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Neuropathies Following an Ultrasound-Guided Axillary Brachial Plexus Block. 超声引导下腋窝臂丛神经阻滞后的神经病变。
IF 2.9 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/LRA.S426515
Keito Koh, Onishi Tatsuki, Sonoko Sakuraba, Sho Yamazaki, Hajime Yako, Takeshi Omae
Purpose Ultrasound-guided brachial plexus block (UGBPB) has interscalene, supraclavicular, infraclavicular, and axillary approaches. The axillary block is considered to be the safest and with fewer adverse events compared to the interscalene (eg, phrenic nerve block, spinal cord or vertebral artery puncture) and supraclavicular (eg, pneumothorax). However, with regard to postoperative neurological symptoms (PONS), it is controversial whether its incidence after an axillary block was higher than that after non-axillary approaches”. In this study, we investigated whether the incidence of a neuropathy after an axillary block was higher than that after non-axillary approaches. Patients and Methods This was a single-center, retrospective cohort study. All UGBPBs were performed under general anesthesia between January 2014 and March 2020. The outcomes included the overall incidence of PONS and neuropathies for axillary and non-axillary approaches. The etiology, symptoms, and outcomes of patients were investigated. Results Of the 992 patients, 143 (14%) and 849 (86%) were subjected to axillary and non-axillary approaches, respectively. Among 19 cases (19.2:1000; 95% confidence interval [CI], 18.2–20.1) of PONS, four (4.0:1000; 95% CI, 3.8–4.2) were neuropathies attributed to the UGBPB, three (21.0:1000; 95% CI, 18.1–23.8) to the axillary and one (2.8:1000; 95% CI, 2.6–3.1) to non-axillary approaches. The incidence of neuropathies after an axillary block was significantly higher than that after non-axillary approaches (P = 0.005). Conclusion The incidence of neuropathies after US-guided axillary block under general anesthesia was significantly higher than that after non-axillary approaches.
目的:超声引导下臂丛阻滞(UGBPB)有斜角肌间、锁骨上、锁骨下和腋窝入路。与斜角肌间(如膈神经阻滞、脊髓或椎动脉穿刺)和锁骨上(如气胸)相比,腋窝阻滞被认为是最安全的,不良事件较少。然而,关于术后神经系统症状(PONS),腋路阻滞后的发生率是否高于非腋路入路仍存在争议”。在这项研究中,我们调查了腋窝阻滞后神经病变的发生率是否高于非腋窝入路。患者和方法:这是一项单中心、回顾性队列研究。所有UGBPBs均于2014年1月至2020年3月在全身麻醉下进行。结果包括腋窝和非腋窝入路的PONS和神经病变的总发生率。对患者的病因、症状和预后进行了调查。结果:992例患者中,143例(14%)采用腋窝入路,849例(86%)采用非腋窝入路。19例中(19.2:1000;PONS的95%置信区间[CI], 18.2-20.1), 4例(4.0:1000;95% CI, 3.8-4.2)为UGBPB所致神经病,3例(21.0:1000;95% CI, 18.1-23.8)和1 (2.8:1000;95% CI, 2.6-3.1)到非腋窝入路。腋窝入路后神经病变发生率明显高于非腋窝入路(P = 0.005)。结论:全麻下us引导下腋窝阻滞术后神经病变的发生率明显高于非腋窝入路。
{"title":"Neuropathies Following an Ultrasound-Guided Axillary Brachial Plexus Block.","authors":"Keito Koh, Onishi Tatsuki, Sonoko Sakuraba, Sho Yamazaki, Hajime Yako, Takeshi Omae","doi":"10.2147/LRA.S426515","DOIUrl":"https://doi.org/10.2147/LRA.S426515","url":null,"abstract":"Purpose Ultrasound-guided brachial plexus block (UGBPB) has interscalene, supraclavicular, infraclavicular, and axillary approaches. The axillary block is considered to be the safest and with fewer adverse events compared to the interscalene (eg, phrenic nerve block, spinal cord or vertebral artery puncture) and supraclavicular (eg, pneumothorax). However, with regard to postoperative neurological symptoms (PONS), it is controversial whether its incidence after an axillary block was higher than that after non-axillary approaches”. In this study, we investigated whether the incidence of a neuropathy after an axillary block was higher than that after non-axillary approaches. Patients and Methods This was a single-center, retrospective cohort study. All UGBPBs were performed under general anesthesia between January 2014 and March 2020. The outcomes included the overall incidence of PONS and neuropathies for axillary and non-axillary approaches. The etiology, symptoms, and outcomes of patients were investigated. Results Of the 992 patients, 143 (14%) and 849 (86%) were subjected to axillary and non-axillary approaches, respectively. Among 19 cases (19.2:1000; 95% confidence interval [CI], 18.2–20.1) of PONS, four (4.0:1000; 95% CI, 3.8–4.2) were neuropathies attributed to the UGBPB, three (21.0:1000; 95% CI, 18.1–23.8) to the axillary and one (2.8:1000; 95% CI, 2.6–3.1) to non-axillary approaches. The incidence of neuropathies after an axillary block was significantly higher than that after non-axillary approaches (P = 0.005). Conclusion The incidence of neuropathies after US-guided axillary block under general anesthesia was significantly higher than that after non-axillary approaches.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/92/b4/lra-16-123.PMC10488563.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10213224","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}
引用次数: 0
Systemic Analgesia versus Continuous Erector Spinae Plane Block (ESPB) Infusion During Paediatric Nephrectomy: A Randomized, Controlled Trial. 在小儿肾切除术中,全身性镇痛与连续勃起脊柱平面阻滞(ESPB)输注:一项随机对照试验。
IF 2.9 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/LRA.S401980
Suzan Adlan, Ahmad Abd El-Rahman, Sahar Abdel-Baky Mohamed, Ahmed M Thabet, Eman Maghawry Hamada, Basma Rezk Farouk, Fatma Adel El Sherif

Purpose: A subcostal flank incision is required for open radical nephrectomy, which is a surgical procedure used to remove tumors of the kidney that are malignant. The erector spinae plane block (ESPB) and continuous catheter use in children are receiving more and more support by paediatric regional anaesthesiologists. Our objective was to compare systemic analgesic to continuous ESPB for pain relief in paediatric patients undergoing open radical nephrectomy.

Methods: Sixty children with cancer ASA I or II and undergoing open radical nephrectomy between the ages of two and seven participated in this prospective, randomized, controlled, and open label study. The cases were divided into two equal groups (E and T groups); Group E received ipsilateral continuous ultrasound-guided ESPB at T9 (thoracic vertebrae), with a bolus of 0.4 mL/kg bupivacaine 0.25%. Immediately postoperatively, Group E (ESPB group) received continuous ESPB with a PCA (patient controlled analgesia) pump at a rate of 0.2 mL/kg/hour bupivacaine 0.125%. Group T (Tramadol group), Tramadol hydrochloride was administered intravenously at a dose of 2 mg/kg/8hour, which could be increased to 2 mg/kg/6hours. Then, we followed up on patients' total analgesic consumption for 48 hours following surgery, as well as the time it took for them to request rescue analgesic, their FLACC and sedation scores, and their hemodynamics and side effects immediately following surgery as well as at 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours.

Results: A highly significant difference in total tramadol consumed in group T 11.97 ± 1.13 mg/kg while group E was 2.07± 1.54 mg/kg (p < 0.001). 100% patients in group T requested analgesia compared to 46.7% patients in group E (p < 0.001). From 2 to 48 hour, FLACC significantly decreased in E compared to T group (p≤ 0.006) at all-time points.

Conclusion: Ultrasound-guided continuous ESPB significantly provided better postoperative pain relief, reduced postoperative tramadol consumption and reduced pain scores compared with the use of tramadol alone, in paediatric cancer patients undergoing nephrectomy.

目的:开放性根治性肾切除术需要肋下侧切口,这是一种用于切除恶性肾肿瘤的外科手术。直立脊柱平面阻滞(ESPB)和连续导管在儿童中的应用越来越受到儿科区域麻醉医师的支持。我们的目的是比较全身性镇痛和持续ESPB在接受开放性根治性肾切除术的儿童患者中的疼痛缓解效果。方法:60名年龄在2至7岁之间的ASA I或II型癌症儿童接受开放性根治性肾切除术,参与了这项前瞻性、随机、对照和开放标签的研究。将病例分为两组(E组和T组);E组在T9(胸椎)行同侧超声引导下连续ESPB,剂量为0.25%布比卡因0.4 mL/kg。术后即刻,E组(ESPB组)采用PCA(患者自控镇痛)泵持续ESPB,剂量为0.2 mL/kg/h布比卡因0.125%。T组(曲马多组),静脉滴注盐酸曲马多,剂量为2 mg/kg/8h,可增加至2 mg/kg/6h。然后,我们随访了患者术后48小时的总镇痛用量,以及他们要求抢救镇痛所需的时间,他们的FLACC和镇静评分,以及手术后立即以及2、4、6、8、12、18、24、36和48小时的血流动力学和副作用。结果:T组曲马多总消耗量为11.97±1.13 mg/kg, E组为2.07±1.54 mg/kg,差异极显著(p < 0.001)。T组100%患者要求镇痛,而E组46.7%患者要求镇痛(p < 0.001)。2 ~ 48 h, E组FLACC在各时间点均较T组显著降低(p≤0.006)。结论:与单独使用曲马多相比,超声引导下的持续ESPB能更好地缓解小儿肿瘤肾切除术患者的术后疼痛,减少术后曲马多的使用,降低疼痛评分。
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引用次数: 0
Intrathecal Morphine versus Morphine-Dexmedetomidine Combination for Postoperative Pain Control After Total Knee Replacement: A Randomized Controlled Trial. 鞘内吗啡与吗啡-右美托咪定联合用于全膝关节置换术后疼痛控制:一项随机对照试验。
IF 2.9 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/LRA.S419465
Amany F Omara, Hadal Hassan Mohsen, Alaa Mohammed Abo Hagar, Ahmed F Abdelrahman

Objective: This prospective study aimed to compare the analgesic efficacy and adverse effects of intrathecal morphine, dexmedetomidine, and a combination of both in patients undergoing total knee replacement (TKR).

Patients and methods: This randomized prospective study was carried out in Tanta university hospital in orthopedic surgery for 6 months on 105 adult patients with American Society of Anesthesiologists Physical Status Class II and III, aged > 50 years, and scheduled for total knee replacement surgery randomly allocated into morphine group received 0.5% heavy bupivacaine plus 0.1 mg of morphine, morphine/ dexmedetomidine group, received 0.5% heavy bupivacaine plus 0.1 mg of morphine and 5 mcg of dexmedetomidine and dexmedetomidine group received 0.5% heavy bupivacaine plus 5 mcg of dexmedetomidine. The time of the first required analgesia, postoperative pain severity, the total dose of morphine, postoperative complication, and the patient's level of sedation were recorded.

Results: About half of the patients in the dexmedetomidine group requested first rescue analgesia 6 hours after the operation, significantly shorter than the other two groups. On the other hand, the other two groups show no significant difference between them regarding the first required analgesia. At rest, the dexmedetomidine group have significantly higher VAS with a significant increase in patients who required morphine as rescue analgesia than the other two groups. While at movement, patients in the dexmedetomidine group felt pain at 4 hrs postoperatively with significantly higher VAS than the other two groups. At the same time, the sedation score was significantly lower in the dexmedetomidine group than in the other two groups. 22.2% of cases in the morphine group developed nausea and vomiting with a significant difference between the three groups.

Conclusion: Despite the absence of substantial side effects, our findings did not suggest enhanced analgesia with the combination of intrathecal morphine and dexmedetomidine.

目的:本前瞻性研究旨在比较鞘内吗啡、右美托咪定以及两者联合应用在全膝关节置换术(TKR)患者中的镇痛效果和不良反应。患者及方法:本随机前瞻性研究在坦塔大学医院骨科外科进行了为期6个月的105例美国麻醉学会身体状态II级和III级,年龄> 50岁,计划行全膝关节置换术的成人患者,随机分为吗啡组,给予0.5%重布比卡因加0.1 mg吗啡,吗啡/右美托咪定组。给予0.5%重布比卡因加吗啡0.1 mg,右美托咪定5 MCG,右美托咪定组给予0.5%重布比卡因加右美托咪定5 MCG。记录首次镇痛时间、术后疼痛严重程度、吗啡总剂量、术后并发症及患者镇静水平。结果:右美托咪定组约有一半患者在术后6小时要求首次抢救性镇痛,明显短于其他两组。另一方面,其他两组在第一组所需的镇痛方面没有显着差异。休息时,右美托咪定组VAS明显高于其他两组,需要吗啡作为救急镇痛的患者明显增加。在运动时,右美托咪定组患者术后4小时感到疼痛,VAS明显高于其他两组。同时,右美托咪定组镇静评分明显低于其他两组。吗啡组出现恶心呕吐的发生率为22.2%,三组间差异有统计学意义。结论:尽管没有明显的副作用,但我们的研究结果并不表明鞘内吗啡和右美托咪定联合使用可以增强镇痛效果。
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引用次数: 0
Case Report: Erector Spinae Block in Perforated Viscus. 病例报告:粘滞穿孔的竖脊肌阻滞。
IF 2.9 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/LRA.S393913
Jassim Rauf, Mohammad Mohsin A M Haji

Background: Erector spinae plane block (ESPB) a new block described for post-operative analgesia. Since 2016 the block has become a common practice in many institutions globally. Evidence has shown that ESPB is superior to truncal and abdominal wall blocks for many thoracic and abdominal surgeries.

Case presentation: A 29-year-old male, ASA (American Society of Anesthesiologists) IIE patient presented with acute appendicitis. Patient was scheduled to undergo Laparoscopic Appendicectomy under general anesthesia (GA) with ESPB for post op analgesia. In the operating room after induction of GA patient received an ultrasound (US) guided bilateral ESPB at T10 level of the spinal cord with 20 mls of 0.25% levobupivacaine on each side. Intraoperatively the appendix was found to be normal and there was an incidental finding of perforated superior/first part of duodenum (D1). The duodenum was repaired. Patient remained hemodynamically stable intraoperatively. No intraoperative morphine was required. After uneventful extubation, the patient was transferred to post-operative anesthesia care unit (PACU). Patient reported pain score of zero on a 11-point numerical rating scale (NRS) in PACU. No morphine was required in the next 24 hours on the ward either.

Conclusion: ESPB can provide opioid free analgesia for laparoscopic repair of perforated duodenal ulcer both intra and postoperatively.

背景:直立脊柱平面阻滞(ESPB)是一种用于术后镇痛的新型阻滞。自2016年以来,区块链已成为全球许多机构的普遍做法。有证据表明,在许多胸腹外科手术中,ESPB优于躯干和腹壁阻滞。病例报告:一名29岁男性,ASA(美国麻醉医师协会)IIE患者出现急性阑尾炎。患者计划在全麻(GA)下行腹腔镜阑尾切除术,并使用ESPB进行术后镇痛。GA诱导后患者在手术室接受超声引导下双侧脊髓T10水平ESPB,两侧各20 ml 0.25%左布比卡因。术中阑尾未见异常,偶见十二指肠上/上段穿孔(D1)。十二指肠修复。术中患者血流动力学保持稳定。术中不需要吗啡。在顺利拔管后,患者被转移到术后麻醉护理病房(PACU)。患者在PACU的11分数值评定量表(NRS)中报告疼痛评分为零。在接下来的24小时里,病房里也不需要吗啡。结论:ESPB在腹腔镜十二指肠溃疡穿孔修复术中及术后均可提供无阿片类镇痛。
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引用次数: 0
A Randomized Control Trial to Compare Hemodynamic Parameters of Patients Undergoing Percutaneous Nephrolithotomy Under Combined Spinal-Epidural and General Anesthesia in a Tertiary Hospital. 三甲医院经皮肾镜取石术中脊髓-硬膜外联合麻醉与全身麻醉血流动力学参数比较的随机对照试验
IF 2.9 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/LRA.S410510
Ksheerabdhi Sankar, Kuppusamy Anand, Swetha Ramani, Balasubramaniam Gayathri

Background and aim: Percutaneous nephrolithotomy (PCNL) under epidural anesthesia has been reported to have few advantages over general anesthesia, like lower postoperative pain and less need for analgesics. There are limited studies on PCNL being performed under neuraxial anesthesia in supine position. Hence the present study was conceived to compare hemodynamic parameters in patients undergoing percutaneous nephrolithotomy (PCNL) in the supine position under combined spinal-epidural with general anesthesia (GA).

Material and methods: A prospective, randomized control trial was conducted among 90 patients who were posted to undergo elective percutaneous nephrolithotomy in the the supine position, after obtaining Institutional Ethical Committee (IEC) approval and CTRI (Clinical Trial Registry - India) registration. Patients were randomly allotted to undergo surgery either under general anesthesia (group GA) or combined spinal epidural anesthesia (group CSE) by computer-generated random number method. Hemodynamic parameters, postoperative analgesic requirement and incidence of blood transfusion were recorded and analyzed.

Results: There was no significant difference between the two groups with respect to gender, ASA grade, surgery duration, calculus size and pulse rate. There was a statistically significant reduction in mean arterial pressure from 5 to 50 minutes of surgery and less incidence of blood transfusion in patients in the CSE group. Patients who underwent PCNL in the supine position under CSE required lesser analgesics postoperatively compared to those under general anesthesia.

Conclusion: Combined spinal epidural analgesia can be used as an alternative to general anesthesia for patients undergoing PCNL in the supine position in view of less MAP and reduced postoperative analgesic and blood transfusion requirement.

背景和目的:据报道硬膜外麻醉下经皮肾镜取石术(PCNL)与全麻相比没有什么优势,比如术后疼痛更低,对镇痛药的需求更少。在仰卧位下,在神经轴麻醉下进行PCNL的研究有限。因此,本研究旨在比较脊髓-硬膜外联合全身麻醉(GA)下仰卧位经皮肾镜取石术(PCNL)患者的血流动力学参数。材料和方法:在获得机构伦理委员会(IEC)批准和CTRI(印度临床试验注册中心)注册后,在90例患者中进行了前瞻性随机对照试验,这些患者在仰卧位接受选择性经皮肾镜取石术。采用计算机生成随机数法将患者随机分为全身麻醉组(GA组)和脊髓硬膜外联合麻醉组(CSE组)。记录并分析血流动力学参数、术后镇痛需求及输血发生率。结果:两组患者在性别、ASA分级、手术时间、结石大小、脉搏率等方面差异无统计学意义。CSE组患者手术后5 - 50分钟平均动脉压降低,输血发生率降低,统计学意义显著。与全麻下的患者相比,在CSE下仰卧位进行PCNL的患者术后需要较少的镇痛药。结论:脊髓硬膜外联合镇痛可作为PCNL患者仰卧位全麻的替代麻醉,可减少MAP,减少术后镇痛和输血需求。
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引用次数: 1
Thermal Imaging to Predict Failed Supraclavicular Brachial Plexus Block: A Prospective Observational Study. 热成像预测锁骨上臂丛神经阻滞失败:一项前瞻性观察研究。
IF 2.9 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/LRA.S406057
Medhat Gamal, Ahmed Hasanin, Nada Adly, Maha Mostafa, Ahmed M Yonis, Ashraf Rady, Nasr M Abdallah, Mohammed Ibrahim, Mohamed Elsayad

Background: Successful brachial plexus blockade produces sympathetic blockade, resulting in increased skin temperature in the blocked segments. This study aimed to evaluate the accuracy of infrared thermography in predicting failed segmental supraclavicular brachial plexus block.

Methods: This prospective observational study included adult patients undergoing upper-limb surgery under supraclavicular brachial plexus block. Sensation was evaluated at the dermatomal distribution of the ulnar, median, and radial nerves. Block failure was defined as absence of complete sensory loss 30 min after block completion. Skin temperature was evaluated by infrared thermography at the dermatomal supply of the ulnar, median, and radial nerves at baseline, 5, 10, 15, and 20 min after block completion. The temperature change from the baseline measurement was calculated for each time point. Outcomes were the ability of temperature change at each site to predict failed block of the corresponding nerve using area under receiver-operating characteristic curve (AUC) analysis.

Results: Eighty patients were available for the final analysis. The AUC (95% confidence interval [CI]) for the ability of temperature change at 5 min to predict failed ulnar, median, and radial nerve block was 0.79 (0.68-0.87), 0.77 (0.67-0.86), and 0.79 (0.69-0.88). The AUC (95% CI) increased progressively and reached its maximum values at 15 min (ulnar nerve 0.98 [0.92-1.00], median nerve 0.97 [0.90-0.99], radial nerve 0.96 [0.89-0.99]) with negative predictive value of 100%.

Conclusion: Infrared thermography of different skin segments provides an accurate tool for predicting failed supraclavicular brachial plexus block. Increased skin temperature at each segment can exclude block failure in the corresponding nerve with 100% accuracy.

背景:成功的臂丛阻滞产生交感阻滞,导致阻滞节段皮肤温度升高。本研究旨在评估红外热成像预测锁骨上臂丛神经阻滞失败的准确性。方法:本前瞻性观察研究纳入锁骨上臂丛阻滞下接受上肢手术的成年患者。在尺神经、正中神经和桡神经的皮皮分布上评估感觉。阻滞失败定义为阻滞完成后30分钟没有完全感觉丧失。在阻滞完成后的基线、5分钟、10分钟、15分钟和20分钟,通过红外热像仪评估尺神经、正中神经和桡神经皮皮供应处的皮肤温度。计算每个时间点与基线测量值相比的温度变化。结果是利用受者操作特征曲线(AUC)分析下的面积,每个部位的温度变化预测相应神经阻滞失败的能力。结果:80例患者可用于最终分析。5分钟温度变化预测尺神经、正中神经和桡神经阻滞失败的AUC(95%置信区间[CI])分别为0.79(0.68-0.87)、0.77(0.67-0.86)和0.79(0.69-0.88)。AUC (95% CI)逐渐增加,15 min时达到最大值(尺神经0.98[0.92-1.00],正中神经0.97[0.90-0.99],桡神经0.96[0.89-0.99]),阴性预测值为100%。结论:不同皮肤节段的红外热成像为预测锁骨上臂丛神经阻滞失败提供了准确的工具。每节段皮肤温度升高可以100%准确地排除相应神经阻滞失败。
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引用次数: 0
Erector Spinae Plane Block as an Analgesic Intervention in Acute Rib Fractures: A Scoping Review. 竖脊肌平面阻滞作为急性肋骨骨折的镇痛干预:范围综述。
IF 2.9 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/LRA.S414056
Michael Jiang, Varun Peri, Bobby Ou Yang, Jaewon Chang, Douglas Hacking

Introduction: Rib fractures are a common sequelae of chest trauma and are associated with significant morbidity. The erector spinae nerve block (ESB) has been proposed as an alternative first-line regional technique for rib fractures due to ease of administration and minimal complication profile. We aimed to investigate the current literature surrounding this topic with a focus on pain and respiratory outcomes.

Methods: A comprehensive literature search was performed on the Medline, Embase, Web of Science, Scopus, and Cochrane databases. Keywords of "erector spinae block" and "rib fractures" were used to form the search strategy. Papers published in English investigating ESB as an analgesic intervention for acute rib fracture were included. Exclusion criteria were operative rib fixation, or where the indication for ESB was not rib fracture.

Results: There were 37 studies which met the inclusion criteria for this scoping review. Of these, 31 studies reported on pain outcomes and demonstrated a 40% decrease in pain scores post administration within the first 24 hours. Respiratory parameters were reported in 8 studies where an increase in incentive spirometry was demonstrated. Respiratory complication was not consistently reported. ESB was associated with minimal complications; only 5 cases of haematoma and infection were (incidence 0.6%) reported, none of which required further intervention.

Discussion: Current literature surrounding ESB in rib fracture management provides a positive qualitative evaluation of efficacy and safety. Improvements in pain and respiratory parameters were almost universal. The notable outcome from this review was the improved safety profile of ESB. The ESB was not associated with complications requiring intervention even in the setting of anticoagulation and coagulopathy. There still remains a paucity of large cohort, prospective data. Moreover, no current studies reflect an improvement in respiratory complication rates compared to current techniques. Taken together, these areas should be the focus of any future research.

简介:肋骨骨折是胸部外伤的常见后遗症,发病率高。竖脊神经阻滞术(ESB)被认为是治疗肋骨骨折的一种替代的一线区域性技术,因为它易于操作且并发症最少。我们的目的是调查当前的文献围绕这一主题,重点是疼痛和呼吸结果。方法:在Medline、Embase、Web of Science、Scopus和Cochrane数据库中进行全面的文献检索。以“竖脊肌阻滞”和“肋骨骨折”为关键词,形成搜索策略。英文发表的研究ESB作为急性肋骨骨折镇痛干预的论文被纳入。排除标准是手术肋骨固定,或ESB的指征不是肋骨骨折。结果:37项研究符合纳入标准。其中,31项研究报告了疼痛结果,并证明在给药后24小时内疼痛评分降低了40%。8项研究报告了呼吸参数,其中激励性肺活量测定法被证实增加。呼吸道并发症的报道并不一致。ESB并发症最少;仅报告了5例血肿和感染(发生率0.6%),均无需进一步干预。讨论:目前关于ESB在肋骨骨折治疗中的文献对其疗效和安全性进行了积极的定性评价。疼痛和呼吸参数的改善几乎是普遍的。这次审查的显著结果是改进了ESB的安全性。ESB与需要干预的并发症无关,即使在抗凝和凝血功能障碍的情况下也是如此。目前仍然缺乏大型队列前瞻性数据。此外,目前没有研究表明与目前的技术相比,呼吸并发症发生率有所改善。综上所述,这些领域应该是未来研究的重点。
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引用次数: 4
Efficacy of Ketamine versus Magnesium Sulphate as Adjuvants to Levobupivacaine in Ultrasound Bilevel Erector Spinae Block in Breast Cancer Surgery (a Double-Blinded Randomized Controlled Study). 氯胺酮与硫酸镁佐剂左布比卡因在乳腺癌手术中超声双水平勃起器脊柱阻滞中的疗效(一项双盲随机对照研究)。
IF 2.9 Q2 Medicine Pub Date : 2022-09-23 eCollection Date: 2022-01-01 DOI: 10.2147/LRA.S379194
Fatma Adel El Sherif, Hamdy Abbas Youssef, Khaled Mohamed Fares, Sahar Abdel-Baky Mohamed, Ali Rabiee Ali, Ahmed M Thabet

Purpose: Breast surgeons seek simple, safe, effective, and novel regional anesthesia techniques for postoperative analgesia. Erector spinae plane (ESP) block is a new ultrasound-guided technique. We aimed to explore the analgesic effect of adding ketamine and magnesium sulfate as adjuvants to levobupivacaine in ESP.

Patients and methods: Sixty female patients (aged 18-60 years) with breast cancer, weighing 50-90 kg who were scheduled for modified radical mastectomy (MRM) were randomly allocated into three groups (20 patients each) to receive an ESP block with 20 mL 0.25% levobupivacaine with adjuvants according to the following groups: group C: levobupivacaine; group K: levobupivacaine + 2 mg/kg ketamine; and group M: levobupivacaine + 2 mg/kg magnesium sulfate. The block was administered preoperatively before anesthesia induction. Postoperatively, hemodynamics, visual analog scale scores, the first request for analgesia, total analgesic consumption, and side effects were observed for 48 hours.

Results: The total amount of Morphine rescue analgesia was significantly lower in groups M (7.00 ± 0.61 mg) and K (7.50 ± 0.58 mg) than in group C (14.40 ± 3.47 mg) during the first 48 h postoperatively. Nine (45%) patients in group M and 13 (65%) patients in K, compared with 20 (100%) patients in group C, requested analgesia. The time to first request of analgesia was significantly longer in groups M (30 h) and K (24 h) than in group C (7 h). No hemodynamic changes or serious side effects were observed.

Conclusion: Magnesium sulphate and ketamine seem to be both effective adjuvants to levobupivacaine in ESP blocks for postoperative analgesia in patients undergoing MRM, with slightly better analgesia provided by magnesium sulphate.

目的:乳房外科医生寻求简单、安全、有效、新颖的区域麻醉技术用于术后镇痛。直立脊柱平面(ESP)块是一种新型超声引导技术。目的探讨左布比卡因加氯胺酮和硫酸镁作为佐剂治疗ESP的镇痛效果。患者和方法:60例体重50 ~ 90 kg的女性乳腺癌患者(年龄18 ~ 60岁),计划行改型乳房根治术(MRM),随机分为3组(每组20例),接受含20 mL 0.25%左布比卡因的ESP阻滞,并辅以佐剂:C组:左布比卡因;K组:左布比卡因+氯胺酮2 mg/kg;M组:左布比卡因+硫酸镁2mg /kg。阻滞在麻醉诱导前术前使用。术后48小时观察血流动力学、视觉模拟评分、首次镇痛请求、总镇痛用量及副作用。结果:术后前48 h吗啡救援镇痛总剂量M组(7.00±0.61 mg)、K组(7.50±0.58 mg)明显低于C组(14.40±3.47 mg)。M组9例(45%),K组13例(65%),C组20例(100%)。M组(30 h)和K组(24 h)首次要求镇痛的时间明显高于C组(7 h),未见血流动力学改变或严重副作用。结论:硫酸镁和氯胺酮似乎都是左布比卡因用于MRM术后ESP阻滞镇痛的有效佐剂,硫酸镁的镇痛效果略好。
{"title":"Efficacy of Ketamine versus Magnesium Sulphate as Adjuvants to Levobupivacaine in Ultrasound Bilevel Erector Spinae Block in Breast Cancer Surgery (a Double-Blinded Randomized Controlled Study).","authors":"Fatma Adel El Sherif,&nbsp;Hamdy Abbas Youssef,&nbsp;Khaled Mohamed Fares,&nbsp;Sahar Abdel-Baky Mohamed,&nbsp;Ali Rabiee Ali,&nbsp;Ahmed M Thabet","doi":"10.2147/LRA.S379194","DOIUrl":"https://doi.org/10.2147/LRA.S379194","url":null,"abstract":"<p><strong>Purpose: </strong>Breast surgeons seek simple, safe, effective, and novel regional anesthesia techniques for postoperative analgesia. Erector spinae plane (ESP) block is a new ultrasound-guided technique. We aimed to explore the analgesic effect of adding ketamine and magnesium sulfate as adjuvants to levobupivacaine in ESP.</p><p><strong>Patients and methods: </strong>Sixty female patients (aged 18-60 years) with breast cancer, weighing 50-90 kg who were scheduled for modified radical mastectomy (MRM) were randomly allocated into three groups (20 patients each) to receive an ESP block with 20 mL 0.25% levobupivacaine with adjuvants according to the following groups: group C: levobupivacaine; group K: levobupivacaine + 2 mg/kg ketamine; and group M: levobupivacaine + 2 mg/kg magnesium sulfate. The block was administered preoperatively before anesthesia induction. Postoperatively, hemodynamics, visual analog scale scores, the first request for analgesia, total analgesic consumption, and side effects were observed for 48 hours.</p><p><strong>Results: </strong>The total amount of Morphine rescue analgesia was significantly lower in groups M (7.00 ± 0.61 mg) and K (7.50 ± 0.58 mg) than in group C (14.40 ± 3.47 mg) during the first 48 h postoperatively. Nine (45%) patients in group M and 13 (65%) patients in K, compared with 20 (100%) patients in group C, requested analgesia. The time to first request of analgesia was significantly longer in groups M (30 h) and K (24 h) than in group C (7 h). No hemodynamic changes or serious side effects were observed.</p><p><strong>Conclusion: </strong>Magnesium sulphate and ketamine seem to be both effective adjuvants to levobupivacaine in ESP blocks for postoperative analgesia in patients undergoing MRM, with slightly better analgesia provided by magnesium sulphate.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/1b/lra-15-87.PMC9514291.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40385378","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}
引用次数: 1
Comparison Between Ultrasound-guided Caudal Analgesia versus Peripheral Nerve Blocks for Lower Limb Surgeries in Pediatrics: A Randomized Controlled Prospective Study. 超声引导下尾侧镇痛与周围神经阻滞在儿科下肢手术中的比较:一项随机对照前瞻性研究。
IF 2.9 Q2 Medicine Pub Date : 2022-09-12 eCollection Date: 2022-01-01 DOI: 10.2147/LRA.S372903
Rabab S S Mahrous, Amin A A Ahmed, Aly Mahmoud Moustafa Ahmed

Background and aim: Ultrasound (US) guided regional analgesia is a safe and effective method in providing perioperative analgesia in pediatrics with a high success rate rapid onset and fewer side effects. The aim of this study was to compare the efficacy of US-guided caudal block versus US-guided peripheral nerve blocks (femoral and sciatic nerve blocks) in providing perioperative analgesia in pediatrics undergoing unilateral lower limb surgery.

Methods: Children aged 1-12 years scheduled for unilateral lower limb surgery during the period from January 2020 to December 2021 were randomly allocated into two groups. Group C where pediatrics received US-guided caudal block, while in group P, pediatrics received US-guided femoral and sciatic nerve blocks after the induction of general anesthesia (GA). The primary aim was to compare the postoperative pain (evaluated by the COMFORT pain score) between the two groups. Secondary aims were to compare perioperative opioids used parents' satisfaction and occurrence of side effects.

Results: Pediatrics who underwent unilateral lower limb surgeries were allocated into two groups (group C and group P). There was no significant difference between patients' baseline characteristics and the postoperative pain score at 2, 4, 16, and 20 h.' However there was a statistical significance at 6, 8, 12, and 24 h postoperatively, frequency of analgesia as well as the total postoperative dose of opiates (nalbuphine). Time to first analgesic (nalbuphine) requirement was significantly less in group C with a mean of (9.6±2.9 h) than in group P with a mean of (15.1±3.5 h). Parents of children in group P were more satisfied than those in group C with no recorded complications for both techniques.

Conclusion: US-guided lower limb peripheral nerve block is a simple and safe method to provide adequate and more prolonged analgesia compared to US-guided caudal block for lower limb surgeries in pediatrics.

背景与目的:超声引导下局部镇痛是一种安全有效、成功率高、起效快、副作用少的儿科围手术期镇痛方法。本研究的目的是比较us引导的尾侧神经阻滞与us引导的周围神经阻滞(股神经和坐骨神经阻滞)在儿科单侧下肢手术围手术期镇痛的效果。方法:选取2020年1月~ 2021年12月拟行单侧下肢手术的1 ~ 12岁儿童,随机分为两组。C组患儿行us引导下的尾侧阻滞,P组患儿行全麻诱导后us引导下的股、坐骨神经阻滞。主要目的是比较两组之间的术后疼痛(通过COMFORT疼痛评分评估)。次要目的是比较围手术期阿片类药物使用父母的满意度和副作用的发生情况。结果:将接受单侧下肢手术的儿科患者分为两组(C组和P组),患者的基线特征和术后2、4、16和20 h的疼痛评分无显著差异。但术后6、8、12、24 h镇痛次数及术后阿片类药物(纳布啡)总剂量差异均有统计学意义。C组首次镇痛(纳布啡)需用时间(9.6±2.9 h)明显少于P组(15.1±3.5 h), P组患儿家长满意度高于C组,两种方法均无并发症记录。结论:在小儿下肢手术中,us引导下的下肢周围神经阻滞比us引导下的尾侧阻滞更能提供充足且更持久的镇痛,是一种简单安全的方法。
{"title":"Comparison Between Ultrasound-guided Caudal Analgesia versus Peripheral Nerve Blocks for Lower Limb Surgeries in Pediatrics: A Randomized Controlled Prospective Study.","authors":"Rabab S S Mahrous,&nbsp;Amin A A Ahmed,&nbsp;Aly Mahmoud Moustafa Ahmed","doi":"10.2147/LRA.S372903","DOIUrl":"https://doi.org/10.2147/LRA.S372903","url":null,"abstract":"<p><strong>Background and aim: </strong>Ultrasound (US) guided regional analgesia is a safe and effective method in providing perioperative analgesia in pediatrics with a high success rate rapid onset and fewer side effects. The aim of this study was to compare the efficacy of US-guided caudal block versus US-guided peripheral nerve blocks (femoral and sciatic nerve blocks) in providing perioperative analgesia in pediatrics undergoing unilateral lower limb surgery.</p><p><strong>Methods: </strong>Children aged 1-12 years scheduled for unilateral lower limb surgery during the period from January 2020 to December 2021 were randomly allocated into two groups. Group C where pediatrics received US-guided caudal block, while in group P, pediatrics received US-guided femoral and sciatic nerve blocks after the induction of general anesthesia (GA). The primary aim was to compare the postoperative pain (evaluated by the COMFORT pain score) between the two groups. Secondary aims were to compare perioperative opioids used parents' satisfaction and occurrence of side effects.</p><p><strong>Results: </strong>Pediatrics who underwent unilateral lower limb surgeries were allocated into two groups (group C and group P). There was no significant difference between patients' baseline characteristics and the postoperative pain score at 2, 4, 16, and 20 h.' However there was a statistical significance at 6, 8, 12, and 24 h postoperatively, frequency of analgesia as well as the total postoperative dose of opiates (nalbuphine). Time to first analgesic (nalbuphine) requirement was significantly less in group C with a mean of (9.6±2.9 h) than in group P with a mean of (15.1±3.5 h). Parents of children in group P were more satisfied than those in group C with no recorded complications for both techniques.</p><p><strong>Conclusion: </strong>US-guided lower limb peripheral nerve block is a simple and safe method to provide adequate and more prolonged analgesia compared to US-guided caudal block for lower limb surgeries in pediatrics.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/4b/lra-15-77.PMC9480592.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40366769","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}
引用次数: 0
Considerations for the Use of Local Anesthesia in the Frail Elderly: Current Perspectives. 体弱多病老年人局部麻醉使用的考虑:当前观点。
IF 2.9 Q2 Medicine Pub Date : 2022-08-10 eCollection Date: 2022-01-01 DOI: 10.2147/LRA.S325877
Philippe Cuvillon, Jean Yves Lefrant, Yann Gricourt

The frail, elderly population is at a high risk of postoperative complications. Besides perioperative rehabilitation techniques and management by geriatric teams, the least invasive techniques in anesthesia are required, making regional anesthesia very interesting in terms of benefit-risk ratio. Among them, local anesthesia is a simple, reproducible, inexpensive technique applied to many superficial or deep surgeries, which should make it a gold standard for the frail person. This review provides an update on the current possibilities for various surgeries and exclusion.

体弱多病的老年人是术后并发症的高危人群。除了围手术期康复技术和老年团队管理外,还需要微创麻醉技术,这使得区域麻醉在收益-风险比方面非常有趣。其中,局部麻醉是一种简单、可重复、廉价的技术,适用于许多浅表或深部手术,这应该使它成为体弱多病者的金标准。本综述提供了目前各种手术和排除的可能性的最新情况。
{"title":"Considerations for the Use of Local Anesthesia in the Frail Elderly: Current Perspectives.","authors":"Philippe Cuvillon,&nbsp;Jean Yves Lefrant,&nbsp;Yann Gricourt","doi":"10.2147/LRA.S325877","DOIUrl":"https://doi.org/10.2147/LRA.S325877","url":null,"abstract":"<p><p>The frail, elderly population is at a high risk of postoperative complications. Besides perioperative rehabilitation techniques and management by geriatric teams, the least invasive techniques in anesthesia are required, making regional anesthesia very interesting in terms of benefit-risk ratio. Among them, local anesthesia is a simple, reproducible, inexpensive technique applied to many superficial or deep surgeries, which should make it a gold standard for the frail person. This review provides an update on the current possibilities for various surgeries and exclusion.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ec/36/lra-15-71.PMC9379105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40637697","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}
引用次数: 4
期刊
Local and Regional Anesthesia
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