective VATS pulmonary resection. INTERVENTIONS Sixty patients were randomly allocated 1:1 to receive CTFB or TPVB using 15 mL aliquots of 0.5% ropivacaine at the T4-5 and T6-7 intercostal levels immediately after the induction of general anesthesia. MEASUREMENTS The primary outcome was the area under the curve (AUC) of numeric rating scale (NRS, 0 to 10) during 24 h postoperatively (noninferiority limit was 24; NRS 1 per hour). The secondary outcomes included postoperative opioid consumption, rescue analgesic use, postoperative nausea and vomiting, pulmonary function, dermatomal spread of the blockade, and quality of recovery. MAIN RESULTS Forty-seven patients were included for final analysis. The difference between the mean 24-h AUCs of NRS in the CTFB (34.25 ± 16.30, n = 24) and TPVB (39.52 ± 17.13, n = 23) groups was -5.27 (95% confidence interval [CI], -15.09 to 4.55), with the upper limit of 95% CI being far below the predefined noninferiority margin of 24. There was no significant difference in the dermatomal spread of the blockades between the groups, as both reached the upper and lower most levels of T3 and T7 (median). Additionally, there were no significant differences in other secondary outcomes between the two groups. CONCLUSIONS The analgesic effect of CTFB was noninferior to that of TPVB during 24 h postoperatively in VATS pulmonary resection. Moreover, CTFB may offer potential safety benefits by keeping the tip of the needle far from the pleura and vascular structure.
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Affiliation(s)
- Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yooyoung Chong
- Department of Thoracic & Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Min-Woong Kang
- Department of Thoracic & Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jaemun Bae
- Department of Thoracic & Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Soomin Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jiyong Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Sujin Baek
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jinsik Jung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
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Yamamoto Y, Tanaka N, Kadoya Y, Umehara M, Suzuka T, Kawaguchi M. Bolus intertransverse process block and continuous erector spinae plane block for perioperative analgesic management of video-assisted thoracoscopic surgery - Three cases report. Anesth Pain Med (Seoul) 2023; 18:198-203. [PMID: 37183288 PMCID: PMC10183616 DOI: 10.17085/apm.22250] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/22/2022] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Common regional anesthesia approaches for video-assisted thoracoscopic surgery (VATS) include paravertebral block (PVB) and erector spinae plane block (ESPB). PVB is considered a deep nerve block which is contraindicated in antithrombotic therapy. ESPB is effective when administered as a bolus, as well as continuously. However, the recently proposed intertransverse process block (ITPB) ensures more effective diffusion of the local anesthetic into the paravertebral space. CASE We report cases of three patients who received bolus ITPB (costotransverse foramen block and mid-point transverse process-to-pleura block in one and two cases, respectively) combined with continuous ESPB when a deep nerve block could not be administered. Opioids were not required postoperatively, and all postoperative numerical rating scale scores (0-10) at rest were maintained below 4. CONCLUSIONS The combination of bolus ITPB and continuous ESPB may be an alternative analgesic method when deep nerve blocks are contraindicated in VATS.
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Affiliation(s)
- Yuki Yamamoto
- Department of Anesthesiology, Nara Prefecture General Medical Center, Nara, Japan
| | - Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Yuma Kadoya
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Miki Umehara
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, Nara, Japan
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Mostafa M, Mousa MS, Hasanin A, Arafa AS, Raafat H, Ragab AS. Erector spinae plane block versus subcostal transversus abdominis plane block in patients undergoing open liver resection surgery: A randomized controlled trial. Anaesth Crit Care Pain Med 2023; 42:101161. [PMID: 36154912 DOI: 10.1016/j.accpm.2022.101161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to compare the analgesic efficacy of erector spinae plane block (ESPB) in relation to subcostal transversus abdominis plane block (TAPB) in patients undergoing open liver resection surgery. METHODS In this randomized controlled trial, we included adult patients undergoing open liver resection surgery. After induction of general anaesthesia, the included patients were randomized to receive either ESPB (n = 30) or subcostal TAPB (n = 30). Postoperative pain was assessed using the numeric rating scale (NRS) at rest and during cough. Intravenous morphine boluses were used for management of breakthrough pain intra- and postoperatively. The study's primary outcome was morphine consumption during the first 24 h postoperatively. Secondary outcomes included intraoperative morphine consumption, time to first postoperative morphine requirement, incidence of complications, and patient satisfaction. RESULTS Sixty patients were included and were available for the final analysis in this study. The intra-and postoperative morphine consumption were less in the ESPB group than the subcostal TAPB group (median [quartiles] morphine dose: 0 [0-0] vs 2 [0-5] mg, p = 0.007 and 20 [15-20] vs 25 [20-30] mg, p = 0.006, respectively). The time to first morphine requirement was longer in the ESPB group (median [quartiles]: 6.5 [5.5-6.5] h) than the subcostal TAPB group (median [quartiles]: 4.3 [1.0-6.5] h), P = 0.013. Patients in the ESPB group had lower incidence of sedation and higher level of satisfaction than the subcostal TAPB group. CONCLUSION In patients undergoing open liver resection surgery, ESPB provided superior analgesic properties than subcostal TAPB. CLINICAL TRIAL REGISTRATION NCT05253079, Principal investigator: Maha Mostafa, Date of registration: February 23, 2022. URL: https://clinicaltrials.gov/ct2/show/NCT05253079.
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Affiliation(s)
- Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
| | - Maggie Saeed Mousa
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Amany S Arafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Heba Raafat
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Shaker Ragab
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
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Hong B, Oh C, Jo Y, Lee S, Park S, Kim YH. Current evidence of ultrasound-guided fascial plane blocks for cardiac surgery: a narrative literature review. Korean J Anesthesiol 2022; 75:460-472. [PMID: 36245347 PMCID: PMC9726460 DOI: 10.4097/kja.22564] [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: 08/28/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022] Open
Abstract
Fascial plane blocks are useful for multimodal analgesia after cardiac surgery since they can provide effective analgesia without the serious risks associated with conventional techniques such as neuraxial hematoma and pneumothorax. This narrative review covers blocks performed at the parasternal intercostal, interpectoral, pectoserratus, serratus anterior, erector spinae, and retrolaminar planes, which are targets for fascial plane blocks in cardiac surgery. Brief anatomical considerations, mechanisms, and currently available evidence are reviewed. Additionally, recent evidence on fascial plane blocks for subcutaneous-implantable cardioverter-defibrillator implantation are also reviewed.
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Affiliation(s)
- Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea,Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Soomin Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seyeon Park
- Department of Nursing, College of Nursing, Chungnam National University, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea,Corresponding author: Yoon-Hee Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, KoreaTel: +82-42-280-7840Fax: +82-42-280-7968
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Joo Y, Moon J, Lee YJ, Bang YS, Yi J, Jang JN, Su MY, Kim YU. A new diagnostic morphological parameter for the Carpal tunnel syndrome: The palmaris longus tendon cross-sectional area. Medicine (Baltimore) 2022; 101:e30906. [PMID: 36221400 PMCID: PMC9542913 DOI: 10.1097/md.0000000000030906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is correlated with increased intracarpal canal pressure (ICP). The effect of palmaris longus tendon (PLT) loading on ICP is documented in previous researches. PLT loading induces the greatest absolute increase in ICP. Therefore, to analyze the connection between the PLT and CTS, we newly made the measurement of the PLT cross-sectional area (PLTCSA). We assumed that PLTCSA is a reliable diagnostic parameter in the CTS. PLTCSA measurement data were acquired from 21 patients with CTS, and from 21 normal subjects who underwent wrist magnetic resonance imaging (W-MRI). We measured the PLTCSA at the level of pisiform on W-MRI. The PLTCSA was measured on the outlining of PLT. The two different cutoff values in the analysis were determined using receiver operating characteristic (ROC) analysis. The mean PLTCSA was 2.34 ± 0.82 mm2 in the normal group and 3.97 ± 1.18 mm2 in the CTS group. ROC curve analysis concluded that the best cutoff point for the PLTCSA was 2.81 mm2, with 76.2% sensitivity, 71.4% specificity, and area under the curve of 0.88 (95% CI, 0.78-0.98). PLTCSA is a sensitive, new, objective morphological parameter for evaluating CTS.
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Affiliation(s)
- Young Joo
- Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University, Goyang, Republic of Korea
| | - JeeYoun Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Yoon Jin Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
- Department of Radiological Sciences, University of California, Irvine, CA, USA
- * Correspondence: Young Uk Kim, Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Simgokro, 100 Gil 25, Seo-Gu, Incheon City, Republic of Korea (e-mail: )
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