Pub Date : 2022-09-08DOI: 10.1136/rapm-2022-103680
D. Choudhry, L. Heredia, B. Brenn, Melinda Brown, Norman F Carvalho, Milicent C Whaley, Sadiq S Shaik, J. Hagerty, Ahmad Bani Hani
Introduction Caudal block is frequently performed to provide analgesia for hypospadias repair. Literature suggests that pudendal block provides prolonged postoperative analgesia as compared with caudal block in children between 2 and 5 years. We compared the efficacy of pudendal and caudal blocks in children less than 2 years. Methods 60 children scheduled for hypospadias repair received standard general anesthesia along with either pudendal or caudal block (groups of 30 each). Variables collected were demographic data, block time, operating room time, intraoperative pain medication need, pain assessment score and medication need in the recovery room and pain assessment at home. Result Groups were demographically similar. No differences were observed in the following recorded times (minutes): block procedure (caudal: 9.5±4.0, pudendal: 10.6±4.1, p=0.30), anesthesia (caudal: 17.3±5.3, pudendal: 17.7±4.3, p=0.75), total OR (caudal: 171±35, pudendal: 172±41; p=0.95) and postanesthesia care unit (PACU) stay (caudal: 88±37, pudendal: 86±42; p=0.80). Additionally, no differences were observed in rescue pain medication need in the operating room (caudal: 0, pudendal: 2 (p=0.49), in PACU (caudal: 4, pudendal: 4, p=0.99), pain assessed at home, time to pain level 2 (caudal: 13.93±8.9, pudendal: 15.17±8.7), average pain scores (p=0.67) and total pain free epochs (pain level of zero) (p=0.80) in the first 24 hours. Discussion In children less than 2 years, both blocks provide comparable intraoperative and postoperative pain relief in the first 24 hours after hypospadias surgery. Trial registration number NCT03145415.
{"title":"Nerve stimulation guided bilateral pudendal nerve block versus landmark-based caudal block for hypospadias repair in young children: a prospective, randomized, pragmatic trial","authors":"D. Choudhry, L. Heredia, B. Brenn, Melinda Brown, Norman F Carvalho, Milicent C Whaley, Sadiq S Shaik, J. Hagerty, Ahmad Bani Hani","doi":"10.1136/rapm-2022-103680","DOIUrl":"https://doi.org/10.1136/rapm-2022-103680","url":null,"abstract":"Introduction Caudal block is frequently performed to provide analgesia for hypospadias repair. Literature suggests that pudendal block provides prolonged postoperative analgesia as compared with caudal block in children between 2 and 5 years. We compared the efficacy of pudendal and caudal blocks in children less than 2 years. Methods 60 children scheduled for hypospadias repair received standard general anesthesia along with either pudendal or caudal block (groups of 30 each). Variables collected were demographic data, block time, operating room time, intraoperative pain medication need, pain assessment score and medication need in the recovery room and pain assessment at home. Result Groups were demographically similar. No differences were observed in the following recorded times (minutes): block procedure (caudal: 9.5±4.0, pudendal: 10.6±4.1, p=0.30), anesthesia (caudal: 17.3±5.3, pudendal: 17.7±4.3, p=0.75), total OR (caudal: 171±35, pudendal: 172±41; p=0.95) and postanesthesia care unit (PACU) stay (caudal: 88±37, pudendal: 86±42; p=0.80). Additionally, no differences were observed in rescue pain medication need in the operating room (caudal: 0, pudendal: 2 (p=0.49), in PACU (caudal: 4, pudendal: 4, p=0.99), pain assessed at home, time to pain level 2 (caudal: 13.93±8.9, pudendal: 15.17±8.7), average pain scores (p=0.67) and total pain free epochs (pain level of zero) (p=0.80) in the first 24 hours. Discussion In children less than 2 years, both blocks provide comparable intraoperative and postoperative pain relief in the first 24 hours after hypospadias surgery. Trial registration number NCT03145415.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74770774","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 : 2022-09-05DOI: 10.1136/rapm-2022-103738
T. Ashken, J. Bowness, A. Macfarlane, L. Turbitt, B. Bellew, N. Bedforth, D. Burckett-St Laurent, A. Delbos, K. El-Boghdadly, N. Elkassabany, Jenny Ferry, B. Fox, J. French, C. Grant, Ashwani Gupta, R. Gupta, Y. Gürkan, N. Haslam, H. Higham, Rosemary Hogg, D. Johnston, R. Kearns, C. Lobo, S. McKinlay, E. Mariano, S. Memtsoudis, P. Merjavy, M. Narayanan, J. A. Noble, David Phillips, M. Rosenblatt, A. Sadler, M. Sebastian, E. Schwenk, Alasdair Taylor, A. Thottungal, L. Valdés-Vilches, T. Volk, S. West, M. Wolmarans, J. Womack, A. Pawa
Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for “block view” (which visualizes the block site and is maintained for needle insertion/injection). A “strong recommendation” was made if ≥75% of participants rated any structure as “definitely include” in any round. A “weak recommendation” was made if >50% of participants rated it as “definitely include” or “probably include” for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a “strong recommendation” was made for 60 structures on orientation scanning and 44 on the block view. A “weak recommendation” was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.
{"title":"Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia","authors":"T. Ashken, J. Bowness, A. Macfarlane, L. Turbitt, B. Bellew, N. Bedforth, D. Burckett-St Laurent, A. Delbos, K. El-Boghdadly, N. Elkassabany, Jenny Ferry, B. Fox, J. French, C. Grant, Ashwani Gupta, R. Gupta, Y. Gürkan, N. Haslam, H. Higham, Rosemary Hogg, D. Johnston, R. Kearns, C. Lobo, S. McKinlay, E. Mariano, S. Memtsoudis, P. Merjavy, M. Narayanan, J. A. Noble, David Phillips, M. Rosenblatt, A. Sadler, M. Sebastian, E. Schwenk, Alasdair Taylor, A. Thottungal, L. Valdés-Vilches, T. Volk, S. West, M. Wolmarans, J. Womack, A. Pawa","doi":"10.1136/rapm-2022-103738","DOIUrl":"https://doi.org/10.1136/rapm-2022-103738","url":null,"abstract":"Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for “block view” (which visualizes the block site and is maintained for needle insertion/injection). A “strong recommendation” was made if ≥75% of participants rated any structure as “definitely include” in any round. A “weak recommendation” was made if >50% of participants rated it as “definitely include” or “probably include” for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a “strong recommendation” was made for 60 structures on orientation scanning and 44 on the block view. A “weak recommendation” was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84166214","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 : 2022-09-02DOI: 10.1136/rapm-2022-103786
S. Shin, Jong-Hyuk Lee, Hyun-Jung Kwon, In-Gyu Lee, Dongseok Kim, Hakmoo Cho, Doo-Hwan Kim, S. Jeong
Introduction Real-time ultrasound-guided thoracic epidural catheter placement (US-TECP) has been recently introduced. Patient’s position is associated with the success of spine interventions; however, the effects of position on the outcome of the procedure remain unknown. We aimed to assess the clinical usefulness of patient positioning during real-time US-TECP. Methods Patients were randomly assigned to the prone position group (group P) and sitting position group (group S). The primary outcome was needling time during the procedure. The secondary outcomes were time to mark space, total number of needle passes, number of skin punctures, first-pass success, final success, crossover success, and visibility of ultrasound (US) views. Global Rating Scale (GRS) score, Patient Comfort Scale score, procedural pain intensity, patient satisfaction, and procedure-related complications were also determined. Results Sixty-four patients were included in this study. The needling time was significantly shorter in group P than in group S (36.5 (26.5–51.0) vs 59.5 (34.5–152.0) s, p<0.01). The numbers of needle passes and skin punctures were significantly lesser in group P than in group S. First-pass success was higher in group P than in group S. Group P had higher GRS compared with group S. The time to mark space, final success, US visibility score, Patient Comfort Scale score, procedural pain intensity, and patient satisfaction did not differ between the groups. One patient in group S developed a vasovagal reaction. Discussion This study shows that prone position may be preferred for real-time US-TECP, considering its better clinical usefulness. Trial registration number KCT0005757.
实时超声引导胸椎硬膜外置管(US-TECP)最近被引入。患者的体位与脊柱干预的成功与否有关;然而，位置对手术结果的影响尚不清楚。我们的目的是评估实时US-TECP期间患者体位的临床实用性。方法将患者随机分为俯卧位组(P组)和坐位组(S组)，主要观察针刺时间。次要结果是标记空间时间、针总次数、皮肤穿刺次数、第一次成功、最终成功、交叉成功和超声(US)视图可见性。全球评分量表(GRS)评分、患者舒适量表评分、手术疼痛强度、患者满意度和手术相关并发症也被确定。结果本研究共纳入64例患者。针刺时间P组明显短于S组(36.5 (26.5-51.0)vs 59.5 (34.5-152.0) S, P <0.01)。P组的针头通过次数和皮肤穿刺次数明显少于s组。P组的首次通过成功率高于s组。P组的GRS高于s组。标记空间时间、最终成功率、US可视性评分、患者舒适量表评分、手术疼痛强度和患者满意度在组间无差异。S组1例患者出现血管迷走神经反应。本研究表明，考虑到实时US-TECP更好的临床用途，俯卧位可能是首选。试验注册号为KCT0005757。
{"title":"Comparison of sitting and prone positions for real-time ultrasound-guided thoracic epidural catheter placement: a randomized controlled trial","authors":"S. Shin, Jong-Hyuk Lee, Hyun-Jung Kwon, In-Gyu Lee, Dongseok Kim, Hakmoo Cho, Doo-Hwan Kim, S. Jeong","doi":"10.1136/rapm-2022-103786","DOIUrl":"https://doi.org/10.1136/rapm-2022-103786","url":null,"abstract":"Introduction Real-time ultrasound-guided thoracic epidural catheter placement (US-TECP) has been recently introduced. Patient’s position is associated with the success of spine interventions; however, the effects of position on the outcome of the procedure remain unknown. We aimed to assess the clinical usefulness of patient positioning during real-time US-TECP. Methods Patients were randomly assigned to the prone position group (group P) and sitting position group (group S). The primary outcome was needling time during the procedure. The secondary outcomes were time to mark space, total number of needle passes, number of skin punctures, first-pass success, final success, crossover success, and visibility of ultrasound (US) views. Global Rating Scale (GRS) score, Patient Comfort Scale score, procedural pain intensity, patient satisfaction, and procedure-related complications were also determined. Results Sixty-four patients were included in this study. The needling time was significantly shorter in group P than in group S (36.5 (26.5–51.0) vs 59.5 (34.5–152.0) s, p<0.01). The numbers of needle passes and skin punctures were significantly lesser in group P than in group S. First-pass success was higher in group P than in group S. Group P had higher GRS compared with group S. The time to mark space, final success, US visibility score, Patient Comfort Scale score, procedural pain intensity, and patient satisfaction did not differ between the groups. One patient in group S developed a vasovagal reaction. Discussion This study shows that prone position may be preferred for real-time US-TECP, considering its better clinical usefulness. Trial registration number KCT0005757.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80932054","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 : 2022-09-01DOI: 10.1136/rapm-2022-104011
M. Carella, F. Beck, N. Piette, J. Lecoq, V. Bonhomme
To the editor We are grateful to Xue et al for their interest in our recent clinical trial concerning the suprainguinal fascia iliaca compartment block (SFICB) and its role in the management of postoperative analgesia after posterolateralapproached total hip arthroplasties (PLTHA). 2 In our trial, we wanted to report how this peripheral nerve block (PNB) technique can be useful in reducing postoperative pain by improving functional performance after PLTHA. We thank Xue et al for giving us the opportunity to clarify and emphasise some methodological aspects of our study and we are pleased to respond to their accurate observation. First, in our trial, SFICB was used in the context of multimodal analgesia, including Cox2selective nonsteroidal antiinflammatory drugs (NSAIDs), acetaminophen and dexamethasone. The details of this scheme are given in Appendix 1 of our publication. As recommended by the recent PROcedure SPEcific postoperative pain managemenT (PROSPECT) guidelines, not only does the evidence support the use of these molecules but recommends that trials inherent to postoperative analgesia research include multimodal schemes consistent with current clinical practice, with at least acetaminophen/NSAID/dexamethasone administration. In addition to preoperative NSAID and intraoperative acetaminophen and dexamethasone, all patients included in the trial received 60 mg etoricoxib once daily and acetaminophen 1 g every 6 hours postoperatively, as a complement to the PatientControlled Analgesia device. We acknowledge that his may have not appeared clearly enough in the Methods section of our manuscript. We believe that further studies on postoperative analgesia and the impact of different PNB techniques on functional recovery after PLTHA are needed. In line with the comment of Xue et al, we do agree that further research should obviously include the new PNBs only in the context of a basic multimodal analgesia regimen consistent with the evidence reported in the most recent guidelines. 4 Michele Carella , Florian Beck , Nicolas Piette, JeanPierre Lecoq, Vincent L Bonhomme 1,3 Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium Inflammation and Enhanced Rehabilitation Laboratory (Regional Anesthesia and Analgesia), GIGAI3 Thematic Unit, GIGAResearch, Liege University, Liege, Belgium Anesthesia and Perioperative Neuroscience Laboratory, GIGAConsciousness Thematic Unit, GIGAResearch, Liege University, Liege, Belgium
我们非常感谢Xue等人对我们最近关于腹股沟上筋膜髂腔室阻滞(SFICB)及其在后外侧全髋关节置换术(PLTHA)术后镇痛管理中的作用的临床试验感兴趣。在我们的试验中，我们想要报道这种外周神经阻滞(PNB)技术如何通过改善PLTHA后的功能表现来减少术后疼痛。我们感谢Xue等人给我们机会澄清和强调我们研究的一些方法学方面，我们很高兴对他们的准确观察做出回应。首先，在我们的试验中，SFICB被用于多模式镇痛，包括cox 2选择性非甾体抗炎药(NSAIDs)、对乙酰氨基酚和地塞米松。此计划的详情载于本刊物的附录1。正如最近的手术特异性术后疼痛管理(PROSPECT)指南所推荐的那样，不仅有证据支持使用这些分子，而且建议术后镇痛研究固有的试验包括符合当前临床实践的多模式方案，至少给予对乙酰氨基酚/非甾体抗炎药/地塞米松。除了术前使用非甾体抗炎药和术中使用对乙酰氨基酚和地塞米松外，所有纳入试验的患者均接受60 mg依托妥昔布，每日一次，术后每6小时使用1 g对乙酰氨基酚，作为患者自控镇痛装置的补充。我们承认他可能没有在我们手稿的方法部分出现得足够清楚。我们认为需要进一步研究术后镇痛以及不同PNB技术对PLTHA术后功能恢复的影响。与Xue等人的评论一致，我们同意进一步的研究显然应该只在与最新指南中报告的证据一致的基本多模式镇痛方案的背景下纳入新的pnb。4 Michele Carella, Florian Beck, Nicolas Piette, JeanPierre Lecoq, Vincent L Bonhomme 1,3比利时列日列日大学医院麻醉与重症监护医学部炎症与强化康复实验室(区域麻醉与镇痛)，GIGAI3专题单元，列日大学，列日，比利时
{"title":"Reply to ‘assessing postoperative benefits of regional blocks: an issue should be noticed’","authors":"M. Carella, F. Beck, N. Piette, J. Lecoq, V. Bonhomme","doi":"10.1136/rapm-2022-104011","DOIUrl":"https://doi.org/10.1136/rapm-2022-104011","url":null,"abstract":"To the editor We are grateful to Xue et al for their interest in our recent clinical trial concerning the suprainguinal fascia iliaca compartment block (SFICB) and its role in the management of postoperative analgesia after posterolateralapproached total hip arthroplasties (PLTHA). 2 In our trial, we wanted to report how this peripheral nerve block (PNB) technique can be useful in reducing postoperative pain by improving functional performance after PLTHA. We thank Xue et al for giving us the opportunity to clarify and emphasise some methodological aspects of our study and we are pleased to respond to their accurate observation. First, in our trial, SFICB was used in the context of multimodal analgesia, including Cox2selective nonsteroidal antiinflammatory drugs (NSAIDs), acetaminophen and dexamethasone. The details of this scheme are given in Appendix 1 of our publication. As recommended by the recent PROcedure SPEcific postoperative pain managemenT (PROSPECT) guidelines, not only does the evidence support the use of these molecules but recommends that trials inherent to postoperative analgesia research include multimodal schemes consistent with current clinical practice, with at least acetaminophen/NSAID/dexamethasone administration. In addition to preoperative NSAID and intraoperative acetaminophen and dexamethasone, all patients included in the trial received 60 mg etoricoxib once daily and acetaminophen 1 g every 6 hours postoperatively, as a complement to the PatientControlled Analgesia device. We acknowledge that his may have not appeared clearly enough in the Methods section of our manuscript. We believe that further studies on postoperative analgesia and the impact of different PNB techniques on functional recovery after PLTHA are needed. In line with the comment of Xue et al, we do agree that further research should obviously include the new PNBs only in the context of a basic multimodal analgesia regimen consistent with the evidence reported in the most recent guidelines. 4 Michele Carella , Florian Beck , Nicolas Piette, JeanPierre Lecoq, Vincent L Bonhomme 1,3 Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium Inflammation and Enhanced Rehabilitation Laboratory (Regional Anesthesia and Analgesia), GIGAI3 Thematic Unit, GIGAResearch, Liege University, Liege, Belgium Anesthesia and Perioperative Neuroscience Laboratory, GIGAConsciousness Thematic Unit, GIGAResearch, Liege University, Liege, Belgium","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82996008","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 : 2022-09-01DOI: 10.1136/rapm-2022-103959
F. Xue, N. He, Yi Cheng
To the editor In a singleblind randomized controlled trial including 86 patients who underwent posterolateral approach total hip arthroplasty, Carella et al assessed the effects of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery and showed that the suprainguinal fascia iliaca compartment block provided opioid sparing, improved postoperative pain control and enhanced functional recovery. Other than the limitations described by authors in the discussion, however, this study used a singlemode postoperative analgesia strategy in the control patients, that is, patientcontrolled analgesia with morphine. In fact, current enhanced recovery after surgery (ERAS) protocols of total hip arthroplasty recommend the multimodal strategies of postoperative analgesia, in which other than nerve or fascial plane blocks, a package of basic analgesics, such as paracetamol, nonsteroidal antiinflammatory drugs (NSAIDs) or cyclooxygenase2 specific inhibitors, and dexamethasone, is also included. 3 Thus, we believe that different results about postoperative analgesic efficacy of the suprainguinal fascia iliaca compartment block would have been obtained, if a package of basic analgesics had been included in the postoperative analgesia strategy of control patients in this study.
{"title":"Assessing postoperative benefits of regional blocks: an issue that should be noticed","authors":"F. Xue, N. He, Yi Cheng","doi":"10.1136/rapm-2022-103959","DOIUrl":"https://doi.org/10.1136/rapm-2022-103959","url":null,"abstract":"To the editor In a singleblind randomized controlled trial including 86 patients who underwent posterolateral approach total hip arthroplasty, Carella et al assessed the effects of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery and showed that the suprainguinal fascia iliaca compartment block provided opioid sparing, improved postoperative pain control and enhanced functional recovery. Other than the limitations described by authors in the discussion, however, this study used a singlemode postoperative analgesia strategy in the control patients, that is, patientcontrolled analgesia with morphine. In fact, current enhanced recovery after surgery (ERAS) protocols of total hip arthroplasty recommend the multimodal strategies of postoperative analgesia, in which other than nerve or fascial plane blocks, a package of basic analgesics, such as paracetamol, nonsteroidal antiinflammatory drugs (NSAIDs) or cyclooxygenase2 specific inhibitors, and dexamethasone, is also included. 3 Thus, we believe that different results about postoperative analgesic efficacy of the suprainguinal fascia iliaca compartment block would have been obtained, if a package of basic analgesics had been included in the postoperative analgesia strategy of control patients in this study.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81804186","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 : 2022-06-17DOI: 10.1136/rapm-2022-103830
L. Kohan, Zachary Pellis, D. Provenzano, A. Pearson, S. Narouze, H. Benzon
The medical field has been experiencing numerous drug shortages in recent years. The most recent shortage to impact the field of interventional pain medicine is that of iodinated contrast medium. Pain physicians must adapt to these changes while maintaining quality of care. This position statement offers guidance on adapting to the shortage.
{"title":"American Society of Regional Anesthesia and Pain Medicine contrast shortage position statement","authors":"L. Kohan, Zachary Pellis, D. Provenzano, A. Pearson, S. Narouze, H. Benzon","doi":"10.1136/rapm-2022-103830","DOIUrl":"https://doi.org/10.1136/rapm-2022-103830","url":null,"abstract":"The medical field has been experiencing numerous drug shortages in recent years. The most recent shortage to impact the field of interventional pain medicine is that of iodinated contrast medium. Pain physicians must adapt to these changes while maintaining quality of care. This position statement offers guidance on adapting to the shortage.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74769251","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 : 2022-06-17DOI: 10.1136/rapm-2022-103584
Jayson S Marwaha, Brendin R Beaulieu-Jones, Chris J Kennedy, Mark C Bicket, Gabriel A Brat
{"title":"Research priorities for the surgical care of patients taking opioids preoperatively.","authors":"Jayson S Marwaha, Brendin R Beaulieu-Jones, Chris J Kennedy, Mark C Bicket, Gabriel A Brat","doi":"10.1136/rapm-2022-103584","DOIUrl":"10.1136/rapm-2022-103584","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91048708","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 : 2022-06-17DOI: 10.1136/rapm-2022-103493
Jessie Markovits, Ondrej Blaha, Emma Zhao, David Spiegel
Background: Hypnosis decreases perioperative pain and has opioid-sparing potential but has not been rigorously studied in knee arthroplasty. This trial investigates the impact of perioperative hypnosis on inpatient opioid use following total knee arthroplasty.
Methods: This prospective randomized controlled trial was conducted at a single academic medical center. The hypnosis arm underwent a scripted 10 min hypnosis session prior to surgery and had access to the recorded script. The control arm received hypnosis education only. The primary outcome was opioid use in milligram oral morphine equivalents per 24 hours during hospital admission. A secondary analysis was performed for patients taking opioids preoperatively.
Results: 64 primary knee arthroplasty patients were randomized 1:1 to hypnosis (n=31) versus control (n=33) and included in the intent-to-treat analysis. The mean (SD) postoperative opioid use in oral morphine equivalents per 24 hours was 70.5 (48.4) in the hypnosis versus 90.7 (74.4) in the control arm, a difference that was not statistically significant (difference -20.1; 95% CI -51.8 to 11.4; p=0.20). In the subgroup analysis of the opioid-experienced patients, there was a 54% daily reduction in opioid use in the hypnosis group (82.4 (56.2) vs 179.1 (74.5) difference of -96.7; 95% CI -164.4 to -29.0; p=<0.01), equivalent to sparing 65 mg of oxycodone per day.
Conclusion: Perioperative hypnosis significantly reduced inpatient opioid use among opioid-experienced patients only. A larger study examining these findings is warranted.
Trial registration number: NCT03308071.
背景：催眠可减轻围手术期疼痛并具有节省阿片类药物的潜力，但在膝关节置换术中尚未进行过严格研究。本试验调查了围手术期催眠对全膝关节置换术后住院患者阿片类药物使用的影响：这项前瞻性随机对照试验在一家学术医疗中心进行。催眠组在手术前接受了10分钟的剧本催眠治疗，并可查看录制的剧本。对照组仅接受催眠教育。主要结果是入院期间每 24 小时阿片类药物的使用量（以毫克口服吗啡当量计）。对术前服用阿片类药物的患者进行了二次分析：64名初次膝关节置换术患者按1:1比例随机接受催眠（31人）和对照组（33人）治疗，并纳入意向治疗分析。以每24小时口服吗啡当量计算的术后阿片类药物平均用量（标度）为：催眠组70.5（48.4），对照组90.7（74.4），差异无统计学意义（差异-20.1；95% CI -51.8至11.4；P=0.20）。在对有阿片类药物使用经验的患者进行的亚组分析中，催眠组的阿片类药物日使用量减少了54%（82.4 (56.2) vs 179.1 (74.5) 差异为-96.7；95% CI -164.4至-29.0；p=结论：围手术期催眠仅能显著减少有阿片类药物使用经验的住院患者的阿片类药物使用量。有必要对这些发现进行更大规模的研究：NCT03308071。
{"title":"Effects of hypnosis versus enhanced standard of care on postoperative opioid use after total knee arthroplasty: the HYPNO-TKA randomized clinical trial.","authors":"Jessie Markovits, Ondrej Blaha, Emma Zhao, David Spiegel","doi":"10.1136/rapm-2022-103493","DOIUrl":"10.1136/rapm-2022-103493","url":null,"abstract":"<p><strong>Background: </strong>Hypnosis decreases perioperative pain and has opioid-sparing potential but has not been rigorously studied in knee arthroplasty. This trial investigates the impact of perioperative hypnosis on inpatient opioid use following total knee arthroplasty.</p><p><strong>Methods: </strong>This prospective randomized controlled trial was conducted at a single academic medical center. The hypnosis arm underwent a scripted 10 min hypnosis session prior to surgery and had access to the recorded script. The control arm received hypnosis education only. The primary outcome was opioid use in milligram oral morphine equivalents per 24 hours during hospital admission. A secondary analysis was performed for patients taking opioids preoperatively.</p><p><strong>Results: </strong>64 primary knee arthroplasty patients were randomized 1:1 to hypnosis (n=31) versus control (n=33) and included in the intent-to-treat analysis. The mean (SD) postoperative opioid use in oral morphine equivalents per 24 hours was 70.5 (48.4) in the hypnosis versus 90.7 (74.4) in the control arm, a difference that was not statistically significant (difference -20.1; 95% CI -51.8 to 11.4; p=0.20). In the subgroup analysis of the opioid-experienced patients, there was a 54% daily reduction in opioid use in the hypnosis group (82.4 (56.2) vs 179.1 (74.5) difference of -96.7; 95% CI -164.4 to -29.0; p=<0.01), equivalent to sparing 65 mg of oxycodone per day.</p><p><strong>Conclusion: </strong>Perioperative hypnosis significantly reduced inpatient opioid use among opioid-experienced patients only. A larger study examining these findings is warranted.</p><p><strong>Trial registration number: </strong>NCT03308071.</p>","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83548935","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 : 2022-06-15DOI: 10.1136/rapm-2021-103427
Michele Carella, Florian Beck, Nicolas Piette, Sébastien Denys, William Kurth, Jean-Pierre Lecoq, Vincent L Bonhomme
Introduction: Posterolateral-approached total hip arthroplasty (PLTHA) is followed by moderate to severe postoperative pain. Suprainguinal fascia iliaca compartment block (SFICB) has been proposed as a promising analgesia technique.
Methods: Data from 86 patients scheduled for PLTHA with spinal anesthesia were analyzed in this prospective randomized controlled trial. Patients were randomly divided into two groups of 43 patients each. As opposed to the control group (group C), ropivacaine group (group R) received additional SFICB using 40 mL of 0.375% ropivacaine. As primary endpoint, blind observers noted total morphine consumption at postoperative 48 hours. Secondary endpoints were pain at rest and mobilization on 0-10 Numeric Rating Scale (rest and dynamic NRS) at fixed time points (1 hour and 6 hours after surgery, and at day 1 and day 2 at 8:00, 13:00 and 18:00 hours), walking performance at day 1 and day 2; postoperative complications including morphine-related side effects or orthostatic intolerance symptoms such as dizziness, nausea, blurred vision or vasovagal syncope.
Results: A 48-hour morphine consumption (mg; median (IQR)) was significantly lower in group R than in group C (11 (8.5-15.5)) vs 26 (21-33.5), p<0001), as well as incidence of morphine-related side effects such as nausea at day 1 (p=0.04) and day 2 (p<0.01). Rest and dynamic NRS were globally significantly lower in group R than in group C (p<0.01). Group R showed less orthostatic intolerance at day 1 (p<0.001) and day 2 (p<0.01) and better functional walking performance at day 1 (<0.001) and day 2 (<0.001).
Discussion: In PLTHA, SFICB provides opioid sparing, improved postoperative pain control, and enhanced functional recovery.
{"title":"Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial.","authors":"Michele Carella, Florian Beck, Nicolas Piette, Sébastien Denys, William Kurth, Jean-Pierre Lecoq, Vincent L Bonhomme","doi":"10.1136/rapm-2021-103427","DOIUrl":"10.1136/rapm-2021-103427","url":null,"abstract":"<p><strong>Introduction: </strong>Posterolateral-approached total hip arthroplasty (PLTHA) is followed by moderate to severe postoperative pain. Suprainguinal fascia iliaca compartment block (SFICB) has been proposed as a promising analgesia technique.</p><p><strong>Methods: </strong>Data from 86 patients scheduled for PLTHA with spinal anesthesia were analyzed in this prospective randomized controlled trial. Patients were randomly divided into two groups of 43 patients each. As opposed to the control group (group C), ropivacaine group (group R) received additional SFICB using 40 mL of 0.375% ropivacaine. As primary endpoint, blind observers noted total morphine consumption at postoperative 48 hours. Secondary endpoints were pain at rest and mobilization on 0-10 Numeric Rating Scale (rest and dynamic NRS) at fixed time points (1 hour and 6 hours after surgery, and at day 1 and day 2 at 8:00, 13:00 and 18:00 hours), walking performance at day 1 and day 2; postoperative complications including morphine-related side effects or orthostatic intolerance symptoms such as dizziness, nausea, blurred vision or vasovagal syncope.</p><p><strong>Results: </strong>A 48-hour morphine consumption (mg; median (IQR)) was significantly lower in group R than in group C (11 (8.5-15.5)) vs 26 (21-33.5), p<0001), as well as incidence of morphine-related side effects such as nausea at day 1 (p=0.04) and day 2 (p<0.01). Rest and dynamic NRS were globally significantly lower in group R than in group C (p<0.01). Group R showed less orthostatic intolerance at day 1 (p<0.001) and day 2 (p<0.01) and better functional walking performance at day 1 (<0.001) and day 2 (<0.001).</p><p><strong>Discussion: </strong>In PLTHA, SFICB provides opioid sparing, improved postoperative pain control, and enhanced functional recovery.</p><p><strong>Trial registration number: </strong>NCT04574479.</p>","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80363208","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 : 2022-06-15DOI: 10.1136/rapm-2022-103577
Seungwon Lee, R. Kang, G. Kim, M. Gwak, G. Choi, J. M. Kim, J. Ko
Background Posterior quadratus lumborum block (QLB) and intrathecal morphine are accepted analgesic strategies in laparoscopic liver resection, but their effects have not been compared after laparoscopic donor hepatectomy. This study was planned to perform this comparison. Methods Fifty-six donors were randomized to receive bilateral posterior (QLB2, 20 mL of 0.375% ropivacaine on each side, 150 mg total) or preoperative injection of 0.4 mg morphine sulfate intrathecally. Primary outcome was resting pain score at 24 hour postsurgery. Secondary outcomes included cumulative opioid consumption and recovery parameters. Serial plasma ropivacaine concentrations were measured in QLB group. Only the outcome assessor was properly blinded. Results Mean resting pain score at 24-hour postsurgery was 4.19±1.66 in QLB group (n=27) and 3.07±1.41 in intrathecal morphine group (n=27, p=0.04). Mean difference (QLB group-intrathecal morphine group) was 1.11 (95% CI 0.27 to 1.95), and the upper limit of CI was higher than prespecified non-inferiority margin (δ=1), indicating an inferior effect of QLB. Cumulative opioid consumption was significantly higher in QLB group at 24 hours and 48 hours postsurgery. QLB group exhibited lower incidence of postoperative pruritus at all time points, and there were no differences in other recovery outcomes. All measured ropivacaine concentrations were below the threshold for systemic toxicity (4.3 µg/mL). Conclusions Bilateral posterior QLB elicited higher resting pain scores at 24-hour after laparoscopic donor hepatectomy than intrathecal morphine and did not meet the definition of non-inferiority. Trial registration number KCT0005360.
{"title":"Comparison of postoperative analgesic effects of posterior quadratus lumborum block and intrathecal morphine in laparoscopic donor hepatectomy: a prospective randomized non-inferiority clinical trial","authors":"Seungwon Lee, R. Kang, G. Kim, M. Gwak, G. Choi, J. M. Kim, J. Ko","doi":"10.1136/rapm-2022-103577","DOIUrl":"https://doi.org/10.1136/rapm-2022-103577","url":null,"abstract":"Background Posterior quadratus lumborum block (QLB) and intrathecal morphine are accepted analgesic strategies in laparoscopic liver resection, but their effects have not been compared after laparoscopic donor hepatectomy. This study was planned to perform this comparison. Methods Fifty-six donors were randomized to receive bilateral posterior (QLB2, 20 mL of 0.375% ropivacaine on each side, 150 mg total) or preoperative injection of 0.4 mg morphine sulfate intrathecally. Primary outcome was resting pain score at 24 hour postsurgery. Secondary outcomes included cumulative opioid consumption and recovery parameters. Serial plasma ropivacaine concentrations were measured in QLB group. Only the outcome assessor was properly blinded. Results Mean resting pain score at 24-hour postsurgery was 4.19±1.66 in QLB group (n=27) and 3.07±1.41 in intrathecal morphine group (n=27, p=0.04). Mean difference (QLB group-intrathecal morphine group) was 1.11 (95% CI 0.27 to 1.95), and the upper limit of CI was higher than prespecified non-inferiority margin (δ=1), indicating an inferior effect of QLB. Cumulative opioid consumption was significantly higher in QLB group at 24 hours and 48 hours postsurgery. QLB group exhibited lower incidence of postoperative pruritus at all time points, and there were no differences in other recovery outcomes. All measured ropivacaine concentrations were below the threshold for systemic toxicity (4.3 µg/mL). Conclusions Bilateral posterior QLB elicited higher resting pain scores at 24-hour after laparoscopic donor hepatectomy than intrathecal morphine and did not meet the definition of non-inferiority. Trial registration number KCT0005360.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87709551","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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