Neveen A. Kohaf, Salama A. Harby, Ahmed F. Abd-Ellatief, M. A. Elsaid, N. Abdelmottaleb, T. F. A. Abd Elsalam
Background: Total hip replacement (THR) is frequently associated with intense post-surgical pain. Effective pain management is of crucial importance to improving patient's condition and increasing his/her satisfaction in the post-operative time. Objectives: This study aimed to compare the analgesic effect and safety of oxycodone and fentanyl after THR. Methods: Seventy-two cases scheduled for elective THR were included in this randomized, triple-blind trial. The patients were equally randomized into 2 groups: fentanyl group (50 ug of fentanyl) and oxycodone group (oxycodone 4 mg). Drugs were received 20 min prior to the end of the operation. Results: Post-operative visual analog scale (VAS) measurements at rest and movement at the post-anesthesia care unit (PACU) and in the ward, 2 h, 4 h, and 8 h post-operatively exhibited a significantly reduced value in the oxycodone group compared to the fentanyl group (P-value < 0.05). Time to first rescue for analgesia was delayed significantly in the oxycodone compared to the fentanyl group (P-value < 0.001). Fentanyl consumption (ug) in the 1st post-operative 12 h, 24 h, and 48 h decreased significantly in the oxycodone group compared to the fentanyl group (P-value < 0.001). Post-operative nausea, vomiting, headache, and pruritus were matched between the 2 groups (P > 0.05). Conclusions: A bolus dose of 4 mg of oxycodone provided superior analgesic efficacy than 50 ug fentanyl as evidenced by significantly lower pain score, delayed onset to first request for analgesia, and the smaller amount of fentanyl consumption at 12, 24, and 48 h post-total hip arthroplasty compared to fentanyl. The incidence of adverse events was comparable between the 2 groups.
{"title":"Comparison of Effectiveness and Safety of Oxycodone Hydrochloride and Fentanyl for Post-operative Pain Following Total Hip Arthroplasty: A Randomized Triple-Blind Trial","authors":"Neveen A. Kohaf, Salama A. Harby, Ahmed F. Abd-Ellatief, M. A. Elsaid, N. Abdelmottaleb, T. F. A. Abd Elsalam","doi":"10.5812/aapm-142710","DOIUrl":"https://doi.org/10.5812/aapm-142710","url":null,"abstract":"Background: Total hip replacement (THR) is frequently associated with intense post-surgical pain. Effective pain management is of crucial importance to improving patient's condition and increasing his/her satisfaction in the post-operative time. Objectives: This study aimed to compare the analgesic effect and safety of oxycodone and fentanyl after THR. Methods: Seventy-two cases scheduled for elective THR were included in this randomized, triple-blind trial. The patients were equally randomized into 2 groups: fentanyl group (50 ug of fentanyl) and oxycodone group (oxycodone 4 mg). Drugs were received 20 min prior to the end of the operation. Results: Post-operative visual analog scale (VAS) measurements at rest and movement at the post-anesthesia care unit (PACU) and in the ward, 2 h, 4 h, and 8 h post-operatively exhibited a significantly reduced value in the oxycodone group compared to the fentanyl group (P-value < 0.05). Time to first rescue for analgesia was delayed significantly in the oxycodone compared to the fentanyl group (P-value < 0.001). Fentanyl consumption (ug) in the 1st post-operative 12 h, 24 h, and 48 h decreased significantly in the oxycodone group compared to the fentanyl group (P-value < 0.001). Post-operative nausea, vomiting, headache, and pruritus were matched between the 2 groups (P > 0.05). Conclusions: A bolus dose of 4 mg of oxycodone provided superior analgesic efficacy than 50 ug fentanyl as evidenced by significantly lower pain score, delayed onset to first request for analgesia, and the smaller amount of fentanyl consumption at 12, 24, and 48 h post-total hip arthroplasty compared to fentanyl. The incidence of adverse events was comparable between the 2 groups.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"59 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139961100","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}
A. Mahmoud, Mohammed Awad Alsaied, S. Ragab, Youmna Ahmed Abdelfattah, Omer Sayed Farghaly, Mohamed Ahmed Shawky
Background: Postoperative pain management is crucial for improving patient outcomes following posterior cervical spine surgery. Opioids are effective but carry a risk of respiratory depression. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used but may not provide adequate pain relief and have potential complications. The inter-semispinalis plane (ISPB) block is a novel technique for postoperative analgesia in cervical spine surgery. Objectives: This study aims to evaluate and compare the efficacy of the ISPB with general anesthesia in terms of analgesia, postoperative Visual Analog Scale (VAS) pain scores, patient-surgeon satisfaction levels, and the occurrence of postoperative complications. Methods: This double-blind, randomized controlled trial was blinded to both the patient and the assessor. Fifty adult patients (18 - 60 years old) undergoing elective posterior cervical spine surgery were enrolled. The participants were divided into 2 groups: The ISPB group (receiving bilateral ultrasound-guided ISPB at the C5 level) and the control group (receiving general anesthesia only), with each group comprising 25 patients. The study assessed intraoperative fentanyl use, postoperative VAS pain levels, the need for rescue analgesia, and complications. Results: The ISPB group showed significantly lower intraoperative fentanyl consumption (median 100 vs. 100 - 150 μg, P = 0.022) and lower postoperative pain scores at 1, 8, 12, and 48 hours (P = 0.016, 0.009, 0.005, 0.016). Additionally, the ISPB group required less postoperative pethidine (20% vs. 64%, P = 0.002) and had a longer delay before requesting pethidine (hazard ratio 0.215, P = 0.001). Surgeon satisfaction was significantly higher in the ISPB group (P = 0.003). These results suggest that the ISPB can effectively reduce pain and analgesic requirements. Conclusions: The ISPB is an effective analgesic technique for posterior cervical spine surgery, reducing opioid consumption, providing better pain control, and enhancing surgeon satisfaction without increasing complications. This approach has the potential to improve postoperative care and patient outcomes in this surgical population.
{"title":"Inter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trial","authors":"A. Mahmoud, Mohammed Awad Alsaied, S. Ragab, Youmna Ahmed Abdelfattah, Omer Sayed Farghaly, Mohamed Ahmed Shawky","doi":"10.5812/aapm-143369","DOIUrl":"https://doi.org/10.5812/aapm-143369","url":null,"abstract":"Background: Postoperative pain management is crucial for improving patient outcomes following posterior cervical spine surgery. Opioids are effective but carry a risk of respiratory depression. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used but may not provide adequate pain relief and have potential complications. The inter-semispinalis plane (ISPB) block is a novel technique for postoperative analgesia in cervical spine surgery. Objectives: This study aims to evaluate and compare the efficacy of the ISPB with general anesthesia in terms of analgesia, postoperative Visual Analog Scale (VAS) pain scores, patient-surgeon satisfaction levels, and the occurrence of postoperative complications. Methods: This double-blind, randomized controlled trial was blinded to both the patient and the assessor. Fifty adult patients (18 - 60 years old) undergoing elective posterior cervical spine surgery were enrolled. The participants were divided into 2 groups: The ISPB group (receiving bilateral ultrasound-guided ISPB at the C5 level) and the control group (receiving general anesthesia only), with each group comprising 25 patients. The study assessed intraoperative fentanyl use, postoperative VAS pain levels, the need for rescue analgesia, and complications. Results: The ISPB group showed significantly lower intraoperative fentanyl consumption (median 100 vs. 100 - 150 μg, P = 0.022) and lower postoperative pain scores at 1, 8, 12, and 48 hours (P = 0.016, 0.009, 0.005, 0.016). Additionally, the ISPB group required less postoperative pethidine (20% vs. 64%, P = 0.002) and had a longer delay before requesting pethidine (hazard ratio 0.215, P = 0.001). Surgeon satisfaction was significantly higher in the ISPB group (P = 0.003). These results suggest that the ISPB can effectively reduce pain and analgesic requirements. Conclusions: The ISPB is an effective analgesic technique for posterior cervical spine surgery, reducing opioid consumption, providing better pain control, and enhancing surgeon satisfaction without increasing complications. This approach has the potential to improve postoperative care and patient outcomes in this surgical population.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"277 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140454733","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}
R. Mahrose, Hany Magdy Fahim, Amr A. Kasem, Mohammed Samy Helmy Sakr, M. A. Menshawi
Background: Anteromedial chest wall fascial plane blocks may serve as a valuable addition to postoperative multimodal pain management following median sternotomy for cardiothoracic surgeries. Objectives: This study aimed to evaluate the impact of implementing the pecto-intercostal fascial plane block (PIFB) in patients scheduled for off-pump coronary artery bypass (OPCAB) surgery. Methods: This randomized controlled study involved 40 adult patients aged 30 to 70 years undergoing OPCAB surgery. They were randomly assigned to two equal groups: Group PI received bilateral ultrasound (US)-guided PIFB with 20 mL of bupivacaine 0.25% with adrenaline 2.5 µg/mL, while group C (control group) received bilateral sham blocks with 20 mL of saline 0.9%. Pain scores in the postoperative period (primary outcome), perioperative analgesic consumption, time until extubation, and discharge from the intensive care unit (ICU) were assessed for both groups. Results: Postoperative pain scores, both at rest and during coughing, were significantly lower in group PI compared to group C. Group PI required significantly less fentanyl perioperatively and less tramadol for postoperative rescue compared to group C. The duration of postoperative ventilation and time to ICU discharge were significantly shorter in group PI than in group C. Conclusions: In patients undergoing OPCAB surgery, pre-incisional ultrasound-guided PIFB can be a beneficial and safe component of multimodal pain management. It provides improved postoperative pain control, reduces the need for perioperative opioids, and leads to faster extubation and ICU discharge.
背景：胸壁前内侧筋膜平面阻滞可作为心胸手术胸骨正中切开术后多模式疼痛治疗的重要补充。研究目的本研究旨在评估对计划接受体外循环冠状动脉搭桥术（OPCAB）的患者实施胸骨肋间筋膜平面阻滞（PIFB）的影响。方法：这项随机对照研究涉及 40 名接受 OPCAB 手术的 30 至 70 岁成年患者。他们被随机分配到两个相同的小组：PI 组接受 20 mL 0.25% 布比卡因加 2.5 µg/mL 肾上腺素的双侧超声（US）引导 PIFB，而 C 组（对照组）接受 20 mL 0.9% 生理盐水的双侧假阻滞。对两组患者的术后疼痛评分（主要结果）、围术期镇痛药消耗量、拔管前时间和重症监护室（ICU）出院情况进行了评估。结果与 C 组相比，PI 组围手术期所需的芬太尼显著减少，术后抢救所需的曲马多也显著减少；PI 组的术后通气时间和 ICU 出院时间显著短于 C 组：对于接受 OPCAB 手术的患者，切口前超声引导 PIFB 是多模式疼痛治疗中有益且安全的组成部分。它能改善术后疼痛控制，减少围手术期对阿片类药物的需求，并能加快拔管和 ICU 出院。
{"title":"Pecto-Intercostal Fascial Plane Block: Effect on the Postoperative Analgesia and Recovery After Off-PUMP Coronary Artery Bypass Surgery","authors":"R. Mahrose, Hany Magdy Fahim, Amr A. Kasem, Mohammed Samy Helmy Sakr, M. A. Menshawi","doi":"10.5812/aapm-144344","DOIUrl":"https://doi.org/10.5812/aapm-144344","url":null,"abstract":"Background: Anteromedial chest wall fascial plane blocks may serve as a valuable addition to postoperative multimodal pain management following median sternotomy for cardiothoracic surgeries. Objectives: This study aimed to evaluate the impact of implementing the pecto-intercostal fascial plane block (PIFB) in patients scheduled for off-pump coronary artery bypass (OPCAB) surgery. Methods: This randomized controlled study involved 40 adult patients aged 30 to 70 years undergoing OPCAB surgery. They were randomly assigned to two equal groups: Group PI received bilateral ultrasound (US)-guided PIFB with 20 mL of bupivacaine 0.25% with adrenaline 2.5 µg/mL, while group C (control group) received bilateral sham blocks with 20 mL of saline 0.9%. Pain scores in the postoperative period (primary outcome), perioperative analgesic consumption, time until extubation, and discharge from the intensive care unit (ICU) were assessed for both groups. Results: Postoperative pain scores, both at rest and during coughing, were significantly lower in group PI compared to group C. Group PI required significantly less fentanyl perioperatively and less tramadol for postoperative rescue compared to group C. The duration of postoperative ventilation and time to ICU discharge were significantly shorter in group PI than in group C. Conclusions: In patients undergoing OPCAB surgery, pre-incisional ultrasound-guided PIFB can be a beneficial and safe component of multimodal pain management. It provides improved postoperative pain control, reduces the need for perioperative opioids, and leads to faster extubation and ICU discharge.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"16 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963305","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 : 2024-01-20eCollection Date: 2023-12-01DOI: 10.5812/aapm-144495
Mahmood-Reza Alebouyeh
{"title":"Expression of Concern for \"Extracorporeal Shock Wave Therapy Versus Phonophoresis Therapy for Neck Myofascial Pain Syndrome: A Randomized Clinical Trial\" [Anesth Pain Med. 2021;11(2):e112592].","authors":"Mahmood-Reza Alebouyeh","doi":"10.5812/aapm-144495","DOIUrl":"10.5812/aapm-144495","url":null,"abstract":"","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"13 6","pages":"e144495"},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11078233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Mosaffa, M. Ghasemi, Afsaneh Habibi, R. Minaei, Narges Bazgir, Elham Memary, Alireza Shakeri
Background: Clavicle fractures account for over one-third of shoulder injuries and up to 3.3% of all fractures in adults. While the majority of these fractures can be managed non-surgically, there are instances where surgical intervention is performed. Regional anesthesia (RA) can be a preferred alternative to general anesthesia (GA) to avoid complications and high costs in this surgery. Moreover, the identification of the most optimal approach for RA remains challenging. Objectives: This study aimed to compare the efficacy of interscalene block (ISB) with and without superficial cervical plexus block (SCPB) as an anesthetic technique for clavicular fracture operation. Methods: This double-blinded, non-inferiority clinical trial was conducted on 120 patients randomly divided into 2 groups: one receiving ISB and the other receiving ISB with SCPB. The primary outcome was defined as the conversion to GA. Various factors were recorded, including surgery duration, nerve block initiation, analgesics required in the postanesthesia care unit (PACU), and sedation during surgery. Pain was evaluated using the Visual Analog Scale (VAS) in PACU. SPSS version 26 was used for statistical analysis, performing descriptive analysis, Student’s T-tests, and Mann-Whitney U tests to compare non-parametric variables between the 2 groups. Statistically significant results had a P value of less than 0.05. Results: A total of 120 patients were randomly divided into 2 equal groups, each consisting of 50 males and 10 females. The mean age of intervention and case groups were 37.23 ± 13.30 and 38.43 ± 11.95 years, respectively. After performing statistical tests (Student's t-test and Mann-Whitney U test), there was no significant difference in the initiation time of nerve block, surgery initiation time, surgery duration, the amount of required sedation, VAS scores, and meperidine consumption (P > 0.05). None of the patients in both groups required conversion to GA. Conclusions: The primary goal was achieved in all included cases, and no patients required conversion to GA. The efficacy of ISB is the same whether or not it is combined with a SCPB. Interscalene block is an alternative RA approach for clavicle fractures. Thus, ISB alone is as efficient as when used in combination with SCPB.
背景：锁骨骨折占肩部损伤的三分之一以上，占成人骨折总数的 3.3%。虽然大多数骨折可以通过非手术治疗，但也有需要进行手术干预的情况。区域麻醉（RA）可作为全身麻醉（GA）的首选，以避免手术并发症和高昂的费用。此外，确定区域麻醉的最佳方法仍具有挑战性。研究目的本研究旨在比较锁骨骨折手术中使用椎间孔阻滞（ISB）和不使用颈浅神经丛阻滞（SCPB）作为麻醉技术的效果。方法：这项双盲、非劣效临床试验将 120 名患者随机分为两组：一组接受 ISB，另一组接受带 SCPB 的 ISB。主要结果定义为转为 GA。试验记录了各种因素，包括手术持续时间、神经阻滞起始时间、麻醉后护理病房（PACU）所需的镇痛剂以及手术过程中的镇静剂。在 PACU 使用视觉模拟量表（VAS）对疼痛进行评估。统计分析采用 SPSS 26 版本，通过描述性分析、学生 T 检验和 Mann-Whitney U 检验来比较两组之间的非参数变量。具有统计学意义的结果的 P 值小于 0.05。结果共 120 名患者被随机分为 2 组，每组 50 名男性和 10 名女性。干预组和病例组的平均年龄分别为（37.23±13.30）岁和（38.43±11.95）岁。经统计学检验（学生 t 检验和 Mann-Whitney U 检验），两组患者的神经阻滞起始时间、手术起始时间、手术持续时间、所需镇静剂量、VAS 评分和甲哌啶用量均无显著差异（P > 0.05）。两组患者均无需改用 GA。结论：所有纳入的病例都达到了主要目标，没有患者需要改用 GA。无论是否结合 SCPB，ISB 的疗效都是一样的。锁骨间阻滞是治疗锁骨骨折的另一种 RA 方法。因此，单独使用 ISB 与联合使用 SCPB 的疗效相同。
{"title":"Efficacy Comparison Between Interscalene Block with and Without Superficial Cervical Plexus Block for Anesthesia in Clavicle Surgery","authors":"F. Mosaffa, M. Ghasemi, Afsaneh Habibi, R. Minaei, Narges Bazgir, Elham Memary, Alireza Shakeri","doi":"10.5812/aapm-142051","DOIUrl":"https://doi.org/10.5812/aapm-142051","url":null,"abstract":"Background: Clavicle fractures account for over one-third of shoulder injuries and up to 3.3% of all fractures in adults. While the majority of these fractures can be managed non-surgically, there are instances where surgical intervention is performed. Regional anesthesia (RA) can be a preferred alternative to general anesthesia (GA) to avoid complications and high costs in this surgery. Moreover, the identification of the most optimal approach for RA remains challenging. Objectives: This study aimed to compare the efficacy of interscalene block (ISB) with and without superficial cervical plexus block (SCPB) as an anesthetic technique for clavicular fracture operation. Methods: This double-blinded, non-inferiority clinical trial was conducted on 120 patients randomly divided into 2 groups: one receiving ISB and the other receiving ISB with SCPB. The primary outcome was defined as the conversion to GA. Various factors were recorded, including surgery duration, nerve block initiation, analgesics required in the postanesthesia care unit (PACU), and sedation during surgery. Pain was evaluated using the Visual Analog Scale (VAS) in PACU. SPSS version 26 was used for statistical analysis, performing descriptive analysis, Student’s T-tests, and Mann-Whitney U tests to compare non-parametric variables between the 2 groups. Statistically significant results had a P value of less than 0.05. Results: A total of 120 patients were randomly divided into 2 equal groups, each consisting of 50 males and 10 females. The mean age of intervention and case groups were 37.23 ± 13.30 and 38.43 ± 11.95 years, respectively. After performing statistical tests (Student's t-test and Mann-Whitney U test), there was no significant difference in the initiation time of nerve block, surgery initiation time, surgery duration, the amount of required sedation, VAS scores, and meperidine consumption (P > 0.05). None of the patients in both groups required conversion to GA. Conclusions: The primary goal was achieved in all included cases, and no patients required conversion to GA. The efficacy of ISB is the same whether or not it is combined with a SCPB. Interscalene block is an alternative RA approach for clavicle fractures. Thus, ISB alone is as efficient as when used in combination with SCPB.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140502253","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}
Sanaz Beig Zali, Rachel Steinhorn, Vivian Hu, Linda Hung, Francis McGovern, Farbod Alinezhad, Tammer Yamany, Thomas Anthony Anderson, A. Sabouri
Background: Poorly managed postoperative pain can prolong hospital stays and increase the risk of complications in patients undergoing open radical cystectomy (ORC). Despite strong support from the clinical guidelines for using surgical site-specific peripheral regional anesthetic techniques and neuraxial analgesia, their effects on postoperative outcomes are unclear. Objectives: This study aims to fill the above knowledge gap by comparing thoracic epidural analgesia (TEA) and continuous transversus abdominis plane (CTAP) blocks in ORC patients. Methods: In this retrospective observational study, we conducted chart reviews at a quaternary care academic hospital in Boston, Massachusetts, between March 2015 and September 2017. Patients undergoing ORC and receiving either CTAP or TEA were included. The primary outcome was the hospital length of stay (HLOS), and secondary outcomes included time until ambulation, postoperative narcotic usage, and renal function as measured by the glomerular filtration rate (GFR). Results: We studied 146 patients, 124 of whom met our inclusion criteria. Patients receiving CTAP had a 17.4% reduction in HLOS (95% CI: 3.2, 29.4; P = 0.02) and a 13.9% reduction in time until ambulation (95% CI: 3.4, 23.3; P = 0.01) compared to those receiving TEA. This was equivalent to a relative decrease in HLOS of approximately 2.1 days in the CTAP group as compared to the TEA group. No significant differences were observed in narcotic usage or GFR between the two groups. Our sensitivity analyses using instrumental variables analysis yielded similar results. Conclusions: Continuous transversus abdominis plane was associated with a shorter HLOS and quicker time to ambulate compared to TEA, without affecting narcotic usage or renal function. These findings suggest that CTAP may be a viable alternative to TEA for perioperative analgesia in ORC patients. Further research is needed to confirm these findings.
{"title":"A Continuous Transversus Abdominis Plane Block Decreases Hospital Length of Stay Compared to Thoracic Epidural Analgesia After Open Radical Cystectomy Surgery: A Retrospective Study","authors":"Sanaz Beig Zali, Rachel Steinhorn, Vivian Hu, Linda Hung, Francis McGovern, Farbod Alinezhad, Tammer Yamany, Thomas Anthony Anderson, A. Sabouri","doi":"10.5812/aapm-143354","DOIUrl":"https://doi.org/10.5812/aapm-143354","url":null,"abstract":"Background: Poorly managed postoperative pain can prolong hospital stays and increase the risk of complications in patients undergoing open radical cystectomy (ORC). Despite strong support from the clinical guidelines for using surgical site-specific peripheral regional anesthetic techniques and neuraxial analgesia, their effects on postoperative outcomes are unclear. Objectives: This study aims to fill the above knowledge gap by comparing thoracic epidural analgesia (TEA) and continuous transversus abdominis plane (CTAP) blocks in ORC patients. Methods: In this retrospective observational study, we conducted chart reviews at a quaternary care academic hospital in Boston, Massachusetts, between March 2015 and September 2017. Patients undergoing ORC and receiving either CTAP or TEA were included. The primary outcome was the hospital length of stay (HLOS), and secondary outcomes included time until ambulation, postoperative narcotic usage, and renal function as measured by the glomerular filtration rate (GFR). Results: We studied 146 patients, 124 of whom met our inclusion criteria. Patients receiving CTAP had a 17.4% reduction in HLOS (95% CI: 3.2, 29.4; P = 0.02) and a 13.9% reduction in time until ambulation (95% CI: 3.4, 23.3; P = 0.01) compared to those receiving TEA. This was equivalent to a relative decrease in HLOS of approximately 2.1 days in the CTAP group as compared to the TEA group. No significant differences were observed in narcotic usage or GFR between the two groups. Our sensitivity analyses using instrumental variables analysis yielded similar results. Conclusions: Continuous transversus abdominis plane was associated with a shorter HLOS and quicker time to ambulate compared to TEA, without affecting narcotic usage or renal function. These findings suggest that CTAP may be a viable alternative to TEA for perioperative analgesia in ORC patients. Further research is needed to confirm these findings.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"31 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140505298","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}
Hesham Elsayed Elashry, Mohamed Abdelbadie, Abeer Ali Elshabacy, Omnia Ali Elmiseery
Background: Appropriate pain management promotes immediate mobilization and allows the parturient to adequately care for her neonate after cesarean section (CS). Objectives: This trial objective was to compare the type III and type II quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) regarding postoperative analgesic effect in CS. Methods: This randomized, controlled, single-blind trial involved 60 women presenting for CS under spinal anesthesia. The patients were assigned randomly to either the QLB type III, QLB type II, or lateral TAPB group. All blocks were performed using 20 mL of bupivacaine 0.25% bilaterally at the end of the operation with ultrasound guidance. Pain was assessed using the numerical rating scale (NRS) score at the post-anesthesia care unit (PACU) at 2, 4, 6, 8, 12, 18, and 24 hours. The level of patient satisfaction was graded on a 5-point Likert scale. Results: Numerical rating scale measurements at 6, 8, and 12 hours and total consumed meperidine in the 1st 24 hours after the operation were reduced significantly in QLB III than in QLB II and TAPB groups (P < 0.05) with an insignificant difference between the QLB II and TAPB groups (P > 0.05). The onset of the first request for analgesia was delayed significantly in QLB III, compared to QLB II and TAPB groups (P < 0.05), without a significant difference between the QLB II and TAPB groups (P > 0.05). Patient satisfaction and adverse events (e.g., postoperative nausea and vomiting, bradycardia, and hypotension) exhibited insignificant differences among the three groups (P > 0.05). Conclusions: The QLB type III ensured better analgesia as evidenced by significantly lower pain measurements and amount of meperidine in the first 24 hours after the operation with delayed time of the first rescue analgesia in comparison to QLB II and TAPB; however, QLB II and TAPB were similar.
背景：适当的疼痛管理可促进产妇立即恢复活动能力，并使其在剖宫产术（CS）后能够充分照顾新生儿。试验目的本试验旨在比较 III 型和 II 型腰方肌阻滞（QLB）与腹横肌平面阻滞（TAPB）对 CS 术后镇痛效果的影响。方法：这项随机对照单盲试验涉及 60 名在脊髓麻醉下接受 CS 的女性患者。患者被随机分配到 QLB III 型、QLB II 型或侧位 TAPB 组。所有阻滞都是在手术结束后，在超声引导下使用 20 mL 0.25% 布比卡因进行的。在麻醉后护理病房（PACU），分别于 2、4、6、8、12、18 和 24 小时使用数字评分量表（NRS）对疼痛进行评估。患者满意度采用李克特五点量表评分。结果：QLB III 组在术后 6、8 和 12 小时的数字评分量表测量值和术后 24 小时的甲哌啶总消耗量显著低于 QLB II 组和 TAPB 组（P < 0.05），QLB II 组和 TAPB 组之间的差异不显著（P > 0.05）。与 QLB II 组和 TAPB 组相比，QLB III 组首次要求镇痛的时间明显推迟（P < 0.05），QLB II 组和 TAPB 组之间的差异不显著（P > 0.05）。患者满意度和不良事件（如术后恶心和呕吐、心动过缓和低血压）在三组之间的差异不明显（P > 0.05）。结论：与 QLB II 型和 TAPB 型相比，QLB II 型和 TAPB 型在术后 24 小时内的疼痛测量值和甲哌丁用量明显降低，首次镇痛抢救时间也有所延迟，这证明 QLB III 型能确保更好的镇痛效果；不过，QLB II 型和 TAPB 型的镇痛效果相似。
{"title":"Analgesic Effect of Quadratus Lumborum Block Type III and Type II Versus Lateral Transversus Abdominis Plane Block in Cesarean Section: A Randomized Controlled Multicenter Trial","authors":"Hesham Elsayed Elashry, Mohamed Abdelbadie, Abeer Ali Elshabacy, Omnia Ali Elmiseery","doi":"10.5812/aapm-140464","DOIUrl":"https://doi.org/10.5812/aapm-140464","url":null,"abstract":"Background: Appropriate pain management promotes immediate mobilization and allows the parturient to adequately care for her neonate after cesarean section (CS). Objectives: This trial objective was to compare the type III and type II quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) regarding postoperative analgesic effect in CS. Methods: This randomized, controlled, single-blind trial involved 60 women presenting for CS under spinal anesthesia. The patients were assigned randomly to either the QLB type III, QLB type II, or lateral TAPB group. All blocks were performed using 20 mL of bupivacaine 0.25% bilaterally at the end of the operation with ultrasound guidance. Pain was assessed using the numerical rating scale (NRS) score at the post-anesthesia care unit (PACU) at 2, 4, 6, 8, 12, 18, and 24 hours. The level of patient satisfaction was graded on a 5-point Likert scale. Results: Numerical rating scale measurements at 6, 8, and 12 hours and total consumed meperidine in the 1st 24 hours after the operation were reduced significantly in QLB III than in QLB II and TAPB groups (P < 0.05) with an insignificant difference between the QLB II and TAPB groups (P > 0.05). The onset of the first request for analgesia was delayed significantly in QLB III, compared to QLB II and TAPB groups (P < 0.05), without a significant difference between the QLB II and TAPB groups (P > 0.05). Patient satisfaction and adverse events (e.g., postoperative nausea and vomiting, bradycardia, and hypotension) exhibited insignificant differences among the three groups (P > 0.05). Conclusions: The QLB type III ensured better analgesia as evidenced by significantly lower pain measurements and amount of meperidine in the first 24 hours after the operation with delayed time of the first rescue analgesia in comparison to QLB II and TAPB; however, QLB II and TAPB were similar.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"105 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140505018","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}
Pooya Derakhshan, N. Nikoubakht, M. Alimian, Sadaf Mohammadi
Background: Tracheal intubation is a common technique used to secure a patient’s airway, which is crucial in anesthesia. Successful tracheal intubation depends on various factors, including the assessment of the patient’s airway before the procedure. In recent years, scoring systems, such as LEMON (an acronym for the assessment of the airway’s appearance, identification of any dental issues, evaluation of Mallampati classification, assessment of airway obstruction, and examination of neck mobility) and intubation difficulty scale (IDS) have gained attention. This study aimed to investigate the relationship between the LEMON criteria and IDS in tracheal intubation. The goal was to provide valuable insights that can assist medical professionals in optimizing their approach to airway management by analyzing clinical data, assessing patient outcomes, and evaluating the consistency between these scoring systems. Methods: This study was based on a descriptive-analytical study involving a group of patients requiring intubation. This study examined 105 patients scheduled for elective surgeries, aged between 19 and 60 years, without specific underlying diseases, such as laryngeal cancer, temporomandibular joint stiffness, or significant tongue enlargement, and with a body mass index (BMI) below 40 kg/m². Initially, expert anesthesiologists assessed the patients using the LEMON criteria, and then the degree of intubation difficulty was measured using the IDS scoring system. Finally, these two criteria were compared. Results: In this study, there was a significant correlation between the LEMON score and the IDS score (P < 0.001). The difficult intubation group (IDS score higher than 0) had higher LEMON scores (with the highest score equal to 4) than the non-difficult intubation group (IDS score of 0) (P = 0.017). The average LEMON and IDS scores were 3.11 and 1.35, respectively. Among the participants, 96.2% had an intubation difficulty score of ≤ 5; nevertheless, 3.8% had a score of > 5. Additionally, limited neck mobility emerged as the sole independent predictor of intubation difficulty (P = 0.002, odds ratio = 6.152). Conclusions: The LEMON score is associated with difficult intubation in adult patients requiring intubation.
{"title":"Relationship Between Airway Examination with LEMON Criteria and Difficulty of Tracheal Intubation with IDS Criteria","authors":"Pooya Derakhshan, N. Nikoubakht, M. Alimian, Sadaf Mohammadi","doi":"10.5812/aapm-142921","DOIUrl":"https://doi.org/10.5812/aapm-142921","url":null,"abstract":"Background: Tracheal intubation is a common technique used to secure a patient’s airway, which is crucial in anesthesia. Successful tracheal intubation depends on various factors, including the assessment of the patient’s airway before the procedure. In recent years, scoring systems, such as LEMON (an acronym for the assessment of the airway’s appearance, identification of any dental issues, evaluation of Mallampati classification, assessment of airway obstruction, and examination of neck mobility) and intubation difficulty scale (IDS) have gained attention. This study aimed to investigate the relationship between the LEMON criteria and IDS in tracheal intubation. The goal was to provide valuable insights that can assist medical professionals in optimizing their approach to airway management by analyzing clinical data, assessing patient outcomes, and evaluating the consistency between these scoring systems. Methods: This study was based on a descriptive-analytical study involving a group of patients requiring intubation. This study examined 105 patients scheduled for elective surgeries, aged between 19 and 60 years, without specific underlying diseases, such as laryngeal cancer, temporomandibular joint stiffness, or significant tongue enlargement, and with a body mass index (BMI) below 40 kg/m². Initially, expert anesthesiologists assessed the patients using the LEMON criteria, and then the degree of intubation difficulty was measured using the IDS scoring system. Finally, these two criteria were compared. Results: In this study, there was a significant correlation between the LEMON score and the IDS score (P < 0.001). The difficult intubation group (IDS score higher than 0) had higher LEMON scores (with the highest score equal to 4) than the non-difficult intubation group (IDS score of 0) (P = 0.017). The average LEMON and IDS scores were 3.11 and 1.35, respectively. Among the participants, 96.2% had an intubation difficulty score of ≤ 5; nevertheless, 3.8% had a score of > 5. Additionally, limited neck mobility emerged as the sole independent predictor of intubation difficulty (P = 0.002, odds ratio = 6.152). Conclusions: The LEMON score is associated with difficult intubation in adult patients requiring intubation.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"40 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140505841","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}
Alaa Ali M. Elzohry, A. S. Hegab, Osama Yehia A. Khalifa, Khadeja M. Elhossieny, F. A. Z. H. Abdel Hameed
Background: Thoracic segmental spinal anesthesia (SA) may be a good alternative to general anesthesia (GA) for abdominal operations and laparoscopic procedures, especially in high-risk patients. Objectives: The aim of this study was to investigate the safety and efficacy of thoracic segmental SA vs GA during abdominal operations and laparoscopic procedures. Methods: This study was conducted at our university hospital and involved a total of 46 patients who underwent abdominal operations and laparoscopic procedures. The study period spanned from January 15, 2022, to October 15, 2022. Patients were divided into 2 groups: Group 1 (n = 23) received standard GA, and group 2 (n = 23) received thoracic segmental SA. A combination of 10 mg of hyperbaric bupivacaine 0.5% and 25 μg of fentanyl was injected through the spinal needle. The epidural catheter was then threaded through the Tuohy needle after withdrawal of the spinal needle to keep only 4 cm up in the epidural space. Demographic data, both intra and postoperative hemodynamic parameters, were monitored. Postoperatively, pain in both groups was treated with intravenous (IV) morphine by patient controlled analgesia (PCA), PCA settings were 1 mg morphine/mL, no background infusion, bolus dose 2 mL and lockout interval 15 min. Postoperative, both resting VAS and VAS during cough were measured for all patients at fixed intervals, and all patients were followed up for postoperative complications. Results: No significant variation was found in demographic data. Intra and postoperative mean arterial pressure (MAP) and heart rate (HR) measurements were higher in group 1 than in group 2 but without a statistically significant difference (P < 0.029). Early postoperative VAS values and discharge time from the postanesthesia care unit (PACU) were significantly reduced in group 2 than in group 1 (P < 0.001). The number of patients asked for analgesia and total opioid consumption were substantially reduced in group 2 than in group 1. Also, the time of the first analgesia request and patient satisfaction were substantially greater in group 2 than in group 1. Conclusions: Combined thoracic spinal/epidural block results in stable hemodynamics, longer postoperative analgesia with fewer side effects, and greater surgeon and patient satisfaction in patients undergoing abdominal operations and laparoscopic procedures.
{"title":"Safety and Efficacy of Ultrasound-Guided Combined Segmental Thoracic Spinal Epidural Anesthesia in Abdominal Surgeries and Laparoscopic Procedures: A Prospective Randomized Clinical Study","authors":"Alaa Ali M. Elzohry, A. S. Hegab, Osama Yehia A. Khalifa, Khadeja M. Elhossieny, F. A. Z. H. Abdel Hameed","doi":"10.5812/aapm-138825","DOIUrl":"https://doi.org/10.5812/aapm-138825","url":null,"abstract":"Background: Thoracic segmental spinal anesthesia (SA) may be a good alternative to general anesthesia (GA) for abdominal operations and laparoscopic procedures, especially in high-risk patients. Objectives: The aim of this study was to investigate the safety and efficacy of thoracic segmental SA vs GA during abdominal operations and laparoscopic procedures. Methods: This study was conducted at our university hospital and involved a total of 46 patients who underwent abdominal operations and laparoscopic procedures. The study period spanned from January 15, 2022, to October 15, 2022. Patients were divided into 2 groups: Group 1 (n = 23) received standard GA, and group 2 (n = 23) received thoracic segmental SA. A combination of 10 mg of hyperbaric bupivacaine 0.5% and 25 μg of fentanyl was injected through the spinal needle. The epidural catheter was then threaded through the Tuohy needle after withdrawal of the spinal needle to keep only 4 cm up in the epidural space. Demographic data, both intra and postoperative hemodynamic parameters, were monitored. Postoperatively, pain in both groups was treated with intravenous (IV) morphine by patient controlled analgesia (PCA), PCA settings were 1 mg morphine/mL, no background infusion, bolus dose 2 mL and lockout interval 15 min. Postoperative, both resting VAS and VAS during cough were measured for all patients at fixed intervals, and all patients were followed up for postoperative complications. Results: No significant variation was found in demographic data. Intra and postoperative mean arterial pressure (MAP) and heart rate (HR) measurements were higher in group 1 than in group 2 but without a statistically significant difference (P < 0.029). Early postoperative VAS values and discharge time from the postanesthesia care unit (PACU) were significantly reduced in group 2 than in group 1 (P < 0.001). The number of patients asked for analgesia and total opioid consumption were substantially reduced in group 2 than in group 1. Also, the time of the first analgesia request and patient satisfaction were substantially greater in group 2 than in group 1. Conclusions: Combined thoracic spinal/epidural block results in stable hemodynamics, longer postoperative analgesia with fewer side effects, and greater surgeon and patient satisfaction in patients undergoing abdominal operations and laparoscopic procedures.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"45 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140508981","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}
Introduction: PHACES syndrome is a neurocutaneous syndrome that consists of posterior fossa brain malformation, hemangiomas of the face, arterial cerebrovascular malformation, cardiovascular anomalies (Coarctation of the aorta), eye anomaly, and sternal defect or supraumbilical raphe. Most of these manifestations would interfere with anesthesia and hence need major considerations.
Case presentation: A 2.5-month-old female weighing 2100 gr was a candidate for laser therapy due to retinopathy of prematurity. She was diagnosed with PHACES syndrome. Her anesthesia was induced and maintained with sevoflurane. LMA #1 was used for airway management. No complications occurred during or after anesthesia, and she was discharged the next day.
Conclusions: PHACES syndrome interacts with numerous anesthesia-related characteristics, such as airway management, cardiovascular disease, and CNS malformations. Based on the accompanying characteristics, perioperative care for these patients should be tailored.
{"title":"Facing PHACES Syndrome; Anesthesiologist's Point of View.","authors":"Dariush Abtahi, Alireza Shakeri, Ardeshir Tajbakhsh","doi":"10.5812/aapm-141896","DOIUrl":"10.5812/aapm-141896","url":null,"abstract":"<p><strong>Introduction: </strong>PHACES syndrome is a neurocutaneous syndrome that consists of posterior fossa brain malformation, hemangiomas of the face, arterial cerebrovascular malformation, cardiovascular anomalies (Coarctation of the aorta), eye anomaly, and sternal defect or supraumbilical raphe. Most of these manifestations would interfere with anesthesia and hence need major considerations.</p><p><strong>Case presentation: </strong>A 2.5-month-old female weighing 2100 gr was a candidate for laser therapy due to retinopathy of prematurity. She was diagnosed with PHACES syndrome. Her anesthesia was induced and maintained with sevoflurane. LMA #1 was used for airway management. No complications occurred during or after anesthesia, and she was discharged the next day.</p><p><strong>Conclusions: </strong>PHACES syndrome interacts with numerous anesthesia-related characteristics, such as airway management, cardiovascular disease, and CNS malformations. Based on the accompanying characteristics, perioperative care for these patients should be tailored.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"13 6","pages":"e141896"},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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