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The Use of a New Device-Assisted Needle Guidance versus Conventional Approach to Perform Ultrasound Guided Brachial Plexus Blockade: A Randomized Controlled Study. 一项随机对照研究:使用一种新的装置辅助针引导与传统方法进行超声引导臂丛阻断。
IF 2.9 Q2 Medicine Pub Date : 2022-07-25 eCollection Date: 2022-01-01 DOI: 10.2147/LRA.S363563
Amaresh Vydyanathan, Priya Agrawal, Naveen Shetty, Singh Nair, Nancy Shilian, Naum Shaparin

Purpose: Ultrasound guidance during nerve blockade poses the challenge of maintaining in-plane alignment of the needle tip. The needle guidance device maintains needle alignment and assists with in-plane needle visualization. The purpose of this study is to evaluate the utility of this device by comparing procedure performance during brachial plexus blockade with the conventional approach.

Methods: After the Institutional Review Board approval and obtaining informed consent, 70 patients receiving either interscalene or supraclavicular nerve blocks were randomly assigned into 2 groups, a conventional approach versus utilizing the needle guidance device. An independent observer recorded: total procedure time; needle insertion time; number of unplanned redirections; and number of reinsertions. Additionally, physician satisfaction and ease of needle visualization were assessed.

Results: Data from seventy patients were analyzed. The median [25th percentile-75th percentile] time to complete the block by the device assisted needle guidance group was 3 (2-3.75) minutes and 4 (3-6) minutes in the conventional approach group (p < 0.001). Additionally, subgroup analyses were performed in the supraclavicular block and interscalene block. Supraclavicular blockade, needle insertion time (median [25th percentile-75th percentile] in seconds) (106 [92-162] vs 197 [140-278]), total procedure time (3 [2-3] vs 4.5 [4-6] in minutes) and unplanned needle redirections (2 [1-5] vs 5.5 [3-9]) were significantly lower in needle guidance group (p < 0.001). With interscalene blockade, needle insertion time (86 [76-146] vs 126 [94-295]) and unplanned needle redirections (2 [1-3] vs 4 [2-8.5]) were significantly lower with needle guidance (p < 0.001), but total procedure time was similar. All the physicians reported that they would use the needle guidance again, and 90% would prefer it for in-plane blocks.

Conclusion: Performing regional blocks using the needle guidance device reduces needle insertion time and unplanned needle redirections in brachial plexus blockade. Moreover, physician satisfaction also improved compared to the use of the conventional technique.

目的:神经阻断术中超声引导对维持针尖平面内对齐提出了挑战。针导向装置保持针对准,并协助在平面内针的可视化。本研究的目的是通过比较臂丛阻滞与常规入路的手术表现来评估该装置的实用性。方法:经机构审查委员会批准并获得知情同意后,将70例接受斜胛间神经阻滞或锁骨上神经阻滞的患者随机分为两组,分别采用常规入路和针导装置。独立观察员记录:总程序时间;针入时间;计划外改道次数;再插入的次数。此外,还评估了医生的满意度和针的可视性。结果:分析了70例患者的资料。器械辅助导针组完成阻滞的中位时间[25 -75百分位数]为3(2-3.75)分钟,常规入路组为4(3-6)分钟(p < 0.001)。此外,对锁骨上阻滞和斜角肌间阻滞进行亚组分析。锁骨上阻断、针插入时间(中位数[25百分位数-75百分位数]秒)(106 [92-162]vs 197[140-278])、总手术时间(3 [2-3]vs 4.5[4-6]分钟)和计划外针重定向(2 [1-5]vs 5.5[3-9])均显著低于针引导组(p < 0.001)。在斜角肌间阻滞下,针插入时间(86 [76-146]vs 126[94-295])和计划外的针重定向(2 [1-3]vs 4[2-8.5])在针引导下显著降低(p < 0.001),但总手术时间相似。所有的医生报告说,他们会再次使用针头引导,90%的人更喜欢平面内阻滞。结论:在臂丛神经阻滞中使用导针装置进行局部阻滞可减少针的插入时间和针的非计划重定向。此外,与使用传统技术相比,医生满意度也有所提高。
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引用次数: 0
Regional and Acute Pain Anesthesiology Post COVID-19 Assessment and Recommendations for Fellowship Web Based Platforms. 区域和急性疼痛麻醉学COVID-19后评估和基于奖学金网络平台的建议。
IF 2.9 Q2 Medicine Pub Date : 2022-07-07 eCollection Date: 2022-01-01 DOI: 10.2147/LRA.S369147
Vladislav Pavlovich Zhitny, Enes Djesevic, Gemma Lagasca, Aziza Dhalai, Brian J Mendelson

In today's applicant landscape, the SARS-COV-2 pandemic has drastically altered the traditional model of in-person interviews shifting it to an online format often conducted by web-based applications. Fellowship programs and naturally fellowship program directors face a new challenge of standardizing information to be distributed to prospective fellowship applicants through American Society of Regional Anesthesia and Pain Medicine (ASRA) common application. Here we describe a set of 11 criteria recommended by other similar studies selected for evaluation of online program training platforms, where only 13.3% of the acute and regional pain fellowship program online platforms met 75% of the criteria with limited presence in areas of research, rotation schedules, list of fellows, alumni, and life in the area. Additional considerations pertaining to the types of procedures performed, evaluation, mentorship, academic involvement, and teaching should be undertaken by the programs.

在当今的求职者环境中,新冠肺炎大流行彻底改变了面对面面试的传统模式,将其转变为通常由基于网络的应用程序进行的在线形式。奖学金项目和奖学金项目主管自然面临着新的挑战,即通过美国区域麻醉和疼痛医学协会(ASRA)的共同申请向潜在的奖学金申请人分发标准化的信息。在这里,我们描述了一组由其他类似研究推荐的11个标准,用于评估在线项目培训平台,其中只有13.3%的急性和局部疼痛奖学金项目在线平台达到75%的标准,在研究、轮换时间表、研究员名单、校友和该领域的生活方面存在有限。有关程序类型、评估、指导、学术参与和教学的其他考虑应由项目承担。
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引用次数: 0
Transmuscular Quadratus Lumborum Block versus Infrainguinal Fascia Iliaca Nerve Block for Patients Undergoing Elective Hip Replacement: A Double-blinded, Pilot, Randomized Controlled Trial. 选择性髋关节置换术患者经腰方肌阻滞与腹股沟下髂筋膜神经阻滞:一项双盲、先导、随机对照试验。
IF 2.9 Q2 Medicine Pub Date : 2022-07-06 eCollection Date: 2022-01-01 DOI: 10.2147/LRA.S350033
Junaid Hashmi, Barbara Cusack, Lauren Hughes, Vikash Singh, Karthikeyan Srinivasan

Purpose: Transmuscular quadratus lumborum (TQL) block has been described as an effective option for postoperative analgesia in patients undergoing hip replacement with single injection described as providing analgesia for up to 24 h. We hypothesize that a TQL block, when compared to fascia iliaca block (FIB), will provide better analgesia and less motor block in the initial 24-h postoperative period.

Patients and methods: Fifty patients undergoing elective hip replacement surgery, ASA I-III, were included in the study. Patients were randomized into two groups. Patients in group A received spinal anesthesia followed by FIB. Patients in group B received spinal anesthesia followed by TQLB. Postoperative pain scores and motor block were assessed at 6 and 24 hours. The primary outcome measure was 24 h total morphine consumption. Secondary outcome measures included pain score (VNS) and motor block (modified Bromage scale) at 6 and 24 h postoperatively.

Results: There was no statistical difference in morphine consumption between the two groups (p-value 0.699). There was no difference in pain scores at 6 h (p-value 0.540) or 24 h (p-value 0.383). There was no difference in motor block at 6 h (p-value 0.497) or at 24 h (p-value 0.773).

Conclusion: Transmuscular quadratus lumborum block along with spinal anesthesia for patients undergoing elective hip replacement surgery does not reduce opioid consumption or motor weakness when compared to fascia iliaca block. The results and conclusion apply to a dose of 20 mL of 0.25% bupivacaine used in each group.

目的:经肌腰方肌阻滞(TQL)已被描述为髋关节置换术患者术后镇痛的有效选择,单次注射可提供长达24小时的镇痛。我们假设与髂筋膜阻滞(FIB)相比,TQL阻滞将在术后最初24小时内提供更好的镇痛和更少的运动阻滞。患者和方法:50例接受择期髋关节置换术的患者被纳入研究,ASA I-III。患者随机分为两组。A组患者行脊髓麻醉后FIB。B组患者先行脊髓麻醉后行TQLB。术后6和24小时分别评估疼痛评分和运动阻滞。主要结局指标为24小时吗啡总消耗量。次要指标包括术后6和24小时的疼痛评分(VNS)和运动阻滞(改良Bromage量表)。结果:两组吗啡用量比较差异无统计学意义(p值为0.699)。6 h (p值0.540)和24 h (p值0.383)疼痛评分无差异。6 h (p值0.497)和24 h (p值0.773)运动阻滞无差异。结论:与髂筋膜阻滞相比,经肌腰方肌阻滞联合脊髓麻醉对择期髋关节置换术患者并不能减少阿片类药物的消耗或运动无力。结果和结论适用于每组使用0.25%布比卡因20 mL。
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引用次数: 2
Peripheral Nerve Blockade for Medial Patellofemoral Ligament Reconstruction in Pediatric Patients: The Addition of a Proximal Single-Injection Sciatic Nerve Block Provides Improved Analgesia. 外周神经阻滞用于儿科患者髌股韧带内侧重建:增加近端单次注射坐骨神经阻滞可改善镇痛效果。
IF 2.9 Q2 Medicine Pub Date : 2022-06-27 eCollection Date: 2022-01-01 DOI: 10.2147/LRA.S360738
Lloyd Halpern, Clark J Kogan, Grady Arnzen

Purpose: We tested the hypothesis that the addition of a single-injection proximal sciatic nerve block to an adductor canal block would significantly reduce pain scores and opioid requirements compared to a group of patients that received only an adductor canal or femoral nerve block for medial patellofemoral ligament reconstruction in pediatric patients. The primary end-point is the number of patients achieving a Patient Acceptable Symptom State (PASS) (pain score less than four) for the entire 24-hour postoperative period in patients with and without a proximal sciatic block.

Patients and methods: This is a retrospective cohort study of 144 consecutive pediatric patients, ages 10 to 18 years, undergoing medial patellofemoral ligament reconstruction with peripheral nerve blockade for postoperative analgesia from 2016-2020 at a pediatric orthopedics children's hospital. Patients were divided into 2 cohorts with and without a proximal sciatic nerve block: group A/F: adductor canal or femoral CPNB and group AS: adductor canal CPNB and a proximal single-injection sciatic nerve block.

Results: There was strong evidence for an increase in the number of patients who reported a pain score less than four for the entire 24-hour postoperative period in the group that received the additional proximal sciatic block. (PASS: A/F 13/62 (21%) vs AS 43/82 (52%), p<0.001) There was strong evidence for a reduction in mean and maximum pain scores and opioid requirements in the first 24-hours after surgery in the proximal sciatic group.

Conclusion: The addition of a proximal sciatic nerve block was associated with significantly reduced mean and maximum pain scores and opioid requirements after medial patellofemoral ligament reconstruction in pediatric patients and supports a randomized clinical trial to confirm these findings. Based on the results of this study we recommend the addition of a proximal sciatic nerve block, anterior or posterior, to an adductor canal block to provide improved analgesia and reduced opioid requirements in the 24-hours after MPFLR in pediatric patients.

目的:我们验证了一个假设,即与仅接受内收管或股神经阻滞的儿童髌股韧带内侧重建患者相比,在内收管阻滞中加入单注射坐骨近端神经阻滞可以显著降低疼痛评分和阿片类药物需求。主要终点是有或没有近端坐骨神经阻滞的患者在术后24小时内达到患者可接受症状状态(PASS)(疼痛评分小于4分)的患者数量。患者和方法:这是一项回顾性队列研究,纳入了一家儿童骨科医院2016-2020年144例连续10至18岁的儿童患者,接受髌骨内侧韧带重建和周围神经阻断术后镇痛。将患者分为有和没有近端坐骨神经阻滞的2组:a /F组:内收管或股动脉CPNB组;AS组:内收管CPNB和近端单次注射坐骨神经阻滞组。结果:有强有力的证据表明,在接受额外的坐骨近端阻滞的组中,在整个24小时的术后期间,报告疼痛评分低于4分的患者数量增加。(PASS: A/F 13/62 (21%) vs AS 43/82(52%))结论:增加近端坐骨神经阻滞与儿科患者内侧髌股韧带重建后平均和最大疼痛评分和阿片类药物需求显著降低相关,并支持随机临床试验来证实这些发现。基于本研究的结果,我们建议在小儿MPFLR后24小时内,在内收管阻滞的基础上,增加坐骨神经近端阻滞,无论是前部还是后部,以改善镇痛效果并减少阿片类药物的需求。
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引用次数: 0
Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases 无阿片类药物分段胸脊麻鞘内镇静用于乳腺和腋窝手术4例报告
IF 2.9 Q2 Medicine Pub Date : 2022-05-01 DOI: 10.2147/LRA.S358157
P. Vincenzi, M. Stronati, P. Isidori, Salvatore Iuorio, Diletta Gaudenzi, G. Boccoli, Roberto Starnari
Purpose Few studies have described segmental thoracic spinal anesthesia (STSA) as primary anesthesiologic method in breast and axillary surgery, documenting the association of intrathecal local anesthetics and opioids. This case series reports an opioid-free scheme of STSA in four elderly patients undergoing major breast and axillary oncological surgery. Patients and Methods STSA was performed in three female patients undergoing unilateral mastectomy ± axillary lymph node dissection (ALND) or sentinel lymph node biopsy for invasive ductal carcinoma and in one male patient undergoing ALND for melanoma metastases. The level of needle insertion was included between T6-8, via a median or paramedian approach. Midazolam (2 mg) and ketamine (20 mg) were used as adjuvants for intrathecal sedation, followed by the administration of hypobaric ropivacaine 0.25% at a dose of 8 mg. The level of sensory blockade achieved was comprised between C2-3 and T11-12. Postoperative analgesia was maintained through continuous intravenous administration of Ketorolac by an elastomeric pump (90 mg over 24 hrs.). Results Spinal anesthesia was completed without complications in all patients. Conversion to general anesthesia (GA) and perioperative intravenous sedation were not required. No major postoperative complications and no episodes of postoperative nausea and vomiting (PONV) were reported. No rescue analgesic was administered. All patients were discharged in postoperative day 2 and are alive at 30, 29, 27 and 13 months after surgery, respectively. High grade of satisfaction on the anesthesiologic method was expressed by all cases. Conclusion STSA with local anesthetic plus midazolam and ketamine might be considered a safe and effective alternative to GA, even in surgeries involving the breast and axillary region, particularly in elderly and frail patients. Larger prospective studies are required to validate these findings.
目的很少有研究将节段性胸椎麻醉(STSA)描述为乳腺和腋窝手术的主要麻醉方法,记录鞘内局部麻醉剂和阿片类药物的相关性。本病例系列报道了四名接受大型乳腺和腋窝肿瘤手术的老年患者的无阿片类药物STSA方案。患者和方法对3例因浸润性导管癌接受单侧乳房切除术±腋窝淋巴结清扫(ALND)或前哨淋巴结活检的女性患者和1例因黑色素瘤转移接受ALND的男性患者进行STSA。针插入水平包括在T6-8之间,通过正中或正中入路。使用咪唑安定(2 mg)和氯胺酮(20 mg)作为鞘内镇静的佐剂,然后以8 mg的剂量给药0.25%的低压罗哌卡因。实现的感觉阻断水平介于C2-3和T11-12之间。术后镇痛通过弹性泵持续静脉注射酮咯酸(90mg,24小时)维持。结果所有患者均完成了脊髓麻醉,无并发症。不需要转为全身麻醉(GA)和围手术期静脉镇静。没有报告主要的术后并发症和术后恶心呕吐(PONV)发作。未给予任何抢救性镇痛药。所有患者均于术后第2天出院,分别于术后30、29、27和13个月存活。所有病例均对麻醉方法表示高度满意。结论即使在涉及乳腺和腋窝的手术中,特别是在年老体弱的患者中,局部麻醉剂加咪达唑仑和氯胺酮的STSA可能被认为是GA的安全有效的替代方案。需要更大规模的前瞻性研究来验证这些发现。
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引用次数: 2
Bupivacaine for Root Canal Treatment - Practitioner Behaviors and Patient Perspectives: Survey Studies. 布比卡因用于根管治疗-医生行为和患者观点:调查研究。
IF 2.9 Q2 Medicine Pub Date : 2022-02-03 eCollection Date: 2022-01-01 DOI: 10.2147/LRA.S339238
Ozge Erdogan, Sharon M Casey, Nikita B Ruparel, Asgeir Sigurdsson

Introduction and objectives: Local anesthesia is essential in dentistry in providing intraoperative analgesia and anesthesia. However, knowledge related to its use for management of post-operative pain is limited. Perioperative pain management is especially important for root canal treatment (ie, endodontic therapy), performed by endodontists. In this study, we sought to better understand endodontists' attitudes regarding the use of long-lasting anesthetic, namely 0.5% bupivacaine HCl with 1:200,000 epinephrine, for the management of post-endodontic pain. Additionally, we aimed to understand the perspectives of dental patients about receiving longer lasting anesthesia for endodontic therapy and to determine factors that affect their anesthetic preferences within the orofacial region.

Methods: An email invitation to participate in an anonymous online survey was sent to members of the American Association of Endodontists. Also, 82 patients attending an in-person visit to an endodontic clinic were recruited to the study.

Results: Data from 474 endodontic practitioners and 82 patients included in analysis. Among practitioners, the majority reported to either never (33.31%) or rarely (34.84%) using bupivacaine. Most chose "I don't think I need it" (47%) and "patient discomfort because of longer duration of soft tissue anesthesia" (30.81%) as reasons for not preferring the use of bupivacaine. Of the practitioners who reported at least rare use, most chose bupivacaine for post-operative pain management (78.02%). Conversely, 52% of patients reported that they were likely/most likely to request long-lasting anesthetics for post-operative pain control.

Conclusion: Bupivacaine is rarely used as a post-operative pain management strategy for endodontic therapy. Specifically, bupivacaine is not preferred not because of adverse events, toxicity, or slow onset concerns, but rather, because of longer duration of soft tissue anesthesia. However, our data suggest that patients may be willing to receive long-lasting anesthesia. Further patient-centered research should investigate the use of long-lasting anesthetic agents for management of post-endodontic pain.

简介和目的:局部麻醉在牙科手术中提供术中镇痛和麻醉是必不可少的。然而,有关其用于治疗术后疼痛的知识是有限的。围手术期疼痛管理对于由牙髓医生进行的根管治疗(即牙髓治疗)尤为重要。在这项研究中,我们试图更好地了解牙髓医生对使用长效麻醉剂的态度,即0.5%盐酸布比卡因和1:20万肾上腺素,用于治疗牙髓后疼痛。此外,我们的目的是了解牙科患者对接受更长时间麻醉进行牙髓治疗的看法,并确定影响他们在口腔面部区域麻醉偏好的因素。方法:通过电子邮件邀请美国牙髓医师协会会员参与匿名在线调查。此外,研究还招募了82名到牙髓诊所亲自就诊的患者。结果:474名根管从业者和82名患者的数据纳入分析。在从业人员中,大多数报告从未(33.31%)或很少(34.84%)使用布比卡因。大多数选择“我认为我不需要”(47%)和“软组织麻醉时间较长导致患者不适”(30.81%)作为不喜欢使用布比卡因的原因。在报告至少很少使用布比卡因的从业人员中,大多数选择布比卡因用于术后疼痛管理(78.02%)。相反,52%的患者报告说他们很可能/最有可能要求使用长效麻醉剂来控制术后疼痛。结论:布比卡因很少用于根管治疗的术后疼痛管理策略。具体来说,布比卡因不是首选不是因为不良事件,毒性,或慢起的问题,而是因为更长的软组织麻醉持续时间。然而,我们的数据表明患者可能愿意接受长期麻醉。进一步以患者为中心的研究应该探讨使用长效麻醉剂来治疗牙髓后疼痛。
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引用次数: 0
Erector Spinae Block with Opioid Free Anesthesia in Cirrhotic Patients Undergoing Hepatic Resection: A Randomized Controlled Trial. 无阿片类药物麻醉用于肝硬化肝切除术患者的竖脊肌阻滞:一项随机对照试验。
IF 2.9 Q2 Medicine Pub Date : 2022-01-25 eCollection Date: 2022-01-01 DOI: 10.2147/LRA.S343347
Minatallah A Elshafie, Magdy K Khalil, Maha L ElSheikh, Nagwa I Mowafy

Background: Hepatic resection is a major abdominal surgery with challenging pain management. We aimed to investigate the effect of erector spinae plane block (ESPB) with opioid free anesthesia (OFA) in cirrhotic patients scheduled for liver resection on perioperative pain management in terms of hemodynamic stability. Secondarily, we assessed time to first request for analgesia and perioperative fentanyl consumption, nausea and vomiting within 24 hours after surgery.

Methods: Forty patients were randomized to block group (n = 20): OFA with ESPB and conventional group (n = 20): conventional balanced anesthesia with opioids (OFA associated non-opioid drugs [dexmedetomidine, magnesium sulfate, xylocaine, and acetaminophen] and ESPB). Bilateral ESP block was done with ultrasound guidance at the level of thoracic vertebrae T 6-7, the local anesthetic dose was 20 mL Bupivacaine 0.25% with adjuvant dexmedetomidine (0.5 µg/kg) on each side. We monitored hemodynamic stability as the primary endpoint (heart rate, mean arterial blood pressure, and cardiac output).

Results: Bilateral ESPB offered somatic and visceral analgesia for hepatic resection patients with no intraoperative fentanyl required. Postoperatively, the block group with dexmedetomidine adjuvant to the local anesthesia drugs showed delay in the first request for analgesia (p = 0.092) and decreased fentanyl requirement (p < 0.001), so no patient in the ESP group suffered from postoperative nausea and vomiting compared to 50% in the conventional group (p < 0.001).

Conclusion: Bilateral ESP block with OFA is an effective approach for intra- and postoperative analgesia in cirrhotic patients undergoing liver resection.

背景:肝切除术是一项主要的腹部手术,具有挑战性的疼痛管理。我们旨在从血流动力学稳定性方面探讨竖脊平面阻滞(ESPB)和无阿片类麻醉(OFA)对肝硬化肝切除术患者围手术期疼痛管理的影响。其次,我们评估了术后24小时内首次要求镇痛和围手术期芬太尼用量、恶心和呕吐的时间。方法:40例患者随机分为阻断组(n = 20): OFA联合ESPB,常规组(n = 20):阿片类药物常规平衡麻醉(OFA相关非阿片类药物[右美托咪定、硫酸镁、木卡因、对乙酰氨基酚]和ESPB)。超声引导胸椎t6 -7水平双侧ESP阻滞,局麻剂量为0.25%布比卡因20 mL,每侧辅助右美托咪定(0.5µg/kg)。我们监测血流动力学稳定性作为主要终点(心率、平均动脉血压和心输出量)。结果:双侧ESPB为肝切除术患者提供躯体和内脏镇痛,术中无需芬太尼。术后右美托咪定辅助局麻药物阻滞组首次请求镇痛延迟(p = 0.092),芬太尼需求量减少(p < 0.001), ESP组无术后恶心呕吐,而常规组为50% (p < 0.001)。结论:双侧ESP阻滞联合OFA是肝硬化肝切除术患者术中及术后镇痛的有效方法。
{"title":"Erector Spinae Block with Opioid Free Anesthesia in Cirrhotic Patients Undergoing Hepatic Resection: A Randomized Controlled Trial.","authors":"Minatallah A Elshafie,&nbsp;Magdy K Khalil,&nbsp;Maha L ElSheikh,&nbsp;Nagwa I Mowafy","doi":"10.2147/LRA.S343347","DOIUrl":"https://doi.org/10.2147/LRA.S343347","url":null,"abstract":"<p><strong>Background: </strong>Hepatic resection is a major abdominal surgery with challenging pain management. We aimed to investigate the effect of erector spinae plane block (ESPB) with opioid free anesthesia (OFA) in cirrhotic patients scheduled for liver resection on perioperative pain management in terms of hemodynamic stability. Secondarily, we assessed time to first request for analgesia and perioperative fentanyl consumption, nausea and vomiting within 24 hours after surgery.</p><p><strong>Methods: </strong>Forty patients were randomized to block group (n = 20): OFA with ESPB and conventional group (n = 20): conventional balanced anesthesia with opioids (OFA associated non-opioid drugs [dexmedetomidine, magnesium sulfate, xylocaine, and acetaminophen] and ESPB). Bilateral ESP block was done with ultrasound guidance at the level of thoracic vertebrae T 6-7, the local anesthetic dose was 20 mL Bupivacaine 0.25% with adjuvant dexmedetomidine (0.5 µg/kg) on each side. We monitored hemodynamic stability as the primary endpoint (heart rate, mean arterial blood pressure, and cardiac output).</p><p><strong>Results: </strong>Bilateral ESPB offered somatic and visceral analgesia for hepatic resection patients with no intraoperative fentanyl required. Postoperatively, the block group with dexmedetomidine adjuvant to the local anesthesia drugs showed delay in the first request for analgesia (<i>p</i> = 0.092) and decreased fentanyl requirement (<i>p</i> < 0.001), so no patient in the ESP group suffered from postoperative nausea and vomiting compared to 50% in the conventional group (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Bilateral ESP block with OFA is an effective approach for intra- and postoperative analgesia in cirrhotic patients undergoing liver resection.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/cb/lra-15-1.PMC8801329.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39588522","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: 8
Positioning the Catheter Tip Anterior or Posterior to the Saphenous Nerve in Continuous Adductor Canal Block: A Mono-Centric Retrospective Comparative Study. 在连续内收管阻滞中,导管尖端在隐神经前方或后方定位:一项单中心回顾性比较研究。
IF 2.9 Q2 Medicine Pub Date : 2022-01-01 DOI: 10.2147/LRA.S383601
Antonio Coviello, Alessio Bernasconi, Giovanni Balato, Ezio Spasari, Marilena Ianniello, Massimo Mariconda, Maria Vargas, Carmine Iacovazzo, Francesco Smeraglia, Andrea Tognù, Giuseppe Servillo

Background and aim: Ultrasound-guided continuous adductor canal block (cACB) is a conventional choice in patients undergoing total knee arthroplasty (TKA) for the management of the postoperative pain. This study aims to compare different catheter tip locations for cACB relative to the saphenous nerve (anteriorly vs posteriorly) in terms of efficacy and complications.

Methods: At the department of Surgical Sciences, Orthopedic Trauma and Emergencies of the University of Naples Federico II (Naples, Italy), between January 2020 and November 2021, retrospective comparative study was executed. Patients planned for TKA were included in the study if they met the follow inclusion criteria: patients undergone TKA; aged 50-85 years; body mass index (BMI) of 18-35 kg/m2; American Society of Anesthesiologists (ASA) physical status classification from I to III; subarachnoid technique for anesthesiology plane; continuous adductor canal block performed by an anesthetist with considerable experience. Patients were assigned to receive cACB with the catheter tip located anteriorly (Group 1, G1) or posteriorly to the saphenous nerve (Group 2, G2). Postoperative pain, ambulation ability, episodes of pump block and rate of catheter dislodgement and leakage were evaluated and analyzed.

Results: Altogether, 102 patients were admitted to the study (48 in G1 and 54 in G2). After the first 8 postoperative hours, in G1 17 patients (35.4%) had a VAS greater than 4, while in group 2 only 3 patients (5.6%) had a VAS greater than 4 (p-value <0.01). All patients of both groups showed ambulation ability in the postoperative period. No episode of leakage was recorded. While the catheter displacement rate was similar in the two groups (2.1% for G1 vs 3.7% for G2; p-value >0.05), the episodes of pump block were significantly less in G2 than in G1 (3.7% vs 20.8%; p-value <0.01).

Conclusion: In cACB for TKA, we found that positioning the catheter tip posteriorly to the saphenous nerve may lead to a greater postoperative analgesia and reduce the risk of pump block compared to placing the catheter tip anteriorly to the nerve.

背景与目的:超声引导连续内收管阻滞(cACB)是全膝关节置换术(TKA)患者治疗术后疼痛的常规选择。本研究的目的是比较不同的导管尖端位置相对于隐神经(前部与后部)的疗效和并发症。方法:于2020年1月至2021年11月在意大利那不勒斯费德里科二世大学外科科学、骨科创伤与急诊科进行回顾性比较研究。计划进行TKA的患者如果符合以下纳入标准,则纳入研究:接受TKA的患者;年龄50-85岁;体重指数(BMI) 18-35 kg/m2;美国麻醉医师协会(ASA)身体状态分级从I到III;麻醉平面的蛛网膜下腔技术;由经验丰富的麻醉师进行连续内收管阻滞。患者被分配接受cACB,导管尖端位于隐神经前方(1组,G1)或后方(2组,G2)。评估和分析术后疼痛、行走能力、泵阻塞发生率、导管移位和漏出率。结果:共纳入102例患者(G1 48例,G2 54例)。术后前8 h, G1组有17例(35.4%)患者VAS评分大于4分,而2组只有3例(5.6%)患者VAS评分大于4分(p值0.05),G2组的泵阻发作次数明显少于G1组(3.7% vs 20.8%;结论:在TKA的cACB中,我们发现将导管尖端置于隐神经后方比将导管尖端置于神经前方可获得更大的术后镇痛效果,并降低泵阻塞的风险。
{"title":"Positioning the Catheter Tip Anterior or Posterior to the Saphenous Nerve in Continuous Adductor Canal Block: A Mono-Centric Retrospective Comparative Study.","authors":"Antonio Coviello,&nbsp;Alessio Bernasconi,&nbsp;Giovanni Balato,&nbsp;Ezio Spasari,&nbsp;Marilena Ianniello,&nbsp;Massimo Mariconda,&nbsp;Maria Vargas,&nbsp;Carmine Iacovazzo,&nbsp;Francesco Smeraglia,&nbsp;Andrea Tognù,&nbsp;Giuseppe Servillo","doi":"10.2147/LRA.S383601","DOIUrl":"https://doi.org/10.2147/LRA.S383601","url":null,"abstract":"<p><strong>Background and aim: </strong>Ultrasound-guided continuous adductor canal block (cACB) is a conventional choice in patients undergoing total knee arthroplasty (TKA) for the management of the postoperative pain. This study aims to compare different catheter tip locations for cACB relative to the saphenous nerve (anteriorly vs posteriorly) in terms of efficacy and complications.</p><p><strong>Methods: </strong>At the department of Surgical Sciences, Orthopedic Trauma and Emergencies of the University of Naples Federico II (Naples, Italy), between January 2020 and November 2021, retrospective comparative study was executed. Patients planned for TKA were included in the study if they met the follow inclusion criteria: patients undergone TKA; aged 50-85 years; body mass index (BMI) of 18-35 kg/m2; American Society of Anesthesiologists (ASA) physical status classification from I to III; subarachnoid technique for anesthesiology plane; continuous adductor canal block performed by an anesthetist with considerable experience. Patients were assigned to receive cACB with the catheter tip located anteriorly (Group 1, G1) or posteriorly to the saphenous nerve (Group 2, G2). Postoperative pain, ambulation ability, episodes of pump block and rate of catheter dislodgement and leakage were evaluated and analyzed.</p><p><strong>Results: </strong>Altogether, 102 patients were admitted to the study (48 in G1 and 54 in G2). After the first 8 postoperative hours, in G1 17 patients (35.4%) had a VAS greater than 4, while in group 2 only 3 patients (5.6%) had a VAS greater than 4 (p-value <0.01). All patients of both groups showed ambulation ability in the postoperative period. No episode of leakage was recorded. While the catheter displacement rate was similar in the two groups (2.1% for G1 vs 3.7% for G2; p-value >0.05), the episodes of pump block were significantly less in G2 than in G1 (3.7% vs 20.8%; p-value <0.01).</p><p><strong>Conclusion: </strong>In cACB for TKA, we found that positioning the catheter tip posteriorly to the saphenous nerve may lead to a greater postoperative analgesia and reduce the risk of pump block compared to placing the catheter tip anteriorly to the nerve.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/c9/lra-15-97.PMC9807124.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10481479","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
Interscalene Block for Analgesia in Orthopedic Treatment of Shoulder Trauma: Single-Dose Liposomal Bupivacaine versus Perineural Catheter. 斜角肌间阻滞在骨科治疗肩关节创伤中的镇痛作用:单剂量布比卡因脂质体与神经周导管。
IF 2.9 Q2 Medicine Pub Date : 2021-12-07 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S303455
Andrzej P Kwater, Nadia Hernandez, Carlos Artime, Johanna Blair de Haan

Background: Interscalene brachial plexus block is frequently utilized to provide perioperative analgesia to patients undergoing shoulder surgery to optimize recovery, minimize opioid consumption, and decrease overall hospital length of stay. The use of an indwelling perineural interscalene catheter provides extended analgesia and is efficacious in managing severe postoperative pain following major shoulder surgery. Currently, the only alternative to perineural catheters for extended analgesia with interscalene block involves the perineural infiltration of liposomal bupivacaine. However, there is limited published data regarding the overall analgesic effectiveness of using interscalene liposomal bupivacaine in the setting of shoulder surgery.

Methods: We performed a retrospective review of 43 patients in the acute trauma setting who underwent major shoulder surgery and received extended analgesia via perioperative interscalene brachial plexus block with either an indwelling continuous catheter or single-dose liposomal bupivacaine to determine if comparable analgesia can be achieved. The primary outcomes of interest were postoperative pain scores and opioid consumption. Due to the ability to titrate and bolus local anesthetic infusions to a desired clinical effect, we hypothesized that opioid consumption and pain scores would be lower when using the continuous catheter technique.

Results: After statistical analysis, our results demonstrated no significant difference between the two techniques in regards to opioid consumption as well as numeric pain scores during the 48-hour postoperative period, but did note a higher rate of complications with patients who received perineural interscalene continuous catheters. Secondary outcomes showed an increase in time required to complete the regional block procedure with the use of indwelling catheters.

Conclusion: Interscalene brachial plexus block with liposomal bupivacaine may be a viable alternative to indwelling continuous catheters for providing extended analgesia in patients undergoing major shoulder surgery.

背景:斜角肌间臂丛阻滞常用于肩关节手术患者的围手术期镇痛,以优化恢复,减少阿片类药物的消耗,并缩短总住院时间。应用神经周围斜角肌间留置导管可提供延长的镇痛,并可有效地处理肩部大手术后的严重术后疼痛。目前,斜角肌间阻滞延长镇痛的唯一替代神经周围导管涉及布比卡因脂质体的神经周围浸润。然而,关于肩关节手术中使用斜角肌间脂质体布比卡因的整体镇痛效果,发表的数据有限。方法:我们对43例急性创伤患者进行回顾性分析,这些患者接受了大肩关节手术,并通过围手术期斜角肌间臂丛阻滞,留置连续导管或单剂量布比卡因脂质体进行延长镇痛,以确定是否可以达到类似的镇痛效果。主要研究结果为术后疼痛评分和阿片类药物消耗。由于能够滴定和滴注局麻达到预期的临床效果,我们假设使用连续导管技术时阿片类药物消耗和疼痛评分会更低。结果:经过统计分析,我们的结果显示,在术后48小时内,两种技术在阿片类药物消耗和数值疼痛评分方面没有显著差异,但确实注意到接受神经周围斜角肌间连续导尿管的患者并发症发生率更高。次要结果显示,使用留置导尿管完成局部阻滞手术所需的时间增加。结论:布比卡因脂质体联合斜角肌间臂丛阻滞可能是一种可行的替代留置连续导管的方法,可为大肩关节手术患者提供延长的镇痛。
{"title":"Interscalene Block for Analgesia in Orthopedic Treatment of Shoulder Trauma: Single-Dose Liposomal Bupivacaine versus Perineural Catheter.","authors":"Andrzej P Kwater,&nbsp;Nadia Hernandez,&nbsp;Carlos Artime,&nbsp;Johanna Blair de Haan","doi":"10.2147/LRA.S303455","DOIUrl":"https://doi.org/10.2147/LRA.S303455","url":null,"abstract":"<p><strong>Background: </strong>Interscalene brachial plexus block is frequently utilized to provide perioperative analgesia to patients undergoing shoulder surgery to optimize recovery, minimize opioid consumption, and decrease overall hospital length of stay. The use of an indwelling perineural interscalene catheter provides extended analgesia and is efficacious in managing severe postoperative pain following major shoulder surgery. Currently, the only alternative to perineural catheters for extended analgesia with interscalene block involves the perineural infiltration of liposomal bupivacaine. However, there is limited published data regarding the overall analgesic effectiveness of using interscalene liposomal bupivacaine in the setting of shoulder surgery.</p><p><strong>Methods: </strong>We performed a retrospective review of 43 patients in the acute trauma setting who underwent major shoulder surgery and received extended analgesia via perioperative interscalene brachial plexus block with either an indwelling continuous catheter or single-dose liposomal bupivacaine to determine if comparable analgesia can be achieved. The primary outcomes of interest were postoperative pain scores and opioid consumption. Due to the ability to titrate and bolus local anesthetic infusions to a desired clinical effect, we hypothesized that opioid consumption and pain scores would be lower when using the continuous catheter technique.</p><p><strong>Results: </strong>After statistical analysis, our results demonstrated no significant difference between the two techniques in regards to opioid consumption as well as numeric pain scores during the 48-hour postoperative period, but did note a higher rate of complications with patients who received perineural interscalene continuous catheters. Secondary outcomes showed an increase in time required to complete the regional block procedure with the use of indwelling catheters.</p><p><strong>Conclusion: </strong>Interscalene brachial plexus block with liposomal bupivacaine may be a viable alternative to indwelling continuous catheters for providing extended analgesia in patients undergoing major shoulder surgery.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2021-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d5/52/lra-14-167.PMC8665777.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39726991","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
Relationship Between Gender, Age, BMI and Side of Body on the Size and Position of Nerves of the Brachial Plexus in Axilla: Pilot Study. 性别、年龄、身体质量指数和身体侧面对腋窝臂丛神经大小和位置关系的初步研究。
IF 2.9 Q2 Medicine Pub Date : 2021-11-20 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S334618
James Lalloo, Pawan Gupta

Background and objectives: Studies demonstrate variations in the size and position of the nerves in the brachial plexus. The objective of this pilot study was to determine the effect of age, gender, BMI and side of body on the size and position of these nerves and to determine the feasibility of a further study.

Methods: Twenty healthy volunteers were recruited. The ultrasound position of the nerves was confirmed by a dynamic scan. The size of the nerves was calculated using the freehand calliper tool. A graph was designed to study the position of the nerves. ImageJ was used to analyse the position of the nerves. Student's t-tests were carried out to compare the gender and side of arm with the size of the nerve. Pearson's correlation coefficients were calculated to determine the correlation between BMI and age with the size of the nerves. The position of the nerves was compared between male and female, and left and right sides of the body.

Results: The mean size of the median nerve, musculocutaneous nerve, radial nerve and ulnar nerve was 0.099, 0.032, 0.179 and 0.076 cm2 (males) and 0.091, 0.022, 0.128 and 0.026 cm2 (females), respectively. There were significant differences between the size of nerves and gender in the musculocutaneous, radial and ulnar nerves (P <0.05). The correlations between the sizes of the nerves with BMI and age were not significant. The position of the radial nerves was found to be variable within the same genders and between males and females. The position of the nerves was variable between the left and right hand side.

Conclusion: The position and size of brachial plexus branches in axilla is very variable. This pilot study highlights the need for further research with larger sample sizes to fully understand the extent and implication of this variability.

背景和目的:研究表明臂丛神经的大小和位置存在差异。这项初步研究的目的是确定年龄、性别、BMI和身体侧面对这些神经的大小和位置的影响,并确定进一步研究的可行性。方法:招募20名健康志愿者。通过动态扫描确认了神经的超声位置。使用徒手卡尺工具计算神经的大小。设计了一个图表来研究神经的位置。ImageJ用于分析神经的位置。进行了学生t检验,以比较性别和手臂的侧面与神经的大小。计算Pearson相关系数以确定BMI和年龄与神经大小之间的相关性。比较了男性和女性以及身体左右两侧的神经位置。结果:正中神经、肌皮神经、桡神经、尺神经的平均大小分别为0.099、0.032、0.179、0.076 cm2(男性)和0.091、0.022、0.128、0.026 cm2(女性)。结论:臂丛神经分支在腋窝的位置和大小有很大的差异。这项初步研究强调需要进一步研究更大的样本量,以充分了解这种可变性的程度和含义。
{"title":"Relationship Between Gender, Age, BMI and Side of Body on the Size and Position of Nerves of the Brachial Plexus in Axilla: Pilot Study.","authors":"James Lalloo,&nbsp;Pawan Gupta","doi":"10.2147/LRA.S334618","DOIUrl":"https://doi.org/10.2147/LRA.S334618","url":null,"abstract":"<p><strong>Background and objectives: </strong>Studies demonstrate variations in the size and position of the nerves in the brachial plexus. The objective of this pilot study was to determine the effect of age, gender, BMI and side of body on the size and position of these nerves and to determine the feasibility of a further study.</p><p><strong>Methods: </strong>Twenty healthy volunteers were recruited. The ultrasound position of the nerves was confirmed by a dynamic scan. The size of the nerves was calculated using the freehand calliper tool. A graph was designed to study the position of the nerves. ImageJ was used to analyse the position of the nerves. Student's t-tests were carried out to compare the gender and side of arm with the size of the nerve. Pearson's correlation coefficients were calculated to determine the correlation between BMI and age with the size of the nerves. The position of the nerves was compared between male and female, and left and right sides of the body.</p><p><strong>Results: </strong>The mean size of the median nerve, musculocutaneous nerve, radial nerve and ulnar nerve was 0.099, 0.032, 0.179 and 0.076 cm2 (males) and 0.091, 0.022, 0.128 and 0.026 cm2 (females), respectively. There were significant differences between the size of nerves and gender in the musculocutaneous, radial and ulnar nerves (P <0.05). The correlations between the sizes of the nerves with BMI and age were not significant. The position of the radial nerves was found to be variable within the same genders and between males and females. The position of the nerves was variable between the left and right hand side.</p><p><strong>Conclusion: </strong>The position and size of brachial plexus branches in axilla is very variable. This pilot study highlights the need for further research with larger sample sizes to fully understand the extent and implication of this variability.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/36/b6/lra-14-161.PMC8612660.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39792730","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
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Local and Regional Anesthesia
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