Regional Anesthesia and Pain Medicine最新文献

Objective: This study aimed to evaluate the effectiveness of the modified catheter in alleviating catheter-related pain.

Methods: This randomized controlled trial included 40 patients with similar characteristics scheduled for repeat transurethral resection of bladder tumor. At the end of surgery, a specially designed urethral catheter with multiple micropores enabling direct administration of local analgesic onto the urethral mucosa was inserted. In the treatment group, 0.5% ropivacaine was infused at 1 mL/hour (5 mg/hour), whereas the control group received normal saline. Visual Analogue Scale (VAS), Morphine Milligram Equivalents (MME), International Prostate Symptom Score (IPSS) and a 5-point Likert scale for willingness to reuse the catheter were assessed.

Results: During the first 6 postoperative hours, mean VAS increased by 1.80±1.06 in the treatment group and by 4.70±0.98 in the control group. The between-group mean difference was -2.90 (95% CI -3.55 to -2.25). From 6 to 24 hours, the change in VAS was -0.30±0.57 in the treatment group and -0.60±1.05 in the control group, with no meaningful between-group difference (mean difference, 0.30; 95% CI -0.24 to 0.84). At 24 hours, mean VAS was 1.75±1.12 in the treatment group and 4.25±0.97 in the control group. Cumulatively, VAS scores were lower in the treatment group compared with the control group (between-group mean difference -2.6, and 95% CI -3.22 to -1.97). The cumulative MME was significantly higher in the control group than in the treatment group (p<0.01), and MME was positively correlated with changes in VAS over 24 hours (R² for control and treatment groups were 0.33 and 0.31, respectively). Differences were also observed in the change of IPSS and its storage subscore between groups (p<0.01). The 5-Point Likert Scale for willingness to use the catheter was significantly higher in the treatment group than in the control group (p<0.01).

Conclusion: Our findings indicate that the novel catheter provides early pain control, reduces postoperative analgesic needs and lessens storage symptoms after catheter removal, improving patient satisfaction.

Background: Methadone is commonly used as an alternative to other opioids for managing cancer-related pain. High-dose methadone, primarily in opioid dependence treatment, has been associated with QTc prolongation and dangerous arrhythmias. The cardiovascular effects of methadone at lower doses, as used in cancer pain management, remain less well characterized.

Methods: We conducted a retrospective chart review of 492 adult patients who received methadone for cancer-related pain management. For each patient, we collected demographic and clinical data, including age, sex, cancer diagnosis, initial methadone dosage, adjuvant medications, and comorbidities. QTc interval measurements were extracted from ECGs performed at baseline (within 12 months prior to methadone initiation) and at follow-up intervals of 0-6 months, 6-12 months, and ≥12 months after initiation.

Results: The linear mixed-effects model shows a statistically significant increase in QTc interval by 4.36 ms at ≥12 months after methadone initiation. The prevalence of cardiac comorbidities was associated with a statistically significant increase in QTc by 9.40 ms. No other timeframe, demographic characteristic, or clinical characteristic that we investigated was associated with a statistically significant change in QTc. The overall proportion of patients with QTc prolongation increased modestly from 3% at baseline to 6.8% after 12 months following the initiation of methadone.

Conclusion: In this large retrospective cohort of oncology patients receiving methadone for pain management, methadone was associated with a small but statistically significant increase in QTc interval ≥12 months after starting therapy, with a mean increase of approximately 4 ms. This magnitude of QTc change is unlikely to produce meaningful clinical manifestations for most patients. These findings support the low risk of QTc prolongation for most patients with cancer taking methadone and encourage a risk-stratified approach to methadone use in cancer pain with targeted ECG monitoring regimens for patients with elevated baseline QTc or underlying cardiac disease.

Background: The external oblique intercostal (EOI) block has been reported to provide analgesia for the anterior and lateral upper abdominal walls. However, the anatomical distribution of the injectate after the EOI block has not been well established. This pilot cadaveric study aimed to evaluate the spread of dye following an ultrasound-guided EOI block.

Methods: Ultrasound-guided EOI injections (n=8) were performed bilaterally on four soft-embalmed Thiel cadavers. Thirty milliliters of water-soluble dye was injected into the plane beneath the external oblique muscle at the sixth intercostal space between the midclavicular and anterior axillary lines. The cadavers were subsequently dissected to assess the dye spread.

Results: In all injections, the spread of the dye into the interspace between the rectus abdominis and the costal cartilage was restricted at the transformation of the external oblique fascia into the aponeurosis and at the costal arch. Consequently, the anterior branches of the thoracoabdominal nerves were not stained. The anteroposterior spread was consistent between the midclavicular and midaxillary lines, but anterior spread beyond the midclavicular line was observed in only 25% of the dissections.

Conclusions: In this cadaveric study, the EOI block demonstrated limited anterior spread, and the anterior branches of the thoracoabdominal nerves were not involved. These findings suggest that the EOI block may not reliably provide midline sensory blockade and may have limited utility for mid-abdominal analgesia. The implications of these cadaveric findings warrant further validation in clinical studies.