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Zhu N, Xiang B, Shi J, Yang P, Dai Y, Wang S. The effect of perineural dexamethasone on nerve injury and recovery of nerve function after surgery: A randomized controlled trial. Heliyon 2024; 10:e35612. [PMID: 39220966 PMCID: PMC11363822 DOI: 10.1016/j.heliyon.2024.e35612] [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: 07/05/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Background While numerous studies have examined the influence of perineural dexamethasone on nerve block duration, its potential impact on postoperative nerve injury has not been adequately addressed. Objective This study aims to elucidate the effect of perineural dexamethasone on nerve injury and nerve function recovery after surgery. Design A prospective randomized double-blinded trial. Setting The First Affiliated Hospital of Chengdu Medical College, Chengdu, China. The study was conducted between 14 June and 30 December 2022. Participants Patients aged 18 - 80 years, ASA I - II, scheduled for elective orthopedic or burn and plastic surgery. Interventions Patients were randomized to receive either perineural dexamethasone (D group) or no dexamethasone (ND group). Main outcome measures Primary outcomes were the incidence and recovery of nerve injury. Secondary outcomes included postoperative pain scores, analgesic consumption, and adverse events. Results Initial postoperative nerve injury rates were similar between groups (D: 30.4 %, ND: 33.3 %, P > 0.05). At 12 weeks post-discharge, significantly more patients in the ND group recovered from nerve deficits (78.8 % vs 60.3 %; OR = 2.45, 95 % CI = 1.05 - 5.72, P < 0.05). No significant differences were observed in postoperative hyperglycemia or surgical site infection rates. Conclusion Perineural dexamethasone may impede nerve function recovery, suggesting caution in its use, particularly for patients with pre-existing nerve damage or diabetes. Further research is needed to elucidate the long-term effects of dexamethasone on nerve tissue recovery. Trial registration chictr.org.cn, ChiCTR2200059424.
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Affiliation(s)
- Na Zhu
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Bingbing Xiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinghong Shi
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Pingliang Yang
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yunke Dai
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Shun Wang
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
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Rashidi M, Mahmoodi K, Akhondzadeh R, Baghbanian R, Jahangiri Mehr F, Safaei Semnani N. Comparison of Dexmedetomidine and Ketamine in Serratus Anterior Plane Block for Postoperative Pain Control in Thoracotomy Patients: A Randomized Clinical Trial. Anesth Pain Med 2024; 14:e137664. [PMID: 38725920 PMCID: PMC11078229 DOI: 10.5812/aapm-137664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 01/10/2024] [Accepted: 01/31/2024] [Indexed: 05/12/2024] Open
Abstract
Background Postoperative pain control after thoracotomy is very important, and if not controlled, it can cause severe complications. Objectives This study aimed to compare dexmedetomidine and ketamine in serratus anterior plane block (SAPB) in pain control after thoracotomy. Methods This randomized clinical trial was conducted on 74 patients aged 18 to 60 years old with American Society of Anesthesiologists (ASA) class I or II who were referred to Imam Khomeini hospital in Ahvaz, Iran, for thoracotomy and randomly divided into two groups. After surgery, the SAPB with ultrasound-guided was performed. In the ropivacaine-ketamine (RK) group, ketamine 0.5 mg/kg and 0.4 cc/kg ropivacaine solution 0.25% and in the ropivacaine-dexmedetomidine (RD) group, in addition to 0.4 cc/kg ropivacaine 0.25%, dexmedetomidine 0.5 µg/kg was added. Verbal Numeric Scale (VNS), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), heart rate (HR), and mean arterial blood pressure (MAP) were recorded. Results There was no significant difference in both groups in terms of demographic information (P < 0.05). The average VNS was lower in the ketamine group than in the dexmedetomidine group; however, there was a significant difference only at 1, 12, and 24 hours after surgery (P < 0.05). There was no statistically significant difference between the two groups in terms of SBP and DBP, HR, and MAP. There was a significant difference in the RR in the two groups at 12 and 24 hours after the operation (P < 0.05). Conclusions Dexmedetomidine and ketamine, which were used as supplements to ropivacaine for SAPB in patients undergoing elective thoracotomy, reduced the pain intensity after thoracotomy; nevertheless, the intensity of pain reduction was more and more effective in the group receiving ketamine.
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Affiliation(s)
- Mahbobeh Rashidi
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kamran Mahmoodi
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Akhondzadeh
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Baghbanian
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Jahangiri Mehr
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Safaei Semnani
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Wu L, Zhang W, Zhang X, Wu Y, Qu H, Zhang D, Wei Y. Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1288697. [PMID: 38035018 PMCID: PMC10687368 DOI: 10.3389/fphar.2023.1288697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Aim of the Study: Brachial plexus block (BPB) is widely used for patients undergoing upper limb surgeries. Ropivacaine is the most commonly used local anesthetic for BPB. This study aimed to identify the optimal ropivacaine concentration for BPB in adult patients undergoing upper limb surgeries. Materials and Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched to identify randomized controlled trials (RCTs) that compared the effects of different concentrations of ropivacaine for BPB in adult patients undergoing upper limb surgeries. The primary outcomes were the onset time of sensory and motor block. RevMan 5.4 software was used for analysis. The GRADE approach was used to assess evidence quality. Results: Nine studies involving 504 patients were included. Compared to 0.5% ropivacaine, 0.75% ropivacaine shortened the onset time of sensory (WMD, -2.54; 95% CI; -4.84 to -0.24; <0.0001, moderate quality of evidence) and motor blockade (WMD, -2.46; 95% CI, -4.26 to -0.66; p = 0.01; moderate quality of evidence). However, 0.5% and 0.75% ropivacaine provided similar duration time of sensory (WMD, -0.07; 95% CI, -0.88 to 0.74; p = 0.81; high quality of evidence) and motor blockade (WMD, -0.24; 95% CI, -1.12 to 0.65; p = 0.55; high quality of evidence), as well as time to first request for oral analgesia (WMD, -1.57; 95% CI, -3.14 to 0.01; p = 0.5; moderate quality of evidence). Conclusion: Moderate-quality evidence suggested that, in terms of the onset time of sensory and motor blockade, 0.75% ropivacaine is a preferred concentration for BPB in upper limb surgeries. Systematic Review Registration: identifier CRD42023392145.
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Affiliation(s)
- Lin Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Weiyi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Zhang
- Department of Anesthesiology, First People’s Hospital of Tianshui City, Tianshui, China
| | - Yinglong Wu
- Department of Anesthesiology, Pu’er People’s Hospital, Pu'er, China
| | - Hua Qu
- Department of Anesthesiology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Donghang Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yiyong Wei
- Department of Anesthesiology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
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Wei XM, Liu Z, Lv LC, Wu GH, Sun PY, Gu CP, Shi PC. Comparison of dexmedetomidine and dexamethasone as adjuvants to the ultrasound-guided interscalene nerve block in arthroscopic shoulder surgery: a systematic review and Bayesian network meta-analysis of randomized controlled trials. Front Med (Lausanne) 2023; 10:1159216. [PMID: 37396910 PMCID: PMC10312098 DOI: 10.3389/fmed.2023.1159216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Interscalene block (ISB) is widely regarded as the gold standard treatment for acute pain following arthroscopic shoulder surgery. However, a single injection of a local anesthetic for ISB may not offer sufficient analgesia. Various adjuvants have been demonstrated to prolong the analgesic duration of the block. Hence, this study aimed to assess the relative efficacy of dexamethasone and dexmedetomidine as adjuncts to prolong the analgesic duration for a single- shot ISB. Methods The efficacy of adjuvants was compared using a network meta-analysis. The methodological quality of the included studies was evaluated using the Cochrane bias risk assessment tool. A comprehensive search of the PubMed, Cochrane, Web of Science, and Embase databases was conducted with a search deadline of March 1, 2023. Various adjuvant prevention randomized controlled trials have been conducted in patients undergoing interscalene brachial plexus block for shoulder arthroscopic surgery. Results Twenty-five studies enrolling a total of 2,194 patients reported duration of analgesia. Combined dexmedetomidine and dexamethasone (MD = 22.13, 95% CI 16.67, 27.58), dexamethasone administered perineurally (MD = 9.94, 95% CI 7.71, 12.17), high-dose intravenous dexamethasone (MD = 7.47, 95% CI 4.41, 10.53), dexmedetomidine administered perineurally (MD = 6.82, 95% CI 3.43, 10.20), and low-dose intravenous dexamethasone (MD = 6.72, 95% CI 3.74, 9.70) provided significantly longer analgesic effects compared with the control group. Discussion The combination of intravenous dexamethasone and dexmedetomidine provided the greatest effect in terms of prolonged analgesia, reduced opioid doses, and lower pain scores. Furthermore, peripheral dexamethasone in prolonging the analgesic duration and lowering opioid usage was better than the other adjuvants when used a single medication. All therapies significantly prolonged the analgesic duration and reduced the opioid dose of a single-shot ISB in shoulder arthroscopy compared with the placebo.
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Affiliation(s)
- Xiu-Min Wei
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
- School of Anesthesiology, Weifang Medical University, Weifang, Shandong, China
| | - Zheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Lian-Chao Lv
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Guang-Han Wu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Peng-Yu Sun
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
- School of Anesthesiology, Weifang Medical University, Weifang, Shandong, China
| | - Chang-Ping Gu
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Peng-Cai Shi
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
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Zhao X, Song Q, Wang Y, Zhang Q, Sun C. Dexmedetomidine improves lung compliance in patients undergoing lateral decubitus position of shoulder arthroscopy: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e33661. [PMID: 37083765 PMCID: PMC10118338 DOI: 10.1097/md.0000000000033661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The improvement of oxygenation and pulmonary mechanics in patients under general anesthesia can be achieved by dexmedetomidine (DEX) infusion. However, its role in patients undergoing lateral supine shoulder arthroscopy has not been thoroughly studied. This study aimed to evaluate the effect of DEX on lung compliance in patients undergoing shoulder arthroscopic surgery in a lateral decubitus position. METHODS The patients who underwent lateral recumbent shoulder arthroscopy under general anesthesia were randomly divided into the DEX group (group D) and the control group (group N). At the start of the trial, group D was given 0.5 μg/kg/hours continuous pumping until 30 minutes before the end of anesthesia; Group N was injected with normal saline at the same volume. The patients were recorded at each time point after intubation: supine position for 5 minutes (T0), lateral position for 5 minutes (T1), lateral position for 1 hour (T2), lateral position for 2 hours (T3), airway peak pressure, platform pressure, dynamic lung compliance, and static lung compliance, etc. RESULTS At the end of the drug infusion, the DEX group showed significant improved pulmonary mechanics and higher lung compliance than the control group. Compared with group N, group D's heart rate and mean arterial pressure were lower at all time points; there was no statistical difference in Tidal volume and Pressure end-tidal carbon dioxide data at each time point in Group D. CONCLUSION DEX can improve lung compliance and reduce airway pressure and platform pressure of patients undergoing shoulder arthroscopy in the lateral position under general anesthesia.
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Affiliation(s)
- Xiujie Zhao
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Qianqian Song
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Yewen Wang
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Quanyi Zhang
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Chao Sun
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
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Khater N, Comardelle NJ, Domingue NM, Borroto WJ, Cornett EM, Imani F, Rajabi M, Kaye AD. Current Strategies in Pain Regimens for Robotic Urologic Surgery: A Comprehensive Review. Anesth Pain Med 2022; 12:e127911. [PMID: 36818482 PMCID: PMC9923340 DOI: 10.5812/aapm-127911] [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: 05/20/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Context Robotic surgery is becoming the most common approach in minimally invasive urologic procedures. Robotic surgery offers less pain to patients because of smaller keyhole incisions and less tissue retraction and stretching of fascia and muscular fibers. Tailored pain regimens have also evolved and allowed patients to feel minimal to no discomfort after robotic urologic surgery, allowing in parallel better surgical outcomes. This study aims to analyze the most current pain regimens in robotic urologic surgery and to evaluate the most current pain protocols and corresponding outcomes. Evidence Acquisition A literature review was performed of published manuscripts utilizing Pubmed and Google Scholar on pain protocols for patients undergoing robotic urologic surgery. Results Multimodal analgesia is gaining ground in robotic urologic surgery. Regional analgesia includes four major modalities: Neuroaxial analgesia, intercostal blocks, tranvsersus abdominis plane blocks, and paravertebral blocks. Each approach has a different injection site, region of analgesia coverage, and duration of coverage depending upon local anesthesia and/or adjuvant utilized with advantages and disadvantages that make each modality unique and efficacious. Conclusions Robotic urologic surgery has offered the advantage of smaller incisions, faster recovery, less postoperative opioid consumption, and better surgical outcomes. Neuraxial, intercostal, transversus abdominis plane, and quadratus lumborum blocks are the best and most adopted approaches which offer optimal outcomes to patients.
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Affiliation(s)
- Nazih Khater
- Department of Urology, Louisiana State University, Shreveport, LA, USA
| | | | | | | | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Shreveport, LA, USA
- Corresponding Author: Department of Anesthesiology, Louisiana State University Shreveport, LA, USA.
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rajabi
- Department of Anesthesiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
- Corresponding Author: Department of Anesthesiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, LA, USA
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Nesioonpour S, Bayat S, Ghomeishi A, Behaeen K, Savaie M, Ahmadzadeh A. Effect of Intravenous Dexmedetomidine on Shivering in Cesarean Section under Intrathecal Anesthesia: Randomized Clinical Trial. Anesth Pain Med 2022; 12:e122735. [PMID: 36818484 PMCID: PMC9923329 DOI: 10.5812/aapm-122735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Shivering is one of the most common side effects after cesarean section (C-section) under spinal or epidural anesthesia. However, it is often not treated. Objectives The aim of this study was to evaluate the effectiveness of intravenous dexmedetomidine (DEX) in the prevention of shivering after intrathecal anesthesia in women undergoing C-sections. Methods This double-blind, placebo-controlled clinical trial was conducted on 80 women candidates for elective C-sections under intrathecal anesthesia who were referred to Imam Khomeini Governmental Hospital in Ahvaz, Iran, during 2020 - 2021. Patients were randomly divided into two groups of intravenous DEX (group D; 0.5 µg/kg) and normal saline (control, group C) and received the medications after umbilical cord clamping. All patients were evaluated during and after surgery for hemodynamic changes, the incidence and severity of shivering based on Chu and Tsai, side effects (e.g., nausea, vomiting), and sedation level based on the Ramsey scale. Results The incidence of shivering in group C was significantly higher than in group D (P = 0.003). Moreover, the severity of shivering on minutes 20, 30, and 45 in group C was significantly higher than in group D (P < 0.05). The mean sedation score during minutes 10 - 30 in group D was significantly higher than in group C (P < 0.05). Heart rate was not significantly different between the two groups (P < 0.05). Systolic and diastolic blood pressure were higher in group D than in group C (P < 0.05). Conclusions The administration of intravenous DEX effectively reduces the incidence and severity of shivering and provides appropriate sedation in patients undergoing C-sections, and it does not cause remarkable side effects.
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Affiliation(s)
- Sholeh Nesioonpour
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Soraya Bayat
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur Univercity of Medical Sciences, Ahvaz, Iran.
| | - Ali Ghomeishi
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kaveh Behaeen
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Savaie
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Azar Ahmadzadeh
- Department of Gynecology, School of Medicine, Ahvaz Jundishapur Univercity of Medical Science, Ahvaz, Iran
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Nazemroaya B, Keleidari B, Arabzadeh A, Honarmand A. Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy. Anesth Pain Med 2022; 12:e122203. [PMID: 35991777 PMCID: PMC9375960 DOI: 10.5812/aapm-122203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background Despite all of the benefits provided by laparoscopic cholecystectomy, such as rapid recovery and shorter hospital stay for patients, the incidence of postoperative nausea and vomiting (PONV) and postoperative pain (POP) still remains high. Objectives This study was designed to compare the effects of intraperitoneal (IP) and intravenous (IV) dexamethasone on the reduction of PONV and POP. Methods This prospective, randomized, double-blind clinical trial was conducted on a study population of 86 adult patients who were scheduled for laparoscopic cholecystectomy with the American Society of Anesthesiologists class I-II. The patients were randomized into three groups, namely IP dexamethasone (n = 29), IV dexamethasone (n = 29), and control (n = 28) groups. The patients were followed for clinical outcomes, including PONV, POP, and consumption of antiemetics, and their hemodynamic status during the first 24 hours after the surgery. Results In the first 24 hours after the operation, no significant differences were observed in nausea (P = 0.41) and vomiting (P = 0.38) between the IP and IV dexamethasone groups. However, there was a lower severity of nausea in the IP group (P = 0.001). Additionally, the visual analog scale score representing POP was significantly reduced in the IP group (P = 0.02). No significant differences in the hemodynamic status were observed after the operation between all the three groups. Conclusions The administration of 8 mg IP dexamethasone was associated with significantly reduced pain and severity of nausea, but not PONV, after laparoscopic cholecystectomy.
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Affiliation(s)
- Behzad Nazemroaya
- Anesthesiology and Critical Care Department , Isfahan University of Medical Sciences, Isfahan, Iran
- Corresponding Author: Anesthesiology and Critical Care Department , Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Behrooz Keleidari
- Surgery Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Arabzadeh
- Anesthesiology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Anesthesiology and Critical Care Department , Isfahan University of Medical Sciences, Isfahan, Iran
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Raouf MM, Alsaeed MA, Hassanien M, Talaat EA, Esmael TE, Kamel EZ. Intracarpal midazolam: does it offer better pain relief than dexamethasone in carpal tunnel syndrome patients? A randomized double-blind clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2059612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Mina Maher Raouf
- Anesthesia, intensive care and pain management department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mohammad Awad Alsaeed
- Anesthesia, intensive care and pain management department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Manal Hassanien
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa A Talaat
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tamer Elzaem Esmael
- Radiodiagnosis and intervention radiology department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Emad Zarief Kamel
- Anesthesia, intensive care, and pain management department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Abu Sabaa MA, Elbadry AA, El Malla DA. Ultrasound-Guided Clavipectoral Block for Postoperative Analgesia of Clavicular Surgery: A Prospective Randomized Trial. Anesth Pain Med 2022; 12:e121267. [PMID: 35433386 PMCID: PMC8995874 DOI: 10.5812/aapm.121267] [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: 11/29/2021] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background Clavicular fractures are commonly encountered in daily practice, and most cases are operated under general surgery. Until now, there has been a debate about the best approach to manage pain in such cases. Objectives We aimed to evaluate whether ultrasound-guided clavipectoral block [clavipectoral fascial plane block (CPB)] would be safe and effective in cases with clavicular fractures. Methods This prospective randomized study included a total of 40 patients with clavicular fractures; they were divided into 2 groups. Group 1 included 20 cases who underwent CPB, and group 2 included 20 cases who underwent placebo block. Pain score, duration of analgesia, total analgesic consumption, and procedure-related complications were noted and recorded. Results Despite the comparable demographic data between the 2 groups, pain scores were significantly lower in group 1 than in group 2, starting from postanesthesia care unit (PACU) admission until 12 hours after the operation. Group 1 showed a significant reduction in 24-hour opioid consumption and significant prolongation of the duration of analgesia compared to the placebo. Patient satisfaction was significantly better in group 1 than in group 2. No block-related adverse events were recorded. Conclusions CPB is a safe and effective regional technique that should be used for pain management after clavicular fixation surgery.
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Affiliation(s)
- Motaz Amr Abu Sabaa
- Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
- Corresponding Author: Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Amr Arafa Elbadry
- Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina Ahmed El Malla
- Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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Kaye AD, Edinoff AN, Yan JY, Kaye AJ, Alvarado MA, Pham AD, Chami AA, Shah RJ, Dixon BM, Shafeinia A, Cornett EM, Fox C. Novel Local Anesthetics in Clinical Practice: Pharmacologic Considerations and Potential Roles for the Future. Anesth Pain Med 2022; 12:e123112. [PMID: 35433373 PMCID: PMC8995776 DOI: 10.5812/aapm.123112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
The treatment of pain, both acute and chronic, has been a focus of medicine for generations. Physicians have tried to develop novel ways to effectively manage pain in surgical and post-surgical settings. One intervention demonstrating efficacy is nerve blocks. Single-injection peripheral nerve blocks (PNBs) are usually preferred over continuous PNBs, since they are not associated with longer lengths of stay. The challenge of single injection PNBs is their length of duration, which at present is a major limitation. Novel preparations of local anesthetics have also been studied, and these new preparations could allow for extended duration of action of anesthetics. An emerging preparation of bupivacaine, exparel, uses a multivesicular liposomal delivery system which releases medication in a steady, controlled manner. Another extended-release local anesthetic, HTX-011, consists of a combination of bupivacaine and low-dose meloxicam. Tetrodotoxin, a naturally occurring reversible site 1 sodium channel toxin derived from pufferfish and shellfish, has shown the potential to block conduction of isolated nerves. Neosaxitoxin is a more potent reversible site 1 sodium channel toxin also found in shellfish that can also block nerve conduction. These novel formulations show great promise in terms of the ability to prolong the duration of single injection PNBs. This field is still currently in development, and more researchers will need to be done to ensure the efficacy and safety of these novel formulations. These formulations could be the future of pain management if ongoing research continues to prove positive effects and low side effect profiles.
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Affiliation(s)
- Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center, Shreveport, Los Angeles, USA
| | - Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center, Shreveport, Los Angeles, USA
- Corresponding Author: Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center, Shreveport, Los Angeles, USA.
| | - Justin Y. Yan
- Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aaron J. Kaye
- Louisiana State University Health Sciences Center, New Orleans, Los Angeles, USA
| | - Michael A. Alvarado
- Department of Anesthesiology, Louisiana State University Health Science Center, Shreveport, Los Angeles, USA
| | - Alex D. Pham
- Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Azem A. Chami
- Department of Anesthesiology, Louisiana State University Health Science Center, Shreveport, Los Angeles, USA
| | - Rutvij J. Shah
- Department of Anesthesiology, Louisiana State University Health Science Center, Shreveport, Los Angeles, USA
| | - Bruce M. Dixon
- Department of Anesthesiology, Louisiana State University Health Science Center, Shreveport, Los Angeles, USA
| | - Amineh Shafeinia
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Akbar Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Science Center, Shreveport, Los Angeles, USA
| | - Charles Fox
- Department of Anesthesiology, Louisiana State University Health Science Center, Shreveport, Los Angeles, USA
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12
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Ghomeishi A, Mohtadi AR, Behaeen K, Nesioonpour S, Bakhtiari N, Khalvati Fahlyani F. Comparison of the Effect of Propofol and Dexmedetomidine on Hemodynamic Parameters and Stress Response Hormones During Laparoscopic Cholecystectomy Surgery. Anesth Pain Med 2021; 11:e119446. [PMID: 35075417 PMCID: PMC8782195 DOI: 10.5812/aapm.119446] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 12/19/2022] Open
Abstract
Background General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect the endocrine system by changing the level of stress hormones and hemodynamic variables of the patient. Objectives The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery. Methods Seventy patients of elective LC were included in this study. The patients were randomly assigned into two equal groups of propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), blood sugar, and serum epinephrine level were monitored and recorded from pre-anesthesia period to 10 min after entry to post-anesthesia care unit (PACU) according to a planned method. Results Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P < 0.001). Conclusions Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery.
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Affiliation(s)
- Ali Ghomeishi
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Reza Mohtadi
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kaveh Behaeen
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sholeh Nesioonpour
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nima Bakhtiari
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Farzad Khalvati Fahlyani
- Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Pain Research Center, Imam Khomeini Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Alimian M, Imani F, Rahimzadeh P, Faiz SHR, Bahari-Sejahrood L, C. Hertling A. Adding Dexmedetomidine to Bupivacaine in Ultrasound-guided Thoracic Paravertebral Block for Pain Management after Upper Abdominal Surgery: A Double-blind Randomized Controlled Trial. Anesth Pain Med 2021; 11:e120787. [PMID: 35291399 PMCID: PMC8908442 DOI: 10.5812/aapm.120787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background Paravertebral blocks are one of the possible postoperative pain management modalities after laparotomy. Adjuvants to local anesthetics, including alpha agonists, have been shown to lead to better pain relief and increased duration of analgesia. Objectives The aim of this study is to examine the effect of adding dexmedetomidine to bupivacaine for ultrasound-guided paravertebral blocks in laparotomy. Methods In this double-blind, randomized controlled trial (RCT), we enrolled 42 patients scheduled for T6 to T8 thoracic paravertebral block (TPVB) for analgesia after laparotomy. The patients were randomly assigned into two groups of BD (bupivacaine 2.5 mg/mL 20 mL plus dexmedetomidine 100 µg) and B (bupivacaine 20 mL alone). Following surgery, intravenous fentanyl patient-controlled analgesia was initiated. The numerical rating scale (NRS) for pain, sedation score, total analgesic consumption, time to first analgesic requirement, side effects (such as nausea and vomiting), respiratory depression, and patients’ satisfaction during the first 48 hours of evaluation were compared in the two groups. Results Pain scores and mean total analgesic consumption at the first 48 hours in the BD group were significantly lower than Group B (P = 0.03 and P < 0.001, respectively). The time of first analgesic request was significantly longer in BD group (P < 0.001). Sedation scores and side effects did not differ significantly between the two groups. Conclusions Adding dexmedetomidine to bupivacaine for TPVB after laparotomy yielded better postoperative pain management without significant complications.
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Affiliation(s)
- Mahzad Alimian
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Bahari-Sejahrood
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Arthur C. Hertling
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University School of Medicine, NY, USA
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Mahmoudi K, Rashidi M, Soltani F, Savaie M, Hedayati E, Rashidi P. Comparison of Intercostal Nerve Block with Ropivacaine and Ropivacaine-Dexmedetomidine for Postoperative Pain Control in Patients Undergoing Thoracotomy: A Randomized Clinical Trial. Anesth Pain Med 2021; 11:e118667. [PMID: 35291405 PMCID: PMC8908443 DOI: 10.5812/aapm.118667] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 01/04/2023] Open
Abstract
Background Thoracotomy is one of the most painful surgeries, and failure to alleviate patients' pain can have dangerous consequences. Objectives This study aimed to evaluate the addition of dexmedetomidine to ropivacaine in the intercostal block for postoperative pain control in patients undergoing thoracotomy. Methods In this randomized clinical trial, 74 patients aged 18 to 60 years with ASA class I or II, BMI less than 40, and no severe systemic problems referred to a teaching hospital in Ahvaz to undergo thoracotomy were included in the study and randomly divided into two groups. After surgery, an ultrasound-guided intercostal block was done with ropivacaine (5 cc of 0.25% solution; group R) or ropivacaine (5 cc of 0.25% solution) plus dexmedetomidine (0.5 µg/kg; group RD) per dermatome. Two dermatomes above and two dermatomes below the level of surgical incision were used. Pain, total opioid consumption, length of ICU stays, time to first rescue analgesic, and time to get out of bed were compared between the two groups. Results The intercostal block significantly reduced pain in both groups (P < 0.0001). The pain was lower in the RD group than in the R group from six hours after the intervention up to 24 hours after (P < 0.001). The number of patients who needed rescue analgesia at 12 hours was significantly lower in the RD group (P < 0.05). The RD group also had lower total opioid consumption and a longer time to receive the first rescue analgesia (P < 0.01). There was no significant difference between the two groups in the length of hospitalization and the time to get out of bed. Conclusions Dexmedetomidine is an effective and safe choice to be used as an adjunct to ropivacaine in ICB, and it extends the duration of analgesia in combination with ropivacaine after thoracotomy.
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Affiliation(s)
- Kamran Mahmoudi
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahboobeh Rashidi
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farhad Soltani
- Department of Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Savaie
- Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ehsan Hedayati
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parisa Rashidi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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15
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Kaye AD, Allampalli V, Fisher P, Kaye AJ, Tran A, Cornett EM, Imani F, Edinoff AN, Djalali Motlagh S, Urman RD. Supraclavicular vs. Infraclavicular Brachial Plexus Nerve Blocks: Clinical, Pharmacological, and Anatomical Considerations. Anesth Pain Med 2021; 11:e120658. [PMID: 35075423 PMCID: PMC8782193 DOI: 10.5812/aapm.120658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
: Peripheral nerve blocks (PNB) have become standard of care for enhanced recovery pathways after surgery. For brachial plexus delivery of anesthesia, both supraclavicular (SC) and infraclavicular (IC) approaches have been shown to require less supplemental anesthesia, are performed more rapidly, have quicker onset time, and have lower rates of complications than other approaches (axillary, interscalene, etc.). Ultrasound-guidance is commonly utilized to improve outcomes, limit the need for deep sedation or general anesthesia, and reduce procedural complications. Given the SC and IC approaches are the most common approaches for brachial plexus blocks, the differences between the two have been critically evaluated in the present manuscript. Various studies have demonstrated slight favorability towards the IC approach from the standpoint of complications and safety. Two prospective RCTs found a higher incidence of complications in the SC approach – particularly Horner syndrome. The IC method appears to support a greater block distribution as well. Overall, both SC and IC brachial plexus nerve block approaches are the most effective and safe approaches, particularly under ultrasound-guidance. Given the success of the supraclavicular and infraclavicular blocks, these techniques are an important skill set for the anesthesiologist for intraoperative anesthesia and postoperative analgesia.
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Affiliation(s)
- Alan D. Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Varsha Allampalli
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Paul Fisher
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Aaron J. Kaye
- Medical University of South Carolina, Department of Anesthesiology and Perioperative Medicine, Charleston, SC, USA
| | - Aaron Tran
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
| | - Elyse M. Cornett
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amber N. Edinoff
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
- Corresponding Author: Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA.
| | - Soudabeh Djalali Motlagh
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Richard D. Urman
- Brigham and Women’s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston MA, USA
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16
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Edinoff AN, Girma B, Trettin KA, Horton CC, Kaye AJ, Cornett EM, Imani F, Bastanhagh E, Kaye AM, Kaye AD. Novel Regional Nerve Blocks in Clinical Practice: Evolving Techniques for Pain Management. Anesth Pain Med 2021; 11:e118278. [PMID: 34692446 PMCID: PMC8520672 DOI: 10.5812/aapm.118278] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/26/2021] [Indexed: 12/20/2022] Open
Abstract
This review examines the use of novel US-guided nerve blocks in clinical practice. Erector spinae block is a regional anesthesia technique doing by injecting a local anesthetic among the erector spinae muscle group and transverse processes. The phrenic nerve is a branch of the cervical plexus, arising from the anterior rami of cervical nerves C3, C4, and C5. The quadratus lumborum muscle is located along the posterior abdominal wall. It originates from the transverse process of the L5 vertebral body, the iliolumbar ligament, and the iliac crest. US-guided peripheral nerve procedures have a considerable scope of use, including treating headaches and hiccups to abdominal surgical pain, cesarean sections, musculoskeletal pathologies. These nerve blocks have been an effective addition to clinical anesthesia practice. The use of peripheral nerve blocks has improved postoperative pain, lessened the use of opioids and their potential side effects, and decreased the incidence of sleep disturbance in patients. More research should be done to further delineate the potential benefits of these blocks.
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Affiliation(s)
- Amber N. Edinoff
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Brook Girma
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Katherine A. Trettin
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Cassidy C. Horton
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Aaron J. Kaye
- Medical University of South Carolina, Department of Anesthesiology and Perioperative Medicine, Charleston, SC, USA
| | - Elyse M. Cornett
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Bastanhagh
- Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran
| | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, USA
| | - Alan D. Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
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Djalali Motlagh S, Rokhtabnak F, Ghodraty MR, Maleki Delarestaghi M, Saadat S, Araghi Z. Effect of Different Loading Doses of Dexmedetomidine on Controlled Hypotension and the Incidence of Bradycardia During Rhinoplasty: A Clinical Trial. Anesth Pain Med 2021; 11:e118857. [PMID: 34692447 PMCID: PMC8520684 DOI: 10.5812/aapm.118857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/13/2022] Open
Abstract
Controlled hypotension, with a mean arterial pressure (MAP) of 60 mmHg - 70 mmHg, provides a bloodless and visible surgical field during rhinoplasty. It has been shown that dexmedetomidine, an α2-adrenoreceptor agonist, is a suitable choice in this regard. One of the disadvantages of this drug is the possibility of severe bradycardia during infusion. Therefore, we compared lower intravenous (IV) loading doses to determine whether the hypotensive effect of the drug was preserved and the bradycardia incidence decreased. In this randomized, double-blinded clinical trial, 81 patients aged 18 to 50 years with the American Society of Anesthesiologists physical status (ASA-PS) class I and II, scheduled for rhinoplasty randomly received 1.0, 0.9, and 0.8 µg/kg (named as groups 1.0, 0.9, and 0.8, respectively) of IV dexmedetomidine before the induction of anesthesia followed by infusion (0.3 - 0.7 µg/kg/h) during operation. The patients' heart rate (HR), MAP, the requirements for nitroglycerin (NTG) and extra fentanyl, as well as the incidence of bradycardia, were recorded. Bleeding and visibility of the surgical field were scored by the surgeon using a 6-point visual scale. MAPs, HRs, and consumption of NTG and extra fentanyl were similar in the studied groups. The surgical field was more visible and bloodless in group 1.0 compared to group 0.8 (P < 0.001); the differences were not significant between groups 1.0 and 0.9 (P = 0.605). The incidence (P = 0.027) and the severity of bradycardia (P = 0.017) were higher in the groups with higher loading doses. We concluded that dexmedetomidine is an acceptable agent to provide controlled hypotension. A loading dose of 0.9 µg/kg, but not 0.8 µg/kg, provides similar surgical field conditions as the dose of 1 µg/kg. Furthermore, despite the decrease in the incidence of bradycardia, the hypotensive effect of the drug is preserved.
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Affiliation(s)
- Soudabeh Djalali Motlagh
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Faranak Rokhtabnak
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ghodraty
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Maleki Delarestaghi
- Department of Otolaryngology Head and Neck Surgery, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of ENT and Head and Neck Research and the Five Senses Institute, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Saadat
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Araghi
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
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18
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Edinoff AN, Houk GM, Patil S, Bangalore Siddaiah H, Kaye AJ, Iyengar PS, Cornett EM, Imani F, Mahmoudi K, Kaye AM, Urman RD, Kaye AD. Adjuvant Drugs for Peripheral Nerve Blocks: The Role of Alpha-2 Agonists, Dexamethasone, Midazolam, and Non-steroidal Anti-inflammatory Drugs. Anesth Pain Med 2021; 11:e117197. [PMID: 34540647 PMCID: PMC8438706 DOI: 10.5812/aapm.117197] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Adjuvant drugs for peripheral nerve blocks are a promising solution to acute postoperative pain and the transition to chronic pain treatment. Peripheral nerve blocks (PNB) are used in the brachial plexus, lumbar plexus, femoral nerve, sciatic nerve, and many other anatomic locations for site-specific pain relief. However, the duration of action of a PNB is limited without an adjuvant drug. The use of non-opioid adjuvant drugs for single-shot peripheral nerve blocks (sPNB), such as alpha-2 agonists, dexamethasone, midazolam, and non-steroidal anti-inflammatory drugs, can extend the duration of local anesthetics and reduce the dose-dependent adverse effects of local anesthetics. Tramadol is a weak opioid that acts as a central analgesic. It can block voltage-dependent sodium and potassium channels, cause serotonin release, and inhibit norepinephrine reuptake and can also be used as an adjuvant in PNBs. However, tramadol's effectiveness and safety as an adjuvant to local anesthetic for PNB are inconsistent. The effects of the adjuvants on neurotoxicity must be further evaluated with further studies to delineate the safety in their use in PNB. Further research needs to be done. However, the use of adjuvants in PNB can be a way to help control postoperative pain.
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Affiliation(s)
- Amber N. Edinoff
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Garrett M. Houk
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Shilpa Patil
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | | | - Aaron J. Kaye
- Medical University of South Carolina, Department of Anesthesiology and Perioperative Medicine, Charleston, SC, USA
| | | | - Elyse M. Cornett
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Mahmoudi
- Pain Research Center, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, USA
| | - Richard D. Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alan D. Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
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19
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Edinoff AN, Fitz-Gerald JS, Holland KAA, Reed JG, Murnane SE, Minter SG, Kaye AJ, Cornett EM, Imani F, Khademi SH, Kaye AM, Urman RD, Kaye AD. Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate. Anesth Pain Med 2021; 11:e117146. [PMID: 34540646 PMCID: PMC8438710 DOI: 10.5812/aapm.117146] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/02/2023] Open
Abstract
The potential for misuse, overdose, and chronic use has led researchers to look for other methods to decrease opioid consumption in patients with acute and chronic pain states. The use of peripheral nerve blocks for surgery has gained increasing popularity as it minimizes peripheral pain signals from the nociceptors of local tissue sustaining trauma and inflammation from surgery. The individualization of peripheral nerve blocks using adjuvant drugs has the potential to improve patient outcomes and reduce chronic pain. The major limitations of peripheral nerve blocks are their limited duration of action and dose-dependent adverse effects. Adjuvant drugs for peripheral nerve blocks show increasing potential as a solution for postoperative and chronic pain with their synergistic effects to increase the duration of action and decrease the required dosage of local anesthetic. N-methyl-d-aspartate (NMDA) receptor antagonists are a viable option for patients with opioid resistance and neuropathic pain due to their affinity to the neurotransmitter glutamate, which is released when patients experience a noxious stimulus. Neostigmine is a cholinesterase inhibitor that exerts its effect by competitively binding at the active site of acetylcholinesterase, which prevents the hydrolysis of acetylcholine and subsequently retaining acetylcholine at the nerve terminal. Epinephrine, also known as adrenaline, can potentially be used as an adjuvant to accelerate and prolong analgesic effects in digital nerve blocks. The theorized role of sodium bicarbonate in local anesthetic preparations is to increase the pH of the anesthetic. The resulting alkaline solution enables the anesthetic to more readily exist in its un-ionized form, which more efficiently crosses lipid membranes of peripheral nerves. However, more research is needed to show the efficacy of these adjuvants for nerve block prolongation as studies have been either mixed or have small sample sizes.
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Affiliation(s)
- Amber N. Edinoff
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Joseph S. Fitz-Gerald
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
| | - Krisha Andrea A. Holland
- School of Allied Health, Louisiana State University Shreveport, Department of Physical Therapy, Shreveport, LA, USA
| | - Johnnie G. Reed
- School of Allied Health, Louisiana State University Shreveport, Department of Physical Therapy, Shreveport, LA, USA
| | - Sarah E. Murnane
- School of Allied Health, Louisiana State University Shreveport, Department of Physical Therapy, Shreveport, LA, USA
| | - Sarah G. Minter
- School of Allied Health, Louisiana State University Shreveport, Department of Physical Therapy, Shreveport, LA, USA
| | - Aaron J. Kaye
- Medical University of South Carolina, Department of Anesthesiology and Perioperative Medicine, Charleston, SC, USA
| | - Elyse M. Cornett
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, USA
| | - Richard D. Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alan D. Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
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