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Turan A, Fang J, Esa WAS, Hamadnalla H, Leung S, Pu X, Raza S, Chelnick D, Mounir Soliman L, Seif J, Ruetzler K, Sessler DI. Naloxegol and Postoperative Urinary Retention: A Randomized Trial. J Clin Med 2022; 11:jcm11020454. [PMID: 35054148 PMCID: PMC8780376 DOI: 10.3390/jcm11020454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. However, the effect of naloxegol on opioid-induced bladder dysfunction remains unknown. Hypothesis: patients given naloxegol have lower residual bladder urine volume than those given placebo. Methods: 136 patients scheduled for elective hip and knee surgery were randomized to oral naloxegol or placebo given the morning of surgery, and on the first two postoperative mornings. Residual urine volume was measured ultrasonographically within 30 min after voiding once in the morning and once in the afternoon for two postoperative days. Opioid-related Symptom Distress Scale (ORSDS), the need for indwelling urinary catheterization, and quality of recovery (QoR) score were secondary outcomes. Results: 67 were randomized to naloxegol and 64 to placebo. We did not identify a significant effect on urine residual volume, with an estimated ratio of geometric means of 0.9 (0.3, 2.6), p = 0.84. There were no significant differences in ORSDS or QoR. There were 19 (29%) patients assigned to naloxegol who needed indwelling urination catheterization versus 7 (11%) patients in the placebo group, p = 0.012. Conclusions: Our results do not support use of naloxegol for postoperative urinary retention after hip and knee surgery.
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Affiliation(s)
- Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
- Correspondence:
| | - Jonathan Fang
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
| | - Wael Ali Sakr Esa
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
| | - Hassan Hamadnalla
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health System, Detroit, MI 48202, USA
| | - Steve Leung
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
| | - Xuan Pu
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Syed Raza
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
| | - David Chelnick
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
| | - Loran Mounir Soliman
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
| | - John Seif
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA; (L.M.S.); (J.S.)
| | - Daniel I. Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA; (J.F.); (W.A.S.E.); (H.H.); (S.L.); (X.P.); (S.R.); (D.C.); (K.R.); (D.I.S.)
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Turan A, Cohen B, Elsharkawy H, Maheshwari K, Soliman LM, Babazade R, Ayad S, Hassan M, Elkassabany N, Essber HA, Kessler H, Mao G, Esa WAS, Sessler DI. Transversus abdominis plane block with liposomal bupivacaine versus continuous epidural analgesia for major abdominal surgery: The EXPLANE randomized trial. J Clin Anesth 2021; 77:110640. [PMID: 34969004 DOI: 10.1016/j.jclinane.2021.110640] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Compare transversus abdominis plane (TAP) blocks with liposomal bupivacaine were to epidural analgesia for pain at rest and opioid consumption in patients recovering from abdominal surgery. BACKGROUND ERAS pathways suggest TAP blocks in preference to epidural analgesia for abdominal surgery. However, the relative efficacies of TAP blocks and epidural analgesia remains unknown. METHODS Patients having major abdominal surgery were enrolled at six sites and randomly assigned 1:1 to thoracic epidural analgesia or bilateral/4-quadrant TAP blocks with liposomal bupivacaine. Intravenous opioids were used as needed. Non-inferiority margins were a priori set at 1 point on an 11-point pain numeric rating scale for pain at rest and at a 25% increase in postoperative opioid consumption. RESULTS Enrollment was stopped per protocol at 3rd interim analysis after crossing an a priori futility boundary. 498 patients were analyzed (255 had TAP blocks and 243 had epidurals). Pain scores at rest in patients assigned to TAP blocks were significantly non-inferior to those given epidurals, with an estimated difference of 0.09 points (CI: -0.12, 0.30; noninferiority P < 0.001). Opioid consumption during the initial 3 postoperative days in TAP patients was not non-inferior to epidurals, with an estimated ratio of geometric means of 1.37 (CI: 1.05, 1.79; non-inferiority P = 0.754). However, the absolute difference was only 21 mg morphine equivalents over the 3 days. Patients with epidurals were more likely to experience mean arterial pressures <65 mmHg than those given TAP blocks: 48% versus 31%, P = 0.006. CONCLUSION Pain scores at rest during the initial three days after major abdominal surgery were similar. Patients assigned to TAP blocks required more opioid then epidural patients but had less hypotension. Clinicians should reconsider epidural analgesia in patients at risk from hypotension. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02996227.
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Affiliation(s)
- Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of General Anesthesiology, Cleveland Clinic, United States of America.
| | - Barak Cohen
- Department of Outcomes Research, Cleveland Clinic, United States of America; Division of Anesthesiology, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hesham Elsharkawy
- Department of Outcomes Research, Cleveland Clinic, United States of America; Pain Center, Anesthesiology Department, MetroHealth, Case Western Reserve University, OH, United States of America
| | - Kamal Maheshwari
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Loran Mounir Soliman
- Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Rovnat Babazade
- Department of Anesthesiology, University of Texas Medical Branch of Galveston, TX, United States of America
| | - Sabry Ayad
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Manal Hassan
- Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Nabil Elkassabany
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, United States of America
| | - Hani A Essber
- Department of Outcomes Research, Cleveland Clinic, United States of America
| | - Hermann Kessler
- Department of Colorectal Surgery, Cleveland Clinic, United States of America
| | - Guangmei Mao
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of Quantitative Health Sciences, Cleveland Clinic
| | - Wael Ali Sakr Esa
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, United States of America
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Elsharkawy H, Kolli S, Soliman LM, Seif J, Drake RL, Mariano ER, El-Boghdadly K. The External Oblique Intercostal Block: Anatomic Evaluation and Case Series. Pain Med 2021; 22:2436-2442. [PMID: 34626112 DOI: 10.1093/pm/pnab296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/29/2021] [Accepted: 07/15/2021] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE We report a modified block technique aimed at obtaining upper midline and lateral abdominal wall analgesia: the external oblique intercostal (EOI) block. DESIGN A cadaveric study and retrospective cohort study assessing the potential analgesic effect of the EOI block. SETTING Cadaver lab and operating room. PATIENTS Two unembalmed cadavers and 22 patients. INTERVENTIONS Bilateral ultrasound-guided EOI blocks on cadavers with 29 mL of bupivacaine 0.25% with 1 mL of India ink; single-injection or continuous EOI blocks in patients. MEASUREMENTS Dye spread in cadavers and loss of cutaneous sensation in patients. MAIN RESULTS In the cadaveric specimens, we identified consistent staining of both lateral and anterior branches of intercostal nerves from T7 to T10. We also found consistent dermatomal sensory blockade of T6-T10 at the anterior axillary line and T6-T9 at the midline in patients receiving the EOI block. CONCLUSIONS We demonstrate the potential mechanism of this technique with a cadaveric study that shows consistent staining of both lateral and anterior branches of intercostal nerves T7-T10. Patients who received this block exhibited consistent dermatomal sensory blockade of T6-T10 at the anterior axillary line and T6-T9 at the midline. This block can be used in multiple clinical settings for upper abdominal wall analgesia.
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Affiliation(s)
- Hesham Elsharkawy
- Department of Anesthesiology, Pain and Healing Center, MetroHealth, Case Western Reserve University, Cleveland, Ohio, USA.,Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sree Kolli
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - John Seif
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard L Drake
- Department of Anatomy and Department of Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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Oweidat A, Soliman LM, Hezkial J, Esa WAS. A combined erector spinae and superior trunk block for a modified Eden-Lange tendon transfer for scapular winging. J Clin Anesth 2021; 73:110332. [PMID: 33964799 DOI: 10.1016/j.jclinane.2021.110332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Adeeb Oweidat
- Regional Anesthesia and Acute Pain Fellow, Department of General Anesthesia and Acute Pain Medicine, Cleveland Clinic, 9500 Euclid Ave, 44195 Cleveland, OH, United States.
| | - Loran Mounir Soliman
- Department of General Anesthesia and Acute Pain Medicine, Cleveland Clinic, 9500 Euclid Ave, 44195 Cleveland, OH, United States.
| | - Joseph Hezkial
- Anesthesia Resident, Department of General Anesthesia and Acute Pain Medicine, Cleveland Clinic, 9500 Euclid Ave, 44195 Cleveland, OH, United States.
| | - Wael Ali Sakr Esa
- Department of General Anesthesia and Acute Pain Medicine, Cleveland Clinic, 9500 Euclid Ave, 44195 Cleveland, OH, United States.
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Migirov A, Oweidat A, Soliman LM, Ali Sakr Esa W. Bilateral Pecto-intercostal fascial plane nerve block with liposomal bupivacaine after modified Ravitch pectus excavatum repair: A case report. J Clin Anesth 2021; 73:110295. [PMID: 33932700 DOI: 10.1016/j.jclinane.2021.110295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Allan Migirov
- Cleveland Clinic, Department of General Anesthesiology, United States.
| | - Adeeb Oweidat
- Cleveland Clinic, Department of General Anesthesiology, United States.
| | | | - Wael Ali Sakr Esa
- Cleveland Clinic, Department of General Anesthesiology, United States.
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Elsharkawy H, Ahuja S, Sessler DI, Maheshwari K, Mao G, Sakr Esa WA, Soliman LM, Ayad S, Khoshknabi D, Khan MZ, Raza S, DeGrande S, Turan A. Subcostal Anterior Quadratus Lumborum Block Versus Epidural Block for Analgesia in Open Nephrectomy: A Randomized Clinical Trial. Anesth Analg 2021; 132:1138-1145. [PMID: 33617181 DOI: 10.1213/ane.0000000000005382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Epidural block are often used for analgesia after open nephrectomy surgery. Subcostal anterior quadratus lumborum block may be an alternative. We therefore tested the hypothesis that the continuous subcostal anterior quadratus lumborum block is noninferior to epidural block for analgesia in patients having open partial nephrectomies. METHODS Adults having open partial nephrectomies were randomly allocated to epidural or unilateral subcostal anterior quadratus lumborum block. The joint primary outcomes were opioid consumption measured in morphine equivalents and pain measured on a numeric rating scale (0-10) from postanesthesia care unit (PACU) until 72 hours after surgery. The noninferiority deltas were 30% for opioid consumption and 1 point on a 0-10 scale for pain. Secondary outcomes included patient global assessment of pain management on the third postoperative day, the number of antiemetic medication doses through the third postoperative day, duration of PACU stay, and postoperative duration of hospitalization. RESULTS Twenty-six patients were randomized to anterior quadratus lumborum block and 29 to epidural analgesia. Neither pain scores nor opioid consumption in the quadratus lumborum patients were noninferior to epidural analgesia. At 72 hours, mean ± standard deviation pain scores in subcoastal anterior quadratus lumborum block and epidural group were 4.7 ± 1.8 and 4.1 ± 1.7, with an estimated difference in pain scores of 0.62 (95% confidence interval [CI], 0.74-1.99; noninferiority P = .21). The median [Q1, Q3] opioid consumption was more than doubled in quadratus lumborum patients at 70 mg [43, 125] versus 30 mg [18, 75] in the epidural group with an estimated ratio of geometric means of 1.69 (95% CI, 0.66-4.33; noninferiority P = .80). Patient global assessment and duration of PACU and hospital stays did not differ significantly in the 2 groups. CONCLUSIONS We were unable to show that subcostal anterior quadratus lumborum block are noninferior to epidural analgesia in terms of pain scores and opioid consumption for open partial nephrectomies. Effectiveness of novel blocks should be rigorously tested in specific surgical setting before widespread adoption.
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Affiliation(s)
- Hesham Elsharkawy
- From the Department of Anesthesiology, Pain and Healing Center, Case Western Reserve University, MetroHealth, Cleveland, Ohio.,Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Sanchit Ahuja
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.,Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health System, Detroit, Michigan
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Kamal Maheshwari
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.,Department of General Anesthesiology and
| | - Guangmei Mao
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Sabry Ayad
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Syed Raza
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Sean DeGrande
- Department of Anesthesia, Seven Hills Anesthesia, Edgewood, Kentucky
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.,Department of General Anesthesiology and
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Turan A, Essber H, Saasouh W, Hovsepyan K, Makarova N, Ayad S, Cohen B, Ruetzler K, Soliman LM, Maheshwari K, Yang D, Mascha EJ, Ali Sakr Esa W, Kessler H, Delaney CP, Sessler DI. Effect of Intravenous Acetaminophen on Postoperative Hypoxemia After Abdominal Surgery: The FACTOR Randomized Clinical Trial. JAMA 2020; 324:350-358. [PMID: 32721009 PMCID: PMC7388016 DOI: 10.1001/jama.2020.10009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Opioid-induced ventilatory depression and hypoxemia is common, severe, and often unrecognized in postoperative patients. To the extent that nonopioid analgesics reduce opioid consumption, they may decrease postoperative hypoxemia. OBJECTIVE To test the hypothesis that duration of hypoxemia is less in patients given intravenous acetaminophen than those given placebo. DESIGN, SETTING, AND PARTICIPANTS Randomized, placebo-controlled, double-blind trial conducted at 2 US academic hospitals among 570 patients who were undergoing abdominal surgery, enrolled from February 2015 through October 2018 and followed up until February 2019. INTERVENTIONS Participants were randomized to receive either intravenous acetaminophen, 1 g (n = 289), or normal saline placebo (n = 291) starting at the beginning of surgery and repeated every 6 hours until 48 postoperative hours or hospital discharge, whichever occurred first. MAIN OUTCOMES AND MEASURES The primary outcome was the total duration of hypoxemia (hemoglobin oxygen saturation [Spo2] <90%) per hour, with oxygen saturation measured continuously for 48 postoperative hours. Secondary outcomes were postoperative opioid consumption, pain (0- 10-point scale; 0: no pain; 10: the most pain imaginable), nausea and vomiting, sedation, minimal alveolar concentration of volatile anesthetic, fatigue, active time, and respiratory function. RESULTS Among 580 patients randomized (mean age, 49 years; 48% women), 570 (98%) completed the trial. The primary outcome, median duration with Spo2 of less than 90%, was 0.7 (interquartile range [IQR], 0.1-5.1) minutes per hour among patients in the acetaminophen group and 1.1 (IQR, 0.1-6.6) minutes per hour among patients in the placebo group (P = .29), with an estimated median difference of -0.04 (95% CI,-0.18 to 0.11) minutes per hour. None of the 8 secondary end points differed significantly between the acetaminophen and placebo groups. Mean pain scores within initial 48 postoperative hours were 4.2 (SD, 1.8) in the acetaminophen group and 4.4 (SD, 1.8) in the placebo group (difference, -0.28; 95% CI, -0.71 to 0.15); median opioid use in morphine equivalents was 50 mg (IQR, 18-122 mg) and 58 mg (IQR, 24-151 mg) , respectively, with a ratio of geometric means of 0.86 (95% CI, 0.61-1.21). CONCLUSIONS AND RELEVANCE Among patients who underwent abdominal surgery, use of postoperative intravenous acetaminophen, compared with placebo, did not significantly reduce the duration of postoperative hypoxemia over 48 hours. The study findings do not support the use of intravenous acetaminophen for this purpose. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02156154.
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Affiliation(s)
- Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Hani Essber
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Wael Saasouh
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Karen Hovsepyan
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Natalya Makarova
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Sabry Ayad
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
- Department of Regional Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Barak Cohen
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
- Division of Anesthesiology, Intensive Care, and Pain Management, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | | | - Kamal Maheshwari
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Dongsheng Yang
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Edward J. Mascha
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Wael Ali Sakr Esa
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Herman Kessler
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Conor P. Delaney
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
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Elsharkawy H, Saasouh W, Cho YJ, Soliman LM, Horn JL. The use of extended release bupivacaine with transversus abdominis plane and subcostal anterior quadratus lumborum catheters: A retrospective analysis of a novel technique. J Anaesthesiol Clin Pharmacol 2020; 36:110-114. [PMID: 32174670 PMCID: PMC7047671 DOI: 10.4103/joacp.joacp_358_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/26/2019] [Accepted: 05/21/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Liposomal bupivacaine (LB) is a formulation of local anesthetic that may exert analgesia over a prolonged period. Anecdotal use of LB suggests benefit and prolonged analgesia when used to supplement infiltration blocks. Our aim was to test the effect of a bolus of LB delivered through a nerve catheter in two types of interfascial plane blocks (transversus abdominis plane and anterior subcostal quadratus lumborum). The effect was evaluated through patient self-reporting of postsurgical pain up to 48 postoperative hours. Material and Methods Medical records of adult postoperative patients who received LB in a peripheral nerve catheter were followed retrospectively and analysed for pain scores and spread of dermatomal numbness over 48 h following the postoperative dose. A chart review of patients who qualified between June 2015 and March 2017 was performed, and clinical data were obtained from the institutional Perioperative Health Documentation System. Results Pain scores decreased following LB bolus, and all patients reported efficient block analgesia after bolus injection. Dermatomal numbness decreased gradually and was minimal by 48 h following bolus. Conclusion LB can be injected through a peripheral nerve catheter to prolong analgesia after catheter removal.
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Affiliation(s)
- Hesham Elsharkawy
- Case Western Reserve University, Cleveland, OH, USA.,Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| | - Wael Saasouh
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.,Department of Anaesthesiology, Detroit Medical Centre, Detroit, MI, USA
| | - Yoon Jeong Cho
- Department of General Anaesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jean-Louis Horn
- Department of Anaesthesiology, Stanford University, Stanford, CA, USA
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Elsharkawy H, Saasouh W, Babazade R, Soliman LM, Horn JL, Zaky S. Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique. Pain Med 2019; 20:1750-1755. [PMID: 30865772 DOI: 10.1093/pm/pnz026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view. DESIGN Prospective descriptive trial on a novel approach. SETTING Operating room and preoperative holding area at a tertiary care hospital. SUBJECTS Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia. METHODS Consented adult patients aged 30-80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2-5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes. RESULTS Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure. CONCLUSIONS We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.
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Affiliation(s)
- Hesham Elsharkawy
- Departments of Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, CCLCM of Case Western Reserve University, Cleveland, Ohio
| | - Wael Saasouh
- Department of Anesthesiology, Detroit Medical Center, Detroit, Michigan; Outcomes Research Consortium, Anesthesiology Institute, Cleveland, Ohio
| | - Rovnat Babazade
- Department of Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, Texas.,Outcomes Research Consortium, Cleveland, Ohio
| | - Loran Mounir Soliman
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jean-Louis Horn
- Division of Regional Anesthesia, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
| | - Sherif Zaky
- Department of Pain Management, Firelands Regional Medical Center, Sandusky, Ohio, USA
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Shaaban M, Esa WAS, Maheshwari K, Elsharkawy H, Soliman LM. Bilateral Continuous Quadratus Lumborum Block for Acute Postoperative Abdominal Pain as a Rescue After Opioid-Induced Respiratory Depression. ACTA ACUST UNITED AC 2015; 5:107-11. [DOI: 10.1213/xaa.0000000000000188] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Elsharkawy HA, Abd-Elsayed AA, Cummings KC, Soliman LM. Analgesic efficacy and technique of ultrasound-guided suprascapular nerve catheters after shoulder arthroscopy. Ochsner J 2014; 14:259-263. [PMID: 24940138 PMCID: PMC4052595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Conventional approaches to brachial plexus blocks may not cover the suprascapular nerve. Accordingly, after shoulder arthroscopy, sensation from the posterior part of the shoulder is commonly spared. Most previous research involving suprascapular nerve blocks described single-injection techniques. However, with the widespread availability and fairly reasonable cost of disposable infusion pumps, continuous catheter techniques provide a more appealing method of prolonging postoperative analgesia. CASE REPORT We describe 2 patients who were successfully treated with ultrasound-guided continuous suprascapular nerve catheters. With the patient seated, a high-frequency linear ultrasound probe was used. Both patients experienced excellent pain relief without complications. CONCLUSION Continuous suprascapular catheter techniques provide good pain relief and improve postoperative analgesia after shoulder arthroscopy.
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Affiliation(s)
- Hesham A. Elsharkawy
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Alaa A. Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, School of Public Medicine and Public Health, Madison, WI
| | - Kenneth C. Cummings
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
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Nair GS, Soliman LM, Maheshwari K, Esa WAS. Importance of vigilant monitoring after continuous nerve block: lessons from a case report. Ochsner J 2013; 13:267-269. [PMID: 23789016 PMCID: PMC3684339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Continuous peripheral nerve block achieves good pain control. However, uncontrolled pain despite an effective block in the target areas of the nerve can be an early sign of ischemia. We report a case of iatrogenic injury to the axillary artery during shoulder surgery in a patient who had continuous supraclavicular block and demonstrate how vigilant monitoring helped the diagnosis and resulted in timely management of upper limb ischemia. CASE REPORT A 58-year-old female underwent total revision surgery of her right shoulder under continuous supraclavicular block. Postoperatively, she complained of pain along the medial side of her forearm despite clinical evidence of nerve block. Continuous neurovascular monitoring and timely angiography confirmed axillary artery injury, and subsequent vascular repair saved the patient's limb. CONCLUSION Iatrogenic injuries to vessels or nerves sometimes occur during orthopedic surgical procedures. Regional anesthesia can mask and delay the onset of these symptoms. Postoperative monitoring and the ability to differentiate between the effects of local anesthetics and the body's response to ischemia are important for avoiding postoperative complications. This case report aims to improve awareness about the need for vigilant monitoring of the distal pulses after peripheral nerve blocks.
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Affiliation(s)
| | | | - Kamal Maheshwari
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Wael Ali Sakr Esa
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
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Guirguis MN, Abd-Elsayed AA, Girgis G, Soliman LM. Ultrasound-Guided Transversus Abdominis Plane Catheter for Chronic Abdominal Pain. Pain Pract 2012; 13:235-8. [DOI: 10.1111/j.1533-2500.2012.00570.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Soliman LM, Narouze S. Ultrasound-guided transversus abdominus plan block for the management of abdominal pain: An alternative to differential epidural block. ACTA ACUST UNITED AC 2009. [DOI: 10.1053/j.trap.2009.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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