1
|
Mutlu IN, Guzelbey T, Erdim C, Dablan A, Kılıckesmez O. A Comparative Analysis of Erector Spinae Plane Block Versus Conscious Sedation in Managing Percutaneous Cholecystostomy Pain. Cardiovasc Intervent Radiol 2024; 47:803-809. [PMID: 38622304 DOI: 10.1007/s00270-024-03722-z] [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: 01/04/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE This study investigates the efficacy of erector spinae plane block (ESPB) for managing perioperative and postoperative pain in patients undergoing percutaneous cholecystostomy (PC) for acute cholecystitis, particularly in high-risk elderly patients with extensive comorbidities and limited functional status. METHODS In a retrospective single-center study, 58 high-risk patients scheduled for PC were assessed. ESPB was administered to 23 patients, while 22 received conscious sedation. Pain intensity was measured using the numeric rating scale before any analgesic or ESPB administration, during the procedure and at 1 and 12 h post-procedure and secondary outcomes included adverse effects and additional analgesic requirements. RESULTS The ESPB group experienced significant pain reduction during and post-procedure compared to the conscious sedation group (p = 0.002). Procedure times were shorter (p = 0.015), and postoperative tramadol was less frequently needed in the ESPB group (p = 0.007). The incidence of nausea was also lower in the ESPB group (p = 0.001). No ESPB-related complications were reported. CONCLUSION ESPB significantly alleviates perioperative and postoperative pain in PC patients, reducing additional analgesic use and side effects. It holds promise as a key component of pain management for high-risk surgical patients. LEVEL OF EVIDENCE Level 3, Non-randomized controlled cohort/follow-up study.
Collapse
Affiliation(s)
- Ilhan Nahit Mutlu
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Tevfik Guzelbey
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey.
| | - Cagri Erdim
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Ali Dablan
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Ozgur Kılıckesmez
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, 34480, Istanbul, Turkey
| |
Collapse
|
2
|
Pande A, Sen IM, Gupta A, Gupta A, Sharma A. Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:744-750. [PMID: 34843806 PMCID: PMC10625136 DOI: 10.1016/j.bjane.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/10/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. METHODS Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. RESULTS All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). CONCLUSION Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.
Collapse
Affiliation(s)
- Aparna Pande
- All India Institute Of Medical Sciences (AIIMS), Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Indu Mohini Sen
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care, Chandigarh, India
| | - Aakriti Gupta
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care, Chandigarh, India
| | - Ankur Gupta
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care, Chandigarh, India.
| | - Ashish Sharma
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Renal Transplant Surgery, Chandigarh, India
| |
Collapse
|
3
|
Shetmahajan M, Kamalakar M, Narkhede A, Bakshi S. Analgesic efficacy of the inferior alveolar nerve block for maxillofacial cancer surgery under general anaesthesia - A randomised controlled study. Indian J Anaesth 2023; 67:880-884. [PMID: 38044914 PMCID: PMC10691602 DOI: 10.4103/ija.ija_313_23] [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: 04/11/2023] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 12/05/2023] Open
Abstract
Background and Aims Mandibular resection during maxillofacial cancer surgery evokes a strong sympathetic response requiring high doses of opioids. We studied the effect of the inferior alveolar nerve block (IANB) for analgesia in maxillofacial cancer surgeries. Methods This randomised controlled study was conducted over five months in a tertiary care cancer hospital following Institutional Ethics approval and trial registration. Fifty consenting adult patients belonging to the American Society of Anesthesiologists (ASA) physical status I and II requiring maxillofacial cancer surgery with unilateral mandibular resection were recruited. Twenty-five patients in the study arm received ipsilateral IANB; a mock injection was given to the control group. Fentanyl requirement and haemodynamic parameters during primary tumour excision were the primary and secondary endpoints. Student's t-test was applied to compare primary and secondary endpoints. Results Forty-nine patients completed the study. Both arms were comparable with respect to age, gender distribution, ASA physical status and baseline heart rate (HR) and blood pressure (BP). The mean (standard deviation) intravenous fentanyl requirement during primary tumour excision in the IANB arm was 70(32) µg, significantly lower than 183(48) µg in the control arm, P < 0.001. The mean maximum HR during primary tumour excision was 82 and 99 per minute in the IANB and control arms, respectively (P < 0.001) whereas the maximum mean BP was 88 and 101 mm Hg, respectively (P < 0.001). Conclusion IANB significantly reduced intraoperative fentanyl requirement and caused fewer haemodynamic changes during maxillofacial cancer surgery requiring unilateral mandibular excision.
Collapse
Affiliation(s)
- Madhavi Shetmahajan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Maya Kamalakar
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Anaesthesiology, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India
| | - Amit Narkhede
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Critical Care Medicine, Jupiter Hospital, Thane, Mumbai, Maharashtra, India
| | - Sumitra Bakshi
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| |
Collapse
|
4
|
Rahimzadeh P, Ahani A, Antar A, Morsali SF, Zojaji F, Dikafraz Shokooh G. Erector Spinae Plane Block for the Treatment of Intractable Pain in a Patient with Pancoast Tumor: A Case Report. Anesth Pain Med 2023; 13:e135829. [PMID: 38021326 PMCID: PMC10664171 DOI: 10.5812/aapm-135829] [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: 02/28/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The erector spinae plane (ESP) block is a regional anesthetic technique that involves injecting a local anesthetic below the erector spinae muscle in an interfascial plane. Case Presentation We report a case of a 66-year-old man with cervicothoracic junction pain caused by an advanced Pancoast tumor. The administration of ESP block at the T2-T3 level led to pain relief of more than 50% in this patient after two sessions. Conclusions Therefore, the application of this method of regional analgesia is both convenient and safe and reduces opioid consumption. Further studies are needed to evaluate the safety and effectiveness of continuous blocks in outpatient settings.
Collapse
Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Ahani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Antar
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Fatemeh Morsali
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faegheh Zojaji
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamali Dikafraz Shokooh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Yang X, Zhang Y, Chen Y, Xu M, Lei X, Fu Q. Analgesic effect of erector spinae plane block in adults undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:7. [PMID: 36609244 PMCID: PMC9817294 DOI: 10.1186/s12871-023-01969-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy is the gold standard surgical procedure for treating gallstone disease. Despite it being minimally invasive, various medications and methods are used to alleviate postoperative pain, and some patients still experience moderate-to-severe pain. This is a crucial problem that must be solved to avoid chronic pain. As part of postoperative multimodal analgesia, regional block is being increasingly applied in surgery under ultrasound guidance. We aimed to evaluate the analgesic effect of erector spinae plane block in adult patients undergoing laparoscopic cholecystectomy. METHODS PubMed, Cochrane Library, EMBASE, and Web of Science were searched for randomized controlled trials investigating the efficacy of erector spinae plane block on postoperative pain after laparoscopic cholecystectomy. The primary outcome was the postoperative pain score. The secondary outcomes were the cumulative intraoperative and postoperative opioid consumption at 24 h, incidence of postoperative nausea and vomiting, and shoulder pain after surgery. The results were pooled using the fixed- or random-effects model with Review Manager 5.3. RESULTS Fifteen randomized controlled trials involving 947 patients were included in the analysis. Postoperative pain score in the erector spinae plane block group was lower than that in the control group at postoperative 12 h (MD - 0.81, 95% CI - 1.1 to - 0.51, p < 0.00001) and 24 h (MD - 0.41, 95% CI - 0.62 to - 0.19, p = 0.0002). Cumulative opioid consumption was lower in the erector spinae plane block group than in the control group at postoperative 24 h (MD - 7.88, 95% CI - 10.17 to - 5.58, p < 0.00001). The erector spinae plane block group also experienced a lower incidence of postoperative nausea and vomiting than the control group. Opioid consumption and the incidence of postoperative nausea and vomiting were similar between the erector spinae plane block group and other block groups, including the oblique subcostal transversus abdominis plane block and quadratus lumborum block groups. CONCLUSIONS Ultrasound-guided erector spinae plane block provides effective postoperative analgesia in adults undergoing laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- Xiaoli Yang
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Yu Zhang
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Yong Chen
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Mingxing Xu
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Xue Lei
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| | - Qiang Fu
- grid.460068.c0000 0004 1757 9645Department of Anesthesiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan China
| |
Collapse
|
6
|
Rizvi MB, Kessler DO, Rabiner JE. Role of regional anesthesia in patients with acute sickle cell pain: A scoping review. Pediatr Blood Cancer 2023; 70:e30063. [PMID: 36308736 DOI: 10.1002/pbc.30063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 12/25/2022]
Abstract
Sickle cell disease is the most prevalent inherited blood disorder in the world, with significant morbidity and mortality. Patients often have recurrent painful vaso-occlusive episodes, and the American Society of Hematology gives a conditional recommendation for the use of regional anesthesia for acute sickle cell pain management. This scoping review summarizes the current evidence and identifies gaps for future research. Our screening process is outlined, and articles that mentioned the use of regional anesthesia for acute sickle cell crises were included. We present and interpret our results and highlight opportunities for future investigation.
Collapse
Affiliation(s)
- Munaza B Rizvi
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - David O Kessler
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Joni E Rabiner
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| |
Collapse
|
7
|
Jiao R, Peng S, Wang L, Feng M, Li Y, Sun J, Liu D, Fu J, Feng C. Ultrasound-Guided Quadratus Lumborum Block Combined with General Anaesthesia or General Anaesthesia Alone for Laparoscopic Radical Gastrectomy for Gastric Adenocarcinoma: A Monocentric Retrospective Study. Int J Gen Med 2022; 15:7739-7750. [PMID: 36249896 PMCID: PMC9563320 DOI: 10.2147/ijgm.s382757] [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: 07/18/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate, in patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, the effects of ultrasound-guided quadratus lumborum block (UG-QLB) combined with general anaesthesia (GA) on the postoperative recovery compared with GA alone. PATIENTS AND METHODS The retrospective study enrolled 231 patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, including 119 patients who received UG-QLB combined with GA (Group QG), and 112 patients undergoing GA alone (Group GA). The primary endpoint was the postoperative 3-year recurrence-free survival (RFS). The secondary endpoints were the average visual analogue scale (VAS) scores within 48 h after surgery, the first time of postoperative ambulation, the first time of flatus, postoperative hospitalization, perioperative opioid requirement and adverse effects after surgery. RESULTS UG-QLB combined with GA did not affect the 3-year RFS in patients undergoing laparoscopic radical gastrectomy (HR 0.659, 95% CI 0.342-1.269, P=0.212). However, the VAS ranking analysis implicated that it could significantly alleviate the postoperative pain in laparoscopic radical gastrectomy patients (P<0.01). In addition, it dramatically facilitated the early recovery of postoperative ambulation and flatus, while shortening the duration of postoperative hospitalization (P<0.01). The most important was it could remarkably reduce the opioid consumption (P<0.01), which in the meanwhile, reduced the incidence of postoperative nausea and vomiting (PONV) (P=0.01). CONCLUSION Although UG-QLB combined with GA did not improve the 3-year RFS for patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, it could provide satisfactory postoperative pain relief, reduce opioid consumption and adverse effects, which subsequently facilitates postoperative early rehabilitation.
Collapse
Affiliation(s)
- Ran Jiao
- Hospital of Shandong University, Jinan, 250100, People’s Republic of China
| | - Shuai Peng
- Department of Nursing, Yankuang New Journey General Hospital, Zoucheng, 273500, People’s Republic of China
| | - Lulu Wang
- Cheeloo College of Medicine, Shandong University, Jinan, 250102, People’s Republic of China
| | - Man Feng
- Department of Pathology, Affiliated Hospital of Shandong Academy of Medical Sciences, the Third Affiliated of Shandong First Medical University, Jinan, 250000, People’s Republic of China
| | - Youqin Li
- Cheeloo College of Medicine, Shandong University, Jinan, 250102, People’s Republic of China
| | - Jing Sun
- Cheeloo College of Medicine, Shandong University, Jinan, 250102, People’s Republic of China
| | - Dongyi Liu
- Department of Anaesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Jia Fu
- Department of Anaesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Chang Feng
- Department of Anaesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China,Correspondence: Chang Feng, Department of Anaesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Jinan, 250033, People’s Republic of China, Tel +86-17660085521, Email
| |
Collapse
|
8
|
Elewa AM, Faisal M, Sjöberg F, Abuelnaga ME. Comparison between erector spinae plane block and paravertebral block regarding postoperative analgesic consumption following breast surgery: a randomized controlled study. BMC Anesthesiol 2022; 22:189. [PMID: 35717148 PMCID: PMC9206353 DOI: 10.1186/s12871-022-01724-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/06/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pain control following breast surgery is of utmost importance in order to reduce the chance of chronic pain development, and facilitate early rehabilitation. The erector spinae plane block (ESPB) is a recently developed regional anaesthesia procedure successfully used for different types of surgical procedures including thoracic and abdominal surgeries. METHODS A double-blind, randomized, controlled trial was conducted on 90 patients who were scheduled for modified radical mastectomy (MRM). Patients were randomly categorized into groups I (women who underwent ESPB), II (women who underwent paravertebral block (PVB), and III (women who underwent general anaesthesia). RESULTS The ESPB (4.9 ± 1.2 mg) and PVB (5.8 ± 1.3 mg) groups had significantly lower total morphine consumption than the control group had (16.4 ± 3.1 mg; p < 0.001). Notably, patients in the ESPB group had insignificantly lower morphine consumption than those in the PVB group had (p = 0.076). Moreover, patients in the ESPB and PVB groups had a significantly longer time to first required anaesthesia than those in the control group (7.9 ± 1.2 versus 7.5 ± 0.9 versus 2 ± 1.2 h, respectively; p < 0.001). The postoperative visual analog scale scores were lower in the ESPB and PVB groups than in the control group on the first 24 h after the procedure (p < 0.001). CONCLUSION ESPB and PVB provide effective postoperative analgesia for women undergoing MRM. The ESPB appears to be as effective as the PVB. TRIAL REGISTRATION The study was registered before the enrolment of the first patient at the Pan African Clinical Trial Registry ( www.pactr.org ) database. Identification number for the registry is (PACTR202008836682092).
Collapse
Affiliation(s)
- Ahmed M. Elewa
- grid.33003.330000 0000 9889 5690Department of anaesthesia, critical care and pain management, Faculty of Medicine, Suez Canal University, Ard Elgameiat, Ismailia, Egypt
| | - Mohammed Faisal
- grid.33003.330000 0000 9889 5690Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt ,grid.1649.a000000009445082XGeneral Surgery Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Folke Sjöberg
- grid.411384.b0000 0000 9309 6304Department of Biomedical and Clinical Sciences (BKV), Linköping University Hospital, Linköping, Sweden
| | - Mohamed E. Abuelnaga
- grid.33003.330000 0000 9889 5690Department of anaesthesia, critical care and pain management, Faculty of Medicine, Suez Canal University, Ard Elgameiat, Ismailia, Egypt
| |
Collapse
|
9
|
Manouchehrian N, Miri Z, Esna-Ashari F, Rahimi-Bashar F. Evaluation Effect of Aspiration of 0.2 ml of Cerebrospinal Fluid After Completion of Injection 0.5% Bupivacaine and Reinjection Into Subarachnoid Space on Sensory and Motor Block in Cesarean Section: A Randomized Clinical Trial. Front Med (Lausanne) 2022; 9:816974. [PMID: 35402445 PMCID: PMC8990041 DOI: 10.3389/fmed.2022.816974] [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: 11/17/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Spinal anesthesia (SPA) is the most common type of anesthesia administered for cesarean section. The main aim of this study was to evaluate the effect of aspiration of CSF (0.2 mL) immediately after SPA with hyperbaric 0.5% bupivacaine on the extent of sensory and motor block. Methods In this clinical trial, 60 women at ≥37 weeks of gestation and aged between 18 and 46 years, candidate for cesarean delivery under spinal anesthesia were randomly allocated into two equal groups (n = 30). Group A (CSF-aspiration group) received the spinal anesthesia with 10 mg of hyperbaric 0.5% bupivacaine with aspiration of 0.2 ml of CSF. Group B (no-CSF-aspiration group) received only 10 mg of 0.5% hyperbaric bupivacaine. Pin-prick analgesia and motor block were tested during the induction. Results The mean maximum level of analgesia was T6 in each group. Although the mean time to reach the maximum level of anesthesia (4.43 ± 5.14 vs. 2.76 ± 2.04, P = 0.107) and to reach T10 level (50.56 ± 11.51 vs. 49.10 ± 13.68, P = 0.665) in the CSF-aspiration group is longer than the non-CSF-aspiration group, but this differences were not significant. There were no significant between-group differences regarding sensory and motor block quality (P = 0.389) or failed SPA (four cases in CSF-aspiration group vs. two cases in no-CSF-aspiration group, P = 0.389). The incidence of bradycardia, hypotension, headache, vomiting and nausea were similar in both groups (P > 0.05). In addition, the difference in hemodynamic parameters between the two groups over times was not statistically significant. Conclusion Our finding indicated that the aspiration of 0.2 ml of CSF after injection of spinal anesthesia with hyperbaric 0.5% bupivacaine does not seem to affect the extent of sensory and motor block, success rate, or outcome after SPA in cesarean section. Clinical Trial Registration [https://www.irct.ir/search/result?query=IRCT20120915010841N25], identifier [IRCT20120915010841N25].
Collapse
Affiliation(s)
- Nahid Manouchehrian
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Miri
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farzaneh Esna-Ashari
- Department of Family and Community Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Rahimi-Bashar
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
10
|
Feng M, Wang L, Sun J, Chen Z, Fu J, Liu D, Zhang R, Li Y, Zhang Y, Zhang H, Zhang W, Feng C. Thoracic Paravertebral Block Combined with General Anaesthesia or General Anaesthesia Alone for Thoracoscopic Lung Adenocarcinoma Surgery: A Retrospective Study. Cancer Manag Res 2022; 14:953-965. [PMID: 35264885 PMCID: PMC8901418 DOI: 10.2147/cmar.s346285] [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: 10/27/2021] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To investigate the effects of ultrasound-guided thoracic paravertebral block combined with general anaesthesia or general anaesthesia alone for thoracoscopic lung adenocarcinoma surgery, and to provide new thoughts for improving the clinical outcomes. Methods This was a retrospective study. Data were retrieved for 195 patients with lung adenocarcinoma undergoing elective radical lobectomy via video-assisted thoracoscopy between January 2018 and August 2019 in The Second Hospital of Shandong University, including 86 patients who received thoracic paravertebral block (TPVB) combined with general anaesthesia (group TG), and 109 patients who received general anaesthesia alone (group GA). All patients were given self-controlled intravenous analgesia pump for 48 h after surgery. The primary outcome was the recurrence-free survival 2 years postoperatively (the time between surgery and the earliest date of recurrence, metastasis or lung cancer-cause death). The secondary outcomes included the average numeric rating scale (NRS) scores within 48 h postoperatively, the first time of postoperative ambulation, duration of chest tube drainage, length of postoperative hospitalization, perioperative opioid consumption and the postoperative side effects. Results There were no statistical differences in the recurrence-free survival 2 years postoperatively between groups (Multivariate hazard ratio 0.706, 95% CI 0.126–3.941, P=0.691). The average NRS scores within 48 h postoperatively were significantly lower in group TG (P<0.05). The first time of postoperative ambulation, duration of chest tube drainage, and length of postoperative hospitalization in group TG were significantly reduced (P<0.05). Opioid consumption was significantly decreased in group TG (P<0.01). Finally, the incidence of postoperative nausea and vomiting (PONV) was significantly lower in group TG (P<0.05). Conclusion TPVB for thoracoscopic lung adenocarcinoma surgery did not improve the recurrence-free survival 2 years postoperatively compared with general anaesthesia alone, but it significantly enhanced the postoperative analgesia effect, reduced opioid consumption as well as side effects, and accelerated postoperative early recovery. Clinical Trial Registration Number The Chinese Clinical Trial Registry (ChiCTR-2100050454).
Collapse
Affiliation(s)
- Man Feng
- Department of Pathology, Affiliated Hospital of Shandong Academy of Medical Sciences, The third Affiliated Hospital of Shandong First Medical University, Jinan, 250000, People’s Republic of China
| | - Lulu Wang
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Jing Sun
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Zheping Chen
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Jia Fu
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Dongyi Liu
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Rumeng Zhang
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Youqin Li
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Yan Zhang
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - He Zhang
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Weiquan Zhang
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Chang Feng
- Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- Correspondence: Chang Feng, Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Jinan, 250033, People’s Republic of China, Tel +86 17660085521, Email
| |
Collapse
|
11
|
Rodriguez-Patarroyo FA, Cuello N, Molloy R, Krebs V, Turan A, Piuzzi NS. A guide to regional analgesia for Total Knee Arthroplasty. EFORT Open Rev 2021; 6:1181-1192. [PMID: 35839095 PMCID: PMC8693230 DOI: 10.1302/2058-5241.6.210045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Regional analgesia has been introduced successfully into the postoperative pain management after total knee arthroplasty, reducing pain scores, opioid use and adverse effects. Combination of regional analgesia techniques is associated with better pain management and lower side effects than single regional techniques. Adductor canal block provides good analgesia and considerably lower detrimental effect in muscular strength than femoral nerve block, enhancing surgical recovery. Infiltration techniques may have equivalent analgesic effect than epidural analgesia and peripheral nerve blocks, however there should be awareness of dose dependent toxicity. Novel long-acting local anesthetics role for regional analgesia is still to be determined, and will require larger randomized trials to support its advantage over traditional local anesthetics.
Cite this article: EFORT Open Rev 2021;6:1181-1192. DOI: 10.1302/2058-5241.6.210045
Collapse
Affiliation(s)
| | - Nadin Cuello
- Department of Orthopaedic and Trauma Surgery, Hospital Interzonal General de Agudos Eva Perón, San Martín, Buenos Aires, Argentina
| | - Robert Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Viktor Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alparslan Turan
- Outcomes Research Department, Anesthesiology Institute, Cleveland Clinic Ohio, USA
- Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicolas S. Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
12
|
Deepika V, Ahuja V, Thapa D, Gombar S, Gupta N. Evaluation of analgesic efficacy of superficial cervical plexus block in patients undergoing modified radical mastoidectomy: A randomised controlled trial. Indian J Anaesth 2021; 65:S115-S120. [PMID: 34703056 PMCID: PMC8500200 DOI: 10.4103/ija.ija_339_21] [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: 04/18/2021] [Revised: 06/26/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Intravenous analgesics and local infiltration are used for postoperative analgesia in patients undergoing mastoidectomy. No randomised controlled trial (RCT) has so far determined response rates of pain reduction after ultrasound-guided superficial cervical plexus block (SCPB) in adult patients undergoing modified radical mastoidectomy. Methods: This double-blind RCT was conducted in 30 adult patients of the American Society of Anesthesiologists (ASA) grade I/II undergoing modified radical mastoidectomy. The primary outcome was a reduction in the visual analogue scale (VAS) score. Secondary outcomes were postoperative diclofenac consumption, haemodynamics, and occurrence of any adverse events. All patients received general anaesthesia. At the end of the surgery, patients were randomised to either Group ‘Block’ (n = 15) ultrasound guided SCPB with 5 mL ropivacaine 0.5% or Group ‘No block’ (n = 15). All patients received intravenous (IV) paracetamol 1 g every 6 hourly and rescue analgesic IV diclofenac 75 mg if VAS score >4. Results: Patients in Group ‘Block’ reported lower VAS score at rest versus Group ‘No block’ at 1 h postoperatively (P = 0.012). VAS score on movement was lower in patients of Group ‘Block’ compared to Group ‘No block’ at 1 h (P = 0.010), 4 h (P = 0.035), 8 h (P = 0.027), and 12 h (*P = 0.003) postoperatively. Diclofenac consumption was lower in patients of Group ‘Block’ (P = 0.041). No adverse effects were reported. Conclusion: Postoperative ultrasound-guided SCPB produced higher response rates in terms of reduction in VAS score in patients undergoing modified radical mastoidectomy.
Collapse
Affiliation(s)
- Vijaya Deepika
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Thapa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Satinder Gombar
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Nitin Gupta
- Department of Otolaryngology, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
13
|
Canıtez A, Kozanhan B, Aksoy N, Yildiz M, Tutar MS. Effect of erector spinae plane block on the postoperative quality of recovery after laparoscopic cholecystectomy a prospective double-blind study. Br J Anaesth 2021; 127:629-635. [PMID: 34340839 DOI: 10.1016/j.bja.2021.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/31/2021] [Accepted: 06/27/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy is a common surgical procedure that frequently results in substantial postoperative pain. Erector spinae plane block (ESPB) has been shown to have beneficial postoperative analgesic effects when used as a part of multimodal analgesia. The aim of this study was to determine whether ESPB improves postoperative recovery quality in patients undergoing laparoscopic cholecystectomy. Evaluation of the effects of ESPB on postoperative pain, opioid consumption, and nausea and vomiting was the secondary objective. METHODS In this prospective double-blind study, 82 patients undergoing laparoscopic cholecystectomy were randomised into one of two groups: a standard multimodal analgesic regimen in Group N (control) or an ESPB was performed in Group E. Preoperative and postoperative recovery quality was measured using the 40-item quality of recovery (QoR-40) questionnaire; postoperative pain was evaluated using the numerical rating scale scores. RESULTS Postoperative mean (standard deviation) QoR-40 scores were higher in Group E (181 [7.3]) than in Group N (167 [11.4]); P<0.01. With repeated measures, a significant effect of group and time was demonstrated for the global QoR-40 score, P<0.01, indicating better quality of recovery in Group E. Pain scores were significantly lower in Group E than in Group N, both during resting and motion at T1-T8 times (P<0.01 at each time). The total amount of tramadol consumed in the first 24 h was lower in Group E [median 0 mg, inter-quartile range (IQR) (0-140)], than in Group N [median 180 mg, IQR (150-240); P<0.01]. CONCLUSIONS ESPB improved postoperative quality of recovery in patients undergoing laparoscopic cholecystectomy. Moreover, ESPB reduced pain scores and cumulative opioid consumption. CLINICAL TRIAL REGISTRATION NCT04112394.
Collapse
Affiliation(s)
- Ahmet Canıtez
- Department of Anaesthesiology and Reanimation, Abdulkadir Yuksel City Hospital, Gaziantep, Turkey
| | - Betul Kozanhan
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey.
| | - Nergis Aksoy
- Department of General Surgery, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Munise Yildiz
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Mahmut S Tutar
- Department of Anaesthesiology and Reanimation, Konya Numune State Hospital, Konya, Turkey
| |
Collapse
|
14
|
Saini S, Rao SM, Agrawal N, Gupta A. Comparison of analgesic efficacy of shoulder block versus interscalene block for postoperative analgesia in arthroscopic shoulder surgeries: A randomised trial. Indian J Anaesth 2021; 65:451-457. [PMID: 34248188 PMCID: PMC8253006 DOI: 10.4103/ija.ija_110_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/04/2021] [Accepted: 05/22/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Arthroscopic orthopaedic surgery may lead to significant postoperative pain. Interscalene block (ISB) is associated with undesirable effects like phrenic nerve palsy. Shoulder block (ShB) is a relatively recent diaphragm sparing alternative for analgesia in these cases. Methods This prospective randomised trial was conducted in 70 adult patients posted for arthroscopic Bankart repair surgery. Patients were randomly assigned into two groups: interscalene block [Group ISB (n = 35): 0.5% bupivacaine 10 ml] or shoulder block [Group ShB (n = 35): 0.5% bupivacaine (suprascapular block 10 ml and axillary block 10 ml)] using ultrasound and nerve stimulator. The primary aim of our study was to compare the ISB with ShB for visual analogue score (VAS) in recovery area (zero hour). Time for block performance, VAS, time to first rescue analgesia, total analgesic requirement, patient satisfaction and complications were recorded. Results VAS was significantly higher in ShB group at 2 and 4 h (P = 0.001 and 0.000) while it was significantly higher in ISB group at 12 h (P = 0.013). The time to first analgesic request was significantly prolonged in ISB group as compared to ShB group (8.22 h vs. 4.69 h; P = 0.002) but total analgesic requirement and patient satisfaction at 24 h were similar. Complications like dyspnoea, ptosis and motor weakness were seen only with ISB group. Conclusion Both ShB and ISB blocks have similar efficacy in terms of postoperative pain scores, cumulative analgesic requirements and patient satisfaction. However, considering the various undesirable effects associated with ISB, like phrenic nerve blockade, prolonged upper limb weakness and the occurrence of rebound pain, shoulder block may be preferred for arthroscopic shoulder surgeries.
Collapse
Affiliation(s)
- Suman Saini
- Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Shruti Mahesh Rao
- Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Nidhi Agrawal
- Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Anju Gupta
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Krishna V, Govil N, Tripathi M, Jain G, Goyal T, Aggarwal S. Comparison of adductor canal block with femoral nerve block for post-operative pain relief after bilateral total knee arthroplasty: A non-randomised controlled trial. Indian J Anaesth 2021; 65:S80-S85. [PMID: 34188260 PMCID: PMC8191188 DOI: 10.4103/ija.ija_1317_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/13/2021] [Accepted: 04/03/2021] [Indexed: 01/05/2023] Open
Abstract
Background and Aims Pain perception and pain threshold vary from one individual to another and also differ in the right and left limbs leading to an inter-cerebral pain variability bias and inter-patient pain variability bias. To date, data comparing adductor canal block (ACB) with femoral nerve block (FNB) in the same patient who underwent bilateral total knee arthroplasty (TKA) remain limited. Methods We performed a prospective, non-randomised, controlled study. Patients scheduled for bilateral TKA with central neuraxial anaesthesia received every 12-hourly intermittent boluses of 15 mL of ropivacaine 0.5% in two different peripheral nerve blocks (ACB and FNB) in either of the lower limbs postoperatively. The primary outcome was to assess postoperative VAS score, and the secondary outcomes were muscle strength of the quadriceps muscle and degree of flexion at the knee joint. Results Among the 80 patients assessed for eligibility, 72 patients were enroled, and 69 were included in the final analysis. VAS scores after the two blocks during rest at 30 minutes, 6 hours, 12 hours and 48 hours post-operatively had no significant difference. VAS scores during rest at 24 hours and on doing exercise at 24 hours and 48 hours showed a significant difference. Quadriceps muscle strength and degree of flexion of knee at 24 hours and 48 hours post-operatively did show a significant difference in favour of the ACB over FNB. Conclusion ACB provides equivalent analgesia in comparison with FNB at rest and during passive exercise up to 48 hours post-operatively. ACB significantly preserved motor power of quadriceps muscles when compared with FNB with no added complications.
Collapse
Affiliation(s)
- Vamshi Krishna
- Department of Anaesthesiology All India Institute of Medical Sciences, Rishikesh, India
| | - Nishith Govil
- Department of Anaesthesiology Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | | | - Gaurav Jain
- Department of Anaesthesiology All India Institute of Medical Sciences, Rishikesh, India
| | - Tarun Goyal
- Department of Orthopaedics All India Institute of Medical Sciences, Bhatinda, India
| | - Shantanu Aggarwal
- Department of Community Medicine Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| |
Collapse
|
16
|
Suresh P, Mukherjee A. Patient satisfaction with regional anaesthesia and general anaesthesia in upper limb surgeries: An open label, cross-sectional, prospective, observational clinical comparative study. Indian J Anaesth 2021; 65:191-196. [PMID: 33776108 PMCID: PMC7989486 DOI: 10.4103/ija.ija_1121_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/08/2020] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Aims: An important assessment of the quality of health care is patient satisfaction. However, only few studies are available which look into this aspect. The primary objective of this study was to compare patient satisfaction between regional anaesthesia (RA) and general anaesthesia (GA) in patients undergoing upper limb surgeries. The length of hospital stay and duration of analgesia between the two techniques were the secondary objectives. Methods: This cross-sectional study was carried out in a tertiary care teaching hospital. Patients aged between 18 years and 60 years, of physical status American Society of Anesthesiologists (ASA) grade 1–3, undergoing upper limb surgeries were included in the study. Patient satisfaction with anaesthesia was assessed in patients receiving GA and RA, with 100 patients in each group, at least 24 h after the surgery with a 10-item predesigned peri-operative questionnaire. The continuous variables were compared between the groups using Mann–Whitney–Wilcoxon test, and for categorical variables Chi-square test was used. Results: The patients in group RA showed significantly higher satisfaction scores than those in GA (P < 0.001) with respect to all the 10 items of the questionnaire and the total score. Duration of analgesia was also significantly longer in RA than GA (P < 0.001). Duration of hospital stay was also significantly longer in GA than in RA (P < 0.001). Conclusions: RA for upper limb surgeries provides better patient satisfaction than GA, along with a longer duration of analgesia and lesser duration of hospital stay.
Collapse
Affiliation(s)
- Priyanka Suresh
- Department of Anaesthesia, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Akash Mukherjee
- Department of Anaesthesia, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
| |
Collapse
|
17
|
Beh ZY, Lim SM, Lim WL, Ramli ARH. Ultrasound-guided combined supraclavicular brachial plexus and PECS II blocks for brachiobasilic fistula transposition surgery. Indian J Anaesth 2020; 64:1079-1080. [PMID: 33542576 PMCID: PMC7852432 DOI: 10.4103/ija.ija_535_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Zhi Yuen Beh
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siu Min Lim
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Woon Lai Lim
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | |
Collapse
|
18
|
Mehdiratta L, Bajwa SJS, Malhotra N, Joshi M. Exploring cocktails, remixes and innovations in regional nerve blocks: The clinical research journey continues. Indian J Anaesth 2020; 64:1003-1006. [PMID: 33542561 PMCID: PMC7852434 DOI: 10.4103/ija.ija_1517_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Center, Bhopal, Madhya Pradesh, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Rajpura, Patiala, Punjab, India. E-mail:
| | - Naveen Malhotra
- Department of Anaesthesiology, In Charge Pain Management Centre, Pt BDS PGIMS, Rohtak, Haryana, India
| | - Muralidhar Joshi
- Department of Anaesthesiology and Pain Medicine, Virinchi Hospitals, Hyderabad, Telangana, India
| |
Collapse
|
19
|
Ahuja V, Thapa D, Nandi S, Gombar S, Dalal A, Bansiwal RK. To evaluate the effect of quadratus lumborum block on the tramadol sparing effect in patients undergoing open inguinal hernia surgery: A randomised controlled trial. Indian J Anaesth 2020; 64:S198-S204. [PMID: 33162602 PMCID: PMC7641059 DOI: 10.4103/ija.ija_545_20] [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: 05/14/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims An ultrasound-guided quadratus lumborum (QL) block provides both somatic and visceral analgesia in abdominal surgeries. We aimed to evaluate the postoperative tramadol sparing effect of single-shot anterior QL block in inguinal hernia surgery patients. Methods This prospective, randomised controlled trial was conducted in a single tertiary care centre over a period of 1 year. A total of 50 patients, American Society of Anaesthesiologists (ASA) physical status I-II of both sexes aged 18-80 years with body mass index (BMI) ≥20 to ≤35 kg/m2 undergoing uncomplicated unilateral inguinal hernia surgery under spinal anaesthesia (SA) were randomly allocated to either of the two groups. The block group (n = 25) received single-shot anterior QL block with 20 ml of 0.5% ropivacaine and the control group (n = 25) received no block. Postoperatively, patients received intravenous (IV) paracetamol 1g every 6 h and tramadol patient-controlled analgesia up to 24 h. Primary outcome was total tramadol consumption at 24 h postoperatively. Results The total tramadol consumption mean ± SD [95% CI (range)] at 24 h in the block group was 84.00 ± 37.86 [68.37-99.63 (20-160)] mg versus 93.60 ± 34.99 [79.16-108.04 (20-160)] mg in control group, (p value = 0.36). Postoperative VAS score, haemodynamics, and patient satisfaction score were similar in both the groups. No adverse events were reported. Conclusion A single-shot anterior QL block did not establish a postoperative tramadol-sparing effect at 24 h as compared to no block in patients undergoing inguinal hernia surgery under SA.
Collapse
Affiliation(s)
- Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Thapa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Souvik Nandi
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Satinder Gombar
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Ashwani Dalal
- Department of General Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Rajesh Kumar Bansiwal
- Department of General Surgery, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
20
|
Gupta N, Kumar A, Harish RK, Jain D, Swami AC. Comparison of postoperative analgesia and opioid requirement with thoracic epidural vs. continuous rectus sheath infusion in midline incision laparotomies under general anaesthesia - A prospective randomised controlled study. Indian J Anaesth 2020; 64:750-755. [PMID: 33162568 PMCID: PMC7641078 DOI: 10.4103/ija.ija_976_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/29/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: To assess and compare the effect of bilateral continuous rectus sheath infusion (CRSB) for postoperative analgesia with continuous thoracic epidural infusion (TEA) in patients undergoing midline incision laparotomies. Methods: A prospective, randomised study involving sixty patients with Indian Society of Anesthesiologists (ASA) grade I to III, planned for elective laparotomy were enrolled for the study. Patients were randomly allocated into two groups. In the TEA group, an epidural was sited before induction of general anaesthesia (GA), whereas in the CRSB group, bilateral ultrasound-guided RSB catheters were placed at the end of the surgical procedure, before extubation. Both groups received continuous 0.2% Ropivacaine infusion for postoperative analgesia. They were followed for two post-operative days (POD), for the opioid requirement and post-operative pain at rest, coughing, and moving. Age and body mass index (BMI) were compared using independent t-test and visual analogue scale (VAS) scores were compared by the Mann–Whitney test between the two groups. Opioid consumption, gender, and type of surgery were compared using the Chi-Square test. Statistical analysis was done using Statistical Package for Social Sciences (SPSS 21.0). Results: Opioid consumption in both groups was comparable, for the first two post-operative days with no statistically significant difference. Pain scores were comparable among the groups at all times except postoperative day (POD) 0 (4 h and 12 h postop) and POD 2 (8 AM and 12 PM), where lower pain scores were observed in CRSB Group. Conclusions: As a part of the multimodal analgesia technique, CRSB offers a reliable, safe, and effective alternative to TEA.
Collapse
Affiliation(s)
- Nandita Gupta
- Department of Anaesthesia, Fortis Hospital, Mohali, Punjab, India
| | - Amit Kumar
- Department of Anaesthesia, Fortis Hospital, Mohali, Punjab, India
| | - Rajesh K Harish
- Department of Anaesthesia, Fortis Hospital, Mohali, Punjab, India
| | - Deepak Jain
- Department of Surgery, Fortis Hospital, Mohali, Punjab, India
| | - Adarsh C Swami
- Department of Anaesthesia, Fortis Hospital, Mohali, Punjab, India
| |
Collapse
|
21
|
Singariya G, Choudhary S, Kamal M, Seervi SN, Bihani P, Kumar M. Analgesic sparing effect of dexamethasone with levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair: A prospective randomised controlled trial. Indian J Anaesth 2020; 64:668-674. [PMID: 32934400 PMCID: PMC7457994 DOI: 10.4103/ija.ija_159_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/21/2020] [Accepted: 05/19/2020] [Indexed: 11/04/2022] Open
Abstract
Background Quadratus lumborum block (QLB) provides somatic and visceral analgesia to the lower thoracic and abdominal wall. The aim was to investigate the analgesic effect of dexamethasone with levobupivacaine in QLB in patients undergoing unilateral inguinal hernia repair surgery. Methods A total of 90 patients of American Society of Anaesthesiologists (ASA) I/II were randomly divided into two groups. Group L received 0.25% levobupivacaine (20 ml) + normal saline (1 ml) and group D received 0.25% levobupivacaine (20 ml) + 4 mg dexamethasone (1 ml) in QL plane on the operated side using ultrasound, after completion of surgery under spinal anaesthesia. The primary objective was to compare time for first rescue analgesia. The secondary objectives were total rescue analgesic consumption and numeric rating scale (NRS) in the first 24 h. Results The demographic data age, sex, height, weight and ASA were comparable in both groups. The mean time to request for first rescue analgesia was longer in group D compared to group L (1016.02 ± 205.97 min versus 640 ± 132.96 min; P < 0.0001). The mean total tramadol consumption in the first 24 h was lower in group D compared to group L (233.55 ± 86.92 mg versus 328.22 ± 78.74 mg; P < 0.0001). Patients in group D had significantly lower NRS scores at rest and on movement as compared to group L. Conclusions The addition of dexamethasone to levobupivacaine in QLB results in prolonged duration of postoperative analgesia, less rescue analgesic requirements and better quality of analgesia as compared to levobupivacaine in unilateral inguinal hernia repair surgery.
Collapse
Affiliation(s)
- Geeta Singariya
- Department of Anaesthesiology and Critical Care, Dr S N Medical College, Jodhpur, Rajasthan, India
| | - Sangeeta Choudhary
- Department of Anaesthesiology and Critical Care, Dr S N Medical College, Jodhpur, Rajasthan, India
| | - Manoj Kamal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Satya Narayan Seervi
- Department of Anaesthesiology and Critical Care, Government Medical College, Pali, Rajasthan, India
| | - Pooja Bihani
- Department of Anaesthesiology and Critical Care, Dr S N Medical College, Jodhpur, Rajasthan, India
| | - Mritunjay Kumar
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
22
|
Mansoor A, Ellwood S, Hoffman G, Scholer A, Gore A, Grech D, Patrick B, Sifri Z. The Efficacy and Safety of Transversus Abdominis Plane Blocks After Open Cholecystectomy in Low- and Middle-Income Countries. J Surg Res 2020; 256:136-142. [PMID: 32693331 DOI: 10.1016/j.jss.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/08/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postoperative pain management is challenging in low- and middle-income countries (LMICs). This study assesses the safety and efficacy of transversus abdominis plane (TAP) blocks as an adjunct for postoperative pain control after an open cholecystectomy in LMICs during short-term surgical missions (STSMs). TAP block is a regional anesthesia technique that has been shown to be effective in providing supplementary analgesia to the anterolateral wall post abdominal surgery. METHODS A retrospective chart review of patients undergoing open cholecystectomy during STSMs was performed. STSMs took place in Guatemala, the Philippines, and Peru from 2009 to 2019. Measured outcomes including pain scores, presence of postoperative nausea or vomiting, and opioid consumption were compared between TAP block and non-TAP block groups. RESULTS Of the 48 patients analyzed, 28 underwent TAP block (58%). Non-TAP block patients received, on average, 8 mg of oral morphine equivalents more than the TAP patients (P = 0.035). No significant difference was noted in pain scores, which were taken immediately after surgery, 2 h after surgery, and at multiple times between these time points to calculate an average. Of the patients who received a TAP block, 11% reported nausea or vomiting compared with 45% in the standard group (P < 0.01). There were no reported procedure-related complications. CONCLUSIONS TAP blocks are safe and effective adjuncts for postoperative pain management on STSMs to LMICs. Additional studies are needed to investigate the potential advantages and disadvantages of more widespread use of TAP blocks in LMICs.
Collapse
Affiliation(s)
- Amtul Mansoor
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
| | - Stephen Ellwood
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
| | - Gary Hoffman
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey.
| | - Anthony Scholer
- John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, California; Department of Surgical Oncology, Prisma Health Greenville Memorial Medical Campus, Greenville, South Carolina
| | - Amy Gore
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
| | - Dennis Grech
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
| | - Bradley Patrick
- International Surgical Health Initiative, Jersey City, New Jersey
| | - Ziad Sifri
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
| |
Collapse
|
23
|
Moggi LE, Ventorutti T, Bennun RD. Cleft Palate Repair: A New Maxillary Nerve Block Approach. J Craniofac Surg 2020; 31:1547-1550. [PMID: 32604288 DOI: 10.1097/scs.0000000000006633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To introduce a different approach for maxillary nerve block (MNB), in cleft palate repair. To reduce the use of opioids during surgery and to prevent frequent respiratory complications by means of an adequate intra and postoperative pain relief. PATIENTS AND METHODS A prospective clinical trial was planned, to collect scientific evidences between 2 groups of patients with primary cleft palate, receiving surgery in 2 Pediatric centers of Buenos Aires, utilizing a different protocol.Sixty patients undergoing primary cleft palate repair in both hospitals, from January 2017 to July 2018, by senior surgeons and the same expert anesthesiologists' team, were included.Syndromic and secondary cases, and patients whose parents rejected to participate of this study were excluded. The first group called Hospital A included 45 children, the second group identified as Hospital B was formed by 15 patients.A combination of general whit local anesthesia and a bilateral regional MNB, was used in all the patients of the Hospital A. Utilizing an aspirating syringe, children received 0.15 ml/kg of lidocaine clorhidrate 2% with epinephrine 1:50.000, under direct vision through the spheno palatine holes, just before surgery. A traditional general anesthesia procedure plus local anesthesia, was utilized in all the patients treated at the Hospital B Medial blood pressure and cardiac frequency parameters were tested during induction, along the surgical procedure and in the immediate post op, to detect any sign of pain (12). After surgery, patient reactivity, airway depression symptoms, time of initial feeding and discharge time, were also monitored (13).This study was approved by the Hospitals Ethics Committees of both hospitals, and is in accordance with the 1975 Helsinki Declaration, as amended in 1983. The parents have signed an informed consent form for all the patients included. RESULTS Patients of both groups did not show any significant variant in the monitored parameters to detect signals of pain, along the surgery. The rest of controls during and after surgery showed significant differences in favor of the patients of Hospital A. CONCLUSIONS Bilateral regional MNB, under direct vision trough the spheno palatine holes results an effective, easy, and safe method for pain relief during and after primary cleft palate repair surgeries.The combination of slight general anesthesia with local anesthesia and regional blocks, results a good option to reduce opioids utilization, to prevent neurotoxicity, respiratory depression, sickness, and vomiting facilitating early feeding and patient discharge.
Collapse
Affiliation(s)
- Luis E Moggi
- Asociacion PIEL.,Ricardo Gutierrez Children's Hospital
| | | | - Ricardo D Bennun
- Asociacion PIEL.,School of Medicine, National University of Buenos Aires.,Dental School, Maimonides University, Buenos Aires, Argentina
| |
Collapse
|
24
|
Sivapurapu V, Bhat RR, Vani NI, Raajesh JI, Aruna S, Paulose DT. A cadaver study of four approaches of ultrasound-guided infraclavicular brachial plexus block. Indian J Anaesth 2020; 64:624-630. [PMID: 32792740 PMCID: PMC7413351 DOI: 10.4103/ija.ija_920_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/15/2020] [Accepted: 05/05/2020] [Indexed: 01/14/2023] Open
Abstract
Background and Aims The ultrasound-guided infraclavicular brachial plexus block (USG ICBPB) is a popular technique for forearm surgeries distal to the elbow. Our study details the ultrasound (US) characteristics of this block and the structures encountered by the needle in four approaches to the infraclavicular area - lateral infraclavicular (LICF), costoclavicular medial to lateral (CML) and lateral to medial (CLM) and retroclavicular (R) by anatomical dissection. Methods USG ICBPB was performed in 10 cadavers-5 on the right side and 5 on the left side by each of four approaches and with an 18 gauge Tuohy needle kept in situ, and US characteristics were noted. Anatomical dissection was done and important structures were described in detail. Results Needle tip and shaft visibility were least with LICF approach and best in R approach. Needle angle correlated with chest and neck circumference in LICF and CML groups. During dissection, in all approaches, neurovascular structures have been observed in the near vicinity of the needle, especially the thoracoacromial artery (TAA) or its branches. In the R approach, the 'blind spot' behind the clavicle is an area where neurovascular structures were present. Conclusion The R approach gives better visibility of needle shaft beyond the clavicle, but the clavicle acts as a 'blind-spot' for the US beam obliterating important neurovascular structures. The various neurovascular structures the needle traverses or in its immediate vicinity, do not necessarily make the CML, CLM or R approach any better than the LICF approach.
Collapse
Affiliation(s)
- Vijayalakshmi Sivapurapu
- Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Ravindra R Bhat
- Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - N Isai Vani
- Anatomy, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Joseph I Raajesh
- Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - S Aruna
- Anatomy, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Deepak T Paulose
- Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| |
Collapse
|
25
|
Mitra S, Jain K, Singh J, Jindal S, Saxena P, Singh M, Saroa R, Ahuja V, Kang J, Garg S. Does an acute pain service improve the perception of postoperative pain management in patients undergoing lower limb surgery? A prospective controlled non-randomized study. J Anaesthesiol Clin Pharmacol 2020; 36:187-194. [PMID: 33013033 PMCID: PMC7480304 DOI: 10.4103/joacp.joacp_104_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/11/2019] [Indexed: 11/05/2022] Open
Abstract
Background and Aim: An acute pain service (APS) has been running in our institute since April 2013 and is managed by the Department of Anesthesia and Intensive Care. However, it is not clear to what extent the patients feel benefited from the APS. The aim of the study was to compare the perception of postoperative pain management in patients receiving care under APS with those receiving routine postoperative pain relief following lower limb surgery. Material and Methods: This was a prospective, hospital-based, controlled non-randomized study. American Society of Anesthesiologists (ASA) grades I–III patients with age 18–75 years undergoing lower limb orthopedic surgery were prospectively recruited into APS (index group) or routine postoperative care (control group) (n = 55 each). Postoperatively, American Pain Society Patient Outcome Questionnaire-Revised (APS-POQ-R) and Short Form (SF-12) were used to evaluate the outcome of postoperative pain management at 24 h and health-related quality of life after 4 weeks respectively. Results: Both groups were comparable in terms of demographic data. Patients in the index group had statistically significant better perception of care than the control group. Index group scored significantly higher than control group on median patient satisfaction score (9; interquartile range [IQR] [7–10] vs. 5 [3–6]; P < 0.001). In index group, there was significant reduction of worst pain in first 24 h along with decreased frequency of severe pain. Conclusion: Implementation of acute pain service plays an important role in improving the quality of postoperative pain relief, perception of care, and patient satisfaction.
Collapse
Affiliation(s)
- Sukanya Mitra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Kompal Jain
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Jasveer Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Swati Jindal
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Puja Saxena
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Manpreet Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Richa Saroa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Jannat Kang
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Sudhir Garg
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
26
|
Divatia JV. Change of guard at the Indian Journal of Anaesthesia. Indian J Anaesth 2019; 63:961-962. [PMID: 31879418 PMCID: PMC6921316 DOI: 10.4103/ija.ija_893_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India. E-mail:
| |
Collapse
|
27
|
Odom M, Byrnes J, Herrman NWC, Micheller D, Seleno N, Majkrzak A. A Low-Fidelity, High-Functionality Ultrasound-Guided Serratus Plane Block Model. J Emerg Med 2019; 57:844-847. [PMID: 31708313 DOI: 10.1016/j.jemermed.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thoracic injuries present many challenges for management in the acute and inpatient settings, including achieving appropriate pain control. Traditional modalities, such as opioids and spinal epidural anesthesia, are associated with multiple complications. Ultrasound-guided regional nerve blocks are becoming more prevalent, and they have been shown to be an effective modality of pain control for other traumatic injuries. Models comprised of animal tissue to simulate human anatomy are widely utilized to facilitate training of needle-guided procedures, but no such model for the serratus anterior plane block has yet been defined in the literature. OBJECTIVES Our goal was to produce a high-functionality serratus anterior plane block model with reasonable anatomic fidelity from low-cost materials. DISCUSSION We describe the creation of an inexpensive high-functionality serratus anterior plane block model from common materials, including pork ribs and chicken breasts, to realistically simulate human anatomy, including multiple muscle and fascial planes, as well as to allow hydrodissection. CONCLUSIONS This model will facilitate training and can improve success when caring for patients with thoracic trauma.
Collapse
Affiliation(s)
- Mitchell Odom
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - James Byrnes
- Clinical Simulation Program for the Advancement of Patient Safety, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - Nicholas W C Herrman
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - Daniel Micheller
- Department of Emergency Medicine, United States Air Force Langley Hospital, Hampton, Virginia
| | - Nicole Seleno
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - Allen Majkrzak
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| |
Collapse
|
28
|
Utilizing Ultrasound-Guided Femoral Nerve Blocks and Fascia Iliaca Compartment Blocks for Proximal Femur Fractures in the Emergency Department. Adv Emerg Nurs J 2019; 41:135-144. [PMID: 31033661 DOI: 10.1097/tme.0000000000000242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Proximal femur fractures (PFF) are one of the many common injuries that present to the emergency department (ED). The current practice for pain management utilizes systemic opioid analgesics. The use of opioids is an excellent analgesic choice, but they carry a significant burden for potential adverse effects. It is vital that providers have a variety of approaches to acute pain control. The use of femoral nerve blocks (FNBs) and fascia iliaca compartment blocks (FICB) are an alternative method of pain control in the ED. They have advantages over systemic opiates in that they do not require hemodynamic monitoring, have less adverse effects, and more importantly they induce rapid pain control with longer duration than systemic analgesics (). This manuscript examines a review of literature and identifies the efficacy, patient safety, indications, contraindications, patient satisfaction, and ultrasound-guided FNB and FICB techniques.
Collapse
|
29
|
Bakshi SG. The subcostal nerve as the target for nerve stimulator-guided transversus abdominis plane blocks - Commentary. Indian J Anaesth 2019; 63:255-256. [PMID: 31000887 PMCID: PMC6460975 DOI: 10.4103/ija.ija_210_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sumitra G Bakshi
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India. E-mail:
| |
Collapse
|
30
|
|
31
|
Zubrzycki M, Liebold A, Skrabal C, Reinelt H, Ziegler M, Perdas E, Zubrzycka M. Assessment and pathophysiology of pain in cardiac surgery. J Pain Res 2018; 11:1599-1611. [PMID: 30197534 PMCID: PMC6112778 DOI: 10.2147/jpr.s162067] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Analysis of the problem of surgical pain is important in view of the fact that the success of surgical treatment depends largely on proper pain management during the first few days after a cardiosurgical procedure. Postoperative pain is due to intraoperative damage to tissue. It is acute pain of high intensity proportional to the type of procedure. The pain is most intense during the first 24 hours following the surgery and decreases on subsequent days. Its intensity is higher in younger subjects than elderly and obese patients, and preoperative anxiety is also a factor that increases postoperative pain. Ineffective postoperative analgesic therapy may cause several complications that are dangerous to a patient. Inappropriate postoperative pain management may result in chronic pain, immunosuppression, infections, and less effective wound healing. Understanding and better knowledge of physiological disorders and adverse effects resulting from surgical trauma, anesthesia, and extracorporeal circulation, as well as the development of standards for intensive postoperative care units are critical to the improvement of early treatment outcomes and patient comfort.
Collapse
Affiliation(s)
- Marek Zubrzycki
- Department of Cardiac Surgery, University of Ulm Medical Center, Ulm, Germany,
| | - Andreas Liebold
- Department of Cardiac Surgery, University of Ulm Medical Center, Ulm, Germany,
| | - Christian Skrabal
- Department of Cardiac Surgery, University of Ulm Medical Center, Ulm, Germany,
| | - Helmut Reinelt
- Department of Cardiac Anesthesiology, University of Ulm Medical Center, Ulm, Germany
| | - Mechthild Ziegler
- Department of Cardiac Anesthesiology, University of Ulm Medical Center, Ulm, Germany
| | - Ewelina Perdas
- Department of Cardiovascular Physiology, Medical University of Lodz, Lodz, Poland
| | - Maria Zubrzycka
- Department of Cardiovascular Physiology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
32
|
Affiliation(s)
- P N Jain
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India E-mail:
| |
Collapse
|
33
|
Jain K, Jaiswal V, Puri A. Erector spinae plane block: Relatively new block on horizon with a wide spectrum of application - A case series. Indian J Anaesth 2018; 62:809-813. [PMID: 30443066 PMCID: PMC6190410 DOI: 10.4103/ija.ija_263_18] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Erector spinae plane (ESP) block is an interfascial plane block where a local anaesthetic is injected in a plane preferably below the erector spinae muscle. It is supposed to work at the origin of spinal nerves based on cadaveric and contrast study. It has emerged as an effective and safe analgesic regional technique. It has a wide variety of applications ranging from control of acute postoperative pain to chronic pain. In this series, we report a series of six cases, which include postoperative pain management in breast, thoracic, and abdominal surgeries along with management of two chronic pain cases to illustrate the potential uses of continuous and single-shot ESP block.
Collapse
Affiliation(s)
- Kompal Jain
- Department of Anesthesiology and Pain Management, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Vikky Jaiswal
- Department of Anesthesiology and Pain Management, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Arun Puri
- Department of Anesthesiology and Pain Management, Max Super Speciality Hospital, Patparganj, New Delhi, India
| |
Collapse
|