Journal of Anesthesia最新文献

Purpose: To appraise the therapeutic impact of high-voltage pulsed radiofrequency (HVPRF) on the management of refractory unilateral cervical radicular pain.

Methods: The study was conducted on 100 patients who had refractory chronic unilateral cervical radicular pain. Patients were divided into two equal groups (50 patients each): group (S): standard-voltage pulsed radiofrequency (SVPRF); and group (H): HVPRF. All patients received ultrasound-guided PRF on the affected cervical nerve root, either SVPRF in group (S) or HVPRF in group (H). The primary outcome was to assess the number of patients who experienced successful pain relief at 6 months' post-intervention, which is defined as ≥ 50% reduction of visual analog scale (VAS) from pre-intervention level. Secondary outcome was to assess the impact of treatment on neck disability index (NDI) which was evaluated before treatment, 1, 3, and 6 months after the procedure.

Results: VAS and NDI values were significantly reduced in group (H) in comparison to group (S) at all follow-ups. After 6 months, all patients in group (H) showed a clinically meaningful response with ≥ 50% decrease in VAS score. Conversely, no participants in group (S) attained a comparable decrease in their VAS scores.

Conclusion: HVPRF could significantly reduce pain and functional disabilities compared to SVPRF up to 6 months after intervention in patients suffering from unilateral resistant cervical radiculopathy. IRB number: Fayoum Faculty of Medicine Research Ethical Committee, approval no. R 427. Research registration number: Registry for Clinical Trials (NCT05749185).

Purpose: Minimally invasive cardiac surgery (MICS) involves fewer complications than median sternotomy. However, difficulties in post-MICS analgesia can undermine these advantages. The serratus anterior plane block (SAPB), an effective analgesic for thoracic surgery, could benefit post-MICS analgesia using programmed intermittent bolus infusion (PIBI). We investigated whether PIBI with SAPB can reduce post-MICS fentanyl administration and evaluated its safety profile.

Methods: This randomized, double-blind, controlled trial included 20 patients (age 20-80 years; Eastern Cooperative Oncology Group Performance Status 0-II; scheduled for elective MICS) randomly allocated to two groups (SAPB or control). All patients underwent preoperative SAPB with catheterization, followed by either 20 mL 0.25% ropivacaine or saline bolus every 6 h postoperatively. All patients received intravenous fentanyl via patient-controlled analgesia. Blood samples were collected 10, 20, 30, and 60 min after preoperative ropivacaine infusion; during and after cardiopulmonary bypass; and on postoperative days 1-5. The primary outcome was cumulative fentanyl consumption up to postoperative day 5. Secondary outcomes included numerical rating scale scores, rehabilitation preoperatively and postoperatively, postoperative nausea and vomiting, ropivacaine toxicity, and PIBI with SAPB complications.

Results: After excluding three patients, data from 17 patients were analyzed. No significant difference in cumulative fentanyl consumption on postoperative day 5 was observed (SAPB: median [interquartile range], 512 µg [457-753] vs. control: 654 µg [439-982], P = 0.96). Serum ropivacaine concentration remained below the toxicity threshold.

Conclusion: PIBI with SAPB did not reduce post-MICS fentanyl consumption, and serum ropivacaine concentration did not reach the toxicity threshold.

Purpose: The impact of multidisciplinary team (MDT) interventions on chronic postsurgical pain remains unclear. This study evaluated the effects of MDT on acute and chronic pain outcomes in total knee arthroplasty (TKA) patients.

Methods: This retrospective cohort study included 324 patients who underwent unilateral TKA between April 2017 and March 2023. The patients were divided into pre-MDT (n = 147) and post-MDT (n = 177) groups. The MDT, comprising anesthesiologists, pain nurses, and pharmacists, conducted daily rounds from postoperative day (POD) 1 to 4. The acute (duration of nerve block, incidence of breakthrough pain [BTP]) and chronic outcomes at 3 months (movement-related numerical rating scale [NRS] scores, regular analgesic use) were compared. Statistical significance was set at p < 0.05.

Results: The preoperative demographics were comparable between groups. The MDT significantly prolonged nerve block duration (2.7 ± 1.0 vs. 3.0 ± 1.5 days, p = 0.027) and reduced BTP incidence (50.3 vs. 29.4%, p = 0.0001). At 3 months, movement-related NRS scores were lower in the post-MDT group (4.2 ± 3.5 vs. 2.1 ± 2.4, p = 0.025), while regular analgesic use showed no significant difference (21.8 vs. 16.9%, p = 0.31).

Conclusion: MDT intervention improved acute pain management by reducing BTP and ensuring optimal nerve block use. Additionally, MDT was associated with better chronic pain outcomes, reflected in lower movement-related NRS scores at 3 months. These findings highlight MDTs' role in improving acute pain management and reducing movement-related pain at 3 months after TKA.

Purpose: To clarify the incidence of activities of daily living (ADL) decline following transcatheter aortic valve implantation (TAVI) and to investigate its contributing factors, including anesthesia methods and sedative drugs.

Methods: This retrospective study included 128 patients who underwent transfemoral TAVI between December 2018 and June 2023. ADL was assessed using the Katz Index preoperatively and one week postoperatively. Patients with decreased scores were assigned to the ADL-decline group. Clinical, physical, cognitive, and perioperative data were analyzed. Multivariate logistic regression analysis was performed to identify predictors of ADL decline.

Results: ADL decline occurred in 25 patients (20%), who were significantly older (87.9 vs. 85.1 years, p = 0.004), had lower preoperative Short Physical Performance Battery (SPPB) scores (7.2 vs. 9.7, p = 0.001), and lower preoperative grip strength (14.6 vs. 17.4, p = 0.04). All three patients of with postoperative cerebral infarction experienced ADL decline. No significant differences in anesthesia methods (general anesthesia vs. monitored anesthesia care) or sedative drugs (propofol vs. remimazolam) were noted. Multivariate analysis revealed that older age (adjusted odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.01-1.31; p = 0.03) and lower preoperative SPPB score (adjusted OR: 0.83; 95% CI: 0.69-0.98; p = 0.03) were independent predictors of ADL decline.

Conclusion: Older age and reduced preoperative physical function were associated with ADL decline after TAVI. In contrast, anesthesia methods and sedative drug choices did not influence postoperative ADL. These findings may help guide patient selection and inform perioperative rehabilitation strategies to preserve independence after TAVI.

Purpose: Reports on postoperative delirium (POD), neutrophil-percentage-to-albumin ratio (NPAR), and systemic immune-inflammatory index (SII) are limited. We aimed to compare the accuracy of preoperative NPAR, SII, and neutrophil-to-lymphocyte ratio (NLR) in predicting POD in patients undergoing head and neck free-flap reconstruction.

Methods: This single-center, observational, retrospective study in Japan included 184 patients who underwent head and neck free-flap reconstruction. POD was diagnosed using the Intensive Care Delirium Screening Checklist. Multivariable logistic regression analyses were conducted to evaluate the association of preoperative NPAR, SII, and NLR with POD. Receiver operating characteristic (ROC) curves were used to compare the accuracy of each inflammatory marker in predicting POD.

Results: Seven patients were excluded, leaving 177 patients (52 females, 125 males). Of these, 38 (21.5%) were diagnosed with POD. Multivariable logistic regression showed that preoperative NPAR, SII, and NLR were significantly associated with POD in patients undergoing head and neck free-flap reconstruction surgery. The areas under the ROC curve of NPAR, SII, and NLR were 0.78 (95% confidence interval: 0.69-0.86), 0.72 (0.62-0.82), and 0.75 (0.66-0.84), respectively.

Conclusion: The Preoperative NPAR and SII were significantly correlated with POD in patients undergoing head and neck reconstruction, similar to NLR. Preoperative NPAR might serve as an established marker in predicting POD in patients undergoing head and neck free-flap reconstruction.

Spinal anesthesia is the technique of choice for cesarean delivery, offering rapid onset and reliable anesthesia, but conventional intrathecal doses of hyperbaric bupivacaine frequently cause significant hypotension and delayed recovery. Low-dose spinal anesthesia (LDSA), generally defined as ≤ 8 mg of hyperbaric bupivacaine, often combined with intrathecal opioids, has been investigated as a strategy to mitigate these effects. Current evidence indicates that LDSA can attenuate hemodynamic fluctuations and reduce intraoperative nausea without compromising neonatal outcomes; however, excessively low doses may increase the risk of incomplete block and conversion to general anesthesia. While LDSA may be advantageous in patients with cardiovascular compromise, routine dose reduction for all parturients is not supported by existing data. Thus, LDSA represents a context-specific alternative within modern obstetric anesthesia practice, with benefits and limitations that must be weighed against established prophylactic strategies for managing spinal-induced hypotension.