Regional Anesthesia and Pain Medicine最新文献

Introduction: Current treatment modalities of lumbar spinal stenosis range from conservative medical management and physical therapy to open surgical decompression. Minimally invasive lumbar decompression (MILD) and Superion interspinous spacers (SISS) Vertiflex offer the promise of effective pain relief with shorter recovery time and lesser potential complications compared with open surgical decompression procedures and general anesthesia. Despite their increasing utilization, their complication profile is not well established in the literature.

Methods: We searched the FDA's Manufacturer and User facility Device Experience (MAUDE) database for all entries on MILD product code 'HRX' and SISS product code 'NQO'. MAUDE database was queried from 2010 to 2021. Duplicate entries were removed, and complications were classified based on the event descriptions.

Results: For the MILD procedure, a total of 10 entries were found in the MAUDE database. Among these, 8 were classified as surgical complications and 2 were device related. On the other hand, a total of 919 reports were found in the MAUDE database for Vertiflex, with 385 medical device reports were included in the analysis. Device-related were the most reported complication, accounting for 189 cases.

Conclusion: As with any new intervention, we must proceed with caution and evaluate the procedure performance over time. Such data should aid physicians to make informed decisions before choosing either technique for their patients. The findings from this study provide insight into the complication profile associated with both MILD and Vertiflex procedures, highlighting the need for continued evaluation and careful consideration in clinical decision-making.

Background: Postamputation pain (PAP) is underexplored in East Asian populations, with most data originating from Western countries. This study aimed to investigate the prevalence and risk factors of PAP in East Asian individuals who underwent surgical amputation, particularly those requiring subsequent analgesia or nerve interventions.

Materials and methods: The study used data from the Longitudinal Health Insurance Database, encompassing claims from 2 million randomly selected individuals out of 23.5 million enrolled in Taiwan's National Health Insurance Research Database from 2000 to 2019. The risk factors for PAP were analyzed using multivariable regression, considering criteria such as chronic postamputation pain, symptomatic neuroma treatment, chronic analgesia use, and nerve interventions.

Results: Among the 7287 amputees (mean age 59.5 years; 65.1% male), 18.1% (95% CI 17.2%, 19.0%) (1318 patients) experienced PAP requiring intervention. Significant risk factors included cancer (OR 2.20 (95% CI 1.27, 3.68)), peripheral artery disease (OR 2.11 (95% CI 1.66, 2.69)), infection (OR 1.93 (95% CI 1.55, 2.40)), diabetes mellitus (OR 1.85 (95% CI 1.45, 2.37)), and a higher Elixhauser Comorbidity Index (OR 1.04 (95% CI 1.02, 1.06)). Prior radiculopathy (OR 1.30 (95% CI 1.13, 1.51)) and myelopathy (OR 1.33 (95% CI 1.14, 1.55)) also increased pain odds, while age showed a slight inverse association (OR 0.99 (95% CI 0.98, 0.99)).

Conclusion: The prevalence of PAP requiring subsequent analgesia or nerve interventions in this East Asian population is 18.1%. Identified risk factors include multiple medical comorbidities and pre-existing radiculopathy or myelopathy. These findings highlight the important considerations for both clinical practice and future research directions.

Background: Intrathecal morphine is the standard for post-cesarean analgesia but often causes pruritus and may be unavailable in resource-limited settings. This study assessed whether a combination of bilateral transversus abdominis plane (TAP) block and intrathecal fentanyl provides non-inferior analgesia compared with intrathecal morphine following cesarean delivery within the multimodal analgesia context.

Methods: Eighty mothers were randomized to receive either intrathecal fentanyl 10 µg with bilateral TAP block using 15 mL of 0.375% ropivacaine per side (TF group) or intrathecal morphine 75 µg with a saline sham block (M group). All patients received standard multimodal analgesia. Primary outcome was pain score with movement at 24 hours postoperatively, with a non-inferiority margin of 1 on the numeric rating scale. Secondary outcomes included opioid consumption, time to first opioid, pruritus, nausea/vomiting, patient satisfaction, and neonatal outcomes.

Results: The mean pain score with movement at 24 hours was 5.4 in the TF group and 4.8 in the M group (mean difference (95% CI), 0.6 (-0.3 to 1.5), p=0.202), with the upper margin of 95% CI exceeding the non-inferior margin. Postoperative fentanyl consumption was higher in the TF group (median (IQR), 585 (390-745) vs 140 (55-405) µg; p<0.001). Pruritus was more frequent in the M group (60% vs 10%; p<0.001).

Conclusions: Bilateral TAP block with intrathecal fentanyl is not non-inferior to intrathecal morphine for post-cesarean analgesia. However, intrathecal morphine was associated with a higher incidence of pruritus, suggesting TAP block with intrathecal fentanyl as a suitable alternative when reducing pruritus is a priority.

Trial registration number: NCT04824274.

Background: The addition of intravenous dexamethasone can significantly prolong analgesia and reduce opioid-related side effects after brachial plexus blockade, but the most effective administration time is yet unknown. The objective of this study is to determine if the timing of administration of dexamethasone affects the duration of analgesia after supraclavicular brachial plexus block.

Methods: This is a double-blind, placebo-controlled, randomized trial performed at a single-center, tertiary academic health sciences center. Patients were randomly assigned to one of four treatment groups to receive dexamethasone 8 mg intravenously (or normal saline infusions) at 1-hour preblock, at the time of the block, and 1 or 2 hours postblock.

Results: 197 patients were randomized and received the intervention (in one of four treatment groups) between January 2018 and November 2023. 39 patients were excluded due to loss to follow-up and unavailability of primary outcome data. The remaining 158 patients have complete data sets and were analyzed. The time to first reported pain was not significantly different between groups (p=0.904). Secondary outcomes including pain scores and opioid consumption, recovery scores and block recovery time did not vary significantly among groups up to 48 hours. Adverse effects such as postoperative neurological symptoms and nausea were similar across groups up to 3 months postoperatively.

Conclusions and relevance: Our results suggest that perioperative administration of 8 mg of intravenous dexamethasone (from 1 hour prior and up to 2 hours postblock) provides similar duration of analgesia to administration at the time of brachial plexus block.

Trial registration number: NCT03394820.