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Fernández Martin MT, Alvarez Lopez S, Aldecoa Alvarez-Santullano C. Role of adjuvants in regional anesthesia: A systematic review. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:97-107. [PMID: 36813032 DOI: 10.1016/j.redare.2021.06.006] [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] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/16/2021] [Indexed: 02/22/2023]
Abstract
The combination of drugs and routes of administration produces a synergistic effect, and one of the most important components of multimodal analgesic strategies are, therefore, nerve blocks for pain management. The effect of a local anaesthetic can be prolonged by administering an adjuvant. In this systematic review, we included studies on adjuvants associated with local anaesthetics in peripheral nerve blocks published in the last 5 years in order to evaluate their effectiveness. The results were reported according to the PRISMA guidelines. The 79 studies selected using our criteria showed a clear prevalence of dexamethasone (n=24) and dexmedetomidine (n=33) over other adjuvants. Different meta-analyses comparing adjuvants suggest that dexamethasone administered perineurally achieves superior blockade with fewer side effects than dexmedetomidine. Based on the studies reviewed, we found moderate evidence to recommend the use of dexamethasone as an adjuvant to peripheral regional anaesthesia in surgeries that can cause moderate to severe pain.
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Affiliation(s)
- M T Fernández Martin
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Valladolid, Spain.
| | - S Alvarez Lopez
- Servicio de Anestesiología y Reanimación, Hospital Abente y Lago, A Coruña, Spain
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2
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Asensio-Samper JM, Quesada-Carrascosa M, Fabregat-Cid G, López-Alarcón MD, de Andrés J. Practical recommendations for the management of the patient with chronic pain during the pandemic of COVID-19. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:495-503. [PMID: 34732353 PMCID: PMC8531195 DOI: 10.1016/j.redare.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/10/2020] [Indexed: 12/23/2022]
Abstract
SARS-CoV-2 infection has evolved into a pandemic and a Public Health Emergency of International Importance that has forced health organizations at the global, regional and local levels to adopt a series of measures to address to COVID-19 and try to reduce its impact, not only in the social sphere but also in the health sphere, modifying the guidelines for action in the health services. Within these recommendations that include the Pain Treatment Units, patients with suspected or confirmed SARS-CoV-2 infection may be waiting for medical consult or interventional procedures for the management of chronic pain refractory to other therapies. A series of guidelines aimed at reducing the risk of infection of health personnel, other patients and the community are included in this manuscript.
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Affiliation(s)
- J M Asensio-Samper
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Departamento Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, Spain.
| | - M Quesada-Carrascosa
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - G Fabregat-Cid
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M D López-Alarcón
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J de Andrés
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Departamento Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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3
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Ruiz-López D, Alonso-Babarro A. [Questionnaire made to understand the opioid analgesics prescription habits in the community of Madrid (Spain)]. Aten Primaria 2021; 53:102040. [PMID: 33857704 PMCID: PMC8065263 DOI: 10.1016/j.aprim.2021.102040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/29/2020] [Accepted: 01/21/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Pain is the fearest and disabling symptom for cancer patients. The cornerstone of treatment is opioid analgesics. The objective of this research was to relate the opioid consumption existing in the Community of Madrid (CM) with the prescription habits expressed by the Primary Care (PrC) and Palliative Care (PalC) physicians. DESIGN An opioid prescription habits questionnaire was designed. Sampling was consecutive non-probability. SITE: PrC and specific PalC resources in the CM. PARTICIPANTS The study population included all the family doctors who worked in PrC in the Madrid Public Health Service and all the physicians who worked in some specific PalC resources, both home-based teams and supportive hospital teams in the CM of the public and private/concerted health network services. MAIN MEASUREMENTS We asked about the strong and weak opioids most used in moderate-severe oncological and non-oncological pain, the preferred administration route, the safety in the use of opioids in the treatment of pain and the preferred clinical practice guidelines. RESULTS The questionnaire was answered by 840 PrC physicians (20%) and 56 PalC physicians (45%). For the treatment of moderate-severe cancer pain in both groups of professionals, the first choice was morphine; however, in non-cancer pain for PrC it was fentanyl and morphine for PalC professionals. Regarding the route of administration, 70% of family doctors and 87% of PalC physicians stated that the oral route was the first choice, compared to 27% in PrC and 5% in PalC who preferred the transdermal route. The PrC physicians rated their ability to use opioids as average (4-7/10), while the palliativists considered it as high (8-10/10). In PrC, they declared that they knew, above all, the European Association for Palliative Care (EAPC) and National Institute for Health and Care Excellence (NICE) guidelines, although the largest number answered that they trusted their experience. PalC physicians preferred to use the EAPC guide. CONCLUSIONS There is a clear disagreement between the actual consumption of opioids and the prescribing habits manifested by family doctors, as well as a false certainty in prescribing these drugs.
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Affiliation(s)
- Diego Ruiz-López
- Equipo de Soporte Paliativo Domiciliario (ESAPD), Centro de Salud Legazpi, Dirección Asistencial Noroeste de Atención Primaria, Servicio Madrileño de Salud, Madrid, España.
| | - Alberto Alonso-Babarro
- Unidad de Cuidados Paliativos, Hospital Universitario de La Paz, Servicio Madrileño de Salud, Madrid, España
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Asensio-Samper JM, Quesada-Carrascosa M, Fabregat-Cid G, López-Alarcón MD, de Andrés J. Practical recommendations for the management of the patient with chronic pain during the pandemic of COVID-19. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 68:S0034-9356(20)30205-X. [PMID: 33823985 PMCID: PMC7467023 DOI: 10.1016/j.redar.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022]
Abstract
SARS-CoV-2 infection has evolved into a pandemic and a Public Health Emergency of International Importance that has forced health organizations at the global, regional and local levels to adopt a series of measures to address to COVID-19 and try to reduce its impact, not only in the social sphere but also in the health sphere, modifying the guidelines for action in the health services. Within these recommendations that include the Pain Treatment Units, patients with suspected or confirmed SARS-CoV-2 infection may be waiting for medical consult or interventional procedures for the management of chronic pain refractory to other therapies. A series of guidelines aimed at reducing the risk of infection of health personnel, other patients and the community are included in this manuscript.
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Affiliation(s)
- J M Asensio-Samper
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España; Departamento Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España.
| | - M Quesada-Carrascosa
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - G Fabregat-Cid
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - M D López-Alarcón
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J de Andrés
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España; Departamento Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España
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González-García J, González-Bada A, López-Ramos JM, Echevarria-Correas MA, Muñecas-Herreras MBG, Aguilera-Celorrio L. Prospective, randomized comparative study of ultrasound-guided blocking of the lateral cutaneous branches of the intercostal nerves versus conventional analgesia in non-reconstructive breast surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:137-143. [PMID: 30545702 DOI: 10.1016/j.redar.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/31/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The objective of this study is to determine whether the accomplishment of an interfascial blockade, the blocking of the cutaneous branches of the intercostal nerves in the axillary line (BRILMA) associated with a multimodal analgesic regimen improves post-operative analgesia and allows saving opioids after non-reconstructive surgery of breast. MATERIAL AND METHODS A prospective, randomised and simple blind study was conducted on patients that underwent non-reconstructive breast surgery. The patients were randomly assigned to the blocking group, or to the standard post-operative analgesia group (paracetamol and dexketoprofen). The main variables analysed were the pain intensity assessed by the verbal numerical scale and the analgesic rescue needs with tramadol. RESULTS Statistically significant differences were observed in the consumption of tramadol during the study period (10.5mg in the BRILMA group, compared to 34.3 in the control group, P=.0001). There were also differences in the pain assessment, with lower values found in the BRILMA group. CONCLUSIONS In non-reconstructive breast surgery, performing a BRILMA block allows obtaining lower pain scores, which implies less need for rescue analgesics and a significant saving of tramadol in the study period.
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Affiliation(s)
- J González-García
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España.
| | - A González-Bada
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - J M López-Ramos
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - M A Echevarria-Correas
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - M B G Muñecas-Herreras
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - L Aguilera-Celorrio
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
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Verástegui E, Plancarte R, Domínguez J, Burgos R, Arrieta O, Campillo C, Celis MÁ, la-Llata MD, Halabe J, Islas S, Jasso L, Lifshitz A, Moreno M, Reyes A, Ruiz-Argüelles G, Soda A, Sotelo J. Recomendaciones para la prescripción segura de opioides en el manejo del dolor crónico no oncológico. GAC MED MEX 2018; 154:532-533. [PMID: 30250317 DOI: 10.24875/gmm.18003760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
El tratamiento del dolor crónico severo es una meta histórica de la medicina. Los opioides naturales (como la morfina) se han usado por muchos años y la aparición reciente de opioides sintéticos se ha sumado a esta opción terapéutica, sin embargo, el potencial adictivo de estas sustancias obliga a la reglamentación de su uso. Las agencias médicas internacionales recomiendan prudencia en el uso terapéutico de opioides. The treatment of chronic and severe pain is a principal goal of medicine. Natural opioids have been used for several years, and the recent development of synthetic opioids has increased therapeutic options; however, the addictive potential of these substances obliges the regulation of their use. International agencies recommend prudent rules in the therapeutic use of opioids.
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Affiliation(s)
- Emma Verástegui
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Ricardo Plancarte
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Judith Domínguez
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Rubén Burgos
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Oscar Arrieta
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Carlos Campillo
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Miguel Ángel Celis
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Manuel De la-Llata
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - José Halabe
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Sergio Islas
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Luis Jasso
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Alberto Lifshitz
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Mucio Moreno
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Alejandro Reyes
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Guillermo Ruiz-Argüelles
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Antonio Soda
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
| | - Julio Sotelo
- Academia Nacional de Medicina, Comité de Ética y Transparencia en la Relación Médico-Industria (Cetremi), Ciudad de México, México
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Fernández Martín MT, López Álvarez S, Pérez Herrero MA. Serratus-intercostal interfascial block as an opioid-saving strategy in supra-umbilical open surgery. ACTA ACUST UNITED AC 2018; 65:456-460. [PMID: 29789137 DOI: 10.1016/j.redar.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The administration of local anaesthetic in the serratus-intercostal space provides adequate analgesia in non-reconstructive breast surgery. The aim of this study was to evaluate whether the blockage of the last intercostal nerves (T7-T11) can lead to opioid savings in supra-umbilical open surgery procedures. MATERIAL AND METHODS A prospective observational study was conducted on patients undergoing open supra-umbilical surgery under general anaesthesia and with a serratus-intercostal plane block [modified Blocking the bRanches of IntercostaL nerves in the Middle Axillary line (BRILMA)] as an associated analgesic strategy. Post-operative pain was assessed with the numerical verbal scale (NVS 0 to 10) on admission to the post-anAesthesia recovery unit, at 6, 12, 24, and 48h postintervention and by need for analgesic rescues with opioids (2mg iv of morphine, if values higher than 3 in NVS). Adverse events related to the technique were also recorded. The statistical package used in the analysis of the data was SPSS® for Windows. RESULTS The study recruited 52 patients. Differences, with a p<.05, were found intra-operatively in the consumption of fentanyl: 400 + 80μg versus 110 + 50μg in patients who underwent pre-incisional blockade. In the first 24hours, only 3 cases (two gastrectomies and one cholecystectomy) required morphine (single bolus of 2mg). Between 24h and 48h it was necessary to administer several morphine boluses (8 + 2mg) in four patients (three gastrectomies and one cholecystectomy). Four patients presented with nausea and / or vomiting and there were no complications related to the analgesic technique. CONCLUSION The intercostal nerves block (T7-T11) in the serratus-intercostal space may constitute an opioid-sparing analgesic strategy in open supra-umbilical surgery.
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Affiliation(s)
- M T Fernández Martín
- Servicio de Anestesiología y Reanimación, Hospital Medina del Campo, Valladolid, España.
| | - S López Álvarez
- Servicio de Anestesiología y Reanimación, Hospital Abente y Lago, A Coruña, España
| | - M A Pérez Herrero
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Gálvez R, Provencio M, Cobo M, Pérez C, Pérez C, Canal J. [Observational and cross-sectional study of prevalence and severity of the opioid-induced bowel dysfunction]. Aten Primaria 2014; 46:32-9. [PMID: 24332445 DOI: 10.1016/j.aprim.2013.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 07/30/2013] [Accepted: 08/01/2013] [Indexed: 12/03/2022] Open
Abstract
Objetivo Analizar la prevalencia y severidad de los síntomas de disfunción intestinal inducida por opioides (DIO). Diseño Estudio epidemiológico, observacional y transversal. Emplazamiento Seis hospitales españoles. Participantes Trescientos diecisiete pacientes en régimen ambulatorio con diagnóstico de dolor oncológico o dolor crónico no oncológico tratados con un único opioide mayor. Mediciones principales La prevalencia de los síntomas de DIO y su severidad se midió usando una escala visual analógica (EVA: 0-100) y el estreñimiento se valoró también mediante el índice de función intestinal (BFI). Se registró el tratamiento para los síntomas gastrointestinales y se comparó su frecuencia según el tratamiento opioide. Finalmente, se estudió la calidad de vida. Resultados La tasa de prevalencia de al menos un trastorno gastrointestinal potencialmente relacionado con la DIO fue del 94,6%, siendo el estreñimiento el síntoma más frecuente (BFI: 91,6%; EVA: 90,2%) y casi la mitad de los pacientes (49,8%) presentaron 3 o más síntomas con un EVA ≥ 4. No se detectaron diferencias significativas en la prevalencia de los síntomas entre los distintos tratamientos opioides. Se detectó una afectación en la calidad de vida de los pacientes relacionada con la presencia de síntomas gastrointestinales de moderada a severa. Conclusiones En pacientes con tratamiento opioide se constata una elevada frecuencia de trastornos gastrointestinales posiblemente relacionados con la DIO, lo que subraya la necesidad de nuevas estrategias para su tratamiento.
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