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Salgado-García D, Díaz-Álvarez A, González-Rodríguez JL, López-Iglesias MR, Sánchez-López E, Sánchez-Ledesma MJ, Martínez-Trufero MI. Comparison of the Analgesic Efficacy between Levobupivacaine 0.25% and Ropivacaine 0.375% for PENG (Pericapsular Nerve Group) Block in the Context of Hip Fracture Surgery of Elderly Patients: A Single-Center, Randomized, and Controlled Clinical Trial. J Clin Med 2024; 13:770. [PMID: 38337464 PMCID: PMC10856763 DOI: 10.3390/jcm13030770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Previous studies have compared levobupivacaine versus ropivacaine in various peripheral nerve blocks in terms of block duration, quality of analgesia, and onset time, but this has not occurred in the PENG block. Here, a single-center, randomized, and controlled clinical trial is presented. One hundred and twenty patients older than 65 years suffering from hip fractures and surgically treated at our institution under spinal anesthesia were eligible for participation; of them, one hundred and eight were analyzed. Patients were randomized to receive ultrasound-guided PENG blocks using 20 mL of either 0.25% levobupivacaine or 0.375% ropivacaine (both of which are equipotent concentrations). The primary endpoint was to compare the analgesic duration (time to first rescue) and analgesic quality (pain scores using the VAS, PAINAD, and AlgoPlus scales) between the groups. Secondary endpoints included comparing the onset time, describing the need for and type of rescue analgesics, and possible associated adverse effects. There were no statistically significant differences in analgesic duration between levobupivacaine (median 861.0, IQR 960) and ropivacaine (median 1205.0, IQR 1379; p = 0.069). Likewise, the quality of analgesia and onset time were comparable among the groups. A small number of patients required opioids as rescue analgesics (4.6%). The possible associated adverse effects included postoperative infection (11.1%) and delirium (2.8%).
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Affiliation(s)
- Daniel Salgado-García
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
| | - Agustín Díaz-Álvarez
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
- Department of Surgery, Faculty of Medicine, Salamanca University, Calle Alfonso X el Sabio, 37007 Salamanca, Castilla y León, Spain
- Instituto de Investigación Biomédica de Salamanca de la FIESCYL (IBSAL-FIESCYL), Paseo de San Vicente 182, 37007 Salamanca, Castilla y León, Spain
| | - José Luis González-Rodríguez
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
- Instituto de Investigación Biomédica de Salamanca de la FIESCYL (IBSAL-FIESCYL), Paseo de San Vicente 182, 37007 Salamanca, Castilla y León, Spain
| | - María Rocío López-Iglesias
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
- Instituto de Investigación Biomédica de Salamanca de la FIESCYL (IBSAL-FIESCYL), Paseo de San Vicente 182, 37007 Salamanca, Castilla y León, Spain
| | - Eduardo Sánchez-López
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
| | - Manuel Jesús Sánchez-Ledesma
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
- Department of Surgery, Faculty of Medicine, Salamanca University, Calle Alfonso X el Sabio, 37007 Salamanca, Castilla y León, Spain
- Instituto de Investigación Biomédica de Salamanca de la FIESCYL (IBSAL-FIESCYL), Paseo de San Vicente 182, 37007 Salamanca, Castilla y León, Spain
| | - María Isabel Martínez-Trufero
- Department of Anesthesiology and Critical Care, Salamanca University Hospital, Gerencia Regional de Salud de Castilla y León (SACYL), Paseo de la Transición Española, 37007 Salamanca, Castilla y León, Spain; (D.S.-G.); (J.L.G.-R.); (M.R.L.-I.); (E.S.-L.); (M.J.S.-L.); (M.I.M.-T.)
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Funakoshi T, Koga R, Koda S, Miyamoto A, Tsukamoto N, Suzuki H, Kusano H, Takahashi T, Yamamoto Y. Drug-dependent Analgesic Efficacy in Interscalene Block for Postoperative Pain after Arthroscopic Rotator Cuff Repair: Comparison between Ropivacaine and Levobupivacaine. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Mutter T, Logan GS, Neily S, Richardson S, Askin N, Monterola M, Abou-Setta A. Postoperative neurologic symptoms in the operative arm after shoulder surgery with interscalene blockade: a systematic review. Can J Anaesth 2022; 69:736-749. [PMID: 35289378 DOI: 10.1007/s12630-022-02229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Postoperative neurologic symptoms (PONS) in the operative arm are important complications of shoulder surgery and interscalene blockade (ISB). This systematic review aimed to compare the risk of PONS between ISB and other techniques, and the relative safety of different agents used in ISB. METHODS Our systematic review followed Cochrane review methodology and was registered in PROSPERO. A search of MEDLINE (Ovid), EMBASE (Ovid), and CENTRAL (Wiley) from inception to June 2020 was completed. We included randomized or quasi-randomized trials of patients (> five years old) undergoing shoulder surgery with any ISB technique as an intervention, compared with any other nonregional or regional technique, or ISB of alternate composition or technique. The primary outcome was PONS (study author defined) assessed a minimum of one week after surgery. RESULTS Fifty-five studies totalling 6,236 participants (median, 69; range, 30-910) were included. Another 422 otherwise eligible trials were excluded because PONS was not reported. Heterogeneity in when PONS was assessed (from one week to one year) and the diagnostic criteria used precluded quantitative meta-analysis. The most common PONS definition, consisting of one or more of paresthesia, sensory deficit, or motor deficit, was only used in 16/55 (29%) trials. Risk of bias was low in 5/55 (9%) trials and high in 36/55 (65%) trials, further limiting any inferences. CONCLUSION These findings highlight the need for a standardized PONS outcome definition and follow-up time, along with routine, rigorous measurement of PONS in trials of ISB. STUDY REGISTRATION PROSPERO (CRD42020148496); registered 10 February 2020.
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Affiliation(s)
- Thomas Mutter
- Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Gabrielle S Logan
- Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sam Neily
- Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Scott Richardson
- Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Askin
- Neil John Maclean Health Sciences Library, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marita Monterola
- Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ahmed Abou-Setta
- George and Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Holbrook HS, Parker BR. Peripheral Nerve Injury Following Interscalene Blocks: A Systematic Review to Guide Orthopedic Surgeons. Orthopedics 2018; 41:e598-e606. [PMID: 30125041 DOI: 10.3928/01477447-20180815-04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 12/18/2017] [Indexed: 02/03/2023]
Abstract
The purpose of this review was to determine the incidence and duration of peripheral neurologic symptoms following interscalene blocks for shoulder surgery. Three databases were reviewed for subjective and objective injuries by guidance modality and delivery method. The incidence of neurologic injuries following single site injection interscalene blocks, 3.16%, was significantly less than the 5.24% incidence for continuous catheter infusion interscalene blocks. Less than 0.51% of peripheral neurologic symptoms persisted beyond 1 year for both groups. There is a notable risk of injury following interscalene blocks by all modes of guidance and anesthetic technique, but only a small percentage of injuries persist. [Orthopedics. 2018; 41(5):e598-e606.].
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Li A, Wei Z, Liu Y, Shi J, Ding H, Tang H, Zheng P, Gao Y, Feng S. Ropivacaine versus levobupivacaine in peripheral nerve block: A PRISMA-compliant meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96:e6551. [PMID: 28383425 PMCID: PMC5411209 DOI: 10.1097/md.0000000000006551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To determine which is more potent in peripheral nerve block between ropivacaine and levobupivacaine. METHODS A literature search was performed in the EMBASE, Medline, the Cochrane Library, and the Web of Science. The trials that were found were then evaluated for eligibility. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. RESULTS Twelve studies including 556 patients were included for final analysis. No statistically significant difference was observed between the 2 drugs with respect to onset time of surgical anesthesia, onset time of sensory block, onset time of motor block, duration of motor block, and patients overall satisfaction. Levobupivacaine provided more long-term anesthesia (weighted mean difference [WMD], -2.94; 95% confidence interval [CI], -5.56 to -0.32; I = 93%) and significantly lower incidence of postoperative rescue analgesia (odds ratio [OR], 2.11; 95% CI 1.18-3.74; I = 21%) than ropivacaine. There was a trend toward greater duration of sensory block in the levobupivacaine group (WMD, -1.16; 95% CI, -1.89 to -0.43; I = 14%). CONCLUSION Levobupivacaine is more potent than ropivacaine in peripheral nerve block to some extent. Otherwise, more rigorous randomized control trials are required in the future.
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Affiliation(s)
- Ang Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin
| | - Zhijian Wei
- Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin
| | - Yang Liu
- Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin
| | - Jiaxiao Shi
- Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin
| | - Han Ding
- Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin
| | - Haoshuai Tang
- Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin
| | - Pengyuan Zheng
- Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin
| | - Yanzheng Gao
- Department of Orthopaedics, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, Tianjin
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Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty. Reg Anesth Pain Med 2017; 42:683-697. [DOI: 10.1097/aap.0000000000000673] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Park JY, Bang JY, Oh KS. Blind suprascapular and axillary nerve block for post-operative pain in arthroscopic rotator cuff surgery. Knee Surg Sports Traumatol Arthrosc 2016; 24:3877-3883. [PMID: 26733274 DOI: 10.1007/s00167-015-3902-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/26/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The goal of the study was to evaluate the efficacy of additional axillary nerve block (ANB) with suprascapular nerve block (SSNB) and patient-controlled anaesthesia (PCA) with no device assistance after arthroscopic rotator cuff repair. The hypothesis is that patients with intravenous (IV) PCA and the blockade of the two main nerves (SSNB + ANB) experienced lesser pain than patients with IV PCA or IV PCA + SSNB. METHODS The 114 patients undergoing arthroscopic rotator cuff repair were allocated randomly to three groups as follows: group I, intravenous PCA pumps (only PCA); group II, IV PCA + SSNB using a blind technique (PCA + SSNB); and group III, IV PCA + SSNB + ANB using a blind technique (PCA + SSNB + ANB). Pain visual analogue scale (VAS) scores were evaluated at 1, 6, 12, 24, 36, and 48 post-operative hours. Furthermore, the degree of pain was compared according to cuff tear size. RESULTS The pain VAS score of group III was lower than that of the other two groups and was significantly lower at post-operative hours 1, 6, and 12. In addition, the larger cuff tear tended to be indicative of greater pain. However, all groups experienced rebound pain. CONCLUSION PCA + SSNB + ANB using a blind technique is a better pain control method than PCA + SSNB and only PCA during the initial 12 post-operative hours. PCA + SSNB + ANB is a cost-effective, time-saving, and easily performed method for post-operative pain control as an axis of multimodal pain control strategy. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Jin-Young Bang
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
| | - Kyung-Soo Oh
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, South Korea
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Li M, Wan L, Mei W, Tian Y. Update on the clinical utility and practical use of ropivacaine in Chinese patients. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:1269-76. [PMID: 25246768 PMCID: PMC4166907 DOI: 10.2147/dddt.s57258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We reviewed the Chinese and English literature for efficacy and tolerability data as well as pharmacological properties of ropivacaine in Chinese patients. Ropivacaine is a long-acting amide local anesthetic agent that elicits nerve block via reversible inhibition of sodium ion influx in nerve fibers. The available evidence in the literature on anesthesia practice indicates that ropivacaine produces equally surgical sensory block and postoperative and obstetrics analgesia with good maternal and fetal outcome to those of bupivacaine or levobupivacaine. It appears to be associated with comparable onset, quality, and duration of sensory block, but with a lower incidence or grade of motor block, compared to bupivacaine. The satisfaction of both patients and surgeons is high when ropivacaine is used. Thus, ropivacaine appears to be an important option for regional anesthesia and for the management of postoperative and labor pain, with its enhanced sensorimotor differentiation blockage at lower concentrations and enhanced safety at higher concentrations.
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Affiliation(s)
- Man Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Li Wan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yuke Tian
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Merritt CK, Mariano ER, Kaye AD, Lissauer J, Mancuso K, Prabhakar A, Urman RD. Peripheral nerve catheters and local anesthetic infiltration in perioperative analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:41-57. [DOI: 10.1016/j.bpa.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 02/09/2014] [Accepted: 02/19/2014] [Indexed: 11/16/2022]
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Bauer M, Wang L, Onibonoje OK, Parrett C, Sessler DI, Mounir-Soliman L, Zaky S, Krebs V, Buller LT, Donohue MC, Stevens-Lapsley JE, Ilfeld BM. Continuous femoral nerve blocks: decreasing local anesthetic concentration to minimize quadriceps femoris weakness. Anesthesiology 2012; 116:665-72. [PMID: 22293719 DOI: 10.1097/aln.0b013e3182475c35] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Whether decreasing the local anesthetic concentration during a continuous femoral nerve block results in less quadriceps weakness remains unknown. METHODS Preoperatively, bilateral femoral perineural catheters were inserted in subjects undergoing bilateral knee arthroplasty (n = 36) at a single clinical center. Postoperatively, right-sided catheters were randomly assigned to receive perineural ropivacaine of either 0.1% (basal 12 ml/h; bolus 4 ml) or 0.4% (basal 3 ml/h; bolus 1 ml), with the left catheter receiving the alternative concentration/rate in an observer- and subject-masked fashion. The primary endpoint was the maximum voluntary isometric contraction of the quadriceps femoris muscles the morning of postoperative day 2. Equivalence of treatments would be concluded if the 95% CI for the difference fell within the interval -20%-20%. Secondary endpoints included active knee extension, passive knee flexion, tolerance to cutaneous electrical current applied over the distal quadriceps tendon, dynamic pain scores, opioid requirements, and ropivacaine consumption. RESULTS Quadriceps maximum voluntary isometric contraction for limbs receiving 0.1% ropivacaine was a mean (SD) of 13 (8) N · m, versus 12 (8) N · m for limbs receiving 0.4% [intrasubject difference of 3 (40) percentage points; 95% CI -10-17; P = 0.63]. Because the 95% CI fell within prespecified tolerances, we conclude that the effect of the two concentrations were equivalent. Similarly, there were no statistically significant differences in secondary endpoints. CONCLUSIONS For continuous femoral nerve blocks, we found no evidence that local anesthetic concentration and volume influence block characteristics, suggesting that local anesthetic dose (mass) is the primary determinant of perineural infusion effects.
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Affiliation(s)
- Maria Bauer
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
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Regional Anesthesia Procedures for Shoulder and Upper Arm Surgery Upper Extremity Update—2005 to Present. Int Anesthesiol Clin 2012; 50:26-46. [DOI: 10.1097/aia.0b013e31821a0284] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fredrickson M, Abeysekera A, Price D, Wong A. Patient-initiated mandatory boluses for ambulatory continuous interscalene analgesia: an effective strategy for optimizing analgesia and minimizing side-effects. Br J Anaesth 2011; 106:239-45. [DOI: 10.1093/bja/aeq320] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010; 65:608-624. [DOI: 10.1111/j.1365-2044.2009.06231.x] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fredrickson M, Price D. Analgesic effectiveness of ropivacaine 0.2% vs 0.4% via an ultrasound-guided C5–6 root/superior trunk perineural ambulatory catheter. Br J Anaesth 2009; 103:434-9. [DOI: 10.1093/bja/aep195] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Heid F, Müller N, Piepho T, Bäres M, Giesa M, Drees P, Rümelin A, Werner C. Postoperative Analgesic Efficacy of Peripheral Levobupivacaine and Ropivacaine: A Prospective, Randomized Double-Blind Trial in Patients After Total Knee Arthroplasty. Anesth Analg 2008; 106:1559-61, table of contents. [DOI: 10.1213/ane.0b013e318168b493] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fuzier R, Cuvillon P, Delcourt J, Lupescu R, Bonnemaison J, Bloc S, Theissen A, Berthou P, Malassine P, Richez AS. ALR périphérique en orthopédie: évaluation multicentrique des pratiques et impact sur l'activité de la SSPI. ACTA ACUST UNITED AC 2007; 26:761-8. [DOI: 10.1016/j.annfar.2007.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Accepted: 07/04/2007] [Indexed: 11/25/2022]
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Danelli G, Berti M, Casati A, Bobbio A, Ghisi D, Mele R, Rossini E, Fanelli G. Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/vol ropivacaine. Ugeskr Laeger 2007; 24:596-601. [PMID: 17437655 DOI: 10.1017/s0265021507000178] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of this prospective, randomized, double-blind, placebo-controlled study was to evaluate the efficacy of phrenic nerve infiltration with ropivacaine 0.2% on the incidence and severity of ipsilateral shoulder pain after thoracotomy in patients receiving continuous thoracic epidural analgesia. METHODS Fifty ASA physical status II-III patients, receiving thoracic epidural analgesia for post-thoracotomy pain, were randomly allocated to receive infiltration of the ipsilateral phrenic nerve with either ropivacaine 0.2% 10 mL (ropivacaine, n = 25), or saline 0.9% (control, n = 25) just before lung expansion and chest closure. A blinded observer recorded the incidence and severity of ipsilateral shoulder pain 6, 12, 24, 36 and 48 h after surgery. Postoperative respiratory function was also evaluated with blood gas analyses. RESULTS The cumulative incidences of ipsilateral shoulder pain during the first 24 h after surgery were 8/25 in the ropivacaine and 16/25 in the control groups (P = 0.047), with median (range) onset times for shoulder pain of 2 (2-24) h with ropivacaine and 0.5 (0.5-24) h in controls (P = 0.005). No differences were reported on the second postoperative day. The areas under the curves of the amount of pain over time were 0 (0-2760) mm h for the ropivacaine and 350 (0-1900) mm h for the control groups (P = 0.06). Postoperatively, similar reductions in indices of oxygenation were observed in both groups. CONCLUSIONS Phrenic nerve infiltration with ropivacaine 0.2% 10 mL reduced the incidence and delayed the onset of ipsilateral shoulder pain during the first 24 h after open lung resection, with no clinically relevant effects on respiratory function.
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Affiliation(s)
- G Danelli
- University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
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