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Fils JF, Kapessidou P, Van der Linden P, Guntz E. A Monte Carlo simulation study comparing the up and down, biased-coin up and down and continual reassessment methods used to estimate an effective dose (ED 95 or ED 90) in anaesthesiology research. BJA Open 2023; 8:100225. [PMID: 37790993 PMCID: PMC10542596 DOI: 10.1016/j.bjao.2023.100225] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
Background Dose-finding studies in anaesthesiology aim to target the effective dose (ED) of an anaesthetic agent in a specific population. The common dose-finding designs used are the up and down method (UDM), the biased-coin up and down (BCD), and the continual reassessment method (CRM). Although the advantages of CRM over the UDM and BCD methods have been described in the statistical literature in terms of precision and direct estimation of ED, CRM may also offer attractive properties from an ethical point of view. Methods Based on Monte Carlo simulations, this article aims to compare the three methods with regard to 1) their ability to find as close an estimate as possible for the ED95 or ED90 and 2) the total number of patients needed to treat and the number of failures. Results In contrast to BCD and UDM, CRM does find an estimate for ED95 and ED90. UDM underestimates both ED95 and ED90. BCD is close to the targeted EDs when the starting dose does not exceed the ED of interest, otherwise it overestimates it. CRM with cohorts of two patients is closest to the ED of interest independently of the starting doses. CRM requires between 20 and 50 observations, UDM should include 90 patients, and BCD 100 or 60 observations. Lastly, CRM is associated with fewer failures, compared with BCD and UDM. Conclusions Based on Monte Carlo simulations, our work suggests that the UDM is not an adequate dose-finding method because it underestimates the ED of interest. Compared with BCD, CRM offers the advantages of being more efficient, requires fewer patients to be included, and is associated with fewer failures.
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Affiliation(s)
| | - Panayota Kapessidou
- Department of Anesthesiology, University Hospital Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Emmanuel Guntz
- Department of Anesthesiology, Hôpital Braine-l’Alleud Waterloo, Université Libre de Bruxelles (ULB), Braine-l’Alleud, Belgium
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Nisolle ML, Ghoundiwal D, Engelman E, El Founas W, Gouwy J, Guntz E, Kapessidou P, Tuna T. Correction: Comparison of the effectiveness of ultrasound-guided versus fluoroscopyguided medial lumbar bundle branch block on pain related to lumbar facet joints: a multicenter randomized controlled noninferiority study. BMC Anesthesiol 2023; 23:157. [PMID: 37158830 PMCID: PMC10165814 DOI: 10.1186/s12871-023-02110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Affiliation(s)
- Marie-Laure Nisolle
- Department of Anesthesiology and Pain Medicine, Erasme Hospital, Universite Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, 1070, Belgium.
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Rue aux Laines 105, Brussels, 1000, Belgium.
| | - Djamal Ghoundiwal
- Department of Anesthesiology and Pain Medicine, Erasme Hospital, Universite Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, 1070, Belgium
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Rue aux Laines 105, Brussels, 1000, Belgium
| | | | - Walid El Founas
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Rue aux Laines 105, Brussels, 1000, Belgium
| | - Jonathan Gouwy
- Department of Anesthesiology and Pain Medicine, Braine l'Alleud Hospital, Université Libre de Bruxelles (ULB), Rue Wayez 35, Braine-l'Alleud, 1420, Belgium
| | - Emmanuel Guntz
- Department of Anesthesiology and Pain Medicine, Braine l'Alleud Hospital, Université Libre de Bruxelles (ULB), Rue Wayez 35, Braine-l'Alleud, 1420, Belgium
| | - Panayota Kapessidou
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Rue aux Laines 105, Brussels, 1000, Belgium
| | - Turgay Tuna
- Department of Anesthesiology and Pain Medicine, Erasme Hospital, Universite Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, 1070, Belgium
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Nisolle ML, Ghoundiwal D, Engelman E, El Founas W, Gouwy J, Guntz E, Kapessidou P, Tuna T. Comparison of the effectiveness of ultrasound-guided versus fluoroscopy-guided medial lumbar bundle branch block on pain related to lumbar facet joints: a multicenter randomized controlled non-inferiority study. BMC Anesthesiol 2023; 23:76. [PMID: 36906521 PMCID: PMC10007783 DOI: 10.1186/s12871-023-02029-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND The aim of this multicenter randomized interventional prospective study was to compare the ultrasound (US)-guided lumbar medial branch block (LMBB) with the fluoroscopy (FS)-guided LMBB in terms of analgesic efficacy and disability in the setting of the treatment of pain arising from the lumbar facet joints (LFJ). METHODS Fifty adults with a "LFJ" syndrome were randomized into two groups: in group FS, fluoroscopic-guidance was used to block the medial branch at three lumbar levels (L3-L4, L4-L5 and L5-S1); in group US, same blocks were performed under ultrasound. Needle transverse approach was used with both techniques. Effects of these procedures were assessed with a Visual Analogue Pain Scale (VAPS), the Oswestry Disability Index (ODI) and the Duke's Activity Status Index (DASI) scale, before the treatment, 1 week and 1 month after. Hospital Anxiety and Depression Scale (HADS) score was also collected before the procedure. Analysis of variance, one (for non-inferiority) and two-sided Mann-Whitney tests and Chi-square tests were performed. RESULTS LMBB under US-guidance was not inferior to FS-guidance (P = 0.047) in terms of VAPS, ODI and DASI at 1 week and 1 month. Duration of techniques and HADS were similar between groups (=0.34; p = 0.59). CONCLUSIONS The medial lumbar bundle branch block under ultrasound-guidance is not inferior to the fluoroscopy-guidance procedure in effectively alleviating pain arising from the facet joints. Considering that this ultrasound technique has the benefit of an irradiation-free, real-time procedure, it can be considered as an effective alternative to the fluoroscopy-guided technique.
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Affiliation(s)
- Marie-Laure Nisolle
- Department of Anesthesiology and Pain Medicine, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium.
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Rue aux Laines 105, 1000, Brussels, Belgium.
| | - Djamal Ghoundiwal
- Department of Anesthesiology and Pain Medicine, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Rue aux Laines 105, 1000, Brussels, Belgium
| | | | - Walid El Founas
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Rue aux Laines 105, 1000, Brussels, Belgium
| | - Jonathan Gouwy
- Department of Anesthesiology and Pain Medicine, Braine l'Alleud Hospital, Rue Wayez 35, 1420, Braine-l'Alleud, Belgium
| | - Emmanuel Guntz
- Department of Anesthesiology and Pain Medicine, Braine l'Alleud Hospital, Rue Wayez 35, 1420, Braine-l'Alleud, Belgium
| | - Panayota Kapessidou
- Department of Anesthesiology and Pain Medicine, CHU Saint-Pierre, Rue aux Laines 105, 1000, Brussels, Belgium
| | - Turgay Tuna
- Department of Anesthesiology and Pain Medicine, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium
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Guntz E, Carini A, Kapessidou Y. Spinal prilocaine for caesarean section: walking a fine line. Anaesthesia 2021; 76:1673. [PMID: 34424531 DOI: 10.1111/anae.15574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Affiliation(s)
- E Guntz
- Université Libre de Bruxelles, Brussels, Belgium
| | - A Carini
- Université Libre de Bruxelles, Brussels, Belgium
| | - Y Kapessidou
- Université Libre de Bruxelles, Brussels, Belgium
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Guntz E, Vasseur C, Ifrim D, Louvard A, Fils JF, Kapessidou Y. Intrathecal chloroprocaine or hyperbaric prilocaine for ambulatory knee surgery? A prospective randomized study. J Exp Orthop 2021; 8:15. [PMID: 33629206 PMCID: PMC7905001 DOI: 10.1186/s40634-021-00332-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/27/2021] [Indexed: 11/11/2022] Open
Abstract
Purpose The aim of this study was to compare intrathecal 1% chloroprocaine with 2% hyperbaric prilocaine in the setting of ambulatory knee arthroscopy. We hypothesized that complete resolution of the sensory block was faster with chloroprocaine. Methods Eighty patients scheduled for knee arthroscopy were included in this prospective randomized double-blind study. Spinal anesthesia was performed with either chloroprocaine (50 mg) or hyperbaric prilocaine (50 mg). Characteristics of sensory and motor blocks and side effects were recorded. Results Mean time to full sensory block recovery was shorter with chloroprocaine (169 (56.1) min vs 248 (59.4)). The characteristics of the sensory blocks were similar at the T12 dermatome level between the two groups. Differences appeared at T10: the percentage of patients with a sensory block was higher, onset quicker and duration longer with hyperbaric prilocaine. The number of patients with a sensory block at T4 dermatome level in both groups was minimal. Times to full motor recovery were identical in both groups (85 (70–99) vs 86 (76–111) min). Time to spontaneous voiding was shorter with chloroprocaine (203 (57.6) min vs 287.3 (47.2) min). Incidence of side effects was low in both groups. Conclusions When considering the characteristics of the sensory block, the use of chloroprocaine may allow an earlier discharge of patients. Cephalic extension was to a higher dermatomal level and the sensory block at T10 level was of prolonged duration with hyperbaric prilocaine, suggesting that the choice between the two drugs should also be performed based on the level of the sensory block requested by the surgery. This study is registered in the US National Clinical Trials Registry, registration number: NCT030389, the first of February 2017, Retrospectively registered.
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Affiliation(s)
- E Guntz
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Université Libre de Bruxelles (ULB), 35 rue Wayez, 1420, Braine l'Alleud-Waterloo, Belgium.
| | - C Vasseur
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Université Libre de Bruxelles (ULB), 35 rue Wayez, 1420, Braine l'Alleud-Waterloo, Belgium
| | - D Ifrim
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Université Libre de Bruxelles (ULB), 35 rue Wayez, 1420, Braine l'Alleud-Waterloo, Belgium
| | - A Louvard
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Université Libre de Bruxelles (ULB), 35 rue Wayez, 1420, Braine l'Alleud-Waterloo, Belgium
| | - J F Fils
- Independant Biostatistician - Ars Statistica, Nivelles, Belgium
| | - Y Kapessidou
- Department of Anesthesiology, CHU St Pierre, ULB, 322 rue Haute, 1000, Bruxelles, Belgium
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Guntz E, Latrech B, Tsiberidis C, Gouwy J, Kapessidou Y. ED50 and ED90 of intrathecal hyperbaric 2% prilocaine in ambulatory knee arthroscopy. Can J Anaesth 2014; 61:801-7. [PMID: 24906303 DOI: 10.1007/s12630-014-0189-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 05/21/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Hyperbaric 2% prilocaine (HP) is increasingly used for spinal anesthesia in day-case surgery. The aim of this prospective double-blind study was to determine the effective dose (ED)50 and the ED90 of HP for patients undergoing knee arthroscopy. METHODS Doses of HP were determined using an up-and-down sequential allocation technique. Sequences were analyzed by isotonic regression analysis. A subsequent observational study was performed with the calculated ED90 in 50 patients to confirm the initial result and to describe the induced blockade effects and side effects. Times corresponding to onset and duration of sensory and motor block, surgical data, and side effects were recorded. RESULTS The ED50 was estimated at 28.9 mg (95% confidence interval [CI]: 26.5 to 35.3) and the ED90 was estimated to be 38.5 mg (95% CI: 35.7 to 39.5). A 40 mg dose of HP provided efficient anesthesia in 46 patients (92%, 95% CI: 82 to 98). The average (SD) time to effective anesthesia was 14.5 (3.9) min. Complete sensory block at level T12 was obtained after ten minutes in 44 of 50 patients. The average (SD) duration of the sensory block was 205 (36.1) min. Maximal level of sensory block was obtained at the T8-T11 levels in 41 of 50 patients without hemodynamic instability. A Bromage 3 score was obtained in 40 of the 46 patients who achieved successful anesthesia after 30 min. Patients did not experience urinary retention, nor were any signs of transient neurologic symptoms observed. CONCLUSION This study determined the ED50 of HP is 28.9 mg and suggests that a 40-mg dose of HP is adequate to provide successful spinal anesthesia for outpatient knee arthroscopy.
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Affiliation(s)
- Emmanuel Guntz
- Department of Anesthesiology, Hôpital Braine l'Alleud Waterloo, Université Libre de Bruxelles (ULB), 35 rue Wayez, 1420, Braine l'Alleud-Waterloo, Belgium,
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Sermeus L, Pirson A, Breebaart B, Decoster J, Dereeper E, Gautier P, Guntz E, Lecoq JP, Londot C, Pandin P, Pirotte T, Van Houwe P, Verelst P, Vermeylen K. Clinical guidelines for the practice of peripheral nerve blocks in the adult. Acta Anaesthesiol Belg 2013; 64:105-108. [PMID: 24279199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
These guidelines, made by BARA, are, like the "Safety First Guidelines" of the SARB, clinical recomendations for a good and safe practice when performing peripheral nerve blocks (PNB). These recommendations were made according to the most recent literature and experts opinion and are therefore prone to changes due to evolution of literature. The guidelines deal with "Informed Consent", preoperative visit, monitoring, equipment and the PNB procedure itself regardless of using ultrasound or neurostimultion or both. Advise is given when combining a PNB with general anesthesia and when a catheter technique is used.
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Affiliation(s)
- L Sermeus
- Department of Anesthesia, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
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Guntz E, Van den Broeck V, Dereeper E, El Founas W, Sosnowski M. Ultrasound-guided block of the brachial plexus at the humeral canal. Can J Anaesth 2009; 56:109-14. [PMID: 19247758 DOI: 10.1007/s12630-008-9024-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 12/01/2008] [Accepted: 12/03/2008] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Conduction block of the brachial plexus block at the humeral canal, as described by Dupre, has certain clinical indications. The aim of this preliminary study was to assess the feasibility of this technique under ultrasound guidance. METHODS After ultrasound evaluation of the brachial plexus at the humeral canal in 61 adult volunteers, we performed ultrasound-guided blocks in another 20 adult patients. A linear 38 mm probe, 13-6 MHz, and a 50-mm insulated block needle were used to guide injection of lidocaine 1.5% with epinephrine. RESULTS Ulnar and median nerves are superficial and located at similar depths. Ultrasound imaging showed the musculocutaneous nerve to be located dorsally. The radial nerve is dorsal to the plane of the musculocutaneous nerve. Relative to the brachial artery, the median nerve is situated between 12 and 1 o'clock in 66% of the cases. Relative to the basilic vein, the ulnar nerve is situated at 3 o'clock in 46% of the cases. The evaluated block sequence was radial, ulnar, musculocutaneous and median nerve; two points of puncture were mandatory, and 6.85 +/- 0.37 min were required to perform the blocks. Sensory onset times were similar for the four nerves. Injectate volume was lower for the musculocutaneous nerve compared to other nerves (P < 0.05). All 20 patients experienced complete sensory and motor blocks. CONCLUSION We describe an approach to, and the feasibility of ultrasound-guided block of the brachial plexus at the humeral canal. Further study will be required to establish the effectiveness and the safety of this technique.
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Affiliation(s)
- Emmanuel Guntz
- Department of Anesthesiology, Hôpital Universitaire Saint-Pierre, Université Libre de Bruxelles, Rue Haute, 322, 1000, Brussels, Belgium.
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Guntz E, Dumont H, Pastijn E, de Kerchove d’Exaerde A, Azdad K, Sosnowski M, Schiffmann SN, Gall D. Expression of Adenosine A2A Receptors in the Rat Lumbar Spinal Cord and Implications in the Modulation of N-Methyl-d-Aspartate Receptor Currents. Anesth Analg 2008; 106:1882-9. [DOI: 10.1213/ane.0b013e318173251f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Segers B, Lemaitre J, Bosschaerts T, Guntz E, Roman A, Jozsa B, Hazane E, Horn D, Pastijn I, Barroy JP. Totally retroperitoneal laparoscopic aortobifemoral bypass. Acta Chir Belg 2007; 107:548-50. [PMID: 18074917 DOI: 10.1080/00015458.2007.11680120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The classic procedure for aortobifemoral bypass is open surgery. Since the first totally laparoscopic aortobifemoral bypass reported in 1997 by Yves-Marie Dion, laparoscopy has been accepted by several authors as a possible minimally invasive alternative for aorto-iliac occlusive disease. The transperitoneal left retrocolic and retrorenal ways are generally used. The totally retroperitoneal laparoscopic procedure has been described as an alternative to the transperitoneal approach. We report here a totally laparoscopic retroperitoneal approach to performing aortobifemoral bypass. This approach was proposed to a 51-year-old man with aorto-iliac occlusive disease. There was no indication for endovascular revascularization. The patient suffered from 10 metres of bilateral intermittent claudication and lower limb ulcers. During the surgical procedure our patient was placed in a 30-degree right lateral decubitus position. The optical system was first placed in an intra-abdominal position to check the positioning of the trocars in the left retroperitoneal space. The dissection of the retroperitoneal space was performed by CO2 insufflation and by blunt dissection using laparoscopic forceps. The infrarenal aorta was exposed and clamped by laparoscopic clamps. A bifurcated graft was sutured on the left-hand side of the aorta by a running suture. Both prosthetic limbs were tunnelized retroperitoneally to the groin under optical control. The femoral anastomoses were performed by classic open surgery.
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Affiliation(s)
- B. Segers
- Department of Vascular and Thoracic surgery — Professeur J.-P. Barroy, St Pierre University Hospital, Brussels Belgium
| | - J. Lemaitre
- Department of Vascular and Thoracic surgery — Professeur J.-P. Barroy, St Pierre University Hospital, Brussels Belgium
| | - Th. Bosschaerts
- Department of Vascular and Thoracic surgery — Professeur J.-P. Barroy, St Pierre University Hospital, Brussels Belgium
| | - E. Guntz
- Department of anesthesiology, St Pierre University Hospital, Brussels Belgium
| | - A. Roman
- Department of intensive care, St Pierre University Hospital, Brussels Belgium
| | - B. Jozsa
- Department of Vascular and Thoracic surgery — Professeur J.-P. Barroy, St Pierre University Hospital, Brussels Belgium
| | - E. Hazane
- Department of Vascular and Thoracic surgery — Professeur J.-P. Barroy, St Pierre University Hospital, Brussels Belgium
| | - D. Horn
- Department of Vascular and Thoracic surgery — Professeur J.-P. Barroy, St Pierre University Hospital, Brussels Belgium
| | - I. Pastijn
- Department of anesthesiology, St Pierre University Hospital, Brussels Belgium
| | - J.-P. Barroy
- Department of Vascular and Thoracic surgery — Professeur J.-P. Barroy, St Pierre University Hospital, Brussels Belgium
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Guntz E, Dumont H, Roussel C, Gall D, Dufrasne F, Cuvelier L, Blum D, Schiffmann SN, Sosnowski M. Effects of remifentanil on N-methyl-D-aspartate receptor: an electrophysiologic study in rat spinal cord. Anesthesiology 2005; 102:1235-41. [PMID: 15915038 DOI: 10.1097/00000542-200506000-00025] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Remifentanil hydrochloride contained in Ultiva (GlaxoSmithKline, Genval, Belgium) has been incriminated in difficult postoperative pain management, promotion of hyperalgesia, and direct N-methyl-D-aspartate (NMDA) receptor activation, but the involved mechanisms have remained unclear. In the current study, the authors investigated the effects of remifentanil hydrochloride, with and without its vehicle, glycine, on the activation of NMDA receptors and the modulation of NMDA-induced current on neurons inside the lamina II from the dorsal horn of rat spinal cord. METHODS To test these effects, whole cell patch clamp recordings were conducted on acute rat lumbar spinal cord slices. Considering that both components of Ultiva (remifentanil hydrochloride and glycine) could be involved in NMDA receptor activation, experiments were performed first with remifentanil hydrochloride, second with glycine, and third with the two components within Ultiva. RESULTS Remifentanil hydrochloride does not induce any current, whereas 3 mm glycine induced a current that was abolished by the specific NMDA glutamate site antagonist D-2-amino-5-phosphonovalerate. Ultiva (remifentanil hydrochloride with its vehicle, glycine) also evoked an inward current that was abolished by D-2-amino-5-phosphonovalerate and not significantly different from the glycine-induced current. Application of remifentanil hydrochloride potentiated the NMDA-induced inward current, and this potentiation was abolished by the mu-opioid receptor antagonist naloxone. CONCLUSION These results show that remifentanil hydrochloride does not directly activate NMDA receptors. The NMDA current recorded after application of Ultiva is related to the presence of glycine. Induced NMDA current is potentiated by application of remifentanil hydrochloride through a pathway involving the mu-opioid receptor.
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Affiliation(s)
- Emmanuel Guntz
- Department of Anesthesiology, Hôpital Universitaire Saint-Pierre, Université Libre de Bruxelles, Rue haute 322, 1000 Brussels, Belgium.
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Guntz E, Herman P, Delbos A, Sosnowski M. The radial nerve should be blocked before the ulnar nerve during a brachial plexus block at the humeral canal. Can J Anaesth 2004; 51:354-7. [PMID: 15064264 DOI: 10.1007/bf03018239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The brachial plexus block through the humeral canal as described by Dupré is indicated in hand and forearm surgery. This block requires a multi-stimulation technique that emphasizes the necessity of a rigorous and safe technique. Nerve injury associated with regional anesthesia can entail significant morbidity for patients. Thus, we investigated the brachial block sequence in terms of unintended nerve stimulation as a surrogate of potential nerve injury. METHODS Sixty patients were randomly allocated in two groups of 30. In Group I the radial nerve was blocked before the ulnar nerve. In Group II the ulnar nerve was blocked before the radial nerve. During the radial nerve approach we recorded, if present, an ulnar nerve response. During the ulnar nerve approach we recorded, if present, a radial nerve response. RESULTS In Group I while looking for the radial nerve, in 50% of the cases, an ulnar motor response was recorded. In Group II while looking for the ulnar nerve, a radial motor response was recorded in 10% of the cases. CONCLUSION Our results indicate that the radial nerve should be blocked before the ulnar nerve when performing a brachial plexus block at the humeral canal.
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Affiliation(s)
- Emmanuel Guntz
- Department of Anesthesiology, Université Libre de Bruxelles, Hôpital Universitaire Saint-Pierre, Brussels, Belgium.
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