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Admiraal M, Smulders PSH, Rutten MVH, de Groot EK, Heine Y, Baumann HM, van der Vegt VHC, Halm JA, Hermanns H, Schepers T, Hollmann MW, Hermanides J, Ten Hoope W. The effectiveness of ambulatory continuous popliteal sciatic nerve blockade on patient-reported overall benefit of analgesia in patients undergoing foot or ankle surgery (CAREFREE trial); a randomized, open label, non-inferiority trial. J Clin Anesth 2024; 95:111451. [PMID: 38574504 DOI: 10.1016/j.jclinane.2024.111451] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
STUDY OBJECTIVE Management of pain after foot and ankle surgery remains a concern for patients and healthcare professionals. This study determined the effectiveness of ambulatory continuous popliteal sciatic nerve blockade, compared to standard of care, on overall benefit of analgesia score (OBAS) in patients undergoing foot or ankle surgery. We hypothesized that usage of ambulatory continuous popliteal sciatic nerve blockade is non-inferior to standard of care. DESIGN Single center, randomized, non-inferiority trial. SETTING Tertiary hospital in the Netherlands. PATIENTS Patients were enrolled if ≥18 years and scheduled for elective inpatient foot or ankle surgery. INTERVENTION Patients were randomized to ambulatory continuous popliteal sciatic nerve blockade or standard of care. MEASUREMENTS The primary outcome was the difference in OBAS, which includes pain, side effects of analgesics, and patient satisfaction, measured daily from the first to the third day after surgery. A non-inferiority margin of 2 was set as the upper limit for the 90% confidence interval of the difference in OBAS score. Mixed-effects modeling was employed to analyze differences in OBAS scores over time. Secondary outcome was the difference in opioid consumption. MAIN RESULTS Patients were randomized to standard of care (n = 22), or ambulatory continuous popliteal sciatic nerve blockade (n = 22). Analyzing the first three postoperative days, the OBAS was significantly lower over time in the ambulatory continuous popliteal sciatic nerve blockade group compared to standard of care, demonstrating non-inferiority (-1.9 points, 90% CI -3.1 to -0.7). During the first five postoperative days, patients with ambulatory continuous popliteal sciatic nerve blockade consumed significantly fewer opioids over time compared to standard of care (-8.7 oral morphine milligram equivalents; 95% CI -16.1 to -1.4). CONCLUSIONS Ambulatory continuous popliteal sciatic nerve blockade is non-inferior to standard of care with single shot popliteal sciatic nerve blockade on patient-reported overall benefit of analgesia.
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Affiliation(s)
- Manouk Admiraal
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Pascal S H Smulders
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Martin V H Rutten
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Eelko K de Groot
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Yvonne Heine
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Holger M Baumann
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Vincent H C van der Vegt
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jens A Halm
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Henning Hermanns
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Tim Schepers
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Werner Ten Hoope
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Anesthesiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands
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Kang H, Park S, Jin Y. Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report. World J Clin Cases 2024; 12:2451-2456. [DOI: 10.12998/wjcc.v12.i14.2451] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Awake fiberoptic nasotracheal intubation (AFNI) is the preferred airway management strategy for patients with difficult airways. However, this procedure can cause significant physical and psychological distress. This case report explores the application of a sphenopalatine ganglion (SPG) block as an alternative analgesic modality to mitigate the discomfort associated with AFNI.
CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion. The patient’s medical history included prior surgery, chemotherapy, and radiation therapy, resulting in significant jaw impairment and limited neck mobility. Considering the anticipated airway challenges, AFNI was planned. A SPG block was performed under real-time ultrasound guidance, providing effective analgesia during nasotracheal intubation.
CONCLUSION The SPG block represents a promising analgesic approach in AFNI, offering potential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.
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Affiliation(s)
- Hangil Kang
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, South Korea
| | - Seongjae Park
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, South Korea
| | - Yehun Jin
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, South Korea
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Ingram J, Williams AY, Bright AC, Caleb Butts C. Use of lateral femoral cutaneous nerve blocks by landmark technique is ineffective in decreasing narcotic usage after skin grafts: A retrospective case-control study. Burns 2024; 50:997-1002. [PMID: 38331662 DOI: 10.1016/j.burns.2024.01.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/24/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Cutaneous burns are commonly treated with autologous skin grafts. Following skin grafting, many patients complain of pain at the donor site. Donor sites are taken most commonly from the lateral thigh, which is innervated by the lateral femoral cutaneous nerve (LFCN). Use of a LFCN blocks should decrease nociception from the donor site. METHODS Our group began utilizing LFCN blocks in 2019. Utilizing anatomic landmarks, LFCN blocks were performed on all patients who received autologous skin grafts to reduce perioperative pain. A retrospective cohort study was performed on all patients with 10% or less total body surface areas burns who received an autologous skin graft. A similar cohort from 2016, prior to use of any local or regional analgesia, was used as a historical control. Post-operative enteral and parenteral narcotic analgesics were collected for each post-operative day up to day 5 or discharge (whichever came first) and converted to morphine milligram equivalents (MME) to quantify analgesia after surgery. RESULTS Chart review identified 55 patients in the 2020 cohort. Fifty-five patients from the 2016 cohort were matched based upon size of skin graft, total body surface area (TBSA) burned, gender, and age. There were no statistically significant differences between the two groups in terms of size of graft, TBSA burned, age, gender, or type of burn. When examining narcotics usage in the immediate perioperative period (days 0-2), we found no difference between the two groups for total MME (113 vs 133, p = 0.28) or IV MME (38 vs 33, p = 0.45). Similar relationships existed in the extended post-operative period (days 1-5) for total MME (149 vs. 188, t = 0.22) or IV MME (37 vs. 50, t = 0.25). Examining daily narcotic usage also yielded no statistically different values. CONCLUSION Our data shows that use of LFCN block by landmark technique did not reduce narcotic usage in patients that undergo skin grafting procedures. Future studies should consider ultrasound-guided LFCN blocks.
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Affiliation(s)
- Jordan Ingram
- University of South Alabama College of Medicine, 5795 USA Drive North, CSAB 170, Mobile, AL 36688, USA.
| | - Ashley Y Williams
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
| | - Andrew C Bright
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
| | - C Caleb Butts
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
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Lin W, Wu JW, Stern JI, Robertson CE, Chiang CC. Lacrimal Neuralgia: A Case Report and Comprehensive Review of the Literature. Curr Pain Headache Rep 2024:10.1007/s11916-024-01250-6. [PMID: 38676822 DOI: 10.1007/s11916-024-01250-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE OF REVIEW Lacrimal neuralgia is a rare periorbital neuralgia. To date, only nine cases have been reported in the literature. Herein, we report a case and a comprehensive overview of the entity with a focus on the differential diagnosis of lacrimal neuralgia. Additionally, we propose putative diagnostic criteria for this rare neuralgia based on cases that have been reported. RECENT FINDINGS Among the ten cases of lacrimal neuralgia reported (including the one in this review), seven out of ten were idiopathic, and the other three were considered secondary. Most patients reported stabbing and shooting pain that was either paroxysmal or continuous. The most effective therapy was nerve block for seven patients and pregabalin for three patients. The most important clues to differentiate lacrimal neuralgia from other causes of periorbital pain include pain topography and pain with features suggestive of neuralgia. The core feature of lacrimal neuralgia is neuralgic pain located in the area supplied by the lacrimal nerve, and the etiology could be primary or secondary. Responsiveness to anesthetic blockade might better serve as a confirmational, rather than mandatory, criterion for diagnosis.
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Affiliation(s)
- Wei Lin
- Department of Neurology, Chang-Bing Show-Chwan Memorial Hospital, Lukang Township, Changhua County, Taiwan
| | - Jr-Wei Wu
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Jennifer I Stern
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carrie E Robertson
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chia-Chun Chiang
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Zhang Z, Kong H, Li Y, Xu ZZ, Li X, Ma JH, Wang DX. Erector spinae plane block versus quadratus lumborum block for postoperative analgesia after laparoscopic nephrectomy: A randomized controlled trial. J Clin Anesth 2024; 96:111466. [PMID: 38677191 DOI: 10.1016/j.jclinane.2024.111466] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
STUDY OBJECTIVE We compared the analgesic effects of erector spinae plane block versus quadratus lumborum block following laparoscopic nephrectomy. DESIGN A randomized controlled trial. SETTING A tertiary hospital in Beijing, China. PATIENTS Patients scheduled for elective laparoscopic nephrectomy. INTERVENTIONS A total of 110 patients were enrolled and randomized to receive either erector spinae plane block (n = 55) or quadratus lumborum block (n = 55) under ultrasound guidance. Patient-controlled sufentanil analgesia was provided after surgery. MEASUREMENTS Our primary outcome was cumulative opioid consumption within 24 h after surgery. Secondary outcomes included postoperative pain intensity, subjective sleep quality, and quality of recovery. MAIN RESULTS All 110 patients (mean 53 years, 57.3% female) were included in the intention-to-treat analysis. Cumulative sufentanil equivalent within 24 h was lower in patients given erector spinae plane block (median 13 μg, interquartile range 4 to 33) than in those given quadratus lumborum block (median 25 μg, interquartile range 13 to 39; median difference - 8 μg, 95% CI -15 to 0, P = 0.041). Pain intensity (0-10 range where 0 = no pain and 10 = the worst pain) at 2, 6, 12, and 24 h after surgery was lower with erector spinae plane block (at rest: median differences -1 point, all P ≤ 0.009; with movement: median differences -2 to -1 points, all P < 0.001). Subjective sleep quality on the night of surgery (the Richards-Campbell Sleep Questionnaire: 0-100 range, higher score better; median difference 12, 95% CI 2 to 23, P = 0.018) and quality of recovery at 24 h (the Quality of Recovery-15: 0-150 range, higher score better; median difference 8, 95% CI 2 to 15, P = 0.012) were better with erector spinae plane block. No procedure-related adverse events occurred. CONCLUSIONS Compared with quadratus lumborum block, erector spinae plane block provided better analgesia as manifested by lower opioid consumption and pain intensity for up to 24 h after laparoscopic nephrectomy.
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Affiliation(s)
- Zhen Zhang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Hao Kong
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Yan Li
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Zhen-Zhen Xu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Xue Li
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Jia-Hui Ma
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland, OH, USA.
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Huaguo Y, Kang S, Hu L, Zhou H. Advancing pain management for extremity trauma: the evolution of ultrasound-guided nerve blocks for patients in the supine position in trauma centers. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02523-w. [PMID: 38649528 DOI: 10.1007/s00068-024-02523-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Trauma, particularly extremity trauma, poses a considerable challenge in healthcare, especially among young adults. Given the severity of patient pain and the risks associated with excessive opioid use, managing acute pain in trauma centers is inherently complex. This study aims to investigate the application and benefits of ultrasound-guided nerve blocks for early pain management in patients with extremity trauma positioned supine. METHODS A comprehensive literature review was conducted to assess the effectiveness and advantages of ultrasound-guided peripheral nerve blocks in the acute pain management of extremity trauma patients in the supine position. Special emphasis was placed on evaluating the selection criteria, indications, contraindications, adverse reactions, and potential complications associated with these nerve block techniques. RESULTS Ultrasound-guided nerve blocks represent a safer and more precise option for managing pain in extremity trauma patients placed in the supine position. These techniques offer significant advantages in terms of reducing healthcare expenses, diminishing reliance on opioid medications, and mitigating opioid-related complications. Nonetheless, challenges may arise due to the necessity for patient cooperation during specific nerve block procedures. CONCLUSION Ultrasound-guided nerve blocks present a promising avenue for early pain management in extremity trauma patients positioned supinely. Their implementation can lead to improved patient outcomes by alleviating pain severity, reducing opioid consumption, and cutting down healthcare costs. Further research and clinical integration of these techniques is imperative to enhance pain management protocols in trauma centers.
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Affiliation(s)
- Yuefeng Huaguo
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China
| | - Shuai Kang
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China
| | - Li Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China.
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China.
| | - Hongmei Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China.
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China.
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Lei G, Yang S, Wu L, Yin Y, Zhang S, Wang G. Intravenous injection of dexamethasone is non-inferior to perineural administration for popliteal sciatic nerve and saphenous nerve blocks: A randomized, controlled, triple-blind study. Heliyon 2024; 10:e28304. [PMID: 38571656 PMCID: PMC10988014 DOI: 10.1016/j.heliyon.2024.e28304] [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: 12/16/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Background The aim of this study was to assess whether intravenous dexamethasone was noninferior to perineural dexamethasone as an adjuvant to ropivacaine for a combination of saphenous and sciatic nerve blocks in patients undergoing foot and ankle surgery. Methods This was a prospective, blinded, randomized noninferiority study. Seventy-five patients, aged 18-75 years, with an American Society of Anesthesiologists (ASA) physical status I-III who underwent foot and ankle surgery were involved. Patients scheduled for ultrasound-guided popliteal sciatic nerve block and saphenous nerve block were randomized to receive 0.375% ropivacaine with 7.5 mg of dexamethasone perineurally (Dex-PN), 10 mg of dexamethasone intravenously (Dex-IV) or neither (Placebo). The primary outcome was the duration of analgesia. The major secondary outcomes were the composite pain intensity and opioid consumption score at 0-48 h intervals after anesthesia. Results The mean analgesic duration was 26.2 h in the Dex-IV group and 27.9 h in the Dex-PN group (duration difference, -1.7; 95% CI, -3.8 to 0.43; P = 0.117), and both durations were significantly longer than that in the placebo group (17.6 h, P < 0.001). Conditions for establishing non-inferiority were met. Conclusions Our findings indicate that a single 10-mg intravenous dose of dexamethasone was noninferior to the combined dose of ropivacaine plus deaxmethasone in terms of duration of analgesia for foot and ankle surgery.
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Affiliation(s)
- Guiyu Lei
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Siliu Yang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Department of Anesthesiology, Beijing Dongcheng Maternal and Child Health Care Hospital, Beijing, 100007, China
| | - Lili Wu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yue Yin
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Shu Zhang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Algyar MF, Abdelsamee KS. Laparoscopic assisted versus ultrasound guided transversus abdominis plane block in laparoscopic bariatric surgery: a randomized controlled trial. BMC Anesthesiol 2024; 24:133. [PMID: 38582852 PMCID: PMC10998407 DOI: 10.1186/s12871-024-02498-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 03/14/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Transversus abdominis plane block (TAPB) guided by laparoscopy and ultrasound showed promise in enhancing the multimodal analgesic approach following several abdominal procedures. This study aimed to compare the efficacy and safety between Laparoscopic (LAP) TAP block (LTAP) and ultrasound-guided TAP block (UTAP) block in patients undergoing LAP bariatric surgery. PATIENTS AND METHODS This non-inferiority randomized controlled single-blind study was conducted on 120 patients with obesity scheduled for LAP bariatric surgeries. Patients were allocated into two equal groups: LTAP and UTAP, administered with 20 mL of 0.25% bupivacaine on each side. RESULTS There was no statistically significant difference in the total morphine consumption, Visual Analogue Scale (VAS) score at all times of measurements, and time to the first rescue analgesia (p > .05) between both groups. The duration of anesthesia and duration of block performance were significantly shorter in the LTAP group than in the UTAP group (p < .001). Both groups had comparable post-operative heart rate, mean arterial pressure, adverse effects, and patient satisfaction. CONCLUSIONS In LAP bariatric surgery, the analgesic effect of LTAP is non-inferior to UTAP, as evidenced by comparable time to first rescue analgesia and total morphine consumption with similar safety blocking through the low incidence of post-operative complications and patient satisfaction. TRIAL REGISTRATION The study was registered in Pan African Clinical Trials Registry (PACTR) (ID: PACTR202206871825386) on June 29, 2022.
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Affiliation(s)
- Mohammad Fouad Algyar
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Kafr ElSheikh University, Kafr ElSheikh, 33516, Egypt.
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Çelik HK, Tulgar S, Bük ÖF, Koç K, Ünal M, Genç C, Süren M. Comparison of the analgesic efficacy of the ultrasound-guided transversalis fascia plane block and erector spinae plane block in patients undergoing open inguinal hernia repair under spinal anesthesia. Korean J Anesthesiol 2024; 77:255-264. [PMID: 38185619 PMCID: PMC10982532 DOI: 10.4097/kja.23404] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/30/2023] [Accepted: 01/07/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Open inguinal hernia repair (OIHR) surgery is a common surgical procedure, and ultrasound guided interfascial plane blocks can also be included in current approaches to postoperative multimodal analgesia regimens. This study aimed to compare the postoperative analgesic efficacy of the erector spinae plane block (ESPB) and transversalis fascia plane block (TFPB) in patients undergoing OIHR. METHODS This prospective, randomized, assessor-blinded comparative study was conducted in the postoperative recovery room and ward of a tertiary hospital. A total of 80 patients with American Society of Anesthesiologists physical status I-III were enrolled and allocated equally to either the ESPB or TFPB group. The patients received standard multimodal analgesia in addition to an ultrasound-guided ESPB or TFPB. During the first 24 h postoperatively, tramadol consumption was assessed and pain levels at rest and during movement were compared using numeric rating scale (NRS) scores at 1, 3, 6, 9, 12, 18, and 24 h postoperatively. RESULTS The results showed no difference in NRS scores at any time point between the groups, except for NRS at rest in the third hour. However, tramadol consumption was lower in the TFPB group than in the ESPB group overall (88 ± 75.2 vs. 131 ± 93.7 mg, respectively; P = 0.027, mean difference: -43, 95% CI [-80.82, -5.18]). CONCLUSIONS The TFPB leads to lower tramadol requirements in the first 24 h postoperatively than the ESPB in patients undergoing OIHR.
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Affiliation(s)
- Hale Kefeli Çelik
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ömer Faruk Bük
- Department of General Surgery, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Kadem Koç
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Murat Ünal
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Caner Genç
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Mustafa Süren
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
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Bello RJ, Palleiko BA, Kennedy K, Cournoyer L, Larkin AC, Dinh KH, LaFemina J. Interpectoral nerve blocks may lower postoperative narcotic use after mastectomy. Surg Oncol 2024; 53:102055. [PMID: 38394843 DOI: 10.1016/j.suronc.2024.102055] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/29/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Pain management following mastectomy is a significant challenge often requiring opioids. Nonopioid pain management utilizing nerve blocks has been shown in other fields to reduce postoperative opioid use and may be effective for postoperative pain in mastectomy patients. The primary purpose of this study was to compare postoperative opioid use, measured in morphine milligram equivalents (MME), between mastectomy patients who underwent interpectoral nerve block (IPNB) and a historical control group. Secondary outcomes included length of stay (LOS) and postoperative pain scores. METHODS This is a single-center, retrospective cohort study. The charts of women who underwent mastectomy for cancer without immediate reconstruction from 10/2017-12/2019 were reviewed. Wilcoxon rank sum test was used for unadjusted analysis and multiple linear regression for adjusted analysis. RESULTS There were 105 patients included in this study, of which 37 (35%) underwent IPNB. In unadjusted analysis, median MME use was significantly lower in patients that received IPNB compared to the control group (IPNB = 5, controls = 17, p = 0.03). Patients that received IPNB had an observed reduction in LOS and postoperative pain, though these results failed to reach statistical significance. There were no IPNB-related complications. CONCLUSIONS IPNB may be an effective strategy to decrease postoperative opioid use in mastectomy patients. Larger, prospective studies are needed to further investigate the effectiveness of IPNB.
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Affiliation(s)
- Ricardo J Bello
- UMass Chan Medical School, Department of Surgery, Worcester, MA, USA
| | | | - Kara Kennedy
- UMass Chan Medical School, Department of Surgery, Worcester, MA, USA
| | - Lauren Cournoyer
- UMass Chan Medical School, Department of Surgery, Worcester, MA, USA
| | - Anne C Larkin
- UMass Chan Medical School, Department of Surgery, Worcester, MA, USA
| | - Kate H Dinh
- UMass Chan Medical School, Department of Surgery, Worcester, MA, USA
| | - Jennifer LaFemina
- UMass Chan Medical School, Department of Surgery, Worcester, MA, USA
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Khosravi A, Azemati S, Gharaati G, Shirazi M, Dehghanpisheh L, Asmarian N. Efficacy of adjuvant dexmedetomidine on penile block for pediatric hypospadias repair. J Pediatr Urol 2024; 20:237.e1-237.e8. [PMID: 38040604 DOI: 10.1016/j.jpurol.2023.11.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION The management of postoperative pain, particularly in younger children, presents a challenge due to their limited ability to articulate the intensity of pain, lower pain threshold, and restricted availability of approved analgesics for pediatric use. Peripheral nerve blocks may be favored over neuraxial blocks because they allow quicker mobilization after surgery. OBJECTIVE The present study aims to investigate the potential impact of adding dexmedetomidine to a local anesthetic (bupivacaine) on the analgesic efficacy in dorsal penile nerve block in hypospadias repair surgery. METHOD In this prospective double-blinded clinical trial, 50 children aged between 6 months and 6 years old undergoing hypospadias repair surgery participated. Analgesia was administered through a dorsal penile nerve block (DPNB) at the end of surgery. Participants were divided into two groups; one received bupivacaine alone, and the other received dexmedetomidine and bupivacaine in DPNB. Pain and sedation levels were assessed with FLACC score and MOAA/S score, respectively, at 0,1,2 and 4 h after surgery. Vital signs and adverse effects were also recorded, including hemodynamic changes, nausea, and vomiting. RESULT There was no statistically significant difference in demographic variables. As illustrated in Figure, the median of FLACC score in group BD was significantly lower compared to group B at every measured time point. MOAA/S score was significantly lower in group BD than in group B (p < 0.001), indicating a higher sedation level. None of the participants in either group experienced any adverse effect except for vomiting, which was not statistically significant (8 % in group B vs. 4 % in group BD, p > 0.999). DISCUSSION Several studies have documented the supplementary analgesic properties of dexmedetomidine when used in conjunction with local anesthetic during various surgical procedures and nerve blocks. The present study provides evidence for the additional analgesic efficacy of dexmedetomidine and bupivacaine in the context of dorsal penile nerve block during hypospadias repair surgery while not yielding any significant adverse outcomes. Although the patients in our study were monitored for 4 h in the postanesthesia care unit (PACU), conducting a more comprehensive assessment of patients is advisable. CONCLUSION The findings of our study indicate that incorporating dexmedetomidine alongside bupivacaine in dorsal penile nerve block during hypospadias repair surgery may lead to enhanced management of postoperative pain. The lack of adverse effects implies it may be a potentially safe supplementary pain reliever for surgical procedures.
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Affiliation(s)
| | - Simin Azemati
- Anesthesiology and Critical Care Research Center, Department of Anesthesia, Shiraz University of Medical Sciences, Iran.
| | - Golnar Gharaati
- Anesthesiology and Critical Care Research Center, Department of Anesthesia, Shiraz University of Medical Sciences, Iran
| | - Mehdi Shirazi
- Histomorphometry and Stereology Research Center, Department of Urology Faghihi Hospital, Shiraz University of Medical Sciences, Iran
| | - Laleh Dehghanpisheh
- Anesthesiology and Critical Care Research Center, Department of Anesthesia, Shiraz University of Medical Sciences, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Iran
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12
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Choi W, Aizik G, Ostertag-Hill CA, Kohane DS. A hybrid nanoparticle-protein hydrogel system for prolonged local anesthesia. Biomaterials 2024; 306:122494. [PMID: 38316090 DOI: 10.1016/j.biomaterials.2024.122494] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Abstract
Local anesthetics are effective in relieving pain, but their duration of action is short. Therefore, the development of injectable sustained release systems to prolong the effect of local anesthetics has been of interest. In such systems delivering conventional local anesthetics, it has been challenging to achieve long durations of effect, particularly without incurring tissue toxicity. To overcome these challenges, we created a platform comprising a protein hydrogel incorporating hydrophobic local anesthetic (bupivacaine) nanoparticles. The nanoparticles were prepared by anti-solvent precipitation stabilized with bovine serum albumin (BSA), followed by crosslinking with glutaraldehyde (GA). The resulting BSA hydrogels prolonged release of bupivacaine in vitro. When bupivacaine nanoparticles within crosslinked BSA were injected at the sciatic nerve in rats, a duration of nerve block of 39.9 h was obtained, compared to 5.5 h for the commercial bupivacaine liposome suspension EXPAREL®. Tissue reaction was benign. We further demonstrated that this system could control the release of the amphiphilic drug diphenhydramine and the hydrophobic paclitaxel.
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Affiliation(s)
- Wonmin Choi
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, United States
| | - Gil Aizik
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, United States
| | - Claire A Ostertag-Hill
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, United States
| | - Daniel S Kohane
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, United States.
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Saldanha U, Aldwinkle R, Chen A, Raut S, Penta D, Valazquez YA, Sen S. Fascia iliaca catheters for donor site pain after split-thickness skin grafting for acute burn injury: a retrospective review. J Burn Care Res 2024:irae052. [PMID: 38512052 DOI: 10.1093/jbcr/irae052] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Indexed: 03/22/2024]
Abstract
The management of acute burn pain poses significant challenges. Regional techniques have become increasingly popular in perioperative burn pain management. Continuous nerve block catheters are particularly useful for split thickness skin grafts where donor site pain can exceed that of the burn-injured site. Donor skin is frequently harvested from the anterolateral thigh. The fascia iliaca (FI) compartment block provides blockade of both the lateral femoral cutaneous nerve and the femoral nerve and thus, it is a useful modality for burn donor pain. Our institution initiated a protocol in which continuous fascia iliaca catheters were placed in patients undergoing split-thickness skin grafting of the anterolateral thigh. This retrospective review seeks to assess the impact of this modality on post-operative pain scores and opioid requirements. Oral morphine equivalent administration was significantly lower in the FI group than the control group starting with POD 0, which is the day of the FI catheter insertion (188 vs 327mg, p<0.001). Over the next 4 postoperative days, OME administration remained lower in the FI group compared to control patients, although not statistically significant on POD 3-4. There was a significant difference in OME administered between the FI group and the control group on POD 5 (159.5 vs 209.2mg, p<0.05). Our retrospective study evaluating the role of fascia iliaca catheters in burn patients undergoing split thickness skin grafting surgery showed significantly lower opioid consumption on postoperative days 1-5 compared to patients without a fascia iliaca catheter.
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Affiliation(s)
- Usha Saldanha
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Robin Aldwinkle
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Amy Chen
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Snehal Raut
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Deepthi Penta
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, 4150 V Street Suite 1200 PSSB, Sacramento, CA 95817, United States of America
| | - Yakelin Arroyo Valazquez
- University of California, Davis School of Medicine, 4610 X Street Sacramento , CA 95817, United States of America
| | - Soman Sen
- Department of Surgery, University of California Medical Center, 2315 Stockton Blvd. Sacramento, CA 95817, United States of America
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Stenberg R, Septaric K, Simon EL. Ultrasound-guided erector spinae nerve block for relief of endometriosis pain in the emergency department. Am J Emerg Med 2024:S0735-6757(24)00110-4. [PMID: 38514357 DOI: 10.1016/j.ajem.2024.03.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/16/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024] Open
Abstract
Endometriosis is a debilitating chronic condition often accompanied by severe pelvic pain and infertility issues. When outpatient medical management is not adequate, controlling pain can be challenging for providers in the acute setting. We report the case of a 23-year-old female with a past medical history of endometriosis who presented to a freestanding emergency department with a chief complaint of 10/10 pelvic pain on a numeric rating scale. She had tried non-steroidal inflammatory medications and heat with no success. The patient had medication intolerances to opioid analgesics and was given ketorolac intramuscularly with no relief of her pain. The emergency physician discussed and offered to perform an erector spinae plane nerve block (ESPB) for pain relief. Ultrasonography was utilized for visualization of landmarks with a curvilinear transducer; a 20-gauge Pajunk® Sonoplex needle was used to inject a total of 100 mg bupivacaine 0.25% without epinephrine along with dexamethasone 10 mg under the bilateral erector spinae fascial planes at the T9 level. Post-procedure, the patient had significant improvement in pain and rated it a 2/10. Utilizing nerve blocks for endometriosis and other chronic pelvic pain in the acute care setting can serve as an effective alternative to opioids. In patients with multiple medication intolerances and for providers navigating pain control in the setting of a nationwide opioid crisis, ESPB blocks can help alleviate acute pain or exacerbations of chronic pain. This case demonstrates the first known use of an ESPB to relieve endometriosis pain in the emergency department.
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Affiliation(s)
- Robert Stenberg
- Department of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH 44272, USA
| | - Kristen Septaric
- Department of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH 44272, USA
| | - Erin L Simon
- Department of Emergency Medicine, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH 44272, USA.
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Amaral S, Lombardi R, Drabovski N, Gadsden J. Infraclavicular versus costoclavicular approaches to ultrasound-guided brachial plexus block: a systematic review and meta-analysis. Braz J Anesthesiol 2024; 74:744465. [PMID: 37748644 DOI: 10.1016/j.bjane.2023.09.004] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The costoclavicular approach to brachial plexus block may have a more favorable anatomy than the classic infraclavicular approach. However, there are conflicting results in the literature regarding the comparative effectiveness of these two techniques. METHODS We systematically searched for Randomized Controlled Trials (RCTs) comparing costoclavicular with infraclavicular brachial plexus blocks for upper extremity surgeries on MEDLINE, EMBASE, and Ovid. The outcomes of interest were sensory and motor block onset times, performance times, block failure, and complication rate. We performed statistical analyses using RevMan 5.4 and assessed heterogeneity using the Cochran Q test and I2 statistics. We appraised the risk of bias according to Cochrane's Risk of Bias 2 tool. RESULTS We included 5 RCTs and 374 patients, of whom 189 (50.5%) were randomized to undergo costoclavicular block. We found no statistically significant differences between the two techniques regarding sensory block onset time in minutes (Mean Difference [MD = -0.39 min]; 95% CI -2.46 to 1.68 min; p = 0.71); motor block onset time in minutes (MD = -0.34 min; 95% CI -0.90 to 0.22 min; p = 0.23); performance time in minutes (MD = -0.12 min; 95% CI -0.89 to 0.64 min; p = 0.75); incidence of block failure (RR = 1.59; 95% CI 0.63 to 3.39; p = 0.63); and incidence of complications (RR = 0.60; 95% CI 0.20 to 1.84; p = 0.37). CONCLUSION This meta-analysis suggests that the CCV block may exhibit similar sensory and motor onset times when compared to the classic ICV approach in adults undergoing distal upper extremity surgery, with comparable rates of block failure and complications.
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Affiliation(s)
- Sara Amaral
- Hospital Regional de Araranguá, Departamento de Anestesiologia, Araranguá, SC, Brazil.
| | - Rafael Lombardi
- University of Nebraska Medical Center, Department of Anesthesiology, Omaha, USA
| | | | - Jeff Gadsden
- Duke University, Department of Anesthesiology, Durham, North Carolina, USA
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Hu J, Li X, Wang Q, Yang J. Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial. Braz J Anesthesiol 2024; 74:744461. [PMID: 37657517 DOI: 10.1016/j.bjane.2023.08.005] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE This trial aimed to identify the Minimum Effective Concentration (MEC90, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). METHODS A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC90, MEC95 and MEC99 were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method. RESULTS Based on the analysis of 52 patients, MEC90, MEC95, and MEC99 of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334-0.372%), 0.363% (95% CI 0.351-0.383%), and 0.373% (95% CI 0.363-0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients. CONCLUSIONS For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.
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Affiliation(s)
- Jian Hu
- Sichuan University, West China Hospital, Department of Anesthesiology, Chengdu, China
| | - Xingcheng Li
- Sichuan University, West China School of Nursing, West China Tianfu Hospital, Department of Urology, Chengdu, China
| | - Qiuru Wang
- Sichuan University, West China Hospital, Department of Orthopedic Surgery, Chengdu, China
| | - Jing Yang
- Sichuan University, West China Hospital, Department of Anesthesiology, Chengdu, China.
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Pires MR, Rodrigues DS, Segura-Grau E. Anaesthetic peripheral nerve blocks for a total knee replacement revision due to infection in a patient with symptomatic chronic coronary syndrome: A case report. J Perioper Pract 2024; 34:75-77. [PMID: 36946239 DOI: 10.1177/17504589231159196] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
This report aims to describe the perioperative management of a high-risk cardiovascular patient proposed for urgent total knee replacement revision. We discuss the use of peripheral nerve blocks and its impact on haemodynamic stability and clinical outcomes, including major cardiovascular adverse events and myocardial injury after non-cardiac surgery.
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Affiliation(s)
- Marta R Pires
- Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal
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Wang Y, Zhu B, Kong L, Wang J, Gao B, Wang J, Tian D, Yao Y. BPSegSys: A Brachial Plexus Nerve Trunk Segmentation System Using Deep Learning. Ultrasound Med Biol 2024; 50:374-383. [PMID: 38176984 DOI: 10.1016/j.ultrasmedbio.2023.11.009] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Ultrasound-guided nerve block anesthesia (UGNB) is a high-tech visual nerve block anesthesia method that can be used to observe the target nerve and its surrounding structures, the puncture needle's advancement and local anesthetics spread in real time. The key in UGNB is nerve identification. With the help of deep learning methods, the automatic identification or segmentation of nerves can be realized, assisting doctors in completing nerve block anesthesia accurately and efficiently. METHODS We established a public data set containing 320 ultrasound images of brachial plexus (BP). Three experienced doctors jointly produced the BP segmentation ground truth and labeled brachial plexus trunks. We designed a brachial plexus segmentation system (BPSegSys) based on deep learning. RESULTS BPSegSys achieves experienced-doctor-level nerve identification performance in various experiments. We evaluated BPSegSys performance in terms of intersection-over-union (IoU). Considering three data set groups in our established public data set, the IoUs of BPSegSys were 0.5350, 0.4763 and 0.5043, respectively, which exceed the IoUs 0.5205, 0.4704 and 0.4979 of experienced doctors. In addition, we determined that BPSegSys can help doctors identify brachial plexus trunks more accurately, with IoU improvement up to 27%, which has significant clinical application value. CONCLUSION We establish a data set for brachial plexus trunk identification and designed a BPSegSys to identify the brachial plexus trunks. BPSegSys achieves the doctor-level identification of the brachial plexus trunks and improves the accuracy and efficiency of doctors' identification of the brachial plexus trunks.
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Affiliation(s)
- Yu Wang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Binbin Zhu
- Department of Anesthesiology, Affiliated Hospital of Medical School of Ningbo University, Ningbo University, China
| | - Lingsi Kong
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, China
| | - Jianlin Wang
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, China
| | - Bin Gao
- Department of Anesthesiology, Affiliated Hospital of Medical School of Ningbo University, Ningbo University, China
| | - Jianhua Wang
- Department of Anesthesiology, Affiliated Hospital of Medical School of Ningbo University, Ningbo University, China
| | - Dingcheng Tian
- Research Institute for Medical and Biological Engineering, Ningbo University, Ningbo, China
| | - Yudong Yao
- Department of Electrical and Computer Engineering, Stevens Institute of Technology, Hoboken, NJ, USA.
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Li S, Wang Y, Zhang Y, Zhang H, Wang S, Ma K, Jiang L, Mao Y. Effect of ultrasound-guided transversus abdominis plane block in reducing atelectasis after laparoscopic surgery in children: A randomized clinical trial. Heliyon 2024; 10:e26594. [PMID: 38420373 PMCID: PMC10901023 DOI: 10.1016/j.heliyon.2024.e26594] [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: 07/04/2023] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
Background Atelectasis is a commonly observed postoperative complication of general anesthesia in children. Pulmonary protective ventilation strategies have been reported to have a beneficial effect on postoperative atelectasis in children. Therefore, the present study aimed to evaluate the efficacy of the ultrasound-guided transversus abdominis plane (TAP) block technique in preventing the incidence of postoperative atelectasis in children. Materials and methods This study enrolled 100 consecutive children undergoing elective laparoscopic bilateral hernia repair and randomly divided them into the control and TAP groups. Conventional lung-protective ventilation was initiated in both groups after the induction of general anesthesia. The children in the TAP group received an ultrasound-guided TAP block with 0.3 mL/kg of 0.5% ropivacaine after the induction of anesthesia. Results Anesthesia-induced atelectasis was observed in 24% and 84% of patients in the TAP (n = 50) and control (n = 50) groups, respectively, before discharge from the post-anesthetic care unit (T3; PACU) (odds ratio [OR], 0.062; 95% confidence interval [CI], 0.019-0.179; P < 0.001). No significant difference was observed between the control and TAP groups in terms of the lung ultrasonography (LUS) scores 5 min after endotracheal intubation (T1). However, the LUS scores were lower in the TAP group than those in the control group at the end of surgery (T2, P < 0.01) and before discharge from the PACU (T3, P < 0.001). Moreover, the ace, legs, activity, cry and consolability (FLACC) pain scores in the TAP group were lower than those in the control group at each postoperative time point. Conclusion Ultrasound-guided TAP block effectively reduced the incidence of postoperative atelectasis and alleviated pain in children undergoing laparoscopic surgery.
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Affiliation(s)
- Siyuan Li
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Yan Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Yunqian Zhang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Hui Zhang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Shenghua Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Ke Ma
- Department of Pain Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Lai Jiang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Yanfei Mao
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
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El-Sherif MW, Nazih MA. A novel extraoral ultrasound-guided approach for mandibular nerve block in Rahmani sheep. BMC Vet Res 2024; 20:74. [PMID: 38402395 PMCID: PMC10893670 DOI: 10.1186/s12917-024-03924-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Regional anesthesia is the favored choice in ruminant animals compared to general anesthesia, primarily due to its high safety margin and reduced demand for cost-intensive equipment in addition to its field applicability. Ultrasound-guided nerve block has gained significant attention in the field of veterinary medicine. This study utilized twenty-seven sheep of the native Rahmani breed to both demonstrate and evaluate the effectiveness of the ultrasound guided inferior alveolar nerve block technique. METHODS The research comprised three phases: Phase 1 involved an anatomical examination of mandibles and sheep heads to locate the mandibular foramen and delineate the mandibular nerve course. Phase 2 included ultrasound-guided injection of methylene blue dye at specific sites along the mandibular nerve in cadaveric sheep heads. In Phase 3, clinical implementation of ultrasound-guided inferior alveolar nerve blocks was conducted in 27 live sheep, assessing efficacy, onset, and duration. RESULTS Vertical extraoral ultrasound-guided nerve block was achieved successfully in 25 sheep (98%). A preliminary cadaveric study showed good distribution of the injectate at the mandibular nerve site. The mean onset time was 138 ± 18 s, and the mean duration time was 54 ± 4.1 min. Prominent analgesia of the ipsilateral mandible, medial surface of the cheek, and lateral border of the tongue was observed. CONCLUSIONS Ultrasound-guided mandibular nerve block holds promise as a technique for providing effective and safe anesthesia in sheep undergoing mandibular procedures.
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Affiliation(s)
- Mohamed Wefky El-Sherif
- Department of Surgery, Faculty of Veterinary Medicine, New Valley University, El Kharga, 72511, New Valley, Egypt.
| | - Mohamed Ahmed Nazih
- Department of Anatomy, Faculty of Veterinary Medicine, New Valley University, El Kharga, 72511, New Valley, Egypt
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Marzok M, Nazih MA, Almubarak AI, Al Mohamad Z, Emam IA, El-Sherif MW. Introducing a novel intraoral mandibular nerve block technique for loco-regional analgesia in camels (Camelus dromedarius): a cadaveric study using computed tomography. BMC Vet Res 2024; 20:42. [PMID: 38308261 PMCID: PMC10837923 DOI: 10.1186/s12917-024-03885-4] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/17/2024] [Indexed: 02/04/2024] Open
Abstract
The aim of this study was to introduce a novel intraoral technique for performing mandibular nerve blocks in dromedary camels (Camelus dromedarius). In this study, 18 adult camel skulls of varying ages and breeds were examined to determine the position of the mandibular foramen. Using a Vernier caliper, three dimensions in millimeters were measured: (1) the distance between the mandibular foramen (MF) and the caudal edge of the third molar tooth at the occlusal surface level, (2) the distance between the MF and the rostral edge border of the mandible's ramus (RER) at the occlusal surface level, and (3) the distance between the MF and the ventral margin border of the mandible (VM). The technique was evaluated using five intact camel cadaver heads (n = 5), and a total of ten mandibular nerve blocks were described. An 18-gauge 80-mm Tuohy needle was inserted into the mouth commissure and advanced caudally while injecting a saline-methylene blue solution. The accuracy of the injection was confirmed through the infiltration of the contrast dye into the target area using computed tomography (CT) and post procedural dissection. Anatomical study of the mandibular nerve site was performed to aid the blind insertion of the needle. The findings contribute to the development of veterinary anesthesia techniques and provide anatomical considerations for clinicians performing oral surgeries in sedated camels. The results demonstrated the successful implementation of the intraoral technique, highlighting its efficacy and reliability in achieving local anesthesia for oral surgeries involving the lower jaw and teeth in sedated camels. Further research studies are needed to evaluate the long-term efficacy and safety of the technique and to compare it with existing approaches.
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Affiliation(s)
- Mohamed Marzok
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
- Department of Surgery, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
| | - Mohamed A Nazih
- Department of Anatomy, Faculty of Veterinary Medicine, New Valley University, Elkharga, New Valley, 72511, Egypt
| | - Adel I Almubarak
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Zakriya Al Mohamad
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Ibrahim A Emam
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Mohamed W El-Sherif
- Department of Surgery, Faculty of Veterinary Medicine, New Valley University, Elkharga, New Valley, 72511, Egypt
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22
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Ju H, Shen K, Li J, Feng Y. Total postoperative opioid dose is an independent risk factor for prolonged postoperative ileus after laparoscopic colorectal surgery: a case-control study. Korean J Anesthesiol 2024; 77:133-138. [PMID: 37096402 PMCID: PMC10834719 DOI: 10.4097/kja.22792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/20/2023] [Accepted: 04/24/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Prolonged postoperative ileus (PPOI) is a major complication of colorectal surgery. Increased opioid consumption has been proposed to increase the risk of PPOI. This study aimed to test the hypothesis that an increased total postoperative opioid dose (TPOD) is associated with the increased incidence of PPOI. METHODS For this matched case-control study, patients who underwent elective laparoscopic colorectal procedures at the Peking University People's Hospital between January 2018 and June 2020 were retrospectively reviewed. Patients with PPOI were assigned to the ileus group, while patients without PPOI (control group) were matched at a 1:1 ratio to the ileus group according to age, American Society of Anesthesiologists physical status score, and type of surgical procedure. The primary outcome was the TPOD between the ileus and control groups. The secondary outcome was risk factors of PPOI. RESULTS A total of 267 participants were included in the final analysis. No differences in baseline or operative factors were found between the two groups. The TPOD, intravenous sufentanil dose on postoperative day 1 (POD1), and the use of patient-controlled analgesia with basal infusion were associated with PPOI (P < 0.05). Multivariate logistic regression analysis revealed that an increased TPOD was an independent risk factor for developing PPOI after laparoscopic colorectal procedures (Odd ratio: 1.67, 95% CI [1.03, 2.71], P = 0.04). CONCLUSIONS The TPOD is an independent risk factor for PPOI after laparoscopic colorectal surgery. We need to explore new strategies of postoperative analgesia to reduce the dosage of TPOD.
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Affiliation(s)
- Hui Ju
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Kai Shen
- Department of Gastroenterologic Surgery, Peking University People’s Hospital, Beijing, China
| | - Jiaxin Li
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
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23
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Duarte MC, Brewer CF, Miranda BH. Nerve block efficacy in breast augmentation: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 89:75-85. [PMID: 38160590 DOI: 10.1016/j.bjps.2023.08.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 01/03/2024]
Abstract
Breast augmentation is often performed as a day-case general anaesthetic operation, with postoperative, opioid-based analgesia regimens. However, it may also be performed using regional anaesthesia; a variety of nerve block techniques are available to reduce postoperative pain and analgesic requirements. This systematic review and meta-analysis were undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines comparing breast augmentation using regional anaesthesia with general anaesthesia, versus general anaesthesia alone or with local field infiltration. All randomised or quasi-randomised studies that recruited adult female patients undergoing breast augmentation using regional anaesthesia were considered. The primary outcome measures were postoperative pain and analgesic requirements. A randomised effects model was used, with standardised mean difference or mean difference outcomes used as appropriate. Thirteen studies were included for systematic review, out of which eight met the inclusion criteria for meta-analysis. Nerve blocks had statistically significant standardised mean difference reductions in postoperative pain scores across all time points: 0 h (-1.2 [-2.1 to -0.3], p = 0.01, I2 = 85%), 1 h (-1.3 [-2.1 to -0.5], p = 0.002, I2 = 89%), 2 h (-1.8 [-2.8 to -0.9], p = 0.0002, I2 = 88%), 4-6 h (-1.2 [-2.1 to -0.4], p = 0.006, I2 = 89%), 24 h (-1.4 [-2.5 to -0.2], p = 0.02, I2 = 94%). There was also a statistically significant reduction in postoperative opioid requirements: -150 mcg fentanyl (-259.2 to -40.9), p = 0.007. Although an element of study heterogeneity is noted, this systematic review and meta-analysis support the concept that regional anaesthesia using nerve blocks in breast augmentation surgery, reduces both postoperative pain and opioid requirements, compared with general anaesthesia.
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Affiliation(s)
- M Correia Duarte
- St Andrew's Centre for Plastic Surgery & Burns, Mid and South Essex NHS Foundation Trust, Broomfield Hospital, Chelmsford CM1 7ET, United Kingdom
| | - C F Brewer
- Department of Plastic Surgery, Cambridge University NHS Trust, Cambridge CB2 0QQ, United Kingdom
| | - B H Miranda
- St Andrew's Centre for Plastic Surgery & Burns, Mid and South Essex NHS Foundation Trust, Broomfield Hospital, Chelmsford CM1 7ET, United Kingdom; St Andrew's Anglia Ruskin Research (StAAR) Group, Faculty of Health Medicine & Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom.
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24
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Cho Y, Park SJ, Lee HN, Lee S, Lee WH, Kim SS, Heo NH. Ultrasound-guided genitofemoral nerve block for femoral arterial access gain and closure: a randomized controlled trial. Eur Radiol 2024; 34:1123-1131. [PMID: 37597030 DOI: 10.1007/s00330-023-10148-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES This study aimed to compare the analgesic efficacy and safety of the femoral branch block of the genitofemoral nerve (FBB) versus local infiltration anesthesia (LIA) for femoral arterial access gain and closure. METHODS Eighty-two patients (age, 64.8 ± 10.9 years; female, 30.5%) undergoing endovascular procedures using 5-Fr femoral sheath were assigned to either FBB (n = 41) or LIA (n = 41). In both groups, 2% lidocaine HCL with 1:100,000 epinephrine was used as an anesthetic solution. Pain scores during access gain and closure were evaluated using a visual analog scale (score 0-10), patient satisfaction levels with the quality of anesthesia were scored on a 7-point Likert scale, and adverse events were recorded. RESULTS The primary endpoint, pain scores during access closure, was significantly lower in the FBB group than in the LIA group (0.1 ± 0.37 vs 1.73 ± 0.92; p < 0.001). The FBB group also had significantly lower pain scores during access gain compared to the LIA group (0.83 ± 0.83 vs 2.78 ± 1.26; p < 0.001). There was an inverse relationship between pain scores and FBB after adjustment for age, gender, and body mass index (p < 0.001). FBB group reported significantly higher satisfaction with anesthesia quality compared to the LIA group (6.49 ± 0.64 vs 4.05 ± 1.05; p < 0.001). No complications were recognized in either group. CONCLUSIONS Ultrasound-guided genitofemoral nerve blocks offered better acute pain relief and higher patient satisfaction than LIA during femoral arterial access gain and closure. CLINICAL RELEVANCE STATEMENT In this prospective randomized controlled trial, ultrasound-guided genitofemoral nerve blocks offered better acute pain relief than local infiltration anesthesia, resulting in enhanced patient satisfaction. KEY POINTS • FBB provided better pain relief during access gain and closure than LIA. • FBB offered higher patient satisfaction with the quality of anesthesia than LIA. • No anesthesia-related or access site complications were recognized in either treatment group.
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Affiliation(s)
- Youngjong Cho
- Department of Radiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Sung-Joon Park
- Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
| | - Sangjoon Lee
- Vascular Center, The Eutteum Orthopedic Surgery Hospital, Paju, Korea
| | - Woong Hee Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Seung Soo Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
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25
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Jo Y, Oh C, Lee WY, Chung HJ, Park H, Park J, Lee J, Kim YH, Ko Y, Chung W, Hong B. Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial. Korean J Anesthesiol 2024; 77:85-94. [PMID: 37679899 PMCID: PMC10834710 DOI: 10.4097/kja.23260] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Among the various diaphragm-sparing alternatives to interscalene block, costoclavicular block (CCB) demonstrated a low hemidiaphragmatic paresis (HDP) occurrence but an inconsistent analgesic effect in arthroscopic shoulder surgery. We hypothesized that a larger volume of local anesthetic for CCB could provide sufficient analgesia by achieving sufficient supraclavicular spreading. METHODS Sixty patients scheduled for arthroscopic rotator cuff repair were randomly assigned to receive CCB using one of two volumes of local anesthetic (CCB20, 0.75% ropivacaine 20 ml; CCB40, 0.375% ropivacaine 40 ml). The primary outcome was the rate of complete analgesia (0 on the numeric rating scale of pain) at 1 h postoperatively. The secondary outcomes included a sonographic assessment of local anesthetic spread, diaphragmatic function, pulmonary function, postoperative opioid use, and other pain-related experiences within 24 h postoperatively. RESULTS The rates of complete analgesia were not significantly different (23.3% [7/30] and 33.3% [10/30] in the CCB20 and CCB40 groups, respectively; risk difference 10%, 95% CI [-13, 32], P = 0.567). There were no significant differences in other pain-related outcomes. Among the clinical factors considered, the only factor significantly associated with postoperative pain was the sonographic observation of supraclavicular spreading. There were no significant differences in the incidence of HDP and the change in pulmonary function between the two groups. CONCLUSIONS Using 40 ml of local anesthetic does not guarantee supraclavicular spread during CCB. Moreover, it does not result in a higher rate of complete analgesia compared to using 20 ml of local anesthetic in arthroscopic shoulder surgery.
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Affiliation(s)
- Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Woo-Yong Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyung-Jin Chung
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hanmi Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Juyeon Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jieun Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
| | - Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
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26
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Keleş BO, Salman N, Yılmaz ET, Birinci HR, Apan A, İnce S, Özyaşar AF, Uz A. Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study. Korean J Anesthesiol 2024; 77:156-163. [PMID: 37964515 PMCID: PMC10834713 DOI: 10.4097/kja.23604] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB. METHODS Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution. RESULTS CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels. CONCLUSIONS Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.
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Affiliation(s)
- Bilge Olgun Keleş
- Department of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Necati Salman
- Department of Anatomy, University of Health Sciences Türkiye, Gülhane Faculty of Medicine, Ankara, Turkey
| | - Elvan Tekir Yılmaz
- Department of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Habip Resul Birinci
- Department of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Alparslan Apan
- Department of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Selami İnce
- Department of Radiology, Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - Ali Faruk Özyaşar
- Department of Anatomy, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Aysun Uz
- Department of Anatomy, Ankara University Faculty of Medicine, Ankara, Turkey
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27
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Hameed M, Samad K. Response to letter to the editor on "Continuous paravertebral block combined with multilevel single-shot intercostal nerve blocks for pain control after thoracotomy". J Anesth 2024; 38:152-153. [PMID: 38212408 DOI: 10.1007/s00540-023-03308-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Malika Hameed
- Department of Anesthesiology, Aga Khan University, 2nd floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Khalid Samad
- Department of Anesthesiology, Aga Khan University, 2nd floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
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28
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Quaye A, McAllister B, Garcia JR, Nohr O, Laduzenski SJ, Mack L, Kerr CR, Kerr DA, Razafindralay CN, Richard JM, Craig WY, Rodrigue S. A prospective, randomized trial of liposomal bupivacaine compared to conventional bupivacaine on pain control and postoperative opioid use in adults receiving adductor canal blocks for total knee arthroplasty. Arthroplasty 2024; 6:6. [PMID: 38297390 PMCID: PMC10832097 DOI: 10.1186/s42836-023-00226-y] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a commonly performed procedure to alleviate pain and improve functional limitations caused by end-stage joint damage. Effective management of postoperative pain following TKA is crucial to the prevention of complications and enhancement of recovery. Adductor canal blocks (ACB) with conventional bupivacaine (CB) provide adequate analgesia after TKA, but carry a risk of rebound pain following block resolution. Liposomal bupivacaine (LB) is an extended-release local anesthetic that can provide up to 72 h of pain relief. The objective of this study was to compare postoperative outcomes between ACBs using LB and CB after TKA. METHODS This single institution, prospective, randomized, clinical trial enrolled patients scheduled for TKA. Participants were randomized to receive ACB with either LB or CB. Pain scores up to 72 h postoperatively were assessed as the primary outcome. Opioid consumption and length of stay were evaluated as secondary outcomes. RESULTS A total of 80 patients were enrolled. Demographic and clinical characteristics were similar between the two groups. LB group showed significantly lower cumulative opioid use during the 72 h evaluated (P = 0.016). There were no differences in pain scores or length of stay between the groups. CONCLUSION The study demonstrated that LB ACBs led to significantly lower opioid consumption in the days following TKA without affecting pain scores or length of stay. This finding has important implications for improving postoperative outcomes and reducing opioid use in TKA patients. Previous studies have reported inconsistent results regarding the benefits of LB, highlighting the need for further research. TRIAL REGISTRATION This project was retrospectively registered with clinicaltrials.gov ( NCT05635916 ) on 2 December 2022.
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Affiliation(s)
- Aurora Quaye
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA.
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA.
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA.
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA.
| | - Brian McAllister
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
| | - Joseph R Garcia
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Orion Nohr
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Sarah J Laduzenski
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
| | - Lucy Mack
- Department of Anesthesiology, Northern Light Mercy Hospital, 175 Fore River Parkway, Portland, ME, 04102, USA
- Division of Anesthesiology, Spectrum Healthcare Partners, 324 Gannett Drive, Suite 200, South Portland, ME, 04106, USA
| | - Christine R Kerr
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Danielle A Kerr
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Charonne N Razafindralay
- University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME, 04005, USA
| | - Janelle M Richard
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Wendy Y Craig
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
- Maine Health Institute for Research, 81 Research Dr, Scarborough, ME, 04074, USA
| | - Stephen Rodrigue
- Northern Light Mercy Orthopedics, 20 Northbrook Dr, Falmouth, ME, 04105, USA
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Affiliation(s)
- Suhrith Bhattaram
- Emergency Medicine, Dr DY Patil Medical College, Dr DY Patil Vidyapeeth, Pune., India.
| | - Varsha S Shinde
- Emergency Medicine, Dr DY Patil Medical College, Dr DY Patil Vidyapeeth, Pune., India.
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Fabry A, Nedunchelian M, Stacoffe N, Guinebert S, Zipfel J, Krainik A, Maindet C, Kastler B, Grand S, Kastler A. Review of craniofacial pain syndromes involving the greater occipital nerve: relevant anatomy, clinical findings, and interventional management. Neuroradiology 2024; 66:161-178. [PMID: 38159141 DOI: 10.1007/s00234-023-03273-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
Craniofacial pain syndromes exhibit a high prevalence in the general population, with a subset of patients developing chronic pain that significantly impacts their quality of life and results in substantial disabilities. Anatomical and functional assessments of the greater occipital nerve (GON) have unveiled its implication in numerous craniofacial pain syndromes, notably through the trigeminal-cervical convergence complex. The pathophysiological involvement of the greater occipital nerve in craniofacial pain syndromes, coupled with its accessibility, designates it as the primary target for various interventional procedures in managing craniofacial pain syndromes. This educational review aims to describe multiple craniofacial pain syndromes, elucidate the role of GON in their pathophysiology, detail the relevant anatomy of the greater occipital nerve (including specific intervention sites), highlight the role of imaging in diagnosing craniofacial pain syndromes, and discuss various interventional procedures such as nerve infiltration, ablation, neuromodulation techniques, and surgeries. Imaging is essential in managing these patients, whether for diagnostic or therapeutic purposes. The utilization of image guidance has demonstrated an enhancement in reproducibility, as well as technical and clinical outcomes of interventional procedures. Studies have shown that interventional management of craniofacial pain is effective in treating occipital neuralgia, cervicogenic headaches, cluster headaches, trigeminal neuralgia, and chronic migraines, with a reported efficacy of 60-90% over a duration of 1-9 months. Repeated infiltrations, neuromodulation, or ablation may prove effective in selected cases. Therefore, reassessment of treatment response and efficacy during follow-up is imperative to guide further management and explore alternative treatment options. Optimal utilization of imaging, interventional techniques, and a multidisciplinary team, including radiologists, will ensure maximum benefit for these patients.
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Affiliation(s)
- Alienor Fabry
- Neuroradiology Unit, University Hospital, Grenoble, France
| | | | | | | | | | | | | | - Bruno Kastler
- Radiology Unit, Necker University Hospital, Paris, France
| | - Sylvie Grand
- Neuroradiology Unit, University Hospital, Grenoble, France
| | - Adrian Kastler
- Neuroradiology Unit, University Hospital, Grenoble, France.
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31
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Xin L, Wang L, Feng Y. Efficacy of ultrasound-guided erector spinae plane block on analgesia and quality of recovery after minimally invasive direct coronary artery bypass surgery: protocol for a randomized controlled trial. Trials 2024; 25:65. [PMID: 38243276 PMCID: PMC10797856 DOI: 10.1186/s13063-024-07925-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Minimally invasive direct coronary artery bypass (MIDCAB) surgery offers an effective option for coronary artery disease (CAD) patients with the avoidance of median sternotomy and fast postoperative recovery. However, MIDCAB is still associated with significant postoperative pain which may lead to delayed recovery. The erector spinae plane block (ESPB) is a superficial fascial plane block. There have not been randomized controlled trials evaluating the effects of ESPB on analgesia and patient recovery following MIDCAB surgery. We therefore designed a double-blind prospective randomized placebo-controlled trial, aiming to prove the hypothesis that ESPB reduces postoperative pain scores in patients undergoing MIDCAB surgery. METHODS The study protocol has been reviewed and approved by the Ethical Review Committee of Peking University People's Hospital. Sixty adult patients of either sex scheduled for MIDCAB surgery under general anesthesia (GA) will be included. Patients will be randomly allocated to receive either a preoperative single-shot ESPB with 30 mL of ropivacaine 0.5% (ESPB group) or normal saline 0.9% (control group). The primary outcomes are the difference between the two groups in numeric rating scale (NRS) scores at rest at different time points (6, 12, 18, 24, 48 h) after surgery. The secondary outcomes include NRS scores on deep inspiration within 48 h, postoperative hydromorphone consumption, and quality of patient recovery at 24 h and 48 h, using the Quality of Recovery-15 (QoR-15) scale. The other outcomes include intraoperative fentanyl requirements, the need for additional postoperative rescue analgesics, time to tracheal extubation and chest tube removal after surgery, incidence of postoperative nausea and vomiting (PONV) and postoperative cognitive dysfunction (POCD), intensive care unit (ICU) length of stay (LOS), hospital discharge time, and 30-day mortality. Adverse events will be also evaluated. DISCUSSION This is a novel randomized controlled study evaluating a preoperative ultrasound-guided single-shot unilateral ESPB on analgesia and quality of patient recovery in MIDCAB surgery. The results of this study will characterize the degree of acute postoperative pain and clinical outcomes following MIDCAB. Our study may help optimizing analgesia regimen selection and improving patient comfort in this specific population. TRIAL REGISTRATION The study was prospectively registered with the Chinese Clinical Trial Registry (trial identifier: ChiCTR2100052810). Date of registration: November 5, 2021.
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Affiliation(s)
- Ling Xin
- Department of Anesthesiology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, China.
| | - Lu Wang
- Department of Anesthesiology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, China
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Yu L, Shen XJ, Liu H, Zhou YT, Zhang Q, Zhang ZD, Shen SM. Effect of ultrasound-guided continuous erector spinae plane block on postoperative pain and inflammatory response in patients undergoing modified radical mastectomy for breast cancer: study protocol for a randomised controlled trial. Trials 2024; 25:51. [PMID: 38225606 PMCID: PMC10788999 DOI: 10.1186/s13063-023-07777-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/06/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND A single injection of local anaesthetic (LA) in the erector spinae plane block (ESPB) can reduce pain after modified radical mastectomy (MRM) surgery, but the duration of analgesia is affected by the duration of the LA. The aim of this study is to investigate the effect of continuous ESPB on acute and chronic pain and inflammatory response after MRM surgery. METHODS In this prospective, randomised, controlled trial, we will recruit 160 patients, aged 18-80 years, scheduled for elective MRM surgery under general anaesthesia. They will be randomly assigned to two groups: a continuous ESPB group (group E) and a sham block group (group C). Both groups of patients will have a nerve block (group C pretended to puncture) and an indwelling catheter fixed prior to surgery. Electronic pumps containing LA are shielded. The primary outcome is the total consumption of analgesic agents. The secondary outcomes include the levels of inflammation-related cytokines; the occurrence of chronic pain (post-mastectomy pain syndrome, PMPS); static and dynamic pain scores at 2, 6, 12, 24 and 48 h postoperatively; and post-operative and post-puncture adverse reactions. DISCUSSION Analgesia after MRM surgery is important and chronic pain can develop when acute pain is prolonged, but the analgesic effect of a nerve block with a single injection of LA is limited by the duration of drug action. The aim of this trial is to investigate whether continuous ESPB can reduce acute pain after MRM surgery and reduce the incidence of chronic pain (PMPS), with fewer postoperative analgesic drug-related complications and less inflammatory response. Continuous ESPB and up to 12 months of follow-up are two innovations of this trial. TRIAL REGISTRATION Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ) ChiCTR2200061935. Registered on 11 July 2022. This trial is a prospective registry with the following registry names: Effect of ultrasound-guided continuous erector spinae plane block on postoperative pain and inflammatory response in patients undergoing modified radical mastectomy for breast cancer.
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Affiliation(s)
- Liang Yu
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Xiao-Juan Shen
- Department of 706A Ward Nursing, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China.
| | - He Liu
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Yu-Ting Zhou
- Department of Breast Surgery, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Qin Zhang
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Zhen-Duo Zhang
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Shu-Min Shen
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
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Yoon JP, Son HS, Lee J, Byeon GJ. Multimodal management strategies for chronic pain after spinal surgery: a comprehensive review. Anesth Pain Med (Seoul) 2024; 19:12-23. [PMID: 38311351 PMCID: PMC10847004 DOI: 10.17085/apm.23122] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024] Open
Abstract
"Chronic pain after spinal surgery" (CPSS) is a nonspecific term for cases in which the end result of surgery generally does not meet the preoperative expectations of the patient and surgeon. This term has replaced the previous term i.e., failed back surgery syndrome. CPSS is challenging for both patients and doctors. Despite advancements in surgical techniques and technologies, a subset of patients continue to experience persistent or recurrent pain postoperatively. This review provides an overview of the multimodal management for CPSS, ranging from conservative management to revision surgery. Drawing on recent research and clinical experience, we aimed to offer insights into the diverse strategies available to improve the quality of life of CPSS patients.
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Affiliation(s)
- Jung-Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hong-Sik Son
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jimin Lee
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Hu X, Wang M, He X, Chen P, Jia F, Wang D, Yang S. Division of neuromuscular compartments and localization of the center of the intramuscular nerve-dense region in pelvic wall muscles based on Sihler's staining. Anat Sci Int 2024; 99:127-137. [PMID: 37768515 PMCID: PMC10771363 DOI: 10.1007/s12565-023-00744-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
The innervation of the pelvic wall muscles is not very clear. This study aimed to reveal the division of neuromuscular compartments and localize the surface position and depth of the center of the intramuscular nerve-dense region (CINDR) of the pelvic wall muscles based on Sihler's staining. Twenty-four adult cadavers were used. To localize the CINDR of the pelvic wall muscles, horizontal (H) and longitudinal (L) reference lines were drawn, and Sihler's staining was used to reveal the intramuscular nerve distribution. The CINDR projection points (P and P' points) behind and in front of the body surface, the positions of the P points projected onto the H and L lines (PH and PL points), and the depth of CINDR were determined by spiral computed tomography scanning. The piriformis and obturator internus muscles can be divided into two and three neuromuscular compartments, respectively. The PH of CINDR of the piriformis muscle was located at 22.61 ± 2.66% of the H line, the PL was at 28.53 ± 6.08% of the L line, and the puncture depth of the piriformis muscle was at 24.64 ± 2.16% of the PP' line. The PH of CINDR of the obturator internus muscle was at 16.49 ± 1.20% of the H line, the PL was at 10.94 ± 1.09% of its L line, and the puncture depth was 6.26 ± 0.38 cm. These findings may guide the design of the compartmentalized transplantation of the pelvic wall muscles and improve the target localization efficiency and efficacy for injecting botulinum toxin A to treat pelvic wall muscle spasm.
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Affiliation(s)
- Xiangnan Hu
- Department of Anatomy, Xinpu New Developing Area, Zunyi Medical University, 6 West University Road, Zunyi, 563099, People's Republic of China
| | - Meng Wang
- Department of Anatomy, Xinpu New Developing Area, Zunyi Medical University, 6 West University Road, Zunyi, 563099, People's Republic of China
| | - Xiaojiao He
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, People's Republic of China
| | - Peng Chen
- Department of Anatomy, Xinpu New Developing Area, Zunyi Medical University, 6 West University Road, Zunyi, 563099, People's Republic of China
| | - Fangfang Jia
- Department of Anatomy, Xinpu New Developing Area, Zunyi Medical University, 6 West University Road, Zunyi, 563099, People's Republic of China
| | - Danli Wang
- Department of Anatomy, Xinpu New Developing Area, Zunyi Medical University, 6 West University Road, Zunyi, 563099, People's Republic of China
| | - Shengbo Yang
- Department of Anatomy, Xinpu New Developing Area, Zunyi Medical University, 6 West University Road, Zunyi, 563099, People's Republic of China.
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Bhattaram S, Shinde VS. Novel use of motor-sparing genicular nerve blocks for knee injuries in the emergency department. Am J Emerg Med 2024; 75:196.e1-196.e4. [PMID: 37923691 DOI: 10.1016/j.ajem.2023.10.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
Knee injuries are quite prevalent in the Emergency Department (ED) and often present with severe pain, necessitating effective pain management strategies. Traditional pain management approaches, including opioid medications, may carry undesirable side effects and potential risks, leading to the growing interest in non-opioid alternatives. Nerve blocks have emerged as promising options for targeted pain relief in the ED. Motor-sparing nerve blocks have gained importance due to their ability to provide effective analgesia without compromising motor function [1]. The case series demonstrates the successful use of ultrasound-guided genicular nerve blocks(GNB) in the Emergency Department, providing targeted pain relief without compromising motor function. GNBs offer a valuable alternative to traditional nerve blocks(femoral, fascia iliaca, adductor canal) and opioid-based pain control strategies in the ED. As the evidence base grows, GNBs may become a more established component of ED pain management protocols, enhancing patient outcomes and safety in the management of acute knee injuries. The incorporation of ultrasound-guided motor-sparing nerve blocks in ED pain management protocols may hold great promise in optimising pain control and enhancing patient comfort. Trial Registration: N/A.
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Affiliation(s)
- Suhrith Bhattaram
- Department of Emergency Medicine, Dr DY Patil Medical College, Pimpri, Pune, Maharashtra 411018, India; Dr DY Patil Medical College, Dr DY Patil Vidyapeeth, Pune, India.
| | - Varsha S Shinde
- Department of Emergency Medicine, Dr DY Patil Medical College, Pimpri, Pune, Maharashtra 411018, India; Dr DY Patil Medical College, Dr DY Patil Vidyapeeth, Pune, India.
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Ou Y, Wu M, Liu D, Luo L, Xu X, Panayi AC, He J, Long Y, Feng J, Nian M, Cui Y. Efficacy and Safety of Nerve Block for Postoperative Analgesia in Patients Undergoing Breast Cosmetic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Aesthetic Plast Surg 2024; 48:71-83. [PMID: 36939869 DOI: 10.1007/s00266-023-03320-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/04/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND To evaluate the postoperative analgesic efficacy and safety of nerve block (NB) in patients undergoing breast surgery for cosmetic purposes. METHODS PubMed, Web of Science, Embase and Cochrane Libraries were searched from inception to September 2022, to identify all eligible randomized controlled trials (RCTs). Continuous data are presented as mean difference (MD) with 95% confidence intervals (CI), whereas dichotomous data are provided as odds ratios (OR) with 95% CI. This meta-analysis was performed in RevMan 5.4. RESULTS A total of 10 RCTs with 565 patients were meta-analyzed. Compared to the control group, the pain score of the NB group was significantly lower at postoperative 2, 3-4, 6-8, 12-16 and 24 h. Opioid consumption in the first postoperative 24 h was significantly lower in the NB group (MD = - 9.02, 95% CI - 14.29 to - 3.75, P < 0.05), I2 = 95%). In addition, the NB group showed a prolonged time to first postoperative analgesic requirement (MD = 43.15, 95% CI 4.74-81.56, P < 0.05, I2 = 96%), decreased incidence of additional postoperative analgesia (OR 0.14, 95% CI 0.07-0.28, P < 0.05, I2 = 0%) and reduced incidence of postoperative nausea or vomiting (OR 0.33; 95% CI 0.22-0.48; P < 0.05; I2 = 0%). There was no significant difference in operation duration between the two groups. CONCLUSIONS Nerve block is an effective and safe option for postoperative analgesia after breast cosmetic surgery. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yanting Ou
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Mengfan Wu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Dandan Liu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Lin Luo
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Xiangwen Xu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Junjun He
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Yun Long
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Jun Feng
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Mingxuan Nian
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Yongyan Cui
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China.
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Kissoon NR, Ray JC, Hutton E. Interventional treatments. Handb Clin Neurol 2024; 199:145-153. [PMID: 38307642 DOI: 10.1016/b978-0-12-823357-3.00002-1] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
In migraine, when patients have failed medication management or are unable to be treated with systemic medications, minimally invasive interventions can be options used to provide pain relief. The type of intervention depends on the pain location, associated clinical features, clinical context, medical comorbidities, and response to prior injections. Interventions can vary from bedside peripheral nerve blocks to fluoroscopically guided interventions. Growing evidence is supporting the use of interventions in migraine, and judicious use can improve clinical outcomes.
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Affiliation(s)
- Narayan R Kissoon
- Division of Headache, Department of Neurology, Mayo Clinic, Rochester, MN, United States; Division of Pain, Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States.
| | - Jason C Ray
- Department of Neurology, Austin Health, Heidelberg, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia; Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Elspeth Hutton
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia; Department of Neuroscience, Monash University, Melbourne, VIC, Australia
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Dost B, De Cassai A, Balzani E, Geraldini F, Tulgar S, Ahiskalioglu A, Karapinar YE, Beldagli M, Navalesi P, Kaya C. Analgesic benefits of pre-operative versus postoperative transversus abdominis plane block for laparoscopic cholecystectomy: a frequentist network meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:408. [PMID: 38087218 PMCID: PMC10714465 DOI: 10.1186/s12871-023-02369-6] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Transversus abdominis plane (TAP) block has been utilized to alleviate pain following laparoscopic cholecystectomy (LC). However, the optimal timing of administration remains uncertain. This study aimed to compare the efficacy of pre-operative and postoperative TAP blocks as analgesic options after LC. METHODS A frequentist network meta-analysis of randomized controlled trials (RCTs) was conducted. We systematically searched PubMed (via the National Library of Medicine), EMBASE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science up to March 2023. The study included RCTs that enrolled adult patients (≥ 18 years) who underwent LC and received either pre-operative or postoperative TAP blocks. The primary outcome assessed was 24-hour postoperative morphine consumption (mg). Additionally, pain rest scores within 3 hours, 12 hours, and 24 hours, as well as postoperative nausea and vomiting (PONV), were considered as pre-specified secondary outcomes. RESULTS A total of 34 trials with 2317 patients were included in the analysis. Postoperative TAP block demonstrated superiority over the pre-operative TAP block in reducing opioid consumption (MD 2.02, 95% CI 0.87 to 3.18, I2 98.6%, p < 0.001). However, with regards to postoperative pain, neither pre-operative nor postoperative TAP blocks exhibited superiority over each other at any of the assessed time points. The postoperative TAP block consistently ranked as the best intervention using SUCRA analysis. Moreover, the postoperative TAP block led to the most significant reduction in PONV. CONCLUSIONS The findings suggest that the postoperative TAP block may be slightly more effective in reducing 24-hour postoperative opioid consumption and PONV when compared to the pre-operative TAP block. TRIAL REGISTRATION PROSPERO, CRD42023396880 .
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Affiliation(s)
- Burhan Dost
- Department of Anesthesiology and Reanimation, School of Medicine, Ondokuz Mayis University Faculty of Medicine, Kurupelit, Samsun, TR55139, Turkey.
| | - Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit "Sant'Antonio", University Hospital of Padua, Padua, Italy
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Federico Geraldini
- UOC Anesthesia and Intensive Care Unit "Sant'Antonio", University Hospital of Padua, Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Yunus Emre Karapinar
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Müzeyyen Beldagli
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Paolo Navalesi
- UOC Institute of Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- DIMED Department of Medicine, University of Padua, Padua, Italy
| | - Cengiz Kaya
- Department of Anesthesiology and Reanimation, School of Medicine, Ondokuz Mayis University Faculty of Medicine, Kurupelit, Samsun, TR55139, Turkey
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Et T, Korkusuz M. Comparison of the pericapsular nerve group block with the intra-articular and quadratus lumborum blocks in primary total hip arthroplasty: a randomized controlled trial. Korean J Anesthesiol 2023; 76:575-585. [PMID: 37013389 PMCID: PMC10718628 DOI: 10.4097/kja.23064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The pericapsular nerve group (PENG) block, quadratus lumborum block (QLB), and intra-articular (IA) local anesthetic injection have been shown to provide effective analgesia in total hip arthroplasty (THA). This randomized study aimed to compare the analgesic efficacy, motor protection, and quality of recovery associated with the PENG block, QLB, and IA injection. METHODS Eighty-nine patients who underwent a unilateral primary THA under spinal anesthesia were randomly assigned to the PENG (n=30), QLB (n=30), or IA (n=29) group. The primary outcome was the numerical rating scale (NRS) score over the first 48 h postoperatively. The secondary outcomes were postoperative opioid consumption, quadriceps and adductor muscle strength, and quality of recovery (QoR-40). RESULTS The dynamic (with movement) NRS scores at 3 and 6 h postoperatively were significantly lower in the PENG and QLB groups compared to the IA group (P = 0.002 and P < 0.001, respectively). The time to first opioid analgesia requirement was longer in the PENG and QLB groups than in the IA group (P = 0.009 and P = 0.016, respectively). A provided better preservation was found in the the PENG group than in the QLB group in terms of quadriceps muscle strength at 3 h postoperatively (P = 0.007) and time to mobilization (P = 0.003). No significant differences in the QoR-40 scores were seen. CONCLUSIONS The PENG and QLB groups showed similar analgesic effects and both showed more effective analgesia 6 h postoperatively than the IA group. All the groups showed similar postoperative quality of recovery.
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Affiliation(s)
- Tayfun Et
- Department of Anesthesiology and Intensive Care Medicine, Karamanoğlu Mehmetbey University Faculty of Medicine, Karaman, Turkey
| | - Muhammet Korkusuz
- Department of Anesthesiology and Intensive Care Medicine, Karamanoğlu Mehmetbey University Faculty of Medicine, Karaman, Turkey
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Kumar S, Hameed M, Shehzad R, Samad K. The comparison of the analgesic efficacy of continuous paravertebral block alone compared with continuous paravertebral and intercostal nerve block for thoracotomy in adults: a randomized controlled trial. J Anesth 2023; 37:923-929. [PMID: 37747499 DOI: 10.1007/s00540-023-03255-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE The study aims to compare the analgesic efficacy of two analgesic interventions, continuous paravertebral (PVB) nerve block alone with continuous paravertebral and intercostal nerve block (PVB/ICB) in patients undergoing thoracotomy. METHODS A total of 70 patients undergoing thoracotomy were randomly enrolled in either continuous paravertebral nerve block (PVB) group or in continuous paravertebral and intercostal nerve block (PVB/ICB) group and received corresponding blocks. Analgesic efficacy measured by Visual Analog Scale (VAS) pain score, hemodynamic effects, total narcotic consumption, sedation score, patient's length of stay in hospital and patient's satisfaction with the analgesic technique were recorded. RESULTS Demographic characteristics of the patients were similar in both groups. The mean VAS pain score was not statistically significant in both groups at 24 h. The mean pulse rate and blood pressures were comparable in both groups for the first 24 h. Nalbuphine consumption was significantly higher in PVB group as compared to PVB/ICB group at 1 h (p = 0.01), 6 h (p = 0.03) and 12 h (p = 0.009) and 24 h (p = 0.03). The mean total nalbuphine consumption in the PVB group was higher (28.29 mg vs. 22.63 mg) and statistically significant then PVB/ICB group (p = 0.03). The total tramadol consumption as a rescue analgesic was higher in the PVB group (131.42 mg) as compared to PVB/ICB group (120 mg) after 24 h but not statistically significant (p = 0.17). CONCLUSION Continuous paravertebral nerve block with intercostal nerve block provides effective post-operative pain relief after thoracotomy with reduced narcotic consumption compared to continuous paravertebral nerve block alone. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrails.gov NCT04715880.
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Affiliation(s)
- Sundeep Kumar
- Department of Anesthesiology, Aga Khan University, 2nd Floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Malika Hameed
- Department of Anesthesiology, Aga Khan University, 2nd Floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Rizwana Shehzad
- Department of Anesthesiology, Aga Khan University, 2nd Floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Khalid Samad
- Department of Anesthesiology, Aga Khan University, 2nd Floor Private Wing, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
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Bethlahmy JM, Hanst BA, Giafaglione SM, Elia JM. Perioperative considerations for patients undergoing surgical stabilization of rib fractures: A narrative review. J Clin Anesth 2023; 91:111275. [PMID: 37797395 DOI: 10.1016/j.jclinane.2023.111275] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Surgical stabilization of rib fractures (SSRF) has become an increasingly common management strategy for traumatic rib fractures. Although historically managed with supportive care, patients with multiple rib fractures and flail chest increasingly undergo SSRF, and so the anesthesiologist must be well-versed in the perioperative management and pain control for these patients, as controlling pain in this population is associated with decreased length of stay and improved outcomes. There are multiple modalities that can be used for both pain control and as part of the anesthetic plan in patients undergoing SSRF. This narrative review provides a comprehensive summary of anesthetic considerations for surgical rib fracture patients, covering the preoperative, intraoperative, and postoperative periods. We describe an approach to the assessment of high-risk patients, analgesic and anesthetic techniques including emerging techniques within locoregional anesthesia, ventilation strategies, and potential complications. This review also identifies areas where additional research is needed to ensure optimal anesthetic management for patients undergoing SSRF.
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Affiliation(s)
- Jessica M Bethlahmy
- UC Irvine School of Medicine, 1001 Health Sciences Road Irvine, CA 92617, USA
| | - Brian A Hanst
- UC Irvine Department of Anesthesiology & Perioperative Care, 101 The City Drive South 52-225C, Orange, CA 92868, USA
| | - Sarah M Giafaglione
- UC Irvine Department of Anesthesiology & Perioperative Care, 101 The City Drive South 52-225C, Orange, CA 92868, USA
| | - Jennifer M Elia
- UC Irvine Department of Anesthesiology & Perioperative Care, 101 The City Drive South 52-225C, Orange, CA 92868, USA.
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Korkusuz M, Basaran B, Et T, Bilge A, Yarimoglu R, Kurucay Y. The effects of dexamethasone added to ilioinguinal/iliohypogastric nerve (IIN/IHN) block on rebound pain in inguinal hernia surgery: a randomized controlled trial. Hernia 2023; 27:1571-1580. [PMID: 37477788 DOI: 10.1007/s10029-023-02841-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The purpose of the present study was to evaluate the effects of IV dexamethasone added to one single injection Ilioinguinal/Iliohypogastric Nerve (IIN/IHN) block on tramadol consumption and Modified Rebound Pain Score (MRPS) in the first postoperative 24 h in inguinal hernia surgery. METHODS Five mg IV dexamethasone as an analgesic adjunct in the multimodal analgesia was administered to the patients who were scheduled for Inguinal Hernia Surgery and randomized to Group Dex and normal saline was administered to the patients who were randomized to the Control Group in addition to IIN/IHN Block. Postoperative tramadol consumption, Modified Rebound Pain Score (MRPS), the incidence of Rebound Pain, Rebound Pain time, postoperative 48-h opioid consumption, Numerical Rating Scale (NRS) scores, Quality of Recovery Score (QoR-15), Sleep Quality, and adverse events were evaluated in the patients. RESULTS The mean scores of MRPS were lower in Group Dex than in the Control Group, both at rest (p = 0.001) and with motion (p = 0.001). Tramadol consumption in the first postoperative 24 h was 45.17 ± 49.59 mg in Group Dex and 95 ± 59.23 mg in the Control Group. The difference between the groups was statistically significant (p < 0.001). CONCLUSIONS In conclusion, adding IV dexamethasone as a part of multimodal analgesia to IIN/IHN block for inguinal hernia surgery resulted in lower MRPS and lower postoperative opioid (tramadol) consumption. For this reason, IV dexamethasone can be added to the IIN/IHN block after inguinal hernia surgery to reduce the incidence of rebound pain, rebound pain scores, and NRS scores for pain, decrease postoperative opioid consumption, and improve the quality of recovery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: Ref; NCT05172908, Date: December 29, 2021.
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Affiliation(s)
- Muhammet Korkusuz
- Department of Anesthesiology and Reanimation, Karamanoglu Mehmetbey University School of Medicine, Karaman, Turkey.
| | - Betul Basaran
- Department of Anesthesiology and Reanimation, Karamanoglu Mehmetbey University School of Medicine, Karaman, Turkey
| | - Tayfun Et
- Department of Anesthesiology and Reanimation, Karamanoglu Mehmetbey University School of Medicine, Karaman, Turkey
| | - Aysegul Bilge
- Department of Anesthesiology and Reanimation, Karamanoglu Mehmetbey University School of Medicine, Karaman, Turkey
| | - Rafet Yarimoglu
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, Karaman, Turkey
| | - Yıldıray Kurucay
- Department of Surgery, Karaman Training and Research Hospital, Karaman, Turkey
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Liu X, Xiao Y, Yang H. A new attempt at the popliteal artery and knee posterior capsule space block. Asian J Surg 2023; 46:5489-5490. [PMID: 37544780 DOI: 10.1016/j.asjsur.2023.07.126] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023] Open
Affiliation(s)
- Xinzhe Liu
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China
| | - Yu Xiao
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China
| | - Haitao Yang
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China.
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Gawel RJ, Grill R, Bradley N, Luong J, Au AK. Ultrasound-Guided Peripheral Nerve Blocks for Shoulder Dislocation in the Emergency Department: A Systemic Review. J Emerg Med 2023; 65:e403-e413. [PMID: 37741738 DOI: 10.1016/j.jemermed.2023.05.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/26/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Shoulder dislocations are among the most common orthopedic emergencies encountered in the emergency department (ED). Ultrasound-guided peripheral nerve blocks (USG-PNBs) are increasingly being used for acute pain management in the ED, but clinical evidence supporting their utility for shoulder dislocation is limited and often conflicting. OBJECTIVE The aim of this review was to summarize and evaluate the utility of USG-PNB for analgesia during closed reduction of dislocated shoulders in the ED. METHODS Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature search of the PubMed, Scopus, and Cochrane databases was performed from database inception to September 2022. We included clinical studies examining USG-PNB for pain management of dislocated shoulders in the ED. Information collected from eligible studies included patient demographic characteristics, USG-PNB approach, alternate analgesia techniques, anesthetic regimens, clinical outcomes, and adverse events. RESULTS Five studies met inclusion criteria, all of which were randomized controlled trials comparing USG-PNB with procedural sedation and analgesia. Pooled patient satisfaction scores were similar for both analgesia methods (3.5 ± 0.6 vs. 3.9 ± 0.6 out of 5; p = 0.76). Patients managed with procedural sedation and analgesia achieved higher rates of overall shoulder reduction (100% vs. 67%; p < 0.001) and successful reduction on the first attempt (86% vs. 48%; p < 0.001). The USG-PNB groups in all but one study had shorter lengths of ED stay. Overall, USG-PNB was associated with a lower risk of adverse events and complications (3.9% vs. 24.9%; p < 0.001), especially adverse respiratory events (0% vs. 14.7%; p < 0.001). CONCLUSIONS USG-PNBs performed by adequately trained emergency physicians should be considered a safe and effective alternative for analgesia during closed reduction of dislocated shoulders in the ED, particularly in patients with cardiorespiratory comorbidities.
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Affiliation(s)
- Richard J Gawel
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Renee Grill
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nathaniel Bradley
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Luong
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Arthur K Au
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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45
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Bali C, Ozmete O. Supra-inguinal fascia iliaca block in older-old patients for hip fractures: a retrospective study. Braz J Anesthesiol 2023; 73:711-717. [PMID: 34582902 PMCID: PMC10625135 DOI: 10.1016/j.bjane.2021.08.008] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/14/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population. METHODS Forty-one ASA III...IV patients who underwent SIFIB...+...PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared. RESULTS Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p...<...0.001). There was a statistically significant reduction in VAS scores at the postoperative 1st, 3rd, and 6th hours at rest (p...<...0.001) and during movement (p...<...0.001 for the 1st and 3rd hours, and p...=...0.02 for the 6th hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12th and 24th hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p...=...0.01). CONCLUSION The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.
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Affiliation(s)
- Cagla Bali
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
| | - Ozlem Ozmete
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey
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46
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Choi S, Choi YH, Lee HS, Shin KW, Kim YJ, Park HP, Cho WS, Oh H. Effects of Scalp Nerve Block on the Quality of Recovery after Minicraniotomy for Clipping of Unruptured Intracranial Aneurysms : A Randomized Controlled Trial. J Korean Neurosurg Soc 2023; 66:652-663. [PMID: 37042173 PMCID: PMC10641417 DOI: 10.3340/jkns.2023.0010] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/13/2023] [Accepted: 04/10/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE This study compared the quality of recovery (QoR) after minicraniotomy for clipping of unruptured intracranial aneurysms (UIAs) between patients with and without scalp nerve block (SNB). METHODS Patients were randomly assigned to the SNB (SNB using ropivacaine with epinephrine, n=27) and control (SNB using normal saline, n=25) groups. SNB was performed at the end of surgery. To assess postoperative QoR, the QoR-40, a patient-reported questionnaire, was used. The QoR-40 scores were measured preoperatively, 1-3 days postoperatively, at hospital discharge, and 1 month postoperatively. Pain and intravenous patient-controlled analgesia (IV-PCA) consumption were evaluated 3, 6, 9, and 12 hours and 1-3 days postoperatively. RESULTS All QoR-40 scores, including those measured 1 day postoperatively (primary outcome measure; 155.0 [141.0-176.0] vs. 161.0 [140.5-179.5], p=0.464), did not significantly differ between the SNB and control groups. The SNB group had significantly less severe pain 3 (numeric rating scale [NRS]; 3.0 [2.0-4.0] vs. 5.0 [3.5-5.5], p=0.029), 9 (NRS; 3.0 [2.0-4.0] vs. 4.0 [3.0-5.0], p=0.048), and 12 (NRS; 3.0 [2.0-4.0] vs. 4.0 [3.0-5.0], p=0.035) hours postoperatively. The total amount of IV-PCA consumed was significantly less 3 hours postoperatively in the SNB group (2.0 [1.0-4.0] vs. 4.0 [2.0-5.0] mL, p=0.044). CONCLUSION After minicraniotomy for clipping of UIAs, SNB reduced pain and IV-PCA consumption in the early postoperative period but did not improve the QoR-40 scores.
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Affiliation(s)
- Seungeun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Choi
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hoo Seung Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Won Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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47
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Diwan S, Sala-Blanch X, Nair A. Anatomic barriers to paraspinal blocks: a cadaver case series. Braz J Anesthesiol 2023; 73:822-826. [PMID: 34848315 PMCID: PMC10625147 DOI: 10.1016/j.bjane.2021.10.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022]
Abstract
The paraspinal space is intriguing in nature. There are several needle tip placements described in compact anatomical spaces. This has led to an incertitude regarding the appropriate anatomic locations for needle tip positions. Through our cadaver models we try to resolve the issues surrounding needle tip positions clarifying anatomical spaces and barriers. Further we propose an anatomical classification based on our findings in cadaveric open dissections and cross and sagittal sections.
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Affiliation(s)
- Sandeep Diwan
- Sancheti Hospital, Department of Anesthesiology, Pune, India
| | - Xavier Sala-Blanch
- University of Barcelona, Anatomy Hospital Clinic, Department of Anesthesia, Barcelona, Spain
| | - Abhijit Nair
- Ibra Hospital, Department of Anesthesiology, Ibra, Oman.
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48
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Abbasi S, Garjani N, Mahshidfar B, Farsi D, Mofidi M, Hafezimoghadam P, Rezai M, Javan A. Comparative Study of Radial and Median Nerve Blocks with Hematoma Block under Ultrasound Guide in Distal Radius Fracture Reduction: A Randomized Clinical Trial. Med J Islam Repub Iran 2023; 37:113. [PMID: 38145179 PMCID: PMC10744119 DOI: 10.47176/mjiri.37.113] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 12/26/2023] Open
Abstract
Background Distal radius fractures are one of the most common upper extremity fractures, and their incidence continues to increase due to an aging population and an increase in osteoporosis. Various methods of analgesia for distal radius fractures have been described-including hematoma blocks and nerve blocks. Hematoma blocks are a simple and effective method of providing analgesia; nonetheless, their efficacy may be limited in some cases. On the other hand, nerve blocks provide more targeted analgesia and may be more effective in reducing pain during fracture reduction. This study aimed to compare the analgesic effectiveness of radial and median nerve blocks with hematoma blocks under ultrasound guidance in treating distal radius fractures. Also, this study aimed to compare the analgesia of radial and median nerve blocks with hematoma blocks under ultrasound guidance to reduce distal radius fractures. Methods In this prospective trial, patients with distal radius fractures referring to 2 academic centers were placed into 2 randomized groups, including hematoma block, and radial median block, both of which were ultrasound-guided. The patient's pain levels were measured and recorded based on the visual analog scale before the block, 5, 10, and 15 minutes after the block, at the start of reduction, during reduction, and 5, 10, and 15 minutes after reduction. Patient satisfaction and physician satisfaction rates were assessed, and side effects were also observed for 1 week. Quantitative variables were reported as mean ± standard deviation, and number and frequency percentages were reported for qualitative variables. The Student t test and the chi-square test were used on a case-by-case basis. The significance level was set at P ˂ 0.05. Results In this study, 120 patients were included. The groups had no significant differences in pain reduction during the procedure. Analgesic medication was needed during the procedure for 17 patients; nerve blocks were applied for 6 patients, and hematoma blocks for 11 patients, which was statistically significant (P = 0.041). Satisfaction rates for patients and physicians performing the procedure were significantly higher in the nerve block group than in the hematoma block group ( P = 0.001; P ˂ 0.001, respectively). Conclusion The results of this study suggest that ultrasound-guided radial and median nerve blocks can be used as alternative methods of analgesia with other techniques in the reduction of distal radius fractures in emergency departments.
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Affiliation(s)
- Saeed Abbasi
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Nayyereh Garjani
- Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran
University of Medical Sciences, Tehran, Iran
| | - Babak Mahshidfar
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Davood Farsi
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Mani Mofidi
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Peyman Hafezimoghadam
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Alireza Javan
- Student Research Committee, School of Medicine, Iran University of Medical
Sciences, Tehran, Iran
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Almeida CR, Vieira L, Alves B, Sousa G, Cunha P, Antunes P. The ultimate technique for posterior rib fractures: the parascapular sub-iliocostalis plane block - A series of cases. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:477-482. [PMID: 37678457 DOI: 10.1016/j.redare.2023.09.003] [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] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/21/2022] [Indexed: 09/09/2023]
Abstract
We report retrospectively a series of four cases involving the successful use of the recently described parascapular sub-iliocostalis plane block (PSIP), for lateral-posterior rib fractures. The efficacy of the PSIP block may potentially depend on different mechanisms of action: (1) direct action in the fracture site by craniocaudal myofascial spread underneath the erector spinae muscle (ESM); (2) spread to deep layers through tissue disruption caused by trauma, to reach the proximal intercostal nerves; (3) medial spread below the ESM, to reach the posterior spinal nerves; and (4) lateral spread in the sub-serratus (SS) plane to reach the lateral cutaneous branches of the intercostal nerves; while avoiding significant negative hemodynamic effects and other possible complications associated to other techniques leading that the PSIP may be considered an alternative in some clinical scenarios to the Erector Spinae Plane block or the Paravertebral block.
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Affiliation(s)
- C R Almeida
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - L Vieira
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - B Alves
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
| | - G Sousa
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - P Cunha
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - P Antunes
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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Lusianawati, Suhardi CJ, Sumartono C, Wungu CDK. Efficacy and safety of the serratus anterior block compared to thoracic epidural analgesia in surgery: Systematic review and meta-analysis. Tzu Chi Med J 2023; 35:329-337. [PMID: 38035055 PMCID: PMC10683523 DOI: 10.4103/tcmj.tcmj_36_23] [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: 02/17/2023] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives The objective of this study was to compare the efficacy and safety of serratus anterior plane block (SAPB) and thoracic epidural analgesia (TEA) in thoracic region surgery. Materials and Methods We implemented a systematic search of PubMed, ScienceDirect, SCOPUS, and Web of Science and through gray literature for all randomized controlled trials that compared SAPB, a novel thoracic wall nerve block, and TEA in surgery. The evaluated outcomes included the Visual Analog Scale (VAS), hypotension, and postoperative nausea and vomiting (PONV). Review Manager, version 5.4.1, was implemented for the analysis of statistics. Results The pooled analysis included six trials that fulfilled the inclusion criteria. In total 384, surgery had received regional blocks (162 - SAPB and 163 - TEA). VAS did not differ significantly between SAPB and TEA, with a mean difference of 0.71, P = 0.08. PONV incidence did not differ significantly between SAPB and TEA (odds ratio = 0.25, P = 0.07). Hypotension incidence was lower in SAPB compared to TEA (odds ratio = 0.10, P = 0.0001). Conclusion SAPB yielded comparable VAS with TEA in pain management of thoracic region surgery. The incidence of hypotension was lower in SAPB than in TEA. No difference in PONV incidence was observed. SAPB can be a viable alternative to TEA in thoracic region surgery.
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Affiliation(s)
- Lusianawati
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Christian Julio Suhardi
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Christrijogo Sumartono
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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