Pub Date : 2024-09-16DOI: 10.1136/rapm-2024-105962
Burhan Dost, Serkan Tulgar, Ali Ahiskalioglu, Alessandro De Cassai
We would like to extend our congratulations to Samerchua et al [1][1] for their valuable contribution to the literature with their cadaveric study exploring the optimal techniques for parasternal blocks. This study presents significant findings that enhance our understanding of the efficacy and
{"title":"Optimal techniques of ultrasound-guided superficial and deep parasternal intercostal plane blocks—a cadaveric study","authors":"Burhan Dost, Serkan Tulgar, Ali Ahiskalioglu, Alessandro De Cassai","doi":"10.1136/rapm-2024-105962","DOIUrl":"https://doi.org/10.1136/rapm-2024-105962","url":null,"abstract":"We would like to extend our congratulations to Samerchua et al [1][1] for their valuable contribution to the literature with their cadaveric study exploring the optimal techniques for parasternal blocks. This study presents significant findings that enhance our understanding of the efficacy and","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We extend our sincere gratitude to Dost et al for their keen interest in our recent cadaveric study, which investigates the optimal techniques for ultrasound-guided parasternal intercostal plane (PIP) blocks.[1 2][1] Our findings indicate that using a total volume of 20 mL of dye, with triple
我们衷心感谢 Dost 等人对我们最近的尸体研究的浓厚兴趣，该研究探讨了超声引导下胸骨旁肋间平面 (PIP) 阻滞的最佳技术。
{"title":"Invited reply letter: optimal techniques of ultrasound-guided superficial and deep parasternal intercostal plane blocks – a cadaveric study","authors":"Artid Samerchua, Prangmalee Leurcharusmee, Kittitorn Supphapipat, Pasuk Mahakkanukrauh","doi":"10.1136/rapm-2024-106012","DOIUrl":"https://doi.org/10.1136/rapm-2024-106012","url":null,"abstract":"We extend our sincere gratitude to Dost et al for their keen interest in our recent cadaveric study, which investigates the optimal techniques for ultrasound-guided parasternal intercostal plane (PIP) blocks.[1 2][1] Our findings indicate that using a total volume of 20 mL of dye, with triple","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1136/rapm-2024-105748
Jordan Ruby, Marko Popovic, Alex Illescas, Pamela Wendel, Michelle Carley, Roger F Widmann, John S Blanco, Kathryn DelPizzo, Ellen M Soffin
Adolescent idiopathic scoliosis (AIS) affects 1%–3% of patients aged 10–16, with some requiring posterior spinal fusion (PSF).[1][1] While multimodal analgesics are standard for managing acute postoperative pain in these patients having PSF, the application of advanced regional anesthetic
{"title":"Multimodal analgesia and the erector spinae plane block in a rapid recovery pathway after posterior spinal fusion in adolescent idiopathic scoliosis: a randomized controlled study of practicality","authors":"Jordan Ruby, Marko Popovic, Alex Illescas, Pamela Wendel, Michelle Carley, Roger F Widmann, John S Blanco, Kathryn DelPizzo, Ellen M Soffin","doi":"10.1136/rapm-2024-105748","DOIUrl":"https://doi.org/10.1136/rapm-2024-105748","url":null,"abstract":"Adolescent idiopathic scoliosis (AIS) affects 1%–3% of patients aged 10–16, with some requiring posterior spinal fusion (PSF).[1][1] While multimodal analgesics are standard for managing acute postoperative pain in these patients having PSF, the application of advanced regional anesthetic","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1136/rapm-2024-106017
Won Uk Koh, Hyungtae Kim, Yeon Ju Kim, Ji In Park, Hyun-Jin Yeo, Youngjin Ro, Ha-Jung Kim
We have read Julio Orrego et al ’s letter[1][1] and are grateful for their interest and feedback on our article.[2][2] They highlighted a potential misinterpretation of our study results, particularly regarding the absence of a statistically significant difference in analgesic effects between the
我们阅读了 Julio Orrego 等人的来信[1][1]，感谢他们对我们文章的关注和反馈意见[2][2]。他们强调了对我们研究结果的潜在误读，尤其是在镇痛效果方面，两种药物之间没有统计学意义上的显著差异。
{"title":"In reply: evaluating the efficacy of PENG and SIFICB in hip fracture analgesia – a critical analysis","authors":"Won Uk Koh, Hyungtae Kim, Yeon Ju Kim, Ji In Park, Hyun-Jin Yeo, Youngjin Ro, Ha-Jung Kim","doi":"10.1136/rapm-2024-106017","DOIUrl":"https://doi.org/10.1136/rapm-2024-106017","url":null,"abstract":"We have read Julio Orrego et al ’s letter[1][1] and are grateful for their interest and feedback on our article.[2][2] They highlighted a potential misinterpretation of our study results, particularly regarding the absence of a statistically significant difference in analgesic effects between the","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We have read with interest the article by Luchsinger et al ,[1][1] investigating the spread of 20 mL of injectate after the performance of an erector spinae plane block (ESPB) at the T9 level in cadavers. Lingering doubts need to be clarified. The study concludes that the ventral rami were not
{"title":"On the need for accuracy and consistency in cadaveric studies between technique and imaging: are we missing “bull’s eye”?","authors":"Mauricio Forero, Alvaro Diaz Rodriguez, Rami Adel Kamel","doi":"10.1136/rapm-2024-105934","DOIUrl":"https://doi.org/10.1136/rapm-2024-105934","url":null,"abstract":"We have read with interest the article by Luchsinger et al ,[1][1] investigating the spread of 20 mL of injectate after the performance of an erector spinae plane block (ESPB) at the T9 level in cadavers. Lingering doubts need to be clarified. The study concludes that the ventral rami were not","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142182329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1136/rapm-2024-105599
Sama Ramo, Stephan Frangakis, Jennifer F Waljee, Mark C Bicket
Despite a decline in opioid prescriptions over the past decade, patients commonly receive opioid analgesics as a treatment for postoperative pain in the USA. One complication that patients may experience after surgery is persistent postoperative opioid use (PPOU), or opioid use beyond the typical recovery period. Often defined as beyond 3 months postsurgery, PPOU is frequently conflated with chronic postsurgical pain (CPSP), where pain persists well after the expected healing time following surgery. This narrative review explores the distinct risk factors for each condition, their interrelation, and potential future research directions. For PPOU, major risk factors include the risky use of substances including misuse and use disorders; depression and other mental health disorders; a history of chronic pain before surgery including back pain; and certain surgical types (ie, total knee arthropathy, open cholecystectomy, total hip arthropathy). Conversely, CPSP risk factors include the type of surgery (ie, thoracic and breast surgeries), mental health conditions (particularly catastrophizing), and pain in both the preoperative and postoperative phases. Despite the overlap of some factors, studies typically employ different frameworks when examining PPOU and CPSP, with a biopsychosocial model applied for CPSP and little emphasis on an individual’s social environment employed for PPOU. Additionally, existing studies predominantly rely on retrospective insurance claims data, which may not capture the full scope of risk factors. To fill gaps in understanding, investigations may prospectively assess and analyze patient-reported outcomes, implement similar frameworks, and concurrently measure both conditions to advance the scientific understanding of PPOU and CPSP. No data are available.
{"title":"Risk factors for persistent postoperative opioid use: an entity distinct from chronic postsurgical pain","authors":"Sama Ramo, Stephan Frangakis, Jennifer F Waljee, Mark C Bicket","doi":"10.1136/rapm-2024-105599","DOIUrl":"https://doi.org/10.1136/rapm-2024-105599","url":null,"abstract":"Despite a decline in opioid prescriptions over the past decade, patients commonly receive opioid analgesics as a treatment for postoperative pain in the USA. One complication that patients may experience after surgery is persistent postoperative opioid use (PPOU), or opioid use beyond the typical recovery period. Often defined as beyond 3 months postsurgery, PPOU is frequently conflated with chronic postsurgical pain (CPSP), where pain persists well after the expected healing time following surgery. This narrative review explores the distinct risk factors for each condition, their interrelation, and potential future research directions. For PPOU, major risk factors include the risky use of substances including misuse and use disorders; depression and other mental health disorders; a history of chronic pain before surgery including back pain; and certain surgical types (ie, total knee arthropathy, open cholecystectomy, total hip arthropathy). Conversely, CPSP risk factors include the type of surgery (ie, thoracic and breast surgeries), mental health conditions (particularly catastrophizing), and pain in both the preoperative and postoperative phases. Despite the overlap of some factors, studies typically employ different frameworks when examining PPOU and CPSP, with a biopsychosocial model applied for CPSP and little emphasis on an individual’s social environment employed for PPOU. Additionally, existing studies predominantly rely on retrospective insurance claims data, which may not capture the full scope of risk factors. To fill gaps in understanding, investigations may prospectively assess and analyze patient-reported outcomes, implement similar frameworks, and concurrently measure both conditions to advance the scientific understanding of PPOU and CPSP. No data are available.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142182328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1136/rapm-2024-105654
Kerry McLaughlin, Alex Konstantatos, Shravya Karna, Stuart Azzopardi, Mark Buckland, Harry Sivakumar, Ron Glick, Mycah Astrera-Srgo, Eldho Paul
Background The value of epidural analgesia in pediatric patients having heart and lung transplant surgery is unknown. We aimed to characterize various quality outcomes in patients who did and did not have epidural analgesia. Methods Data were collected retrospectively for 62 patients from 2006 to 2023 at a tertiary care transplant center. Patients were evaluated by epidural status. The primary outcome was a hospital stay in days. Other measures of morbidity and mortality were measured as secondary endpoints. Results The mean age was 12.7 (3) years; 54 (87%) received bilateral lung transplantation, and 8 (13%) received en bloc heart-lung transplantation. 41 (66%) were female. Epidural utilization rate was 74 %, n=45. On univariate analysis, epidural analgesia compared with no epidural was associated with a reduction in the median length of hospital stay from 26.5 to 20 days (p=0.02). After adjustment for age, sex and type of operation, there was no significant difference in LOS. Other findings following univariate analysis included reduced time of postoperative ventilation with a median reduction of 7–2 days (p=0.019), and a reduced 5-day postoperative opioid requirement; median of 2.94–1.21 mg/kg/24 hours (p=0.004) with epidural analgesia. Epidural analgesia was not associated with a change in overall survival (p=0.49). Conclusion Despite a likely improvement in analgesia, we could not demonstrate a definitive impact of epidural analgesia on outcomes in this small cohort of patients. Larger datasets through registries and institutional collaboration will be needed to increase sample size to identify effect sizes and adjust for confounders. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as online supplemental information. We are happy for all free text entered below to be published.
{"title":"Postoperative epidural analgesia and outcomes following pediatric bilateral lung and heart-lung transplantation: a retrospective observational study","authors":"Kerry McLaughlin, Alex Konstantatos, Shravya Karna, Stuart Azzopardi, Mark Buckland, Harry Sivakumar, Ron Glick, Mycah Astrera-Srgo, Eldho Paul","doi":"10.1136/rapm-2024-105654","DOIUrl":"https://doi.org/10.1136/rapm-2024-105654","url":null,"abstract":"Background The value of epidural analgesia in pediatric patients having heart and lung transplant surgery is unknown. We aimed to characterize various quality outcomes in patients who did and did not have epidural analgesia. Methods Data were collected retrospectively for 62 patients from 2006 to 2023 at a tertiary care transplant center. Patients were evaluated by epidural status. The primary outcome was a hospital stay in days. Other measures of morbidity and mortality were measured as secondary endpoints. Results The mean age was 12.7 (3) years; 54 (87%) received bilateral lung transplantation, and 8 (13%) received en bloc heart-lung transplantation. 41 (66%) were female. Epidural utilization rate was 74 %, n=45. On univariate analysis, epidural analgesia compared with no epidural was associated with a reduction in the median length of hospital stay from 26.5 to 20 days (p=0.02). After adjustment for age, sex and type of operation, there was no significant difference in LOS. Other findings following univariate analysis included reduced time of postoperative ventilation with a median reduction of 7–2 days (p=0.019), and a reduced 5-day postoperative opioid requirement; median of 2.94–1.21 mg/kg/24 hours (p=0.004) with epidural analgesia. Epidural analgesia was not associated with a change in overall survival (p=0.49). Conclusion Despite a likely improvement in analgesia, we could not demonstrate a definitive impact of epidural analgesia on outcomes in this small cohort of patients. Larger datasets through registries and institutional collaboration will be needed to increase sample size to identify effect sizes and adjust for confounders. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as online supplemental information. We are happy for all free text entered below to be published.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142182149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1136/rapm-2024-105535
Zemene Demelash Kifle, Jing Tian, Dawn Aitken, Phillip E Melton, Flavia Cicuttini, Graeme Jones, Feng Pan
Introduction Musculoskeletal pain typically occurs in multiple sites; however, no study has examined whether excessive visceral and subcutaneous adipose tissue are associated with musculoskeletal pain. This study therefore aimed to describe the associations between MRI-derived abdominal adipose tissue and multisite and widespread chronic musculoskeletal pain. Methods Data from the UK Biobank, a large prospective, population-based cohort study, were used. Abdominal MRI scans were performed at two imaging visits to quantify visceral adipose tissue and subcutaneous adipose tissue. Pain in the neck/shoulder, back, hip, knee or ‘all over the body’ was assessed at the corresponding visits. Mixed-effects ordinal/multinomial/logistic regression models were used for the analyses. Results A total of 32 409 participants were included (50.8% women, mean age 55.0±7.4 years). In multivariable analyses, there was a dose–response association of visceral adipose tissue, subcutaneous adipose tissue and their ratio with the number of chronic pain sites in both women (visceral adipose tissue: OR 2.04 per SD (95% CI 1.85 to 2.26); subcutaneous adipose tissue: OR 1.60 (95% CI 1.50 to 1.70); and their ratio: OR 1.60 (95% CI 1.37 to 1.87)) and men (visceral adipose tissue: OR 1.34 (95% CI 1.26 to 1.42); subcutaneous adipose tissue: OR 1.39 (95% CI 1.29 to 1.49); and their ratio: OR 1.13 (95% CI 1.07 to 1.20)). Higher levels of adipose tissue were also associated with greater odds of reporting chronic pain in both sexes. The effect estimates of these adipose measures were relatively larger in women than in men. Conclusion Abdominal adipose tissue was associated with chronic musculoskeletal pain, suggesting that excessive and ectopic fat depositions may be involved in the pathogenesis of multisite and widespread chronic musculoskeletal pain. The identified stronger effects in women than men may reflect sex differences in fat distribution and hormones. Data from the UK Biobank is available to researchers by application via the UK Biobank online Access Management System.
引言 肌肉骨骼疼痛通常发生在多个部位；然而，还没有研究探讨过多的内脏和皮下脂肪组织是否与肌肉骨骼疼痛有关。因此，本研究旨在描述 MRI 导出的腹部脂肪组织与多部位和广泛慢性肌肉骨骼疼痛之间的关联。方法 采用英国生物库的数据，这是一项大型前瞻性人群队列研究。在两次造影检查中进行了腹部核磁共振扫描，以量化内脏脂肪组织和皮下脂肪组织。颈部/肩部、背部、臀部、膝部或 "全身 "疼痛则在相应的检查中进行评估。分析采用混合效应序数/多项式/逻辑回归模型。结果 共纳入 32 409 名参与者（50.8% 为女性，平均年龄为 55.0±7.4 岁）。OR 2.04 per SD (95% CI 1.85 to 2.26)；皮下脂肪组织：OR1.60（95% CI 1.50 至 1.70）；及其比率：OR 1.60 (95% CI 1.37 to 1.87)）和男性（内脏脂肪组织：内脏脂肪组织：OR 1.34（95% CI 1.26 至 1.42）；皮下脂肪组织：内脏脂肪组织：OR 1.34（95% CI 1.26 至 1.42）；皮下脂肪组织：OR 1.39（95% CI 1.29 至 1.49）；两者的比率：OR 1.13（95% CI 1.29 至 1.49）：OR 1.13 (95% CI 1.07 to 1.20)）。脂肪组织水平越高，男女报告慢性疼痛的几率越大。这些脂肪测量指标对女性的影响估计值相对大于男性。结论 腹部脂肪组织与慢性肌肉骨骼疼痛有关，表明过量和异位脂肪沉积可能与多部位和广泛的慢性肌肉骨骼疼痛的发病机制有关。与男性相比，女性受到的影响更大，这可能反映了脂肪分布和荷尔蒙的性别差异。研究人员可通过英国生物库在线访问管理系统申请获取英国生物库的数据。
{"title":"MRI-derived abdominal adipose tissue is associated with multisite and widespread chronic pain","authors":"Zemene Demelash Kifle, Jing Tian, Dawn Aitken, Phillip E Melton, Flavia Cicuttini, Graeme Jones, Feng Pan","doi":"10.1136/rapm-2024-105535","DOIUrl":"https://doi.org/10.1136/rapm-2024-105535","url":null,"abstract":"Introduction Musculoskeletal pain typically occurs in multiple sites; however, no study has examined whether excessive visceral and subcutaneous adipose tissue are associated with musculoskeletal pain. This study therefore aimed to describe the associations between MRI-derived abdominal adipose tissue and multisite and widespread chronic musculoskeletal pain. Methods Data from the UK Biobank, a large prospective, population-based cohort study, were used. Abdominal MRI scans were performed at two imaging visits to quantify visceral adipose tissue and subcutaneous adipose tissue. Pain in the neck/shoulder, back, hip, knee or ‘all over the body’ was assessed at the corresponding visits. Mixed-effects ordinal/multinomial/logistic regression models were used for the analyses. Results A total of 32 409 participants were included (50.8% women, mean age 55.0±7.4 years). In multivariable analyses, there was a dose–response association of visceral adipose tissue, subcutaneous adipose tissue and their ratio with the number of chronic pain sites in both women (visceral adipose tissue: OR 2.04 per SD (95% CI 1.85 to 2.26); subcutaneous adipose tissue: OR 1.60 (95% CI 1.50 to 1.70); and their ratio: OR 1.60 (95% CI 1.37 to 1.87)) and men (visceral adipose tissue: OR 1.34 (95% CI 1.26 to 1.42); subcutaneous adipose tissue: OR 1.39 (95% CI 1.29 to 1.49); and their ratio: OR 1.13 (95% CI 1.07 to 1.20)). Higher levels of adipose tissue were also associated with greater odds of reporting chronic pain in both sexes. The effect estimates of these adipose measures were relatively larger in women than in men. Conclusion Abdominal adipose tissue was associated with chronic musculoskeletal pain, suggesting that excessive and ectopic fat depositions may be involved in the pathogenesis of multisite and widespread chronic musculoskeletal pain. The identified stronger effects in women than men may reflect sex differences in fat distribution and hormones. Data from the UK Biobank is available to researchers by application via the UK Biobank online Access Management System.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142182330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-14DOI: 10.1136/rapm-2024-105388
Michael Yohay Stav, Shai Fein, Yuri Matatov, Dana Hoffman, Philip Heesen, Yair Binyamin, Daniel Iluz-Freundlich, Leonid Eidelman, Sharon Orbach-Zinger
Background Intraoperative pain during cesarean delivery with or without conversion to general anesthesia has been shown to negatively impact maternal and perinatal morbidity. Efforts to reduce these adverse events are a recent focus of obstetric anesthesia care. We aimed to assess rates of and risk factors for conversion to general anesthesia and intraoperative pain during intrapartum cesarean delivery with an indwelling epidural catheter in our academic center. Methods In this retrospective cohort study, all women undergoing cesarean delivery with an indwelling epidural catheter between January 2017 and June 2022 were included. Labor epidural analgesia was provided according to a standardized protocol, and conversion to epidural anesthesia was achieved in the operating room before surgery. We determined the conversion rate to general anesthesia and associated risk factors. Second, we examined the rate of administration of analgesics/sedatives and related risk factors in cesarean cases that were not converted to general anesthesia. Results Among the 1192 women undergoing intrapartum cesarean delivery with epidural anesthesia, there were 97 cases with conversion to general anesthesia (8.1%), of which 87 (89.7%) were due to a failed epidural. Higher age, higher weight, and higher gestational age were associated with decreased odds of conversion to general anesthesia. Higher gravidity and longer surgical time were associated with increased odds. An emergent indication was not associated with conversion to general anesthesia. Intravenous analgesic/sedative supplementation occurred in 141 cases (12.9%). Higher age was associated with decreased odds of supplementation, and longer surgical time was associated with increased odds. Conclusion In our tertiary academic center, the rate of intraoperative conversion to general anesthesia and administration of analgesic/sedative medication among women undergoing intrapartum cesarean delivery with epidural anesthesia was relatively high. Emergency cesarean delivery was not associated with either of the above endpoints. Data are available upon reasonable request.
{"title":"Conversion to general anesthesia and intravenous supplementation during intrapartum cesarean delivery with an indwelling epidural catheter: a retrospective study","authors":"Michael Yohay Stav, Shai Fein, Yuri Matatov, Dana Hoffman, Philip Heesen, Yair Binyamin, Daniel Iluz-Freundlich, Leonid Eidelman, Sharon Orbach-Zinger","doi":"10.1136/rapm-2024-105388","DOIUrl":"https://doi.org/10.1136/rapm-2024-105388","url":null,"abstract":"Background Intraoperative pain during cesarean delivery with or without conversion to general anesthesia has been shown to negatively impact maternal and perinatal morbidity. Efforts to reduce these adverse events are a recent focus of obstetric anesthesia care. We aimed to assess rates of and risk factors for conversion to general anesthesia and intraoperative pain during intrapartum cesarean delivery with an indwelling epidural catheter in our academic center. Methods In this retrospective cohort study, all women undergoing cesarean delivery with an indwelling epidural catheter between January 2017 and June 2022 were included. Labor epidural analgesia was provided according to a standardized protocol, and conversion to epidural anesthesia was achieved in the operating room before surgery. We determined the conversion rate to general anesthesia and associated risk factors. Second, we examined the rate of administration of analgesics/sedatives and related risk factors in cesarean cases that were not converted to general anesthesia. Results Among the 1192 women undergoing intrapartum cesarean delivery with epidural anesthesia, there were 97 cases with conversion to general anesthesia (8.1%), of which 87 (89.7%) were due to a failed epidural. Higher age, higher weight, and higher gestational age were associated with decreased odds of conversion to general anesthesia. Higher gravidity and longer surgical time were associated with increased odds. An emergent indication was not associated with conversion to general anesthesia. Intravenous analgesic/sedative supplementation occurred in 141 cases (12.9%). Higher age was associated with decreased odds of supplementation, and longer surgical time was associated with increased odds. Conclusion In our tertiary academic center, the rate of intraoperative conversion to general anesthesia and administration of analgesic/sedative medication among women undergoing intrapartum cesarean delivery with epidural anesthesia was relatively high. Emergency cesarean delivery was not associated with either of the above endpoints. Data are available upon reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141612057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-14DOI: 10.1136/rapm-2024-105717
Fu-Shan Xue, Daoyi Lin, Xiao-Chun Zheng
By conducting a prospective randomised open-label non-inferiority trial in 90 patients who underwent elective unilateral video-assisted lobectomy or wedge resection, van den Broek et al [1][1] compared the effects of adding continuous erector spinae plane block and thoracic epidural analgesia into a
van den Broek 等人[1][1] 在 90 名接受选择性单侧视频辅助肺叶切除术或楔形切除术的患者中进行了一项前瞻性随机开放标签非劣效性试验，比较了将持续竖脊肌平面阻滞和胸硬膜外镇痛添加到楔形切除术中的效果。
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