Pub Date : 2024-07-11DOI: 10.1136/rapm-2024-105406
Olga C Nin, Andre Boezaart, Christopher Giordano, Steven J Hughes, Hari K Parvataneni, Miguel A Reina, Abigail Schirmer, Terrie Vasilopoulos
Objective An unwanted side effect associated with epidural analgesia is the reduction in blood pressure (BP) due to the sympathetic blockade. This study evaluated the hemodynamic effects of adding different epinephrine concentrations to epidurally injected local anesthetic solution to counteract sympathectomy. We hypothesized that epinephrine could mitigate the decrease in BP possibly caused by the local anesthetic, specifically decreasing the incidence of hypotension. Methods Sixty-six patients were enrolled in a randomized, controlled, quadruple-blinded prospective study into three groups: epidural ropivacaine 0.2% without epinephrine (control) or with 2 µg/mL or 5 µg/mL epinephrine. Our primary outcome was the assessment of differences in hypotension between groups, defined as a >20% decrease in hypotension from baseline to the end of the intraoperative period. Results Forty-seven patients completed the study, and 19 were withdrawn. Fifteen patients were in the control group, while 16 patients received 0.2% ropivacaine +2 µg/mL epinephrine, and 16 received 0.2% ropivacaine +5 µg/mL epinephrine. The overall rate of hypotension was 21.3% (10/47). There were no statistically significant differences in hypotension rates between the control group (33%) and groups receiving either +2 µg/mL (13%, p=0.165) or +5 µg/mL (19%, p=0.353) of epinephrine. In secondary analyses, respiratory rate showed greater decreases in control groups across the perioperative period compared with treatment groups (p=0.016) Conclusion Adding epinephrine to the epidural local anesthetic did not significantly decrease the rate of hypotension. However, epinephrine mitigated decreases in respiratory rate across the perioperative period. Future studies will focus on increasing group size and higher epinephrine concentrations (10 µg/mL). Trial registration number [NCT02722746][1]. No data are available. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02722746&atom=%2Frapm%2Fearly%2F2024%2F07%2F11%2Frapm-2024-105406.atom
{"title":"Pilot epinephrine dose-finding study to counter epidural-related blood pressure reduction","authors":"Olga C Nin, Andre Boezaart, Christopher Giordano, Steven J Hughes, Hari K Parvataneni, Miguel A Reina, Abigail Schirmer, Terrie Vasilopoulos","doi":"10.1136/rapm-2024-105406","DOIUrl":"https://doi.org/10.1136/rapm-2024-105406","url":null,"abstract":"Objective An unwanted side effect associated with epidural analgesia is the reduction in blood pressure (BP) due to the sympathetic blockade. This study evaluated the hemodynamic effects of adding different epinephrine concentrations to epidurally injected local anesthetic solution to counteract sympathectomy. We hypothesized that epinephrine could mitigate the decrease in BP possibly caused by the local anesthetic, specifically decreasing the incidence of hypotension. Methods Sixty-six patients were enrolled in a randomized, controlled, quadruple-blinded prospective study into three groups: epidural ropivacaine 0.2% without epinephrine (control) or with 2 µg/mL or 5 µg/mL epinephrine. Our primary outcome was the assessment of differences in hypotension between groups, defined as a >20% decrease in hypotension from baseline to the end of the intraoperative period. Results Forty-seven patients completed the study, and 19 were withdrawn. Fifteen patients were in the control group, while 16 patients received 0.2% ropivacaine +2 µg/mL epinephrine, and 16 received 0.2% ropivacaine +5 µg/mL epinephrine. The overall rate of hypotension was 21.3% (10/47). There were no statistically significant differences in hypotension rates between the control group (33%) and groups receiving either +2 µg/mL (13%, p=0.165) or +5 µg/mL (19%, p=0.353) of epinephrine. In secondary analyses, respiratory rate showed greater decreases in control groups across the perioperative period compared with treatment groups (p=0.016) Conclusion Adding epinephrine to the epidural local anesthetic did not significantly decrease the rate of hypotension. However, epinephrine mitigated decreases in respiratory rate across the perioperative period. Future studies will focus on increasing group size and higher epinephrine concentrations (10 µg/mL). Trial registration number [NCT02722746][1]. No data are available. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02722746&atom=%2Frapm%2Fearly%2F2024%2F07%2F11%2Frapm-2024-105406.atom","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"152 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141587993","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 : 2024-07-09DOI: 10.1136/rapm-2024-105486
Xin Yin, Yanchun Chen, Lihui Zhou, Hongxi Yang, Yaogang Wang
Background Although chronic pain was deleteriously related to single cardiometabolic diseases, the relationship between chronic pain and cardiometabolic multimorbidity remains unclear. The purpose of this study was to investigate the association between chronic pain with the risk of cardiometabolic multimorbidity. Methods A prospective cohort study included 452 818 participants who were free of cardiometabolic multimorbidity at baseline. Chronic pain was assessed in diverse anatomical sites including the head, face, neck/shoulder, stomach/abdominal area, back, hip and knee or ‘all over the body’. Participants were classified into six groups according to the amount of chronic pain sites: no chronic pain, chronic pain at one, two, three and four or more sites, and those reporting pain ‘all over the body’. Cardiometabolic multimorbidity was defined as the occurrence of at least two cardiometabolic diseases, involving type 2 diabetes, ischaemic heart disease and stroke. Results After a median follow-up of 13.7 years, 4445 participants developed cardiometabolic multimorbidity. Compared with individuals without chronic pain, those experiencing chronic pain in four or more sites were associated with a 1.82-fold (HR: 1.82, 95% CI: 1.61, 2.06) higher risk of cardiometabolic multimorbidity. Pain distributed ‘all over the body’ was associated with a 59% (HR: 1.59, 95% CI: 1.30, 1.93) increased risk of cardiometabolic multimorbidity Additionally, individuals who had chronic pain in both the head and stomach/abdomen showed the highest risk with cardiometabolic multimorbidity (HR: 1.88, 95% CI: 1.60, 2.20). Conclusions Our findings suggested that there was an elevated risk of cardiometabolic multimorbidity associated with an increased amount of chronic pain sites. Data are available upon reasonable request. The data that support the findings of this study are available from UK Biobank (), but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of UK Biobank.
{"title":"Association between chronic pain and risk of cardiometabolic multimorbidity: a prospective cohort study","authors":"Xin Yin, Yanchun Chen, Lihui Zhou, Hongxi Yang, Yaogang Wang","doi":"10.1136/rapm-2024-105486","DOIUrl":"https://doi.org/10.1136/rapm-2024-105486","url":null,"abstract":"Background Although chronic pain was deleteriously related to single cardiometabolic diseases, the relationship between chronic pain and cardiometabolic multimorbidity remains unclear. The purpose of this study was to investigate the association between chronic pain with the risk of cardiometabolic multimorbidity. Methods A prospective cohort study included 452 818 participants who were free of cardiometabolic multimorbidity at baseline. Chronic pain was assessed in diverse anatomical sites including the head, face, neck/shoulder, stomach/abdominal area, back, hip and knee or ‘all over the body’. Participants were classified into six groups according to the amount of chronic pain sites: no chronic pain, chronic pain at one, two, three and four or more sites, and those reporting pain ‘all over the body’. Cardiometabolic multimorbidity was defined as the occurrence of at least two cardiometabolic diseases, involving type 2 diabetes, ischaemic heart disease and stroke. Results After a median follow-up of 13.7 years, 4445 participants developed cardiometabolic multimorbidity. Compared with individuals without chronic pain, those experiencing chronic pain in four or more sites were associated with a 1.82-fold (HR: 1.82, 95% CI: 1.61, 2.06) higher risk of cardiometabolic multimorbidity. Pain distributed ‘all over the body’ was associated with a 59% (HR: 1.59, 95% CI: 1.30, 1.93) increased risk of cardiometabolic multimorbidity Additionally, individuals who had chronic pain in both the head and stomach/abdomen showed the highest risk with cardiometabolic multimorbidity (HR: 1.88, 95% CI: 1.60, 2.20). Conclusions Our findings suggested that there was an elevated risk of cardiometabolic multimorbidity associated with an increased amount of chronic pain sites. Data are available upon reasonable request. The data that support the findings of this study are available from UK Biobank (<https://www.ukbiobank.ac.uk/>), but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of UK Biobank.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141571128","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 : 2024-07-09DOI: 10.1136/rapm-2024-105762
Keisuke Yoshida, Takayuki Hasegawa, Masaya Sekiguchi, Ko Kakinouchi, Satoki Inoue
Thoracoabdominal nerve block through the perichondrial approach (TAPA) is an abdominal wall block covering T5–T11. The original TAPA block requires local anesthetics to be first injected deep into the 10th costal cartilage (between the internal oblique and transversus abdominis muscles), and then
经软骨周围途径的胸腹神经阻滞（TAPA）是一种覆盖 T5-T11 的腹壁阻滞。最初的 TAPA 阻滞要求首先将局麻药注射到第 10 肋软骨深部（腹内斜肌和腹横肌之间），然后再将局麻药注射到第 11 肋软骨深部（腹内斜肌和腹横肌之间）。
{"title":"Advice on how to improve the visibility of ultrasound images in TAPA/M-TAPA block","authors":"Keisuke Yoshida, Takayuki Hasegawa, Masaya Sekiguchi, Ko Kakinouchi, Satoki Inoue","doi":"10.1136/rapm-2024-105762","DOIUrl":"https://doi.org/10.1136/rapm-2024-105762","url":null,"abstract":"Thoracoabdominal nerve block through the perichondrial approach (TAPA) is an abdominal wall block covering T5–T11. The original TAPA block requires local anesthetics to be first injected deep into the 10th costal cartilage (between the internal oblique and transversus abdominis muscles), and then","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141571129","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 : 2024-06-04DOI: 10.1136/rapm-2024-105679
Giuseppe Pascarella, Fabio Costa, Alessandro Strumia, Alessandro Ruggiero, Felice E Agrò, Massimiliano Carassiti, Rita Cataldo
We congratulate Girón-Arango and Peng for their latest work, which provides interesting insights about pericapsular nerve group (PENG) block and its state of the art.[1][1] Since its first description in 2018, PENG block has become increasingly popular for hip surgery analgesia, and actually, more
{"title":"Pericapsular nerve group (PENG) block: what do we have still to learn for recommending its use in clinical practice?","authors":"Giuseppe Pascarella, Fabio Costa, Alessandro Strumia, Alessandro Ruggiero, Felice E Agrò, Massimiliano Carassiti, Rita Cataldo","doi":"10.1136/rapm-2024-105679","DOIUrl":"https://doi.org/10.1136/rapm-2024-105679","url":null,"abstract":"We congratulate Girón-Arango and Peng for their latest work, which provides interesting insights about pericapsular nerve group (PENG) block and its state of the art.[1][1] Since its first description in 2018, PENG block has become increasingly popular for hip surgery analgesia, and actually, more","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141255068","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 : 2024-06-04DOI: 10.1136/rapm-2024-105277
Esmee van Helden, Josephine Kranendonk, Ad Vermulst, Arjen de Boer, Philip de Reuver, Camiel Rosman, Johannes de Wilt, Kees van Laarhoven, Gert Jan Scheffer, Christiaan Keijzer, Michiel Warlé
Background Increasing evidence supports a positive relationship between the intensity of early postoperative pain, and the risk of 30-day postoperative complications. Higher pain levels may hamper recovery and contribute to immunosuppression after surgery. This leaves patients at risk of postoperative complications. Methods One thousand patients who underwent major abdominal surgery (cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, esophageal, liver, or pancreas surgery) at the Radboud university medical center were randomly selected from eligible patients between 2014 and 2020. Pain scores on day 1, the independent variable of interest, were extracted from the electronic patient files. Outcome measures were 30-day postoperative complications (infectious, non-infectious, total complications and classification according to Clavien-Dindo). Results Seven hundred ninety complications occurred in 572 patients within 30 days after surgery, of which 289 (36.7%) were of infectious origin, and 501 (63.4%) complications were non-infectious. The mean duration from the end of surgery to the occurrence of infectious complications was 6.5 days (SD 5.6) and 4.1 days (SD 4.7) for non-infectious complications (p<0.001). Logistic regression analysis revealed that pain scores on postoperative day 1 (POD1) were significantly positively associated with 30-day total complications after surgery (OR=1.132, 95% CI (1.076 to 1.190)), Clavien-Dindo classification (OR=1.131, 95% CI (1.071 to 1.193)), infectious complications (OR=1.126, 95% CI (1.059 to 1.196)), and non-infectious complications (OR=1.079, 95% CI (1.022 to 1.140)). Conclusions After major abdominal surgery, higher postoperative pain scores on day 1 are associated with an increased risk of 30-day postoperative complications. Further studies should pursue whether optimization of perioperative analgesia can improve immune homeostasis, reduce complications after surgery and enhance postoperative recovery. Data are available upon reasonable request.
{"title":"Early postoperative pain and 30-day complications following major abdominal surgery: a retrospective cohort study","authors":"Esmee van Helden, Josephine Kranendonk, Ad Vermulst, Arjen de Boer, Philip de Reuver, Camiel Rosman, Johannes de Wilt, Kees van Laarhoven, Gert Jan Scheffer, Christiaan Keijzer, Michiel Warlé","doi":"10.1136/rapm-2024-105277","DOIUrl":"https://doi.org/10.1136/rapm-2024-105277","url":null,"abstract":"Background Increasing evidence supports a positive relationship between the intensity of early postoperative pain, and the risk of 30-day postoperative complications. Higher pain levels may hamper recovery and contribute to immunosuppression after surgery. This leaves patients at risk of postoperative complications. Methods One thousand patients who underwent major abdominal surgery (cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, esophageal, liver, or pancreas surgery) at the Radboud university medical center were randomly selected from eligible patients between 2014 and 2020. Pain scores on day 1, the independent variable of interest, were extracted from the electronic patient files. Outcome measures were 30-day postoperative complications (infectious, non-infectious, total complications and classification according to Clavien-Dindo). Results Seven hundred ninety complications occurred in 572 patients within 30 days after surgery, of which 289 (36.7%) were of infectious origin, and 501 (63.4%) complications were non-infectious. The mean duration from the end of surgery to the occurrence of infectious complications was 6.5 days (SD 5.6) and 4.1 days (SD 4.7) for non-infectious complications (p<0.001). Logistic regression analysis revealed that pain scores on postoperative day 1 (POD1) were significantly positively associated with 30-day total complications after surgery (OR=1.132, 95% CI (1.076 to 1.190)), Clavien-Dindo classification (OR=1.131, 95% CI (1.071 to 1.193)), infectious complications (OR=1.126, 95% CI (1.059 to 1.196)), and non-infectious complications (OR=1.079, 95% CI (1.022 to 1.140)). Conclusions After major abdominal surgery, higher postoperative pain scores on day 1 are associated with an increased risk of 30-day postoperative complications. Further studies should pursue whether optimization of perioperative analgesia can improve immune homeostasis, reduce complications after surgery and enhance postoperative recovery. Data are available upon reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141255322","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 : 2024-05-06DOI: 10.1136/rapm-2024-105479
Glen Katsnelson, Connor T A Brenna, Laura Girón-Arango, Yasmeen M Abdallah, Richard Brull
Introduction Transition-related surgery is an effective treatment for gender dysphoria, but the perioperative analgesic management of transgender patients is nuanced and potentially complicated by higher rates of mood and substance use disorders. Regional anesthetic techniques are known to reduce pain severity and opioid requirements; however, little is known regarding the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery. Methods We performed a systematic review of the literature to evaluate original reports characterizing the analgesic effectiveness of regional anesthetic techniques for patients undergoing chest and/or genital transition-related surgery. Our primary outcomes were pain severity and opioid requirements on the first postoperative day. Results Of the 1863 records identified, 10 met criteria for inclusion and narrative synthesis. These included two randomized controlled trials, three cohort studies, and five case reports/series, comprising 293 patients. Four reports described 243 patients undergoing chest surgery, of whom 86% were transgender men undergoing mastectomy with pectoralis nerve blocks or local anesthetic instillation devices. The remaining six reports comprised 50 patients undergoing genital surgery, of whom 56% were transgender women undergoing vaginoplasty with erector spinae plane blocks or epidural anesthesia. Three studies directly compared regional techniques to parenteral analgesia alone. Two of these studies reported lower pain scores and opioid requirements on the first postoperative day with nerve blocks compared with none while the third study reported no difference between groups. Complications related to regional anesthetic techniques were rare among patients undergoing transition-related surgery. Discussion Despite the ever-growing demand for transition-related surgery, the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery is very understudied and insufficient to guide clinical practice. Our systematic review of the literature serves to underscore regional anesthesia for transition-related surgery as a priority area for future research.
{"title":"Analgesic benefits of regional anesthesia in the perioperative management of transition-related surgery: a systematic review","authors":"Glen Katsnelson, Connor T A Brenna, Laura Girón-Arango, Yasmeen M Abdallah, Richard Brull","doi":"10.1136/rapm-2024-105479","DOIUrl":"https://doi.org/10.1136/rapm-2024-105479","url":null,"abstract":"Introduction Transition-related surgery is an effective treatment for gender dysphoria, but the perioperative analgesic management of transgender patients is nuanced and potentially complicated by higher rates of mood and substance use disorders. Regional anesthetic techniques are known to reduce pain severity and opioid requirements; however, little is known regarding the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery. Methods We performed a systematic review of the literature to evaluate original reports characterizing the analgesic effectiveness of regional anesthetic techniques for patients undergoing chest and/or genital transition-related surgery. Our primary outcomes were pain severity and opioid requirements on the first postoperative day. Results Of the 1863 records identified, 10 met criteria for inclusion and narrative synthesis. These included two randomized controlled trials, three cohort studies, and five case reports/series, comprising 293 patients. Four reports described 243 patients undergoing chest surgery, of whom 86% were transgender men undergoing mastectomy with pectoralis nerve blocks or local anesthetic instillation devices. The remaining six reports comprised 50 patients undergoing genital surgery, of whom 56% were transgender women undergoing vaginoplasty with erector spinae plane blocks or epidural anesthesia. Three studies directly compared regional techniques to parenteral analgesia alone. Two of these studies reported lower pain scores and opioid requirements on the first postoperative day with nerve blocks compared with none while the third study reported no difference between groups. Complications related to regional anesthetic techniques were rare among patients undergoing transition-related surgery. Discussion Despite the ever-growing demand for transition-related surgery, the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery is very understudied and insufficient to guide clinical practice. Our systematic review of the literature serves to underscore regional anesthesia for transition-related surgery as a priority area for future research.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140889192","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 : 2024-05-02DOI: 10.1136/rapm-2024-105497
Thomas Esquerré, Marion Mure, Vincent Minville, Alice Prevost, Frédéric Lauwers, Fabrice Ferré
Background Double-jaw surgeries are known to be painful and to require opioids. Maxillary (V2) and mandibular (V3) nerves block could provide adequate pain management with minimal opioid-related side effects. Our main objective was to evaluate the analgesic effect of bilateral ultrasound-guided V2 and V3 combined nerves block in patients undergoing double-jaw orthognathic surgery. Methods In this single-blind, randomized control study, 50 patients were prospectively allocated to either bilateral ultrasound-guided V2 and V3 combined nerves block or intraoral infiltration of local anesthetic. Primary outcome was the cumulative oral morphine equivalent (OME) consumption assessed at postoperative day 1. Secondary outcomes were cumulative OME consumption and pain scores in recovery room and at postoperative day 2, intraoperative anesthetic consumption, and opioid-related side effects. Preoperative anxiety was investigated by the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Results Compared with infiltration, ultrasound-guided regional anesthesia reduced cumulative OME consumption on day 1 (45.7±37.6 mg vs 25.5±19.8 mg, respectively, mean difference of −20.1 (95% CI −37.4 to −2.9) mg, p=0.023) and day 2 (64.5±60 mg vs 35.8±30.2 mg, respectively, mean difference of −28.7 (95% CI −55.9 to −1.43) mg, p=0.040). Interestingly, worst pain score and cumulative OME consumptions on day 2 were positively correlated with the APAIS (Pearson’s correlation coefficient of 0.42 (p=0.003) and 0.39 (p=0.006), respectively). Conclusion Bilateral ultrasound-guided V2 and V3 combined nerves block reduces postoperative opioid consumption by about 50% in patients undergoing double-jaw surgery. Trial registration number [NCT05351151][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05351151&atom=%2Frapm%2Fearly%2F2024%2F05%2F02%2Frapm-2024-105497.atom
背景 众所周知，双颌手术疼痛难忍，需要使用阿片类药物。上颌（V2）和下颌（V3）神经阻滞可提供充分的镇痛效果，且与阿片类药物相关的副作用最小。我们的主要目的是评估双侧超声引导下 V2 和 V3 神经联合阻滞对双颌正颚手术患者的镇痛效果。方法 在这项单盲随机对照研究中，50 名患者被前瞻性地分配到双侧超声引导下 V2 和 V3 神经联合阻滞或口内浸润局麻药。主要结果是术后第 1 天评估的累积口服吗啡当量（OME）消耗量。次要结果是恢复室和术后第 2 天的累积 OME 消耗量和疼痛评分、术中麻醉剂消耗量以及阿片类药物相关副作用。阿姆斯特丹术前焦虑和信息量表（APAIS）调查了术前焦虑。结果 与浸润相比，超声引导区域麻醉减少了第1天（45.7±37.6 mg vs 25.5±19.8 mg，平均差异为-20.1 (95% CI -37.4 to -2.9) mg，p=0.023）和第2天（64.5±60 mg vs 35.8±30.2 mg，平均差异为-28.7 (95% CI -55.9 to -1.43) mg，p=0.040）的累积阿片类镇痛药消耗量。有趣的是，第 2 天最严重疼痛评分和累计 OME 消耗量与 APAIS 呈正相关（皮尔逊相关系数分别为 0.42（P=0.003）和 0.39（P=0.006））。结论 双侧超声引导下 V2 和 V3 神经联合阻滞可将双颌手术患者的术后阿片类药物用量减少约 50%。试验注册号[NCT05351151][1]。如有合理要求，可提供相关数据。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05351151&atom=%2Frapm%2Fearly%2F2024%2F05%2F02%2Frapm-2024-105497.atom
{"title":"Bilateral ultrasound-guided maxillary and mandibular combined nerves block reduces morphine consumption after double-jaw orthognathic surgery: a randomized controlled trial","authors":"Thomas Esquerré, Marion Mure, Vincent Minville, Alice Prevost, Frédéric Lauwers, Fabrice Ferré","doi":"10.1136/rapm-2024-105497","DOIUrl":"https://doi.org/10.1136/rapm-2024-105497","url":null,"abstract":"Background Double-jaw surgeries are known to be painful and to require opioids. Maxillary (V2) and mandibular (V3) nerves block could provide adequate pain management with minimal opioid-related side effects. Our main objective was to evaluate the analgesic effect of bilateral ultrasound-guided V2 and V3 combined nerves block in patients undergoing double-jaw orthognathic surgery. Methods In this single-blind, randomized control study, 50 patients were prospectively allocated to either bilateral ultrasound-guided V2 and V3 combined nerves block or intraoral infiltration of local anesthetic. Primary outcome was the cumulative oral morphine equivalent (OME) consumption assessed at postoperative day 1. Secondary outcomes were cumulative OME consumption and pain scores in recovery room and at postoperative day 2, intraoperative anesthetic consumption, and opioid-related side effects. Preoperative anxiety was investigated by the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Results Compared with infiltration, ultrasound-guided regional anesthesia reduced cumulative OME consumption on day 1 (45.7±37.6 mg vs 25.5±19.8 mg, respectively, mean difference of −20.1 (95% CI −37.4 to −2.9) mg, p=0.023) and day 2 (64.5±60 mg vs 35.8±30.2 mg, respectively, mean difference of −28.7 (95% CI −55.9 to −1.43) mg, p=0.040). Interestingly, worst pain score and cumulative OME consumptions on day 2 were positively correlated with the APAIS (Pearson’s correlation coefficient of 0.42 (p=0.003) and 0.39 (p=0.006), respectively). Conclusion Bilateral ultrasound-guided V2 and V3 combined nerves block reduces postoperative opioid consumption by about 50% in patients undergoing double-jaw surgery. Trial registration number [NCT05351151][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05351151&atom=%2Frapm%2Fearly%2F2024%2F05%2F02%2Frapm-2024-105497.atom","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835172","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 : 2024-05-02DOI: 10.1136/rapm-2024-105456
Mark C Bicket, Elizabeth C Wick, Christopher L Wu
Epidural analgesia is the gold standard for pain relief after invasive surgical procedures with recovery profiles that necessitate admission to the hospital, given its ability to achieve complete visceral and somatic analgesia. Epidural analgesia provides a wide range of pain relief from childbirth
{"title":"Beyond the block: evaluation of epidurals on length of stay","authors":"Mark C Bicket, Elizabeth C Wick, Christopher L Wu","doi":"10.1136/rapm-2024-105456","DOIUrl":"https://doi.org/10.1136/rapm-2024-105456","url":null,"abstract":"Epidural analgesia is the gold standard for pain relief after invasive surgical procedures with recovery profiles that necessitate admission to the hospital, given its ability to achieve complete visceral and somatic analgesia. Epidural analgesia provides a wide range of pain relief from childbirth","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835170","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 : 2024-05-01DOI: 10.1136/rapm-2021-103452corr1
BMJ Publishing Group Ltd
Ding L, Chen D, Chen Y, et al . Intrathecal hydromorphone for analgesia after partial hepatectomy: a randomized controlled trial. Reg Anesth Pain Med 2022;47:664-671. doi:10.1136/rapm-2021-103452 The first affiliation has also been updated in the online version only and not in print to: Department
Ding L, Chen D, Chen Y, et al .肝部分切除术后鞘内氢吗啡酮镇痛：随机对照试验》。doi:10.1136/rapm-2021-103452 第一个所属单位也仅在网络版中更新，印刷版未更新：部门
{"title":"Correction: Intrathecal hydromorphone for analgesia after partial hepatectomy: a randomized controlled trial","authors":"BMJ Publishing Group Ltd","doi":"10.1136/rapm-2021-103452corr1","DOIUrl":"https://doi.org/10.1136/rapm-2021-103452corr1","url":null,"abstract":"Ding L, Chen D, Chen Y, et al . Intrathecal hydromorphone for analgesia after partial hepatectomy: a randomized controlled trial. Reg Anesth Pain Med 2022;47:664-671. doi:10.1136/rapm-2021-103452 The first affiliation has also been updated in the online version only and not in print to: Department","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140889171","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}
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