Regional Anesthesia & Pain Medicine最新文献

英文中文

Single-center cross-sectional study of high opioid prescribing among U.S. veterans with peripheral arterial disease 美国外周动脉疾病退伍军人高阿片类药物处方的单中心横断面研究

Regional Anesthesia & Pain Medicine

Pub Date : 2022-06-10 DOI: 10.1136/rapm-2022-103574

J. Stern, A. Kou, Aditi Kapoor, Samantha Regala, Han He, R. Stafford, E. Mariano, Seshadri C. Mudumbai

Division of Vascular & Endovascular Surgery, Stanford University School of Medicine, Stanford, California, USA Surgical Service, VA Palo Alto Health Care System, Palo Alto, California, USA Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA

美国斯坦福大学医学院血管及血管内外科部，加利福尼亚州斯坦福大学，美国外科服务部，VA帕洛阿尔托医疗保健系统，加利福尼亚州帕洛阿尔托，美国斯坦福大学医学院，美国麻醉科，围手术期和疼痛医学，美国麻醉和围手术期护理服务部，VA帕洛阿尔托医疗保健系统，加利福尼亚州帕洛阿尔托，美国心血管医学部，斯坦福大学医学院，美国加利福尼亚州斯坦福

引用次数: 0

Correction: Dose-dependent effects of high intensity focused ultrasound on compound action potentials in an ex vivo rodent peripheral nerve model: comparison to local anesthetics 校正:高强度聚焦超声对离体啮齿动物周围神经模型复合动作电位的剂量依赖性影响:与局部麻醉剂的比较

Regional Anesthesia & Pain Medicine

Pub Date : 2022-05-23 DOI: 10.1136/rapm-2021-103115corr1

引用次数: 0

Correction: Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial 纠正:全髋关节置换术术前囊周神经组(PENG)阻滞:一项随机、安慰剂对照试验

Regional Anesthesia & Pain Medicine

Pub Date : 2022-05-23 DOI: 10.1136/rapm-2021-103228corr1

Zheng J, Pan D, Zheng B, et al. Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebocontrolled trial. Reg Anesth Pain Med 2022;47:155–160. doi: 10.1136/rapm2021103228 The correct affiliation for the corresponding author, Xiangcai Ruan, is: Department of Anesthesiology and Pain Medicine, The Sixth Affiliated Hospital, Sun Yatsen University, Guangzhou, China.

郑军，潘东，郑波，等。全髋关节置换术术前囊周神经组阻滞:一项随机、安慰剂对照试验。中华医学杂志(英文版);2009;31(1):555 - 561。doi: 10.1136/rapm2021103228通讯作者阮祥才的正确所属单位是:中国广州中山大学附属第六医院麻醉与疼痛医学科。

引用次数: 0

Association between thoracic epidural block and major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia 胸膜硬膜外阻滞与全麻下恶性胸膜间皮瘤胸膜切除/去皮术后主要并发症的关系

Regional Anesthesia & Pain Medicine

Pub Date : 2022-05-20 DOI: 10.1136/rapm-2022-103688

K. Onoe, Hiroki Ogata, Takuma Okamoto, H. Okutani, R. Ueki, N. Kariya, T. Tatara, M. Hashimoto, S. Hasegawa, Y. Matsuki, Munetaka Hirose

Introduction A curative-intent surgical procedure, pleurectomy/decortication, for malignant pleural mesothelioma is accompanied by a high incidence of major postoperative complications. Although epidural block, which suppresses nociception during and after surgery, reportedly has both benefits and disadvantages in terms of outcomes after thoracic surgery for other diseases, the effects of epidural block on major complications after pleurectomy/decortication have not been evaluated. The aim of this study was to evaluate the association between epidural block and major postoperative complications following pleurectomy/decortication. Methods In a single-institutional observational study, consecutive adult patients undergoing pleurectomy/decortication under general anesthesia were enrolled from March 2019 to December 2021. Multivariable logistic regression analysis was performed to determine the association between perioperative variables and major complications. Next, patients were divided into two groups: general anesthesia with and without epidural block. Incidences of major postoperative complications, defined as Clavien-Dindo grades≥III, were compared between groups. Results In all patients enrolled with American Society of Anesthesiologists (ASA) physical status II or III (n=99), general anesthesia without epidural block was identified as a sole risk factor for major complications among perioperative variables. The incidence of major complications was 32.3% (95% CI 19.1% to 49.2%) in patients with epidural block (n=34), which was significantly lower than 63.1% (95% CI 50.9% to 73.8%) in patients without epidural block (n=65). In sensitivity analysis in patients with ASA physical status II alone, the same results were obtained. Conclusion Epidural block is likely associated with reduction of the incidence of major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia.

恶性胸膜间皮瘤的胸膜切除术/去皮术是一种治疗目的明确的外科手术，其术后主要并发症的发生率很高。据报道，硬膜外阻滞在手术期间和手术后抑制伤害感受，对其他疾病胸外科手术后的结果既有好处也有缺点，但硬膜外阻滞对胸膜切除/去皮术后主要并发症的影响尚未得到评估。本研究的目的是评估硬膜外阻滞与胸膜切除术/去皮术后主要并发症之间的关系。方法在一项单机构观察性研究中，于2019年3月至2021年12月连续招募在全身麻醉下接受胸膜切除术/去皮术的成年患者。采用多变量logistic回归分析确定围手术期变量与主要并发症的关系。接下来，将患者分为两组:全麻加硬膜外阻滞和不加硬膜外阻滞。比较两组术后主要并发症发生率，Clavien-Dindo分级≥III。结果在美国麻醉医师学会(ASA)身体状态II或III的所有患者(n=99)中，在围手术期变量中，无硬膜外阻滞的全身麻醉被确定为主要并发症的唯一危险因素。硬膜外阻滞患者(n=34)的主要并发症发生率为32.3% (95% CI 19.1% ~ 49.2%)，显著低于无硬膜外阻滞患者(n=65)的63.1% (95% CI 50.9% ~ 73.8%)。在单独对ASA身体状态为II的患者进行敏感性分析时，得到了相同的结果。结论硬膜外阻滞可降低全身麻醉下恶性胸膜间皮瘤切除/去皮术后主要并发症的发生率。

{"title":"Association between thoracic epidural block and major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia","authors":"K. Onoe, Hiroki Ogata, Takuma Okamoto, H. Okutani, R. Ueki, N. Kariya, T. Tatara, M. Hashimoto, S. Hasegawa, Y. Matsuki, Munetaka Hirose","doi":"10.1136/rapm-2022-103688","DOIUrl":"https://doi.org/10.1136/rapm-2022-103688","url":null,"abstract":"Introduction A curative-intent surgical procedure, pleurectomy/decortication, for malignant pleural mesothelioma is accompanied by a high incidence of major postoperative complications. Although epidural block, which suppresses nociception during and after surgery, reportedly has both benefits and disadvantages in terms of outcomes after thoracic surgery for other diseases, the effects of epidural block on major complications after pleurectomy/decortication have not been evaluated. The aim of this study was to evaluate the association between epidural block and major postoperative complications following pleurectomy/decortication. Methods In a single-institutional observational study, consecutive adult patients undergoing pleurectomy/decortication under general anesthesia were enrolled from March 2019 to December 2021. Multivariable logistic regression analysis was performed to determine the association between perioperative variables and major complications. Next, patients were divided into two groups: general anesthesia with and without epidural block. Incidences of major postoperative complications, defined as Clavien-Dindo grades≥III, were compared between groups. Results In all patients enrolled with American Society of Anesthesiologists (ASA) physical status II or III (n=99), general anesthesia without epidural block was identified as a sole risk factor for major complications among perioperative variables. The incidence of major complications was 32.3% (95% CI 19.1% to 49.2%) in patients with epidural block (n=34), which was significantly lower than 63.1% (95% CI 50.9% to 73.8%) in patients without epidural block (n=65). In sensitivity analysis in patients with ASA physical status II alone, the same results were obtained. Conclusion Epidural block is likely associated with reduction of the incidence of major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"33 1","pages":"494 - 499"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78118122","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}

引用次数: 2

Is there a correlation between Altmetric Attention Scores and citation count in Regional Anesthesia and Pain Medicine journal articles? 区域麻醉与疼痛医学期刊文章的Altmetric注意力评分和引用数之间是否存在相关性?

Regional Anesthesia & Pain Medicine

Pub Date : 2022-05-17 DOI: 10.1136/rapm-2022-103554

Taras Grosh, James Kim, Veena Graff, E. Mariano, N. Elkassabany

To cite: Grosh T, Kim J, Graff V, et al. Reg Anesth Pain Med Epub ahead of print: [please include Day Month Year]. doi:10.1136/rapm-2022103554 Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA

引用:Grosh T, Kim J, Graff V等。Reg Anesth Pain Med Epub提前打印:[请包括年月日]。doi:10.1136/rapm-2022103554麻醉学和重症监护，宾夕法尼亚大学，费城，宾夕法尼亚州，美国麻醉和围手术期护理服务，VA帕洛阿尔托卫生保健系统，帕洛阿尔托，加利福尼亚州，美国，斯坦福大学医学院麻醉学，围手术期和疼痛医学系，斯坦福，加利福尼亚州，美国

引用次数: 3

Cervical spine ligamentum flavum gaps: MR characterisation and implications for interlaminar epidural injection therapy 颈椎黄韧带间隙:MR表征及其对椎板间硬膜外注射治疗的意义

Regional Anesthesia & Pain Medicine

Pub Date : 2022-05-17 DOI: 10.1136/rapm-2022-103552

Jatin Joshi, M. Roytman, R. Aiyer, E. Mauer, J. L. Chazen

Background Cervical epidural steroid injections are commonly performed to manage pain from cervical spine disease. Cadaveric studies have demonstrated incomplete ligamentum flavum fusion in the central interlaminar region with resultant midline gaps. We performed an MR-based characterization of cervical ligamentum flavum midline gaps to improve understanding of their prevalence and guide interventionalists in procedural planning. Methods Fifty patients were retrospectively reviewed following institutional review board approval. Axial T2-weighted spinecho sequences were used to evaluate ligamentum flavum integrity at the interlaminar spaces of C5–C6, C6–C7 and C7–T1. Interlaminar spaces were further subdivided into superior, middle, and inferior portions, yielding 150 interlaminar regions characterized from C5 to T1. Subsequently, a novel categorization of gap morphology was performed, highlighting gap morphology (anterior, posterior, full, or no gap). Results Full gaps of the ligamentum flavum, with direct epidural space exposure, were observed with variable prevalence at all three levels evaluated. The highest incidence of full ligamentum flavum gaps were observed at C7–T1, occurring in 71.4% of patients at both its middle and inferior portions. The inferior aspect of C5–C6 demonstrated the lowest observed rates of full ligamentum flavum gap (2%). Conclusions Ligamentum flavum gaps occur in the lower cervical spine at high rates, with the highest prevalence of full thickness ligamentum flavum gaps at C7–T1. Interventionists must be aware of these important normal variants and evaluate preprocedural MRI to plan interventions.

背景颈椎硬膜外类固醇注射通常用于治疗颈椎疾病引起的疼痛。尸体研究表明，中央层间区黄韧带融合不完全，导致中线间隙。我们对颈椎黄韧带中线间隙进行了基于mri的表征，以提高对其患病率的了解，并指导介入医生进行手术计划。方法经机构审查委员会批准，对50例患者进行回顾性分析。轴向t2加权脊柱回声序列评估C5-C6、C6-C7和C7-T1椎间间隙黄韧带完整性。层流空间进一步细分为上、中、下三部分，形成150个层流区，特征从C5到T1。随后，进行了一种新的间隙形态分类，突出了间隙形态(前、后、全或无间隙)。结果黄韧带完全间隙，直接暴露于硬膜外间隙，在所有三个水平均观察到不同的患病率。在C7-T1处观察到黄韧带完全间隙的发生率最高，71.4%的患者在其中部和下段均出现了黄韧带完全间隙。C5-C6下侧黄韧带间隙完整率最低(2%)。结论下颈椎黄韧带间隙发生率高，C7-T1全层黄韧带间隙发生率最高。介入医生必须意识到这些重要的正常变异，并在手术前评估MRI以计划干预。

{"title":"Cervical spine ligamentum flavum gaps: MR characterisation and implications for interlaminar epidural injection therapy","authors":"Jatin Joshi, M. Roytman, R. Aiyer, E. Mauer, J. L. Chazen","doi":"10.1136/rapm-2022-103552","DOIUrl":"https://doi.org/10.1136/rapm-2022-103552","url":null,"abstract":"Background Cervical epidural steroid injections are commonly performed to manage pain from cervical spine disease. Cadaveric studies have demonstrated incomplete ligamentum flavum fusion in the central interlaminar region with resultant midline gaps. We performed an MR-based characterization of cervical ligamentum flavum midline gaps to improve understanding of their prevalence and guide interventionalists in procedural planning. Methods Fifty patients were retrospectively reviewed following institutional review board approval. Axial T2-weighted spinecho sequences were used to evaluate ligamentum flavum integrity at the interlaminar spaces of C5–C6, C6–C7 and C7–T1. Interlaminar spaces were further subdivided into superior, middle, and inferior portions, yielding 150 interlaminar regions characterized from C5 to T1. Subsequently, a novel categorization of gap morphology was performed, highlighting gap morphology (anterior, posterior, full, or no gap). Results Full gaps of the ligamentum flavum, with direct epidural space exposure, were observed with variable prevalence at all three levels evaluated. The highest incidence of full ligamentum flavum gaps were observed at C7–T1, occurring in 71.4% of patients at both its middle and inferior portions. The inferior aspect of C5–C6 demonstrated the lowest observed rates of full ligamentum flavum gap (2%). Conclusions Ligamentum flavum gaps occur in the lower cervical spine at high rates, with the highest prevalence of full thickness ligamentum flavum gaps at C7–T1. Interventionists must be aware of these important normal variants and evaluate preprocedural MRI to plan interventions.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"50 1","pages":"459 - 463"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85850093","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}

引用次数: 3

Lidocaine infusions for refractory chronic migraine: a retrospective analysis 利多卡因输注治疗难治性慢性偏头痛的回顾性分析

Regional Anesthesia & Pain Medicine

Pub Date : 2022-05-06 DOI: 10.1136/rapm-2021-103180

E. Schwenk, Aaron Walter, M. Torjman, Sarah Mukhtar, Harsh T Patel, Bryan Nardone, George Sun, Bhavana Thota, C. Lauritsen, S. Silberstein

Introduction Patients with refractory chronic migraine have poor quality of life. Intravenous infusions are indicated to rapidly ‘break the cycle’ of pain. Lidocaine infusions may be effective but evidence is limited. Methods The records of 832 hospital admissions involving continuous multiday lidocaine infusions for migraine were reviewed. All patients met criteria for refractory chronic migraine. During hospitalization, patients received additional migraine medications including ketorolac, magnesium, dihydroergotamine, methylprednisolone, and neuroleptics. The primary outcome was change in headache pain from baseline to hospital discharge. Secondary outcomes measured at the post-discharge office visit (25–65 days after treatment) included headache pain and the number of headache days, and percentage of sustained responders. Percentage of acute responders, plasma lidocaine levels, and adverse drug effects were also determined. Results In total, 609 patient admissions met criteria. The mean age was 46±14 years; 81.1% were female. Median pain rating decreased from baseline of 7.0 (5.0–8.0) to 1.0 (0.0–3.0) at end of hospitalization (p<0.001); 87.8% of patients were acute responders. Average pain (N=261) remained below baseline at office visit 1 (5.5 (4.0–7.0); p<0.001). Forty-three percent of patients were sustained responders at 1 month. Headache days (N=266) decreased from 26.8±3.9 at baseline to 22.5±8.3 at the post-discharge office visit (p<0.001). Nausea and vomiting were the most common adverse drug effects and all were mild. Conclusion Lidocaine infusions may be associated with short-term and medium-term pain relief in refractory chronic migraine. Prospective studies should confirm these results.

难治性慢性偏头痛患者生活质量较差。静脉输注可迅速“打破”疼痛循环。利多卡因输注可能有效，但证据有限。方法回顾性分析832例连续多日输注利多卡因治疗偏头痛的住院记录。所有患者均符合难治性慢性偏头痛的标准。住院期间，患者接受额外的偏头痛药物治疗，包括酮乐酸、镁、二氢麦角胺、甲基强的松龙和抗精神病药。主要结局是从基线到出院时头痛的变化。在出院后办公室访问(治疗后25-65天)测量的次要结果包括头痛和头痛天数，以及持续应答者的百分比。同时还测定了急性反应百分比、血浆利多卡因水平和药物不良反应。结果共609例患者符合标准。平均年龄46±14岁;81.1%为女性。住院结束时中位疼痛评分从基线7.0(5.0-8.0)降至1.0 (0.0-3.0)(p<0.001);87.8%的患者为急性反应者。平均疼痛(N=261)在第一次就诊时仍低于基线(5.5 (4.0-7.0);p < 0.001)。43%的患者在1个月时有持续反应。头痛天数(N=266)从基线时的26.8±3.9天减少到出院后就诊时的22.5±8.3天(p<0.001)。恶心和呕吐是最常见的药物不良反应，而且都是轻微的。结论利多卡因输注可缓解难治性慢性偏头痛的中短期疼痛。前瞻性研究应证实这些结果。

{"title":"Lidocaine infusions for refractory chronic migraine: a retrospective analysis","authors":"E. Schwenk, Aaron Walter, M. Torjman, Sarah Mukhtar, Harsh T Patel, Bryan Nardone, George Sun, Bhavana Thota, C. Lauritsen, S. Silberstein","doi":"10.1136/rapm-2021-103180","DOIUrl":"https://doi.org/10.1136/rapm-2021-103180","url":null,"abstract":"Introduction Patients with refractory chronic migraine have poor quality of life. Intravenous infusions are indicated to rapidly ‘break the cycle’ of pain. Lidocaine infusions may be effective but evidence is limited. Methods The records of 832 hospital admissions involving continuous multiday lidocaine infusions for migraine were reviewed. All patients met criteria for refractory chronic migraine. During hospitalization, patients received additional migraine medications including ketorolac, magnesium, dihydroergotamine, methylprednisolone, and neuroleptics. The primary outcome was change in headache pain from baseline to hospital discharge. Secondary outcomes measured at the post-discharge office visit (25–65 days after treatment) included headache pain and the number of headache days, and percentage of sustained responders. Percentage of acute responders, plasma lidocaine levels, and adverse drug effects were also determined. Results In total, 609 patient admissions met criteria. The mean age was 46±14 years; 81.1% were female. Median pain rating decreased from baseline of 7.0 (5.0–8.0) to 1.0 (0.0–3.0) at end of hospitalization (p<0.001); 87.8% of patients were acute responders. Average pain (N=261) remained below baseline at office visit 1 (5.5 (4.0–7.0); p<0.001). Forty-three percent of patients were sustained responders at 1 month. Headache days (N=266) decreased from 26.8±3.9 at baseline to 22.5±8.3 at the post-discharge office visit (p<0.001). Nausea and vomiting were the most common adverse drug effects and all were mild. Conclusion Lidocaine infusions may be associated with short-term and medium-term pain relief in refractory chronic migraine. Prospective studies should confirm these results.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"68 1","pages":"408 - 413"},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81696658","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}

引用次数: 4

Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials. 区域麻醉和镇痛在促进结直肠癌术后恢复中的作用：随机对照试验的系统综述。

Regional Anesthesia & Pain Medicine

Pub Date : 2022-05-01 Epub Date: 2022-03-09 DOI: 10.1136/rapm-2021-103256

Kariem El-Boghdadly, James M Jack, Aine Heaney, Nick D Black, Marina F Englesakis, Henrik Kehlet, Vincent W S Chan

Background: Effective analgesia is an important element of enhanced recovery after surgery (ERAS), but the clinical impact of regional anesthesia and analgesia for colorectal surgery remains unclear.

Objective: We aimed to determine the impact of regional anesthesia following colorectal surgery in the setting of ERAS.

Evidence review: We performed a systematic review of nine databases up to June 2020, seeking randomized controlled trials comparing regional anesthesia versus control in an ERAS pathway for colorectal surgery. We analyzed the studies with successful ERAS implementation, defined as ERAS protocols with a hospital length of stay of ≤5 days. Data were qualitatively synthesized. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.

Findings: Of the 29 studies reporting ERAS pathways, only 13 comprising 1170 patients were included, with modest methodological quality and poor reporting of adherence to ERAS pathways. Epidural analgesia had limited evidence of outcome benefits in open surgery, while spinal analgesia with intrathecal opioids may potentially be associated with improved outcomes with no impact on length of stay in laparoscopic surgery, though dosing must be further investigated. There was limited evidence for fascial plane blocks or other regional anesthetic techniques.

Conclusions: Although there was variable methodological quality and reporting of ERAS, we found little evidence demonstrating the clinical benefits of regional anesthetic techniques in the setting of successful ERAS implementation, and future studies must report adherence to ERAS in order for their interventions to be generalizable to modern clinical practice.

Prospero registration number: CRD42020161200.

背景：有效的镇痛是提高术后恢复（ERAS）的重要因素，但区域麻醉和镇痛在结直肠手术中的临床影响尚不清楚。目的：我们旨在确定区域麻醉对结肠直肠手术后ERAS的影响。证据回顾：我们对截至2020年6月的9个数据库进行了系统回顾，寻求比较区域麻醉与对照组在结直肠手术ERAS途径中的随机对照试验。我们分析了ERAS成功实施的研究，定义为住院时间≤5天的ERAS方案。对数据进行定性合成。使用Cochrane Risk of bias 2工具评估偏倚风险。结果：在29项报告ERAS通路的研究中，只有13项包括1170例患者，方法质量一般，ERAS通路依从性报告较差。硬膜外镇痛在开放手术中的疗效证据有限，而鞘内阿片类药物的脊髓镇痛可能与改善结果有关，但对腹腔镜手术的住院时间没有影响，但剂量必须进一步研究。筋膜平面阻滞或其他区域麻醉技术的证据有限。结论：尽管ERAS的方法质量和报告存在差异，但我们发现很少有证据表明区域麻醉技术在成功实施ERAS的情况下的临床益处，未来的研究必须报告ERAS的依从性，以便其干预措施推广到现代临床实践。普洛斯彼罗注册号：CRD42020161200。

{"title":"Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials.","authors":"Kariem El-Boghdadly, James M Jack, Aine Heaney, Nick D Black, Marina F Englesakis, Henrik Kehlet, Vincent W S Chan","doi":"10.1136/rapm-2021-103256","DOIUrl":"10.1136/rapm-2021-103256","url":null,"abstract":"Background: Effective analgesia is an important element of enhanced recovery after surgery (ERAS), but the clinical impact of regional anesthesia and analgesia for colorectal surgery remains unclear.Objective: We aimed to determine the impact of regional anesthesia following colorectal surgery in the setting of ERAS.Evidence review: We performed a systematic review of nine databases up to June 2020, seeking randomized controlled trials comparing regional anesthesia versus control in an ERAS pathway for colorectal surgery. We analyzed the studies with successful ERAS implementation, defined as ERAS protocols with a hospital length of stay of ≤5 days. Data were qualitatively synthesized. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.Findings: Of the 29 studies reporting ERAS pathways, only 13 comprising 1170 patients were included, with modest methodological quality and poor reporting of adherence to ERAS pathways. Epidural analgesia had limited evidence of outcome benefits in open surgery, while spinal analgesia with intrathecal opioids may potentially be associated with improved outcomes with no impact on length of stay in laparoscopic surgery, though dosing must be further investigated. There was limited evidence for fascial plane blocks or other regional anesthetic techniques.Conclusions: Although there was variable methodological quality and reporting of ERAS, we found little evidence demonstrating the clinical benefits of regional anesthetic techniques in the setting of successful ERAS implementation, and future studies must report adherence to ERAS in order for their interventions to be generalizable to modern clinical practice.Prospero registration number: CRD42020161200.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"28 1","pages":"282-292"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73469156","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}

引用次数: 0

Ultrasound-guided selective trunk block (SeTB): a cadaver anatomic study to evaluate the spread of dye after a simulated injection 超声引导选择性主干阻滞(SeTB):一种模拟注射后评估染料扩散的尸体解剖研究

Regional Anesthesia & Pain Medicine

Pub Date : 2022-04-21 DOI: 10.1136/rapm-2022-103630

B. Songthamwat, P. Luangjarmekorn, Wirinaree Kampitak, R. Sivakumar, M. Karmakar

Background and objectives Recent reports suggest that a selective trunk block (SeTB) can produce sensorimotor blockade of the entire upper extremity, except for the T2 dermatome. There are no data demonstrating the anatomic mechanism of SeTB. This cadaver study aimed to evaluate the spread of an injectate after a simulated ultrasound-guided (USG) SeTB. Methods USG SeTB (n=7) was performed on both sides of the neck in four adult human cadavers with 25 mL of 0.1% methylene blue dye. Anatomic dissection was performed to document staining (deep, faint, and no stain) of the various elements of the brachial plexus from the level of the roots to the cords, including the phrenic, dorsal scapular, and long thoracic nerves. Only structures that were deeply stained were defined as being affected by the SeTB. Results All the trunks and divisions of the brachial plexus, as well as the ventral rami of C5–C7 and suprascapular nerve, were deeply stained in all (100%) the simulated injections. The ventral rami of C8 and T1 (86%), dorsal scapular and long thoracic nerve (71%), and the phrenic nerve (57%) were also deeply stained in a substantial number of the injections. Conclusion This cadaver study demonstrates that an USG SeTB consistently affects all the trunks and divisions of the brachial plexus, as well as the suprascapular nerve. This study also establishes that SeTB may not be phrenic nerve sparing. Future research to evaluate the safety and efficacy of SeTB as an all-purpose brachial plexus block technique for upper extremity surgery is warranted. Trial registration number Registered at https://www.thaiclinicaltrials.org on December 13, 2021 under the trial registration number TCTR20211213005.

背景和目的最近的报道表明，选择性主干阻滞(SeTB)可导致除T2皮段外的整个上肢的感觉运动阻滞。目前还没有数据证明SeTB的解剖机制。这项尸体研究旨在评估模拟超声引导(USG) SeTB后注射的扩散。方法用0.1%亚甲基蓝染色25 mL在4具成人尸体的颈部两侧行USG SeTB (n=7)。解剖解剖以记录从根水平到束的臂神经丛的各种成分的染色(深、暗、无染色)，包括膈神经、肩胛骨背神经和胸长神经。只有深度染色的结构才被定义为受到SeTB的影响。结果所有模拟注射的臂丛干、分支、C5-C7腹支和肩胛上神经均有深度染色(100%)。C8和T1的腹侧支(86%)、肩胛背神经和胸长神经(71%)和膈神经(57%)也在大量注射中被深度染色。结论:该尸体研究表明，USG SeTB持续影响臂丛的所有干和分支，以及肩胛上神经。这项研究也证实了SeTB可能不是膈神经的保留。未来的研究评估SeTB作为上肢手术中臂丛阻滞技术的安全性和有效性是必要的。试验注册号于2021年12月13日在https://www.thaiclinicaltrials.org注册，试验注册号为TCTR20211213005。

{"title":"Ultrasound-guided selective trunk block (SeTB): a cadaver anatomic study to evaluate the spread of dye after a simulated injection","authors":"B. Songthamwat, P. Luangjarmekorn, Wirinaree Kampitak, R. Sivakumar, M. Karmakar","doi":"10.1136/rapm-2022-103630","DOIUrl":"https://doi.org/10.1136/rapm-2022-103630","url":null,"abstract":"Background and objectives Recent reports suggest that a selective trunk block (SeTB) can produce sensorimotor blockade of the entire upper extremity, except for the T2 dermatome. There are no data demonstrating the anatomic mechanism of SeTB. This cadaver study aimed to evaluate the spread of an injectate after a simulated ultrasound-guided (USG) SeTB. Methods USG SeTB (n=7) was performed on both sides of the neck in four adult human cadavers with 25 mL of 0.1% methylene blue dye. Anatomic dissection was performed to document staining (deep, faint, and no stain) of the various elements of the brachial plexus from the level of the roots to the cords, including the phrenic, dorsal scapular, and long thoracic nerves. Only structures that were deeply stained were defined as being affected by the SeTB. Results All the trunks and divisions of the brachial plexus, as well as the ventral rami of C5–C7 and suprascapular nerve, were deeply stained in all (100%) the simulated injections. The ventral rami of C8 and T1 (86%), dorsal scapular and long thoracic nerve (71%), and the phrenic nerve (57%) were also deeply stained in a substantial number of the injections. Conclusion This cadaver study demonstrates that an USG SeTB consistently affects all the trunks and divisions of the brachial plexus, as well as the suprascapular nerve. This study also establishes that SeTB may not be phrenic nerve sparing. Future research to evaluate the safety and efficacy of SeTB as an all-purpose brachial plexus block technique for upper extremity surgery is warranted. Trial registration number Registered at https://www.thaiclinicaltrials.org on December 13, 2021 under the trial registration number TCTR20211213005.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"22 1","pages":"414 - 419"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83725916","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}

引用次数: 2

Use of epidurography in the perioperative and acute pain setting 硬膜外造影在围手术期和急性疼痛环境中的应用

Regional Anesthesia & Pain Medicine

Pub Date : 2022-04-20 DOI: 10.1136/rapm-2021-103274

J. R. Coleman, P. Hartmann, Matthew Kona, Robert Thiele, Reza Salajegheh, N. Hanson

Ensuring proper placement of epidural catheters is critical to improving their reliability for pain control and maintaining confidence in their continued use. This article will seek to address the role of objective confirmation of successful epidural placement via either single view or continuous epidural contrast studies, each creating an ‘epidurogram.’ Furthermore, the pertinent anatomical corollaries of continuous fluoroscopy used frequently in chronic pain medicine, from which these techniques emerged, will be addressed. Technical radiographic information needed to better understand and troubleshoot these studies is also included. Image examples which highlight the patterns key for successful interpretation of epidurograms will be provided. The aim of this paper was to provide an anesthesiologist unfamiliar with fluoroscopic evaluation of epidural catheters with the tools necessary to successfully conduct and interpret such an examination.

确保硬膜外导管的正确放置对于提高其疼痛控制的可靠性和保持其继续使用的信心至关重要。本文将通过单视图或连续硬膜外对比研究，分别生成硬膜外造影图，探讨硬膜外放置成功的客观确认作用。此外，在慢性疼痛医学中经常使用的连续透视的相关解剖学推论，这些技术的出现，将被解决。还包括了更好地理解和解决这些研究问题所需的技术放射学信息。图像的例子，突出模式的关键，成功的解释硬膜外图将提供。本文的目的是为不熟悉硬膜外导管透视评估的麻醉师提供必要的工具，以成功地进行和解释这种检查。

引用次数: 4

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Regional Anesthesia & Pain Medicine

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀