Anesthesiology and Pain Medicine最新文献

Background: Postoperative analgesia is of utmost importance in the treatment of patients undergoing surgery. Good postoperative pain management reduces hospital stay and improves early ambulation. This study compared the efficacy of epidural bupivacaine with buprenorphine to butorphanol in lower limb orthopedic surgery.

Objectives: This study was carried out to investigate the onset of analgesia, the extent of analgesia, sedation score, and side effects of butorphanol with bupivacaine versus buprenorphine with bupivacaine.

Methods: In a clinical trial study, 100 patients who underwent elective orthopedic lower limb surgery were randomly allocated to two groups. A total of 100 patients with American Society of anesthesiologists grades I and II posted for lower limb orthopedic surgery were enrolled in this randomized, double-blind study. The patients were divided into groups A and B. Subarachnoid block was achieved with 3.4 mL of 0.5% bupivacaine. The pain was monitored by the visual analog scale postoperatively. The patients in group A received bupivacaine with buprenorphine, and group B received bupivacaine with butorphanol when they complained of pain in the postoperative period. The onset of analgesia, duration of analgesia, sedation score, and side effects were compared between the two groups.

Results: The onset of analgesia was observed earlier in group A than in group B (7.7 ± 1.6 vs. 12.6 ± 1.7 minutes, P < 0.001). The duration of analgesia was longer in group A than in group B (590 ± 40 vs. 480 ± 54 minutes, P < 0.001). Pulse rates and mean arterial pressures were significantly different (P < 0.001). Side effects were common in both groups.

Conclusions: Buprenorphine added to bupivacaine provides earlier onset and longer postoperative epidural analgesia than epidural butorphanol with bupivacaine.

Introduction: Painful diabetic polyneuropathy (P-DPN) occurs in 20% - 30% of diabetic patients. Currently, therapeutic strategies include lifestyle modifications, good glycemic control, and neuropathic pain drugs. Spinal cord stimulation (SCS) has been shown to be successful in patients who have not responded to other treatments. The American Diabetes Association strongly recommends early screening and diagnosis for this condition through clinical tests and nerve conduction study (NCS). In recent years, high-resolution ultrasonography (HRUS) with the analysis of cross-sectional area (CSA) has shown an increasingly important role in detecting changes in the nervous structures, blood vessels, echo, and mobility of the nerve. Cross-sectional area is frequently enlarged in these patients, even those with normal NCS. We aimed to use SCS with fast-acting sub-perception therapy (FAST) modality to treat P-DPN. We also evaluated the CSA of the involved nerves before and after treatment.

Case presentation: A 58-year-old female patient was referred to our hospital in 2020 (Civitavecchia, Italy). She suffered from P-DPN for 3 years and did not respond to conventional medical treatments. Preoperative electromyography (EMG) was negative for radiculopathy, while electroneurography (ENG) showed a reduction in sensory conduction velocity (SCV) in the sural nerve (SN) bilaterally. Clinical tests on perceived pain and quality of life showed high severity. The report was confirmed by HRUS with enlargement of the CSA of the posterior tibial nerve (PTN), external popliteal nerve (EPN), and SN. The patient was successfully subjected to all-in-one SCS implantation in the FAST modality. She obtained immediate pain relief that remained unaltered at the 3-month follow-up. The patient completely discontinued drug therapy. One month after implantation, ENG highlighted an increased SN SCV, and the HRUS of PTN EPN and SN showed a significant reduction in CSA in all 3 nerves involved.

Conclusions: Early diagnosis and treatment are crucial in improving the clinical outcome of P-DPN, but there is still no gold standard therapy. Spinal cord stimulation in the new FAST modality was effective in this clinical case. The pain relief was supported by a significant reduction in the CSA of the studied nerves observed on HRUS 1 month after SCS implantation. The results and the improvement of a pathological nervous pattern, albeit with a short follow-up of only 3 months, could suggest not only a symptomatic but perhaps also a therapeutic role of SCS in P-DPN.

Background: Surgery and anesthesia are associated with increased patient anxiety. Perioperative anxiety is a common problem in regional anesthesia procedures and has an extensive impact. Immersive virtual reality (IVR) is a potential non-pharmacological distraction method to reduce anxiety. Immersive virtual reality creates a virtual environment that allows patients to interact and immerse in the virtual world, reducing patient anxiety.

Objectives: This study aimed to examine the effect of IVR on the anxiety of patients undergoing regional anesthetic surgery.

Methods: A total of 30 participants referred to Dr. Kariadi General Hospital (Indonesia) from October 2021 to December 2021 were enrolled in this randomized, single-blind clinical trial. The patients were divided into virtual reality (VR) and control groups (n = 15 in each group). The control group received midazolam (0.02 mg/kg) as premedication. The VR group received an IVR intervention without premedication. The data of anxiety scores were assessed using the Spielberger State-Trait Anxiety Inventory 6 (STAI-6). This study also collected vital signs, side effects, and patient and surgeon satisfaction level data.

Results: The average anxiety level during surgery in the operating room decreased in both groups (P < 0.05); the VR group had a lower score (P = 0.04). A significant reduction in perioperative anxiety levels was observed in the VR group compared to the control group. The patient satisfaction level was also significantly higher in the VR group than in the control group (P = 0.024). Both groups had no significant difference in monitored vital signs, side effects, and surgeon satisfaction.

Conclusions: The IVR intervention could reduce anxiety in patients undergoing surgery under regional anesthesia and improve patient satisfaction.

Background: Uncontrolled elevation of intraoperative blood pressure can result in deleterious effects with increased risk of morbidity and mortality.

Objectives: We aimed to compare nitroglycerine infusion with dexmedetomidine infusion in controlling accidental intraoperative uncontrolled hypertension.

Methods: This comparative study was conducted on 73 hypertensive patients undergoing cancer surgeries who experienced uncontrolled intraoperative hypertension. The data of 38 patients were retrieved from the medical records for the nitroglycerine group and 35 patients were prospectively enrolled for the dexmedetomidine group. Group N received nitroglycerine infusion (0.3 - 1 µg/kg/min), while group D received dexmedetomidine infusion (0.2 - 0.7 µg/kg/h).

Results: Both groups were comparable regarding their demographic data and clinical characteristics. Systolic, diastolic, and mean arterial pressure (MAP) values were significantly lower in group N compared to group D during the period between 60 and 120 minutes intraoperatively (P < 0.001). Heart rate values were significantly lower in group D than in group N (P < 0.001). Postoperative sedation scores were better for group D with lower analgesic requirements (P < 0.001).

Conclusions: Dexmedetomidine infusion can be used to manage the uncontrolled intraoperative elevation of blood pressure in selected patient population.

Background: Magnetic resonance imaging (MRI) is highly sensitive to motion, resulting in artifacts and lowering image quality. Laryngeal mask airway (LMA) provides numerous advantages over endotracheal tubes as it reduces laryngospasm, coughing, and the risk of postoperative desaturation.

Objectives: We aimed to compare LMA with oral airway for airway management during brain MRI in terms of reducing motion artifacts, which can improve image quality.

Methods: This randomized, controlled, double-blind trial was carried out on 40 pediatrics aged 1 - 18 years, American Society of Anesthesiologists (ASA) physical status І and П undergoing brain MRI. Patients were randomized into two equal groups according to the airway method, the control (Guedel oral airway) group and the LMA group. A compatible anesthesia machine was used to provide O₂ and sevoflurane 2% - 4%.

Results: The mean MRI image quality score was significantly higher in the LMA group than in the control group (26.10 ± 3.97 versus 18.60 ± 5.30, P < 0.001). Mean arterial blood pressure and heart rate were significantly lower in the LMA group than in the control group at all study times except at baseline and immediate post-extubation (P < 0.05). Cough was significantly lower in LMA than in the control group (15% vs. 50%, P = 0.040). Airway complications (sore throat, laryngeal spasm, and bronchospasm), nausea, and vomiting did not have a significantly different between the two groups.

Conclusions: Compared to Guedel oral airway, using LMA for airway management in pediatrics undergoing MRI scans improved the image quality with less cough and better hemodynamics.

Background: Cardiac index (CI) and metabolic response to surgery are important indicators of the course of the intraoperative period.

Objectives: This study aimed to determine the effect of sevoflurane, isoflurane, and propofol on CI and metabolic outcomes during aortic and mitral valve replacement in adults.

Methods: In this single-center prospective randomized controlled clinical study, a total of 75 patients were randomly assigned into 3 groups according to the type of anesthesia: The propofol group (n = 25), the sevoflurane group (n = 25), and the isoflurane group (n = 25). Cardiac stroke volume (SV) was determined by intraesophageal echocardiography (SV = end-diastolic volume - end-systolic volume). Cardiac output (CO) and CI were calculated according to the formulas. Oxygen consumption during surgery = CI × arteriovenous difference. Indirect calorimetry was used to determine energy expenditure during anesthesia using a spirometry device.

Results: The use of anesthetics did not change CI. Cardiac index decreased from 3 to 2.9 L/min/m² in the propofol group, increased from 3.1 to 3.2 L/min/m² in the sevoflurane group, and decreased from 2.9 to 2.7 L/min/m² in the isoflurane group. Compared to inhaled anesthetics, propofol significantly reduced VO₂ from 179.1 to 135.7 mL/min/m². Propofol reduced energy expenditure from 1483.7 to 1333.5 kcal.

Conclusions: Volatile anesthetics, propofol has practically no effect on CI in an uncomplicated surgery. Anesthesia with propofol is associated with lower VO₂ and better oxygen delivery to tissues. Energy consumption during propofol anesthesia decreases.

Background: Recently, increased attention has been paid to calcitonin for the management of osteoarthritis (OA) regarding its metabolic properties for bone turnover and cartilage.

Objectives: This study was designed to assess the efficacy of intramuscular calcitonin injection in the functional status of individuals suffering from knee OA.

Methods: A total of 40 eligible cases with OA were randomly assigned into intervention and control groups. At baseline, pain intensity and functional ability were evaluated based on the Numeric Rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. Both groups were prescribed with AcetaGel (500 mg) and piroxicam (0.5% topical gel) every 8 hours as needed, and the patients were instructed about conservative treatments and lifestyle modifications. In the case group, the patients received calcitonin (50 IU/mL solution for injection; Aburaihan Pharmaceutical Co., Iran) intramuscularly (gluteal muscle) once a week for 4 consecutive weeks. One month after the last dose, the patients were evaluated based on NRS and WOMAC questionnaires.

Results: Demographic data did not show any statistically significant difference. A total of 40 cases (male and female) with mean age values of 53.10 ± 5.28 and 54.55 ± 5.26 years were included in the case and control groups, respectively. The mean body mass index values of the case and control groups were 27.45 ± 1.57 and 27.15 ± 1.53 kg/m², respectively. After 1 month of treatment with calcitonin, significant improvements were observed in NRS outcomes (P < 0.001). The total WOMAC score was also statistically improved (P < 0.001).

Conclusions: The findings of the present study revealed that the weekly administration of 50 IU calcitonin for 28 days could significantly improve physical ability and pain intensity in OA patients.

Background: Transversus abdominis plane (TAP) block is one of the novel approaches and an effective method for providing postoperative analgesia in patients undergoing lower abdominal surgeries.

Objectives: To evaluate the efficacy and routine usage of TAP block for postoperative analgesia in different lower abdominal surgeries.

Methods: It is a randomized, double-blind trial. Sixty patients undergoing lower abdominal surgeries in sub-arachnoid block with bupivicaine 0.5% were randomized to undergo TAP block (n = 30) using ropivacaine 0.375% as the study group. In the control group (n = 30), only the standard analgesic regimen (paracetamol 1 gm IV and tramadol 50 mg IV) was given. Postoperative pain was assessed using Visual Analogue Scale (VAS) at 30 min and 4, 8, 12, 16, 20, and 24 hrs. First analgesic request after TAP block was compared with a subsequent number of analgesics given postoperatively. Rescue analgesia given postoperatively at request after TAP block was paracetamol 1 gm IV and tramadol 50 mg IV.

Results: Patients who received TAP block had a significant reduction in postoperative pain scores at 30 min - 0 (0 - 1), 4 hrs - 0 (0 - 4), 8 hrs - 4 (3 - 5), 12 hrs - 1 (0 - 4), 16 hrs - 1 (1 - 2), 20 hrs -1 (0 - 2), 24 hrs -1 (0 - 1) with P-value < 0.05 in the first 24 hrs. TAP block also delayed the first rescue analgesic request (265 ± 24 min Vs. 66 ± 15 min with P-value < 0.005) and reduction in subsequent analgesic requirements in the first 24 hrs (1.04 ± 0.26 Vs. 2.3 ± 0.48 with P-value < 0.05).

Conclusions: TAP block holds a considerable part in postoperative analgesia. Highly effective for the first 24 hrs in patients undergoing different lower abdominal surgeries, it delays the first rescue analgesic request, decreases the subsequent analgesic requirement, and augments early mobilization, discharge, and cost-effectiveness.

Background: Anemia is more common in cardiac surgery patients than in other people. Severe anemia before cardiac surgery strongly predicts blood transfusion.

Objectives: This study aimed to evaluate the outcomes of Intravenous (IV) iron and erythropoietin (EPO) injection preoperatively in anemic patients waiting for coronary artery bypass graft (CABG) surgery.

Methods: This cross-sectional study was performed between May to December 2020 at Masih Daneshvari hospital in Tehran, Iran. Anemia was described according to the WHO definition (Hb < 130 g/L in men). The study was designed in two groups of men CABG patients. Hematocrit level, platelet count, partial thromboplastin time, international normalized ratio, prothrombin time before surgery, red blood cells (RBCs) transfusion, as well as plasma and platelet units' transfusion during surgery and at the time of hospitalization were obtained from patient's files. The length of stay in the hospital and the consequences, including infection, stroke and heart attack, and mortality, were also obtained from the patient's files and recorded in the checklists. Pearson's chi-squared test, Fisher's exact test, independent samples t-test, univariate logistic regression, and odds ratio (OR) were used. All statistical analyses were performed by the SPSS software version 21. The significance level in this study was considered 0.05.

Results: In this study, the data of 64 patients were gathered, among whom 16 (25%) were injected with IV iron and EPO, and the remaining 48 (75%) did not receive any medications for stimulating erythropoiesis. The mean age of patients was 64.05 ± 8.21 years, with an age range of 51 - 91 years. Infection (P = 0.258) and mortality rate (P = 0.440) in the two groups of injection and non-injection did not show a statistically significant difference. The duration of the clamp at the time of surgery (r = 0.699, P = 0.001) and the duration of hospitalization (r = 0.399, P = 0.023) had statistically significant positive relationships with the pump duration. Red blood cell consumption in the injection and non-injection groups was 2.50 ± 2.07 and 2.90 ± 1.80 (P = 0.469), respectively.

Conclusions: Infection (P = 0.258), mortality rate (P = 0.440), and RBC utilization (P = 0.469) in the two groups of injection and non-injection were not significantly different.

Background: Nerve blocks have been one of the most common anesthetic methods for abdominal surgeries since the last four decades.

Objectives: This study aimed to compare the postoperative analgesic efficacy of bilateral ultrasound-guided quadratus lumborum block (QLB) against bilateral ultrasound-guided transversus abdominis block (TAB) and Ilioinguinal/Iliohypogastric nerve blocks (IINB) in abdominal total hysterectomy.

Methods: Sixty female patients scheduled for the surgery of total abdominal hysterectomy under spinal anesthesia participated in this randomized prospective trial. They were randomly assigned to two dual TAB / IINB (n = 30) and QLB (n = 30) groups. Moreover, the visual analog scores (VAS), the total amount of morphine consumed after surgery during the first 24 hours, the number of individuals requiring rescue analgesia, postoperative analgesia duration, and postoperative complications were recorded.

Results: Morphine consumption was equal in both groups (P = 0.908). Furthermore, the analgesia duration in the two groups was statistically insignificant (P = 0.879), with mean values of 15.4 and 15.6 hours, respectively. During 24 hours, there was no statistically significant difference in terms of VAS between the two groups (P > 0.05).

Conclusions: The QLB might be a viable replacement for TAB/IINB for postoperative analgesia after total abdominal hysterectomy.