Anesthesiology最新文献

Background: Periacetabular osteotomy (PAO) is an established treatment for symptomatic developmental hip dysplasia. Epidural analgesia is traditionally used for perioperative pain management but may have negative secondary effects, including distal motor and sensory deficits, and hypotension which delays rehabilitation and prolongs discharge. One alternative is Erector Spinae Plane Block (ESPB), an ultrasound-guided injection or catheter insertion remote to the spinal canal. Despite high success with minimal complications, ESPB use during PAO has not been studied. This study's purpose was to retrospectively evaluate the efficacy and side effect profile of ESPB compared to epidural analgesia for PAO pain control.

Methods: Patients at a single site received preoperative epidural (n=73) or ESPB (n=73) for PAO pain management. Data including pain scores, morphine equivalents, complications, and discharge details was retrospectively reviewed. Welch's t test, Glass' Delta, and Fisher exact tests were utilized, with an alpha level of 0.05 to indicate statistical significance.

Results: There were no significant differences in patient populations, catheter use duration, or length of stay between groups (p>0.05). Patients reported slightly more pain with ESPB on postoperative day 0 (4.5 [CI: 4.0,4.9]) compared to epidural (3.5 [CI: 2.9,4.0]), p=0.008. Patients who received ESPB required fewer morphine equivalents than epidural patients on postoperative day 0, postoperative day 1, and postoperative day 2 (p<0.001). The epidural cohort had more weakness (16.44%), numbness (39.73%), and symptomatic hypotension (10.96%) compared to the ESPB cohort (4.11%, 9.59%, 1.37% respectively, p=0.03, p<0.001, p=0.03). Epidural patients were more likely to report adverse events (17.81% vs 43.16%, p<0.001).

Conclusion: ESPB provides an effective method of pain control for PAO patients. Compared to lumbar epidurals, patients required less systemic opioids and reported fewer side effects, particularly numbness, symptomatic hypotension, and weakness. ESPB is an attractive option in multimodal pain protocol for PAO.

Background: Despite the frequent use of ropivacaine and bupivacaine, there is limited guidance on redosing of these medications following an initial bolus. Intermittent redosing is a clinical practice in the setting of nerve catheters, often utilizing large doses. Comparatively, theoretical elimination rates are available from pharmacokinetic studies, providing estimates on total body content of these drugs. We hypothesized that published redosing of bupivacaine and ropivacaine in clinical literature comported with safe elimination of the drugs based on pharmacokinetic studies.

Methods: Clinical redosing of bupivacaine and ropivacaine were identified from previously published manuscripts that used intermittent bolus dosing into the transversus abdominis plane and paravertebral space. The dosing data were fit to an exponential curve using least squares regression and 1/Y2 weighting with the equation : Y = YM - (YM - Y0)* e-k*x where YM is the maximal dose (175 mg for bupivacaine, 210 mg for ropivacaine), Y0 is the dose at time zero, k is the elimination constant and x is time. Both minimal (i.e. slowest) and average pharmacokinetic elimination constants for ropivacaine and bupivacaine were identified in the published literature. Clinical redosing was compared with pharmacokinetic elimination.

Results: The maximal pharmacokinetic half-lives of bupivacaine and ropivacaine were 603 minutes (range 154 - 2970 minutes, N=49) and 528 minutes (range 204 - 3276 minutes, N=39) respectively. Clinically reported redosing of bupivacaine fit to an exponential curve with kbupi(clinical) = 0.077 hrs-1 , representing the 53.5 th percentile of extracted pharmacokinetic minimal elimination constants. Clinically reported redosing of ropivacaine fit to a curve with kropi(clinical) = 0.083 hrs-1 consistent with the 52nd percentile of minimal pharmacokinetic elimination constants.

Conclusions: Clinically reported redosing of bupivacaine and ropivacaine in the published literature reflect the slowest pharmacokinetic elimination based on human studies. The combined data without evidence of toxicity permit us to make practical recommendations about safe redosing of these agents.

Background: Improving healthcare professional well-being and reducing burnout requires improving work ecosystems and cultures. Current well-being metrics focus on distal outcomes within individuals (e.g., professional fulfillment or burnout). In this study, we developed and evaluated the performance of an inventory measuring perceptions of modifiable workplace dimensions-termed influencers-that shape healthcare professionals' well-being.

Methods: A core team developed the Well-Being Influencers Survey for Healthcare (WISH), an inventory designed to measure these systemic, occupational well-being influencers (e.g., leadership support, psychological safety, working conditions). Following content validation and refinement, 223 healthcare professionals from an academic department of anesthesiology completed WISH alongside established well-being measures, including the Maslach Burnout Inventory (MBI), Professional Fulfillment Index (PFI), Perceived Stress Scale (PSS), PROMIS short forms for meaning, purpose, and life satisfaction, as well as standard items of affective commitment (AC, a measure of engagement) and a standard item assessing intention to leave (ITL). Factor analysis was used to assess WISH's internal structure, while correlation and regression analyses assessed its criterion-related validity using the above established measures.

Results: WISH showed expected relationships with established well-being measures, and outperformed established metrics in predicting AC and ITL after adjusting for those measures and/or covariates. Factor analysis indicated that most WISH variance reflects a single common factor, supporting the use of an instrument-level score. Unique variance at the influencer level highlights the added value of examining influencer scores.

Conclusions: WISH fills a key gap in healthcare professional well-being improvement science by assessing causal factors of well-being and burnout, rather than the conditions themselves. Here, we established initial validity of this unique inventory and further reinforce the relevance of system-level and cultural factors in influencing healthcare professionals' well-being. WISH is well suited to assist healthcare professional well-being improvement efforts driven by system-improvement mindsets.