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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 Q3 ANESTHESIOLOGY 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。
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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 Q3 ANESTHESIOLOGY 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。
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引用次数: 1
Spinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial. 脊髓或静脉注射右美托咪定与氯丙卡因用于膝关节置换术的脊髓麻醉:一项双盲随机试验。
IF 2.9 Q3 ANESTHESIOLOGY Pub Date : 2021-11-20 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S324876
Margaretha B Breebaart, Lies Saerens, Jordi Branders, Sari Casaer, Luc Sermeus, Patrick Van Houwe

Purpose: Chloroprocaine provides spinal anesthesia for day-case surgery lasting up to 40 minutes. Intravenous and spinal dexmedetomidine can prolong spinal anesthesia, but no data are available for the combination with chloroprocaine. This double-blind randomized controlled trial compares chloroprocaine with spinal or intravenous dexmedetomidine regarding block characteristics, micturition, and discharge times.

Patients and methods: After ethical approval and informed consent, 135 patients scheduled for knee arthroscopy were randomized to receive either 40mg spinal chloroprocaine (Chloro-group), 40mg chloroprocaine with 5 mcg spinal dexmedetomidine (Spinal Dex-group) or 40mg chloroprocaine with 0.5 mcg/kg IV dexmedetomidine (IV DEXgroup). Block characteristics, hemodynamic variables and the use of analgesics were registered. Voiding and discharge times were noted. A scoring system was used for micturition problems and sedation. Transient neurological symptoms (TNS) and other late side effects were evaluated after one week.

Results: Demographic data were similar between groups. Block onset times and intensity of motor block were comparable between groups. The time to L2 and Bromage 1 regression was prolonged in the SpinalDEx-group by approximately 30 minutes compared to the other groups (p < 0.01). First voiding as well as discharge from the hospital was prolonged in the Spinal Dex-group by approximately 40 minutes p < 0.01. There was no significant difference between groups regarding treatment of hypotension, sedation, micturition problems or the use of postoperative analgesics (P > 0.8). One patient experienced TNS.

Conclusion: Intrathecal but not intravenous (0.5 mcg/kg) dexmedetomidine can prolong chloroprocaine (40mg) spinal anesthesia when surgery is expected to last over 40 minutes. Despite a similar incidence of adverse effects, this also led to a postponed hospital discharge time.

目的:氯普鲁卡因为日间手术提供长达40分钟的脊髓麻醉。静脉注射和脊髓注射右美托咪定可延长脊髓麻醉时间,但与氯普鲁卡因联用没有相关数据。这项双盲随机对照试验比较氯普鲁卡因与脊髓或静脉注射右美托咪定在阻滞特征、排尿和排泄时间方面的差异。患者和方法:经伦理批准和知情同意后,135例膝关节镜患者随机接受40mg氯普鲁卡因(氯组)、40mg氯普鲁卡因加5mcg右美托咪定(脊髓右美托咪定组)或40mg氯普鲁卡因加0.5 mcg/kg静脉右美托咪定(静脉右美托咪定组)治疗。记录阻滞特征、血流动力学变量和镇痛药的使用。记录排尿和出院时间。排尿问题和镇静使用评分系统。一周后评估短暂性神经症状(TNS)和其他晚期副作用。结果:组间人口学数据相似。两组间阻滞发作时间和运动阻滞强度具有可比性。与其他组相比,spinaldex组的L2和Bromage 1回归时间延长了约30分钟(p < 0.01)。Spinal dex组首次排尿和出院时间延长约40分钟,p < 0.01。两组患者在低血压、镇静、排尿问题及术后镇痛药使用方面差异无统计学意义(P > 0.8)。一名患者经历了TNS。结论:当手术时间超过40分钟时,鞘内注射右美托咪定可延长氯普鲁卡因(40mg)脊髓麻醉时间,但静脉注射(0.5 mcg/kg)无效。尽管不良反应发生率相似,但这也导致了出院时间的推迟。
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引用次数: 0
Evaluation of the Analgesic Efficacy of Bilateral Ultrasound-Guided Transversus Thoracic Muscle Plane Block on Post-Sternotomy Pain: A Randomized Controlled Trial. 评估双侧超声引导胸横肌平面阻滞对切除术后疼痛的镇痛效果:随机对照试验。
IF 2.9 Q3 ANESTHESIOLOGY Pub Date : 2021-11-12 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S338685
Hoda Shokri, Ihab Ali, Amr A Kasem

Purpose: Transverse thoracic block is a new perioperative analgesic method for post-sternotomy discomfort. This study discusses the efficacy of an ultrasound-guided transversus thoracic muscle plane block (TTPB) in patients undergoing heart surgery, including sternotomy.

Patients and methods: In this prospective trial, 60 patients were randomly assigned to two groups: transversus (T) or general anesthesia (GA). Patients in the T group received TTPB with GA and 15 mL of 0.25% bupivacaine was administered on either side. Patients in the GA group received TTPB along with GA, but 15 mL saline was injected on either side instead. The patients were followed up postoperatively. The percentage of patients receiving additional opioids, extubation time, intensive care unit (ICU) length, postoperative morphine dose, and adverse events were documented.

Results: The percentage of patients requiring additional morphine was significantly lower in the T group (p<0.015). Pain scores were comparable between the groups at extubation time and 18 h postoperatively. At 8, 12, and 24 h after surgery, pain scores in the T group were significantly lower (P<0.001). The total amount of morphine required after surgery was much lower in the T group (8±0.74 mg), and the duration to initial analgesic necessity was significantly greater in the GA group (P<0.001). Patients in the GA group had a considerably longer ventilation time (11.07±0.64) (P<0.001). The ICU stay in the T group was substantially shorter (P<0.001), and postoperative complications were comparable.

Conclusion: For patients undergoing heart surgery, TTPB offers sufficient postoperative pain control, resulting in lower pain scores, lower postoperative analgesic doses, shorter extubation times, and shorter ICU stay lengths.

目的:胸横肌阻滞是治疗胸骨切开术后不适的一种新的围手术期镇痛方法。本研究探讨了超声引导下胸横肌平面阻滞(TTPB)对心脏手术(包括胸骨切开术)患者的疗效:在这项前瞻性试验中,60 名患者被随机分配到两组:横纹肌(T)组或全身麻醉(GA)组。T 组患者在 GA 下接受 TTPB,两侧各注射 15 毫升 0.25% 布比卡因。GA 组患者在接受 GA 的同时接受 TTPB,但在两侧注射 15 毫升生理盐水。术后对患者进行了随访。记录了接受额外阿片类药物治疗的患者比例、拔管时间、重症监护室(ICU)时间、术后吗啡剂量和不良事件:结果:需要额外使用吗啡的患者比例在 T 组明显降低(p):对于接受心脏手术的患者,TTPB 可以充分控制术后疼痛,从而降低疼痛评分,减少术后镇痛剂剂量,缩短拔管时间和重症监护室住院时间。
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引用次数: 0
Short Communication: Lumbar Plexus Block versus Suprainguinal Fascia Iliaca Block to Provide Analgesia Following Hip and Femur Surgery in Pediatric-Aged Patients - An Analysis of a Case Series. 简短的交流:腰丛阻滞与腹股沟上筋膜髂阻滞在儿科老年患者髋关节和股骨手术后提供镇痛-一个病例系列分析。
IF 2.9 Q3 ANESTHESIOLOGY Pub Date : 2021-10-19 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S334561
Lauren DeLong, Senthil Krishna, Catherine Roth, Giorgio Veneziano, Mauricio Arce Villalobos, Kevin Klingele, Joseph D Tobias

Introduction: For surgical procedures involving the hip and femur, various regional anesthetic techniques may be used to provide analgesia. Although there has been an increase in the use of lumbar plexus block (LPB), the technique may be time consuming and associated with complications. Suprainguinal fascia iliaca compartment block (FICB) is a potentially easier and safer alternative. The current study prospectively compares LPB with suprainguinal FICB.

Methods: This prospective, double-blinded, randomized, study included patients undergoing elective orthopedic procedures of the hip and/or femur. All study patients received general anesthesia with randomization to either an LPB or suprainguinal FICB using 0.5% ropivacaine with epinephrine and dexamethasone. Postoperative pain control was achieved with intravenous hydromorphone delivered by patient-controlled analgesia with scheduled acetaminophen and ketorolac. Outcome data included time to perform the block, perioperative opioid consumption, postoperative pain scores (VAS) and hospital length of stay.

Results: The study cohort included 15 patients between the ages of 7 and 16 years (LPB N = 7, FICB N = 8). The median block time was 6 minutes (IQR: 4.11) for the LPB group and 3 minutes (IQR: 3.6) for the FICB group (p = 0.107). Median postoperative pain scores were 4 (IQR: 0.6) for the LPB group and 2 (IQR: 0.5) for the FICB group (p = 0.032). There were no differences in the intraoperative or postoperative opioid and NSAID use between the two groups.

Discussion: The suprainguinal FICB provides analgesia that is at least as effective as a LPB following hip and femur surgery. Time to perform the block was shorter with the FICB due to the supine patient position and limited needle trajectory. Although we noted no adverse effects, the superficial needle trajectory of the FICB offers a less invasive approach and the potential for decreased risks of adverse effects.

对于涉及髋关节和股骨的外科手术,可以使用各种区域麻醉技术来提供镇痛。尽管腰丛阻滞术(LPB)的使用有所增加,但该技术可能耗时且伴有并发症。腹股沟上筋膜髂隔室阻滞(FICB)是一个潜在的更容易和更安全的选择。本研究前瞻性地比较了LPB和腹股沟上FICB。方法:这项前瞻性、双盲、随机研究纳入了接受选择性髋关节和/或股骨矫形手术的患者。所有研究患者均接受全身麻醉,随机分配至LPB或腹股沟上FICB,使用0.5%罗哌卡因联合肾上腺素和地塞米松。术后疼痛控制是通过静脉注射氢吗啡酮和患者自行控制的对乙酰氨基酚和酮罗拉酸镇痛来实现的。结局数据包括阻滞时间、围手术期阿片类药物消耗、术后疼痛评分(VAS)和住院时间。结果:纳入15例7 ~ 16岁患者(LPB N = 7, FICB N = 8), LPB组中位阻滞时间为6分钟(IQR: 4.11), FICB组中位阻滞时间为3分钟(IQR: 3.6) (p = 0.107)。LPB组术后疼痛中位评分为4分(IQR: 0.6), FICB组为2分(IQR: 0.5) (p = 0.032)。两组患者术中或术后阿片类药物和非甾体抗炎药的使用无差异。讨论:在髋关节和股骨手术后,腹股沟上FICB提供的镇痛效果至少与LPB一样有效。由于患者仰卧位和针头轨迹有限,FICB的阻滞时间较短。虽然我们没有注意到不良反应,但FICB的浅表针头轨迹提供了一种侵入性较小的方法,并有可能降低不良反应的风险。
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引用次数: 1
Anastomoses (Superficial Cervical Ansa) Between the Cervical Plexus and Peripheral Facial Nerve Branches: Implications for Regional Anesthesia in Carotid Endarterectomies - Anatomical Study. 颈丛与周围面神经分支之间的吻合口(颈浅Ansa):颈动脉内膜切除术中区域麻醉的意义-解剖学研究。
IF 2.9 Q3 ANESTHESIOLOGY Pub Date : 2021-10-13 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S328987
Ronald Seidel, Andreas Wree, Marko Schulze

Purpose: Sensory innervation in the carotid triangle involves the cervical plexus, cranial nerves, and the sympathetic trunk. This innervation also applies to skin incision, including various anatomical structures with potentially different innervation, such as the skin (dermatomes), the platysma (myotomes), and the superficial layer of the cervical fascia (fasciotomes), as well as retromandibular retractor insertion (co-innervation: V, VII). The aim of this anatomical study was to develop an injection technique for carotid endarterectomies to additionally block anastomoses between the transverse cervical nerve (TCN), the cervical branch VII (CB VII), and the marginal mandibular branch VII (MMB VII). These anastomoses are also termed superficial cervical ansa (SCA).

Materials and methods: Preparations (n=16) were performed on unembalmed donor cadavers (n=8). Subplatysmal injections (each using 5 mL of Alcian blue) were performed cranially within the carotid triangle between the anterior margin of the sternocleidomastoid muscle and the submandibular gland.

Results: Anastomoses between the TCN, CB VII, and MMB VII were stained in all preparations (n=16).

Conclusion: This anatomical study presents an ultrasound-guided subplatysmal SCA block to optimize, in addition to a cervical plexus block, the quality of anesthesia for carotid endarterectomies.

目的:颈动脉三角的感觉神经支配包括颈丛、颅神经和交感神经干。这种神经支配也适用于皮肤切口,包括各种可能有不同神经支配的解剖结构,如皮肤(皮节)、阔阔肌(肌节)和颈筋膜浅层(筋膜节),以及下颌后牵开器的插入(共神经支配:这项解剖学研究的目的是开发一种用于颈动脉内膜切除术的注射技术,以额外阻断颈横神经(TCN)、颈VII支(CB VII)和下颌边缘支VII (MMB VII)之间的吻合,这些吻合也被称为颈浅ansa (SCA)。材料与方法:对8具未防腐处理的供尸进行制备(n=16)。在胸锁乳突肌前缘和颌下腺之间的颈动脉三角内进行颅侧颈动脉下注射(每次使用5ml阿利新蓝)。结果:所有制剂均有TCN、cbvii、MMB VII吻合口染色(n=16)。结论:本解剖研究提出了超声引导下的颈颈动脉内膜下SCA阻滞,除了颈丛阻滞外,还可以优化颈动脉内膜切除术的麻醉质量。
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引用次数: 0
Efficacy and Safety of Cryoneurolysis for Treatment of Chronic Head Pain Secondary to Occipital Neuralgia: A Pilot Study. 冷冻神经溶解治疗继发于枕神经痛的慢性头痛的有效性和安全性:一项初步研究。
IF 2.9 Q3 ANESTHESIOLOGY Pub Date : 2021-09-17 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S324527
Eric Grigsby, Richard Radnovich, Srinivas Nalamachu

Purpose: Treatment of chronic pain associated with occipital neuralgia (ON) is complex, and no consensus statement or guidelines have been published for ON management. This pilot study evaluated the efficacy and safety of cryoneurolysis for management of ON-associated chronic pain.

Patients and methods: The study was a prospective, multicenter, nonrandomized cohort study assessing the degree and duration of clinical effect of cryoneurolysis therapy for reducing pain in patients diagnosed with unilateral or bilateral ON. The primary outcome measure was improvement in pain due to ON from baseline to day 7, measured on an 11-point numeric rating scale for pain. Secondary outcome measures included duration of treatment effects and safety events, including anticipated observations and adverse events. Treatment effect was assessed at days 7, 30, and 56 by asking the patient if they were continuing to experience a treatment effect, with potential responses of "effect," "no effect," or "no longer effective." A posttreatment questionnaire evaluated patient satisfaction.

Results: Twenty-six patients (9 men, 17 women) with a mean age of 49.1 years enrolled and completed the study. A total of 64% (16/25) of participants reported a clinically important improvement of ≥2 points in numeric rating scale pain scores at day 7; similar results persisted to day 30. Treatment effects were reported by 50% (13/26) of participants at day 30, with a continued effect reported by 35% (9/26) of participants at day 56. Overall, ~70% of participants were satisfied with treatment at 7, 30, and 56 days. No serious anticipated observations, adverse events, or unanticipated adverse device effects were reported.

Conclusion: Cryoneurolysis provided significant relief from pain associated with ON ≤30 days after treatment and had an acceptable safety profile.

目的:慢性疼痛与枕神经痛(ON)的治疗是复杂的,并没有共识的声明或指南已发表的ON管理。这项初步研究评估了冷冻神经溶解治疗on相关慢性疼痛的有效性和安全性。患者和方法:该研究是一项前瞻性、多中心、非随机队列研究,评估了单侧或双侧ON患者使用冷冻神经溶解治疗减轻疼痛的临床效果的程度和持续时间。主要结局指标是从基线到第7天因ON引起的疼痛的改善,以11分的疼痛数值评定量表进行测量。次要结局指标包括治疗效果持续时间和安全事件,包括预期观察和不良事件。在第7、30和56天评估治疗效果,通过询问患者是否继续经历治疗效果,潜在的回答是“有效”、“没有效果”或“不再有效”。治疗后问卷评估患者满意度。结果:26例患者(男9例,女17例)入组并完成研究,平均年龄49.1岁。在第7天,共有64%(16/25)的参与者报告了数值评定量表疼痛评分≥2分的临床重要改善;类似的结果持续到第30天。在第30天,50%(13/26)的参与者报告了治疗效果,在第56天,35%(9/26)的参与者报告了持续的效果。总体而言,约70%的参与者在第7、30和56天对治疗感到满意。没有严重的预期观察、不良事件或意外的不良器械效应报告。结论:在治疗后≤30天,冷冻神经松解术可以显著缓解与ON相关的疼痛,并且具有可接受的安全性。
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引用次数: 1
Serious Complications After Epidural Catheter Placement: Two Case Reports. 硬膜外置管后严重并发症2例报告。
IF 2.9 Q3 ANESTHESIOLOGY Pub Date : 2021-07-24 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S324362
Ronald Seidel, Marc Tietke, Oliver Heese, Uwe Walter

Thoracic epidural analgesia (TEA) is a standard procedure in multimodal analgesia applied in major thoracic and abdominal surgeries. Two cases are presented with serious complications related to TEA. In both cases, earlier reaction of the treating physicians to patient-reported sensory symptoms could have prevented the complicated course. The first case was a 73-year-old patient with bronchial carcinoma who underwent right lower lobe resection. In this case, dabigatran 150 mg/d (indication: permanent atrial fibrillation) had been discontinued 72 hours before surgery, and enoxaparin 80 mg (every 12 hours) had been started 11 hours after surgery. An epidural hematoma developed postoperatively. Magnetic resonance imaging (MRI) was performed only after paraplegia had developed the next day. Unfortunately, delayed hematoma evacuation could not prevent persistent paraplegia in this case, which was complicated by hospital-acquired pneumonia with sepsis and acute renal failure. The second case was a 39-year-old patient with ulcerative colitis and an initially undetected malposition of the epidural catheter. Immediately after test bolus injection, the patient reported paresthesia and overall discomfort, which however could not be safely attributed to either the test dose or the already started general anesthesia. The patient could only be extubated after stopping the epidural infusion. Accidental re-start of epidural infusion led to coma, conjugate eye deviation, and respiratory arrest, necessitating re-intubation. Computed tomography (CT) ruled out intracerebral pathology and showed a catheter position centrally in the spinal canal. Fortunately, no neurological deficits were detected after catheter removal.

胸廓硬膜外镇痛(TEA)是胸腹外科手术中多模式镇痛的一种标准方法。两例出现与TEA相关的严重并发症。在这两种情况下,治疗医生对患者报告的感觉症状的早期反应可能会阻止复杂的过程。第一个病例是一位73岁的支气管癌患者,他接受了右下叶切除术。本例患者术前72小时停用达比加群150mg /d(适应症:永久性房颤),术后11小时开始使用依诺肝素80mg(每12小时一次)。术后出现硬膜外血肿。仅在截瘫发展的第二天才进行磁共振成像(MRI)。不幸的是,延迟血肿清除不能防止该病例的持续性截瘫,并并发医院获得性肺炎合并败血症和急性肾功能衰竭。第二个病例是一名39岁的溃疡性结肠炎患者,最初未发现硬膜外导管位置错误。试验丸注射后,患者立即报告感觉异常和全身不适,然而,这不能安全地归因于试验剂量或已经开始全身麻醉。患者只有在停止硬膜外输注后才能拔管。意外重新开始硬膜外输注导致昏迷、共轭眼偏差和呼吸停止,需要重新插管。计算机断层扫描(CT)排除了脑内病理,并显示导管位于椎管中央。幸运的是,拔管后未发现神经功能缺损。
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引用次数: 1
Comparison of Ultrasound-Guided Modified BRILMA Block with Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy - A Randomized Controlled Trial. 超声引导改良BRILMA阻滞与肋下经腹平面阻滞用于腹腔镜胆囊切除术术后镇痛的比较——一项随机对照试验。
IF 2.9 Q3 ANESTHESIOLOGY Pub Date : 2021-07-02 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S316320
Ravi Saravanan, Rajagopalan Venkatraman, Urkavalan Karthika

Background and aims: Subcostal Transversus Abdominis Plane (TAP) block is the standard practice for postoperative analgesia following laparoscopic cholecystectomy. This study aimed to compare the efficacy of modified BRILMA Block (blocking the BRanches of Intercostal nerves at the Level of Mid-Axillary line) with Subcostal TAP block for pain relief following laparoscopic cholecystectomy.

Methods: Sixty cases scheduled for laparoscopic cholecystectomy were randomly divided into two groups: modified BRILMA block (Group B) and Subcostal TAP block (Group T). General anesthesia was standardized for both groups. Blocks were performed with 20 mL of 0.2% Ropivacaine under ultrasound guidance after induction of anesthesia. Patients were administered morphine through patient controlled analgesia (PCA) pump with a bolus dose of 1 mg, 10 min lockout interval, and a basal infusion rate of 0.1 mg/h. The pain was assessed by the Visual Analog Scale (VAS) scores of one to ten. The total morphine consumption, time to first request for rescue analgesia, and VAS scores at rest and with movement, and complications, if any, were recorded.

Results: The morphine consumption in Group B was 5.67 ± 1.98 mg and in Group T was 5.17 ± 1.85 mg, which was found to be statistically insignificant (p-value = 0.317). The time to first request for rescue analgesia was 759.33 ± 80.29 min in Group B which was comparable to 854 ± 93.01 min in Group T and statistically insignificant (p-value = 0.295). The average VAS scores at rest as well as on movement were comparable in both the groups during the entire 24 h postoperative period. No complications were encountered in our study.

Conclusion: Ultrasound-guided modified BRILMA block is equally efficacious as subcostal TAP block in providing postoperative analgesia with similar morphine consumption and no significant difference in VAS scores at rest and movement following laparoscopic cholecystectomy.

Trial registration number: CTRI/2020/02/023457.

背景和目的:肋下腹横面阻滞(TAP)是腹腔镜胆囊切除术后镇痛的标准做法。本研究旨在比较改良BRILMA阻滞(在腋中线水平阻滞肋间神经分支)与肋下TAP阻滞对腹腔镜胆囊切除术后疼痛缓解的疗效。方法:将60例腹腔镜胆囊切除术患者随机分为改良BRILMA阻滞组(B组)和肋下TAP阻滞组(T组),两组均采用标准化全身麻醉。诱导麻醉后,在超声引导下用0.2%罗哌卡因20 mL进行阻滞。患者通过患者自控镇痛(PCA)泵给予吗啡,起始剂量为1 mg,闭锁间隔10 min,基础输注速率为0.1 mg/h。疼痛通过视觉模拟量表(VAS)评分1 - 10分进行评估。记录吗啡总用量、首次要求抢救镇痛的时间、静止和运动时的VAS评分以及并发症(如有)。结果:B组吗啡用量为5.67±1.98 mg, T组为5.17±1.85 mg,差异无统计学意义(p值= 0.317)。B组患者首次请求抢救镇痛时间为759.33±80.29 min,与T组854±93.01 min比较,差异无统计学意义(p值= 0.295)。两组患者术后24小时内静息和运动时的平均VAS评分具有可比性。本研究未发生并发症。结论:超声引导改良BRILMA阻滞与肋下TAP阻滞在吗啡用量相近的情况下提供术后镇痛效果相同,且腹腔镜胆囊切除术后静息和运动时VAS评分无显著差异。试验注册号:CTRI/2020/02/023457。
{"title":"Comparison of Ultrasound-Guided Modified BRILMA Block with Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy - A Randomized Controlled Trial.","authors":"Ravi Saravanan,&nbsp;Rajagopalan Venkatraman,&nbsp;Urkavalan Karthika","doi":"10.2147/LRA.S316320","DOIUrl":"https://doi.org/10.2147/LRA.S316320","url":null,"abstract":"<p><strong>Background and aims: </strong>Subcostal Transversus Abdominis Plane (TAP) block is the standard practice for postoperative analgesia following laparoscopic cholecystectomy. This study aimed to compare the efficacy of modified BRILMA Block (blocking the BRanches of Intercostal nerves at the Level of Mid-Axillary line) with Subcostal TAP block for pain relief following laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>Sixty cases scheduled for laparoscopic cholecystectomy were randomly divided into two groups: modified BRILMA block (Group B) and Subcostal TAP block (Group T). General anesthesia was standardized for both groups. Blocks were performed with 20 mL of 0.2% Ropivacaine under ultrasound guidance after induction of anesthesia. Patients were administered morphine through patient controlled analgesia (PCA) pump with a bolus dose of 1 mg, 10 min lockout interval, and a basal infusion rate of 0.1 mg/h. The pain was assessed by the Visual Analog Scale (VAS) scores of one to ten. The total morphine consumption, time to first request for rescue analgesia, and VAS scores at rest and with movement, and complications, if any, were recorded.</p><p><strong>Results: </strong>The morphine consumption in Group B was 5.67 ± 1.98 mg and in Group T was 5.17 ± 1.85 mg, which was found to be statistically insignificant (p-value = 0.317). The time to first request for rescue analgesia was 759.33 ± 80.29 min in Group B which was comparable to 854 ± 93.01 min in Group T and statistically insignificant (p-value = 0.295). The average VAS scores at rest as well as on movement were comparable in both the groups during the entire 24 h postoperative period. No complications were encountered in our study.</p><p><strong>Conclusion: </strong>Ultrasound-guided modified BRILMA block is equally efficacious as subcostal TAP block in providing postoperative analgesia with similar morphine consumption and no significant difference in VAS scores at rest and movement following laparoscopic cholecystectomy.</p><p><strong>Trial registration number: </strong>CTRI/2020/02/023457.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"14 ","pages":"109-116"},"PeriodicalIF":2.9,"publicationDate":"2021-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/04/5c/lra-14-109.PMC8259940.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39166426","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: 2
Analysis of Epidural Waveform to Determine Correct Epidural Catheter Placement After CSE Labor Analgesia. 剖宫产镇痛后硬膜外置管波形分析。
IF 2.9 Q3 ANESTHESIOLOGY Pub Date : 2021-06-17 eCollection Date: 2021-01-01 DOI: 10.2147/LRA.S312194
Alessandra Coccoluto, Giorgio Capogna, Michela Camorcia, Mark Hochman, Matteo Velardo

Background: The epidural pressure is pulsatile and synchronized with arterial pulsations. Monitoring the epidural waveform has been suggested as a technique to reliably confirm the appropriate localization of the epidural catheter.

Objective: The aim of this study was to evaluate the sensitivity and specificity of the Computer Controlled Drug Delivery System with continuous pressure and waveform sensing technology (CCDDS) (CompuFlo® CathCheck™) as an instrument to assess the correct placement of the catheter in the epidural space in parturients who have received combined spinal-epidural technique (CSE) for labor analgesia.

Methods: We enrolled 40 consecutive healthy patients undergoing CSE labor analgesia with successful analgesia. All the cases in which pulsatile waveforms in synchrony with heart rate were detected were considered to be true positives; all the cases in which there was the absence of pulsatile waves were followed up. If these patients had to eventually relocate or manipulate the epidural catheter, they were considered to be true negative. If the absence of pulse waves was observed in the presence of successful analgesia during labor, the patients were considered to be false negatives.

Results: Pulsatile waveforms synchronous with heart rate were observed in 33 cases associated with adequate analgesia. In 5 cases, the pulsatile waveforms were absent due to unilateral analgesia or catheter occlusion (true negatives). In 2 cases, the patients had effective analgesia but we were not able to observe a distinct pulsatile waveform. The pressure waveform analysis through the epidural catheter had a sensitivity of 95%, a positive predictive value of 100%, a specificity of 100% and a negative predictive value of 60%.

Conclusion: Pulsatile pressure waveform recording with CCDDS through the epidural catheter resulted in high sensitivity and positive predictive value which can help the proper placement of the epidural catheter.

背景:硬膜外压力是搏动的,与动脉搏动同步。监测硬膜外波形已被建议作为一种技术,以可靠地确认适当的定位硬膜外导管。目的:本研究的目的是评估连续压力和波形传感技术(CCDDS)计算机控制给药系统(CompuFlo®CathCheck™)作为一种评估硬膜外导管在接受脊髓-硬膜外联合技术(CSE)分娩镇痛的产妇硬膜外间隙正确放置的工具的敏感性和特异性。方法:连续40例健康患者行全身性CSE分娩镇痛并成功镇痛。所有检测到脉搏波形与心率同步的病例均被认为是真阳性;所有没有脉冲波的病例都进行了随访。如果这些患者最终不得不重新放置或操作硬膜外导管,他们被认为是真阴性。如果在分娩过程中成功镇痛时观察到脉搏波的缺失,则认为患者为假阴性。结果:33例足量镇痛患者脉搏波形与心率同步。5例因单侧镇痛或导管阻塞导致脉搏波形消失(真阴性)。2例患者镇痛有效,但未能观察到明显的脉搏波形。硬膜外导管压力波形分析灵敏度为95%,阳性预测值为100%,特异性为100%,阴性预测值为60%。结论:CCDDS经硬膜外导管记录脉搏压力波形灵敏度高,具有阳性的预测价值,有助于硬膜外导管的正确放置。
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引用次数: 4
期刊
Local and Regional Anesthesia
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