Pub Date : 2024-07-11eCollection Date: 2024-01-01DOI: 10.2147/LRA.S470574
Andreas Clipet-Jensen, Hans Fjeldsøe-Nielsen, Peter Roy Kirkegaard
Although peripheral nerve blocks are deemed very safe, a significant number of patients for whom this anesthetic technique may be particularly appealing to apply may present with preexisting peripheral neuropathies, putting them at risk for further nerve damage. We present a case with a 74-year-old male with several risk factors for peripheral neuropathy who developed a foot drop following a popliteal sciatic nerve block with ropivacaine. We suggest that the vasoconstrictive properties of ropivacaine may have contributed to a preexisting neuronal ischemia, thus further damaging an already compromised nerve.
{"title":"Foot Drop Following a Popliteal Sciatic Nerve Block with Ropivacaine, A Case Report and Literature Review.","authors":"Andreas Clipet-Jensen, Hans Fjeldsøe-Nielsen, Peter Roy Kirkegaard","doi":"10.2147/LRA.S470574","DOIUrl":"10.2147/LRA.S470574","url":null,"abstract":"<p><p>Although peripheral nerve blocks are deemed very safe, a significant number of patients for whom this anesthetic technique may be particularly appealing to apply may present with preexisting peripheral neuropathies, putting them at risk for further nerve damage. We present a case with a 74-year-old male with several risk factors for peripheral neuropathy who developed a foot drop following a popliteal sciatic nerve block with ropivacaine. We suggest that the vasoconstrictive properties of ropivacaine may have contributed to a preexisting neuronal ischemia, thus further damaging an already compromised nerve.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-12eCollection Date: 2024-01-01DOI: 10.2147/LRA.S459530
Suwarman, Osmond Muftilov Pison, Mohammad Fikry Maulana, Prapanca Nugraha
Objective: Acute postoperative pain is one of the major clinical problems that occurs in patients undergoing cesarean section with a prevalence of 89.8%. Postoperative pain causes discomfort and various complications for the mother. In addition, postoperative pain that is not handled properly can increase the risk of becoming chronic pain by 2.5 times. One of the methods recommended in the Enhanced Recovery After Caesarean Section (ERACS) protocol to prevent acute postoperative pain is the use of intrathecal long-acting opioids, with intrathecal morphine as the gold standard and Transversus Abdominis Plane (TAP) block. This study aims to assess the comparison of opioid needs as analgesic rescue between the administration of 0.1mg spinal morphine and TAP block with bupivacaine 0.2% 10mg in patients undergoing cesarean section.
Methods: This study is an observational study in a single Tertiary Hospital in West Java - Indonesia. Patients were given patient-controlled anesthesia (PCA) with fentanyl as analgesic rescue. Statistical analysis of the numerical data used the unpaired t-test and Chi-Square test for categorical data.
Results: In the group that was given spinal morphine, the duration of additional opioids was longer (p < 0.05), and the total dose of additional opioids was less than the TAP block group (p < 0.05).
Conclusion: The spinal morphine requires fewer additional opioids than the TAP block.
目的:急性术后疼痛是剖腹产患者的主要临床问题之一,发生率高达 89.8%。术后疼痛会给产妇带来不适和各种并发症。此外,术后疼痛如果处理不当,变成慢性疼痛的风险会增加 2.5 倍。增强剖腹产术后恢复(ERACS)方案中推荐的预防术后急性疼痛的方法之一是使用鞘内长效阿片类药物,其中鞘内吗啡是金标准,另外还有腹横肌平面(TAP)阻滞。本研究旨在评估剖宫产手术患者在使用 0.1 毫克脊髓吗啡和使用 0.2% 10 毫克布比卡因进行 TAP 阻滞时阿片类药物镇痛需求的比较:本研究是在印度尼西亚西爪哇的一家三级甲等医院进行的观察性研究。患者接受患者自控麻醉(PCA),并使用芬太尼镇痛。数字数据的统计分析采用非配对 t 检验,分类数据采用 Chi-Square 检验:结果:与 TAP 阻滞组相比,给予脊髓吗啡组的额外阿片类药物持续时间更长(P < 0.05),额外阿片类药物的总剂量更少(P < 0.05):结论:与TAP阻滞相比,脊髓吗啡所需的额外阿片类药物更少。
{"title":"Comparison of Spinal Morphine and Transversus Abdominis Plane Block on Opioid Requirements After Caesarean Section: An Observational Study.","authors":"Suwarman, Osmond Muftilov Pison, Mohammad Fikry Maulana, Prapanca Nugraha","doi":"10.2147/LRA.S459530","DOIUrl":"10.2147/LRA.S459530","url":null,"abstract":"<p><strong>Objective: </strong>Acute postoperative pain is one of the major clinical problems that occurs in patients undergoing cesarean section with a prevalence of 89.8%. Postoperative pain causes discomfort and various complications for the mother. In addition, postoperative pain that is not handled properly can increase the risk of becoming chronic pain by 2.5 times. One of the methods recommended in the Enhanced Recovery After Caesarean Section (ERACS) protocol to prevent acute postoperative pain is the use of intrathecal long-acting opioids, with intrathecal morphine as the gold standard and Transversus Abdominis Plane (TAP) block. This study aims to assess the comparison of opioid needs as analgesic rescue between the administration of 0.1mg spinal morphine and TAP block with bupivacaine 0.2% 10mg in patients undergoing cesarean section.</p><p><strong>Methods: </strong>This study is an observational study in a single Tertiary Hospital in West Java - Indonesia. Patients were given patient-controlled anesthesia (PCA) with fentanyl as analgesic rescue. Statistical analysis of the numerical data used the unpaired <i>t</i>-test and Chi-Square test for categorical data.</p><p><strong>Results: </strong>In the group that was given spinal morphine, the duration of additional opioids was longer (p < 0.05), and the total dose of additional opioids was less than the TAP block group (p < 0.05).</p><p><strong>Conclusion: </strong>The spinal morphine requires fewer additional opioids than the TAP block.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11180432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Rebound pain after regional anesthesia, a common phenomenon when the analgesic effect wears off, has been recognized in the last a few years. The aim of this study is to analyze the status and tendency of this area in a macroscopic perspective.
Methods: Bibliometric analysis is the primary methodology of this study. Literature retrieval was conducted in Web of Science (WoS) Core Collection. WoS, Excel, VOSviewer and CiteSpace were employed to do the analyses and visualization. Parameters were analyzed, such as publications, citations, journals, and keywords, etc.
Results: In total, 70 articles in the past 10 years were identified eligible. Most articles (14 pieces) were published in 2021, followed by 2022 and 2023 with 13 articles. Researchers come from 134 institutions and 20 countries. Huang Jung-Taek, Hallym College, and USA are the most productive author, institution and country, respectively. The articles were mainly published on the top journals of anesthesiology, orthopedics and surgery. The topic of these articles is primarily about the clinical issues of rebound pain. Peripheral nerve block, brachial plexus block and femoral nerve block are the activist keywords in the area, while perioperative management, fracture surgery and outcome may become hotpots in the next years.
Conclusion: Our results show that the study of rebound pain after regional anesthesia starts relatively late and is in upward tendency, future studies can focus on the perioperative management and outcomes of fracture patients, and the definition and mechanism of rebound pain after regional anesthesia.
{"title":"Current Status and Global Trend of Rebound Pain After Regional Anesthesia: A Bibliometric Analysis.","authors":"Rui Zhou, Wencai Jiang, Qingyuan Miao, Xinyang Li, Lize Xiong","doi":"10.2147/LRA.S455347","DOIUrl":"10.2147/LRA.S455347","url":null,"abstract":"<p><strong>Purpose: </strong>Rebound pain after regional anesthesia, a common phenomenon when the analgesic effect wears off, has been recognized in the last a few years. The aim of this study is to analyze the status and tendency of this area in a macroscopic perspective.</p><p><strong>Methods: </strong>Bibliometric analysis is the primary methodology of this study. Literature retrieval was conducted in Web of Science (WoS) Core Collection. WoS, Excel, VOSviewer and CiteSpace were employed to do the analyses and visualization. Parameters were analyzed, such as publications, citations, journals, and keywords, etc.</p><p><strong>Results: </strong>In total, 70 articles in the past 10 years were identified eligible. Most articles (14 pieces) were published in 2021, followed by 2022 and 2023 with 13 articles. Researchers come from 134 institutions and 20 countries. Huang Jung-Taek, Hallym College, and USA are the most productive author, institution and country, respectively. The articles were mainly published on the top journals of anesthesiology, orthopedics and surgery. The topic of these articles is primarily about the clinical issues of rebound pain. Peripheral nerve block, brachial plexus block and femoral nerve block are the activist keywords in the area, while perioperative management, fracture surgery and outcome may become hotpots in the next years.</p><p><strong>Conclusion: </strong>Our results show that the study of rebound pain after regional anesthesia starts relatively late and is in upward tendency, future studies can focus on the perioperative management and outcomes of fracture patients, and the definition and mechanism of rebound pain after regional anesthesia.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-08eCollection Date: 2024-01-01DOI: 10.2147/LRA.S428661
Intisar Ahmed Abdi, John Mark Kasumba, Agnes Wabule, Mary T Nabukenya, Joseph Kayongo, Bernadette Kyoheirwe, Abdirizak Abdullahi Sheikdon, Kamaludin D Osman
Introduction: Local anaesthetics (LA) are commonly used in dental and surgical emergency wards by both anaesthesia professionals and non-anaesthesia professionals. Anecdotal evidence shows that non-anaesthesia health-care professionals do not monitor vital signs during the use of local anaesthesia, and there are no standard hospital guidelines on the use of LA and management of LA toxicity by non-anaesthesia professionals.
Purpose: This study sought to assess the knowledge, attitudes and practices regarding local anaesthetic use among non-anaesthesia health-care professionals at Mulago National Referral Hospital.
Patients and methods: This was a cross-sectional study that utilized a quantitative research approach. The sample size of the study was 43 non-anaesthesia healthcare professionals from the casualty and surgical outpatient wards and Mulago dental ward. Data was collected using a questionnaire and analyzed using STATA 15.
Results: Overall, 66.67% of the Specialist, 76.47% of the senior house officers, 100% of medical officers, and 80% of the clinical orthopedic house officers had unsatisfactory levels of knowledge in Mulago casualty and surgical outpatient wards. 20% of the specialist and 16.67% of the senior house officers had unsatisfactory levels of knowledge in Mulago dental ward. 87.5% of the non-anaesthesia health-care professionals do not give a test dose on a routine basis in Mulago casualty and surgical outpatient wards. A total of 63.64% of the non-anaesthesia healthcare professionals in Mulago dental ward do not sterilize the site of injection.
Conclusion: Non-anaesthesia health-care professionals had unsatisfactory levels of knowledge, somewhat good practices, and negative attitudes toward LA use.
{"title":"Knowledge, Attitudes and Practices Regarding Use of Local Anaesthetics Among Non-Anaesthesia Healthcare Professionals at Mulago National Referral Hospital.","authors":"Intisar Ahmed Abdi, John Mark Kasumba, Agnes Wabule, Mary T Nabukenya, Joseph Kayongo, Bernadette Kyoheirwe, Abdirizak Abdullahi Sheikdon, Kamaludin D Osman","doi":"10.2147/LRA.S428661","DOIUrl":"10.2147/LRA.S428661","url":null,"abstract":"<p><strong>Introduction: </strong>Local anaesthetics (LA) are commonly used in dental and surgical emergency wards by both anaesthesia professionals and non-anaesthesia professionals. Anecdotal evidence shows that non-anaesthesia health-care professionals do not monitor vital signs during the use of local anaesthesia, and there are no standard hospital guidelines on the use of LA and management of LA toxicity by non-anaesthesia professionals.</p><p><strong>Purpose: </strong>This study sought to assess the knowledge, attitudes and practices regarding local anaesthetic use among non-anaesthesia health-care professionals at Mulago National Referral Hospital.</p><p><strong>Patients and methods: </strong>This was a cross-sectional study that utilized a quantitative research approach. The sample size of the study was 43 non-anaesthesia healthcare professionals from the casualty and surgical outpatient wards and Mulago dental ward. Data was collected using a questionnaire and analyzed using STATA 15.</p><p><strong>Results: </strong>Overall, 66.67% of the Specialist, 76.47% of the senior house officers, 100% of medical officers, and 80% of the clinical orthopedic house officers had unsatisfactory levels of knowledge in Mulago casualty and surgical outpatient wards. 20% of the specialist and 16.67% of the senior house officers had unsatisfactory levels of knowledge in Mulago dental ward. 87.5% of the non-anaesthesia health-care professionals do not give a test dose on a routine basis in Mulago casualty and surgical outpatient wards. A total of 63.64% of the non-anaesthesia healthcare professionals in Mulago dental ward do not sterilize the site of injection.</p><p><strong>Conclusion: </strong>Non-anaesthesia health-care professionals had unsatisfactory levels of knowledge, somewhat good practices, and negative attitudes toward LA use.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140110566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique-sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks -in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments.
Patients and methods: Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1% lidocaine and 0.5% levobupivacaine.
Results: The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) were performed without complications in all patients. Three of the patients received light sedation prior to the initiation of the block procedure. All surgeries were completed successfully without the need for additional analgesics or conversion to general anesthesia.
Conclusion: The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) appears to be a safe anesthetic option for unstable or high-risk patients requiring lower limb surgery. Further research with a larger cohort is necessary to validate our findings and to potentially standardize this approach.
{"title":"Combined Supra-Inguinal Fascia Iliaca, Sciatic Nerve, and Posterior Femoral Cutaneous Nerve Blocks in Austere Settings for Hemodynamically Unstable Patients with Vascular Injuries from Weapon Wounds: A Case Series.","authors":"Majaliwa Shabani, Seydina Alioune Beye, Abdoulaye Traore, Xavier Raingeval, Daouda Coulibaly, Sophie Crespo","doi":"10.2147/LRA.S452367","DOIUrl":"10.2147/LRA.S452367","url":null,"abstract":"<p><strong>Purpose: </strong>The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique-sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks -in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments.</p><p><strong>Patients and methods: </strong>Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1% lidocaine and 0.5% levobupivacaine.</p><p><strong>Results: </strong>The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) were performed without complications in all patients. Three of the patients received light sedation prior to the initiation of the block procedure. All surgeries were completed successfully without the need for additional analgesics or conversion to general anesthesia.</p><p><strong>Conclusion: </strong>The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) appears to be a safe anesthetic option for unstable or high-risk patients requiring lower limb surgery. Further research with a larger cohort is necessary to validate our findings and to potentially standardize this approach.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10916515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-23eCollection Date: 2024-01-01DOI: 10.2147/LRA.S438176
Muhammad Jaffar Khan, Yasir Eltayeb, Arunabha Karmakar, Rohma Malik, Tarig Elsafi
Background: Patients diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) are at high risk of perioperative cardiovascular complications. While it is important to focus on optimizing their cardiac function, it is also crucial to address and optimize any other modifiable risk factors that could potentially impact postoperative outcome. This also includes careful consideration of anesthetic techniques to suit the patient and facilitate the surgery. However, there is a scarcity of evidence regarding the safety of specific anesthetic approaches for heart failure patients.
Case presentation: We describe the case of an adult patient in mid-50s, with a history of ischemic dilated cardiomyopathy with reduced Ejection Fraction (about 25%) who presented with acute gangrenous appendicitis and was scheduled for an open appendectomy. It was deemed to be a high-risk patient for general and spinal anesthesia. With the guidance of a multidisciplinary team, surgery was successfully performed using a quadratus lumborum block with standard monitoring. The patient was comfortable and hemodynamically stable throughout the procedure. The postoperative course was uneventful.
Conclusion: Quadratus Lumborum Block for open appendectomy can be a beneficial alternative anesthesia technique in high-risk patients that significantly lowers perioperative cardiovascular risk, maintains hemodynamics, enhances satisfaction, and shortens hospital stay.
{"title":"Successful Use of Ultrasound Guided Quadratus Lumborum Block Without General Anesthesia for Open Appendectomy in a Patient with Heart Failure with Reduced Ejection Fraction- A Case Report and Literature Review.","authors":"Muhammad Jaffar Khan, Yasir Eltayeb, Arunabha Karmakar, Rohma Malik, Tarig Elsafi","doi":"10.2147/LRA.S438176","DOIUrl":"10.2147/LRA.S438176","url":null,"abstract":"<p><strong>Background: </strong>Patients diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) are at high risk of perioperative cardiovascular complications. While it is important to focus on optimizing their cardiac function, it is also crucial to address and optimize any other modifiable risk factors that could potentially impact postoperative outcome. This also includes careful consideration of anesthetic techniques to suit the patient and facilitate the surgery. However, there is a scarcity of evidence regarding the safety of specific anesthetic approaches for heart failure patients.</p><p><strong>Case presentation: </strong>We describe the case of an adult patient in mid-50s, with a history of ischemic dilated cardiomyopathy with reduced Ejection Fraction (about 25%) who presented with acute gangrenous appendicitis and was scheduled for an open appendectomy. It was deemed to be a high-risk patient for general and spinal anesthesia. With the guidance of a multidisciplinary team, surgery was successfully performed using a quadratus lumborum block with standard monitoring. The patient was comfortable and hemodynamically stable throughout the procedure. The postoperative course was uneventful.</p><p><strong>Conclusion: </strong>Quadratus Lumborum Block for open appendectomy can be a beneficial alternative anesthesia technique in high-risk patients that significantly lowers perioperative cardiovascular risk, maintains hemodynamics, enhances satisfaction, and shortens hospital stay.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10899805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139990536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01eCollection Date: 2024-01-01DOI: 10.2147/LRA.S446667
Danxu Ma, Abulaihaiti Maimaitimin, Yun Wang
Objective: Cervicogenic headache (CEH) is a condition resulting from upper cervical spine dysfunction and associated structural and soft tissue abnormalities, significantly impacting patients' quality of life. To acquire better therapeutic results, we presented a novel ultrasound-guided "three in one" approach plus interfascial plane (IFP) blocks for the treatment of CEH. This approach allows for the modulation of C2 dorsal root ganglion (DRG), third occipital nerve (TON), and C3 medial branch with one-point puncture. Additionally, it allows for IFP blocks between the upper neck and occipital muscles within the same scanning plane.
Patients and methods: We evaluated patients diagnosed with CEH from July 2021 to December 2022 in our pain clinic. We included those who did not respond to conservative treatment and single occipital nerve block, therefore received nerve block or pulsed radiofrequency (PRF) using the "Three in One" approach plus IFP blocks. The accuracy of the ultrasound-guided C2 DRG puncture procedures was confirmed through fluoroscopy with C-arm and the sensory testing of PRF. The therapeutic effect of these interventions was assessed using the numerical rating scale (NRS) scores during telephone follow-ups at 1, 3, and 6 months.
Results: Utilizing the "Three in One" approach, a total of 5 patients diagnosed with CEH underwent nerve block plus IFP blocks, while 2 patients underwent PRF plus IFP blocks. Employing ultrasound-guided C2 DRG puncture procedures, the needle tip's correct placement was confirmed through both fluoroscopy and sensory testing of PRF. Notably, none of the cases experienced any complications associated with the approach. Subsequent follow-up assessments revealed an improvement in the NRS scores for CEH in all patients.
Conclusion: The ultrasound-guided "Three in One" approach plus IFP blocks may be a potential effective method for the treatment of CEH.
{"title":"A Novel Ultrasound-Guided \"Three in One\" Approach Plus Interfascial Plane Blocks for the Treatment of Cervicogenic Headache.","authors":"Danxu Ma, Abulaihaiti Maimaitimin, Yun Wang","doi":"10.2147/LRA.S446667","DOIUrl":"10.2147/LRA.S446667","url":null,"abstract":"<p><strong>Objective: </strong>Cervicogenic headache (CEH) is a condition resulting from upper cervical spine dysfunction and associated structural and soft tissue abnormalities, significantly impacting patients' quality of life. To acquire better therapeutic results, we presented a novel ultrasound-guided \"three in one\" approach plus interfascial plane (IFP) blocks for the treatment of CEH. This approach allows for the modulation of C2 dorsal root ganglion (DRG), third occipital nerve (TON), and C3 medial branch with one-point puncture. Additionally, it allows for IFP blocks between the upper neck and occipital muscles within the same scanning plane.</p><p><strong>Patients and methods: </strong>We evaluated patients diagnosed with CEH from July 2021 to December 2022 in our pain clinic. We included those who did not respond to conservative treatment and single occipital nerve block, therefore received nerve block or pulsed radiofrequency (PRF) using the \"Three in One\" approach plus IFP blocks. The accuracy of the ultrasound-guided C2 DRG puncture procedures was confirmed through fluoroscopy with C-arm and the sensory testing of PRF. The therapeutic effect of these interventions was assessed using the numerical rating scale (NRS) scores during telephone follow-ups at 1, 3, and 6 months.</p><p><strong>Results: </strong>Utilizing the \"Three in One\" approach, a total of 5 patients diagnosed with CEH underwent nerve block plus IFP blocks, while 2 patients underwent PRF plus IFP blocks. Employing ultrasound-guided C2 DRG puncture procedures, the needle tip's correct placement was confirmed through both fluoroscopy and sensory testing of PRF. Notably, none of the cases experienced any complications associated with the approach. Subsequent follow-up assessments revealed an improvement in the NRS scores for CEH in all patients.</p><p><strong>Conclusion: </strong>The ultrasound-guided \"Three in One\" approach plus IFP blocks may be a potential effective method for the treatment of CEH.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yong-Kang Gui, Rui-Fei Xiao, Ya-Ru Luo, Yang Liu, Xin Da, Sizhu Zhu, De-Wen Shi, Xu-Dong Hu, Guang-Hong Xu
{"title":"Analgesic Effects of Different Local Infiltration Anesthesia Techniques Combined with Femoral Nerve Block in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Clinical Trial","authors":"Yong-Kang Gui, Rui-Fei Xiao, Ya-Ru Luo, Yang Liu, Xin Da, Sizhu Zhu, De-Wen Shi, Xu-Dong Hu, Guang-Hong Xu","doi":"10.2147/lra.s436767","DOIUrl":"https://doi.org/10.2147/lra.s436767","url":null,"abstract":"","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139022159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30eCollection Date: 2023-01-01DOI: 10.2147/LRA.S439429
James Harvey Jones
Background: The aims of this study are to analyze the association between the number of recorded pain scores and baseline pain following surgery, analgesia technique, and patient demographics, as well as the substitution of missing data with the results from mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.
Methods: This retrospective chart review was approved by the Institutional Review Board (IRB). The following data were collected: patient demographics (age, gender, body mass index (BMI), race, and ethnicity); surgery type and date; analgesia with or without transversus abdominis plane (TAP) block; as well as the time, date, and value for all postoperative pain scores on the first postoperative day (POD). The following null hypotheses were tested: (1) the number of pain recordings will be independent of TAP block analgesia, baseline pain on POD 1, and patient demographics; and (2) there will be no significant differences in pain scores with and without TAP block analgesia following complete case analysis, mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.
Results: This study analyzed 486 patients including 2562 recorded pain scores. An increase in age by one year is, on average, associated with a 0.04 (95% confidence interval (CI) -0.060 to -0.025) decrease in the number of pain scores recorded (p < 0.001). Black race is associated with 0.763 less pain scores, on average (95% CI -1.49 to -0.039) and this value is statistically significant (p = 0.039). All datasets with substituted values for missing data yield lower pain scores for patients who did not receive TAP block. Significant differences in recorded pain scores are only noted for scores recorded between 0400 and 0759 and 1600-1959 in mixed models.
Conclusion: Discrepancies in pain score recordings among patients are associated with age and black race. When these discrepancies are addressed with statistical methods, clinically significant differences are appreciated.
研究背景本研究的目的是分析记录的疼痛评分次数与术后基线疼痛、镇痛技术和患者人口统计学特征之间的关联,以及用平均替代、最后观察结转、回归归因、多重归因和混合模型的结果替代缺失数据:这项回顾性病历审查已获得机构审查委员会(IRB)批准。收集的数据包括:患者人口统计学特征(年龄、性别、体重指数 (BMI)、种族和民族);手术类型和日期;使用或不使用腹横肌平面 (TAP) 阻滞镇痛;以及术后第一天 (POD) 所有术后疼痛评分的时间、日期和数值。对以下零假设进行了检验:(1) 疼痛记录的数量与 TAP 阻滞镇痛、POD 1 的基线疼痛和患者人口统计学特征无关;(2) 经过完整病例分析、平均值替代、最后观察结果结转、回归归因、多重归因和混合模型分析后,采用 TAP 阻滞镇痛和未采用 TAP 阻滞镇痛的疼痛评分无显著差异:本研究分析了 486 名患者,包括 2562 份疼痛评分记录。年龄每增加一岁,记录的疼痛评分数量平均会减少 0.04(95% 置信区间 (CI) -0.060 至 -0.025)(p < 0.001)。黑种人的疼痛评分平均减少 0.763 分(95% CI -1.49 至 -0.039),且该值具有统计学意义(p = 0.039)。所有用替代值替代缺失数据的数据集都显示,未接受 TAP 阻滞的患者疼痛评分较低。在混合模型中,只有在 4:00 至 0759 和 16:00 至 1959 之间记录的疼痛评分存在显著差异:结论:患者疼痛评分记录的差异与年龄和黑人种族有关。结论:患者疼痛评分记录的差异与年龄和黑人种族有关。当使用统计方法处理这些差异时,就会发现有临床意义的差异。
{"title":"The Impact of Missing Postoperative Longitudinal Pain Data on Study Results Investigating Analgesia from Transversus Abdominis Plane Block on Postoperative Day One Following Abdominal Surgery: A Single-Center Retrospective Chart Review.","authors":"James Harvey Jones","doi":"10.2147/LRA.S439429","DOIUrl":"10.2147/LRA.S439429","url":null,"abstract":"<p><strong>Background: </strong>The aims of this study are to analyze the association between the number of recorded pain scores and baseline pain following surgery, analgesia technique, and patient demographics, as well as the substitution of missing data with the results from mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.</p><p><strong>Methods: </strong>This retrospective chart review was approved by the Institutional Review Board (IRB). The following data were collected: patient demographics (age, gender, body mass index (BMI), race, and ethnicity); surgery type and date; analgesia with or without transversus abdominis plane (TAP) block; as well as the time, date, and value for all postoperative pain scores on the first postoperative day (POD). The following null hypotheses were tested: (1) the number of pain recordings will be independent of TAP block analgesia, baseline pain on POD 1, and patient demographics; and (2) there will be no significant differences in pain scores with and without TAP block analgesia following complete case analysis, mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.</p><p><strong>Results: </strong>This study analyzed 486 patients including 2562 recorded pain scores. An increase in age by one year is, on average, associated with a 0.04 (95% confidence interval (CI) -0.060 to -0.025) decrease in the number of pain scores recorded (p < 0.001). Black race is associated with 0.763 less pain scores, on average (95% CI -1.49 to -0.039) and this value is statistically significant (p = 0.039). All datasets with substituted values for missing data yield lower pain scores for patients who did not receive TAP block. Significant differences in recorded pain scores are only noted for scores recorded between 0400 and 0759 and 1600-1959 in mixed models.</p><p><strong>Conclusion: </strong>Discrepancies in pain score recordings among patients are associated with age and black race. When these discrepancies are addressed with statistical methods, clinically significant differences are appreciated.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10695121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138487918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-10eCollection Date: 2023-01-01DOI: 10.2147/LRA.S403567
Cassandra Hoffmann, Angela Snow, Celine Chedid, Carol Abi Shadid, Eiichi A Miyasaka
Purpose: Neonates present unique challenges for pediatric surgical teams. To optimize outcomes, it is imperative to standardize perioperative care by using early extubation and multimodal analgesic techniques. The quadratus lumborum (QL) block provides longer duration and superior pain relief than other single-injection abdominal fascial plane techniques. The purpose of this case series was to report our initial experience with QL blocks in neonatal patients treated with intestinal ERAS.
Patients and methods: Ten neonates requiring intestinal surgery at a single tertiary care center who received QL blocks between December 2019 and April 2022 for enhanced recovery were studied. Bilateral QL blocks were performed with 0.5 mL/kg of 0.25% ropivacaine per side with an adjuvant of 1 mcg/kg of dexmedetomidine.
Results: Gestational age at birth ranged from 32.2 to 41 weeks. The median age, weight, and American Society of Anesthesiologists (ASA) score at the time of surgery was 5 days [range 7.5 hours, 60 days], 2.84 kg [range 1.5, 4.5], and 3, respectively. Bilateral QL blocks were performed without complications in all patients. Two patients were outside the neonatal range from birth to surgery, but were under 42 weeks gestational age when corrected for prematurity. All patients were extubated with well-controlled pain, and no patient required reintubation within the first 24 hours. Postoperatively, median cumulative morphine equivalents were 0.16 mg/kg [range 0, 0.79] and six patients received scheduled acetaminophen. Morphine (0.1 mg/kg) was administered to patients with a modified neonatal infant pain scale (NIPS) score greater than or equal to 4, and pain was reassessed 1 hour after administration (Appendix).
Conclusion: When developing intestinal ERAS protocols, Bilateral QL blocks may be considered for postoperative analgesia in the neonatal population. Further prospective studies are required to validate this approach in neonates.
{"title":"Quadratus Lumborum Block as a Cornerstone for Neonatal Intestinal Surgery Enhanced Recovery (ERAS): A Case Series.","authors":"Cassandra Hoffmann, Angela Snow, Celine Chedid, Carol Abi Shadid, Eiichi A Miyasaka","doi":"10.2147/LRA.S403567","DOIUrl":"10.2147/LRA.S403567","url":null,"abstract":"<p><strong>Purpose: </strong>Neonates present unique challenges for pediatric surgical teams. To optimize outcomes, it is imperative to standardize perioperative care by using early extubation and multimodal analgesic techniques. The quadratus lumborum (QL) block provides longer duration and superior pain relief than other single-injection abdominal fascial plane techniques. The purpose of this case series was to report our initial experience with QL blocks in neonatal patients treated with intestinal ERAS.</p><p><strong>Patients and methods: </strong>Ten neonates requiring intestinal surgery at a single tertiary care center who received QL blocks between December 2019 and April 2022 for enhanced recovery were studied. Bilateral QL blocks were performed with 0.5 mL/kg of 0.25% ropivacaine per side with an adjuvant of 1 mcg/kg of dexmedetomidine.</p><p><strong>Results: </strong>Gestational age at birth ranged from 32.2 to 41 weeks. The median age, weight, and American Society of Anesthesiologists (ASA) score at the time of surgery was 5 days [range 7.5 hours, 60 days], 2.84 kg [range 1.5, 4.5], and 3, respectively. Bilateral QL blocks were performed without complications in all patients. Two patients were outside the neonatal range from birth to surgery, but were under 42 weeks gestational age when corrected for prematurity. All patients were extubated with well-controlled pain, and no patient required reintubation within the first 24 hours. Postoperatively, median cumulative morphine equivalents were 0.16 mg/kg [range 0, 0.79] and six patients received scheduled acetaminophen. Morphine (0.1 mg/kg) was administered to patients with a modified neonatal infant pain scale (NIPS) score greater than or equal to 4, and pain was reassessed 1 hour after administration (Appendix).</p><p><strong>Conclusion: </strong>When developing intestinal ERAS protocols, Bilateral QL blocks may be considered for postoperative analgesia in the neonatal population. Further prospective studies are required to validate this approach in neonates.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/98/d9/lra-16-165.PMC10576531.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}