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Li H, Xu Y, Tong Y, Dan Y, Zhou T, He J, Liu S, Zhu Y. Sucrose Acetate Isobutyrate as an In situ Forming Implant for Sustained Release of Local Anesthetics. Curr Drug Deliv 2019; 16:331-340. [PMID: 30451111 DOI: 10.2174/1567201816666181119112952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In this study, an injectable Sucrose Acetate Isobutyrate (SAIB) drug delivery system (SADS) was designed and fabricated for the sustained release of Ropivacaine (RP) to prolong the duration of local anesthesia. METHODS By mixing SAIB, RP, and N-methyl-2-pyrrolidone, the SADS was prepared in a sol state with low viscosity before injection. After subcutaneous injection, the pre-gel solution underwent gelation in situ to form a drug-released depot. RESULT The in vitro release profiles and in vivo pharmacokinetic analysis indicated that RP-SADS had suitable controlled release properties. Particularly, the RP-SADS significantly reduced the initial burst release after subcutaneous injection in rats. CONCLUSION In a pharmacodynamic analysis of rats, the duration of nerve blockade was prolonged by over 3-fold for the RP-SADS formulation compared to RP solution. Additionally, RP-SADS showed good biocompatibility in vitro and in vivo. Thus, the SADS-based depot technology is a safe drug delivery strategy for the sustained release of local anesthetics with long-term analgesia effects.
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Affiliation(s)
- Hanmei Li
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Yuling Xu
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Yuna Tong
- Department of Nephrology, The Third People's Hospital of Chengdu, Chengdu, 610031, China
| | - Yin Dan
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Tingting Zhou
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Jiameng He
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Shan Liu
- Department of Laboratory Medicine, Affiliated Hospital of University of Electronic Science and Technology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu 610072, China
| | - Yuxuan Zhu
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
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Abstract
Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain. Patients with anxiety and depression, preoperative narcotic use, and medical comorbidities are at an increased risk for suboptimal pain control. Minimizing narcotic use decreases opioid-related adverse effects and facilitates productive rehabilitation efforts.
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Affiliation(s)
- Jason L Codding
- The Rothman Institute at Thomas Jefferson University, Department of Orthopaedic Surgery, 925 Chestnut Street, 5th floor, Philadelphia, PA 19107, USA.
| | - Charles L Getz
- The Rothman Institute at Thomas Jefferson University, Department of Orthopaedic Surgery, 925 Chestnut Street, 5th floor, Philadelphia, PA 19107, USA
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Baskan S, Cankaya D, Unal H, Yoldas B, Taspinar V, Deveci A, Tabak Y, Baydar M. Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery. J Orthop Surg (Hong Kong) 2017; 25:2309499016684093. [PMID: 28116968 DOI: 10.1177/2309499016684093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. METHODS This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. RESULTS A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. CONCLUSION The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.
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Affiliation(s)
- Semih Baskan
- 1 Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Deniz Cankaya
- 2 Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hidayet Unal
- 1 Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Burak Yoldas
- 2 Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Vildan Taspinar
- 1 Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Alper Deveci
- 2 Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Yalcin Tabak
- 2 Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mustafa Baydar
- 1 Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Lee HJ, Kim YS, Park I, Ha DH, Lee JH. Administration of analgesics after rotator cuff repair: a prospective clinical trial comparing glenohumeral, subacromial, and a combination of glenohumeral and subacromial injections. J Shoulder Elbow Surg 2015; 24:663-8. [PMID: 25648969 DOI: 10.1016/j.jse.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/25/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Local analgesic injections are commonly used for pain relief after shoulder surgery. The aim of this study was to compare the efficacy of local injections administered in the glenohumeral joint, the subacromial space, or both locations after arthroscopic rotator cuff repair. METHODS Between March 2011 and December 2011, 121 consecutive patients who had undergone arthroscopic rotator cuff repair surgery were enrolled in the study and all patients were randomly allocated to 3 groups. In group 1, 40 patients received a postoperative glenohumeral injection of bupivacaine (20 mL) and lidocaine (10 mL). In group 2, 42 patients received the same postoperative injection, but it was administered in the subacromial space. In group 3, 39 patients received the same amount of local anesthesia but with half injected in the glenohumeral joint and half in the subacromial space. The visual analog scale was used to assess pain intensity before surgery and at postoperative hours 1, 2, 6, 12, and 24. Demerol was used as a postinjection rescue analgesic, and the total number of administrations was recorded at each time point. RESULTS There were no significant differences between groups in patient age, sex, or rotator cuff tear size (P > .05). The visual analog scale scores for pain between each group were not significantly different at any time point, including before surgery (P > .05). In addition, the amount of supplementary analgesic administered was not significantly different between the groups (P > .05). CONCLUSION Injection of local analgesics after arthroscopic rotator cuff repair relieves postoperative pain regardless of the injection location.
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Affiliation(s)
- Hyo-Jin Lee
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, South Korea
| | - Yang-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - In Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dae-Ho Ha
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, South Korea
| | - Jun-Hyung Lee
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, South Korea
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Eroglu A. The effect of intravenous anesthetics on ischemia-reperfusion injury. BIOMED RESEARCH INTERNATIONAL 2014; 2014:821513. [PMID: 24527458 PMCID: PMC3914339 DOI: 10.1155/2014/821513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/03/2013] [Indexed: 02/07/2023]
Abstract
The effects of intravenous anesthetics on ischemia-reperfusion injury (IRI) have been investigated in both animals and clinical studies. The protective effects and the dosages of the intravenous anesthetics on IRI were discussed in this paper. The prevention of the tissue injury after the IRI was demonstrated with intravenous anesthetics in some studies. In the future, the studies should be focused on the dosage of the anesthetics related to diminishing the tissue injuries. Further studies might be required in order to investigate the effects of the anesthetics on molecular levels.
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Affiliation(s)
- Ahmet Eroglu
- Karadeniz Technical University, Anesthesiology and Intensive Care Medicine, 61000 Trabzon, Turkey
- *Ahmet Eroglu:
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Sulaiman L, Macfarlane RJ, Waseem M. Current concepts in anaesthesia for shoulder surgery. Open Orthop J 2013; 7:323-8. [PMID: 24082970 PMCID: PMC3785039 DOI: 10.2174/1874325001307010323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 10/06/2012] [Accepted: 11/24/2012] [Indexed: 12/16/2022] Open
Abstract
There has been an exponential growth in the volume of shoulder surgery in the last 2 decades and a very wide variety of anaesthetic techniques have emerged to provide anaesthesia and post-operative analgesia. In this article we examine current opinion, risks, benefits and practicalities of anaesthetic practice and the provision of post-operative analgesia for shoulder surgery.
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Affiliation(s)
- Lutfi Sulaiman
- East Cheshire NHS Trust, Victoria Rd, Macclesfield, SK10 3BL, UK
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Yun MJ, Oh JH, Yoon JP, Park SH, Hwang JW, Kil HY. Subacromial patient-controlled analgesia with ropivacaine provides effective pain control after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2012; 20:1971-7. [PMID: 22207026 DOI: 10.1007/s00167-011-1841-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 12/13/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the postoperative analgesic effect of subacromial patient-controlled analgesia (SA-PCA) with ropivacaine in comparison with intravenous patient-controlled analgesia (IV-PCA) after arthroscopic rotator cuff repair. METHODS Sixty patients were prospectively randomized into one of the two types of analgesics for 48 h after the operation. In the SA-PCA group, patients received 0.5% ropivacaine at a rate of 2 ml/h with a patient-controlled bolus dose of 2 ml. In the IV-PCA group, patients received intravenous patient-controlled analgesia. Pain relief was regularly assessed using visual analog scale (VAS) for 48 h, and side effects were noted. RESULTS The postoperative pain VAS at 1 h after the operation was lower for the SA-PCA group (4.3 ± 2.7) than for the IV-PCA group (6.3 ± 2.6, P = 0.009). The frequency of requested bolus doses by patients in the IV-PCA (19 ± 19) was higher than in the SA-PCA (7 ± 10, P = 0.04). Rescue opioid or NSAID requirements were not different. More patients in the IV-PCA (17/30) experienced nausea than in the SA-PCA (7/30, P = 0.03). Patient satisfaction was higher in the SA-PCA than in the IV-PCA [6.7 (3-10) vs. 5.6 (0-8), P = 0.04]. The mean total venous plasma concentration of ropivacaine at 8 and 24 h was below the maximum tolerated venous plasma concentration, and symptoms of systemic toxicity were not noted during 48 h in the SA-PCA. CONCLUSIONS The analgesic effect of subacromial patient-controlled analgesia with ropivacaine was better than intravenous analgesia during the immediate postoperative period with fewer side effects. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Mi Ja Yun
- Department of Anesthesiology and Pain Medicine, National Medical Center, 243 Euljiro, Jung-gu, Seoul, Korea
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Abstract
Pain after major abdominal, orthopedic, and thoracic surgeries can be significant causing unacceptable morbidity. Poorly controlled pain results in patient dissatisfaction and may also be associated with major morbidities, including perioperative myocardial ischemia, pulmonary complications, altered immune function, and postoperative cognitive dysfunction. Various techniques are currently used to manage this pain, and opioids are amongst the most frequently used. Recent literature supports the use of regional anesthesia in the form of various peripheral nerve blocks as a better alternative. This article discusses the role and evidence for wound infiltration analgesia in general surgery, orthopedic surgery, neurosurgery, and thoracic surgery.
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Affiliation(s)
- Sugantha Ganapathy
- Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, B3213, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
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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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Kim IS, Shin KM, Kang SS, Jang JS, Hong SJ, Yoon YJ, Lee HJ. A comparative study on the analgesic effect of continuous intraarticular infusion with ropivacaine, ropivacaine/fentanyl and ropivacaine/fentanyl/ketorolac after arthroscopic shoulder surgery. Korean J Anesthesiol 2009; 56:303-308. [PMID: 30625740 DOI: 10.4097/kjae.2009.56.3.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arthroscopic shoulder surgery can result in severe postoperative pain. A variety of methods have been used to control pain in postoperative period and the results are variable. The purpose of this study was to compare the relative analgesic efficacies of the postoperative intraarticular infusion of ropivacaine, ropivacaine/fentanyl, and ropivacaine/fentanyl/ketorolac after arthroscopic shoulder surgery. METHODS Thirty patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to three groups. At the end of surgery, 0.5% ropivacaine 20 ml was infused into the articular space and a continuous infusion catheter was inserted into intraarticular operated site. After surgery, continuous infusion of 0.5% ropivacaine 100 ml (Group 1, n = 10), 0.5% ropivacaine 100 ml including fentanyl 10 microg/kg (Group 2, n = 10), or 0.5% ropivacaine 100 ml including fentanyl 10 microgram/kg and ketorolac 150 mg (Group 3, n = 10) was started through catheter at rate of 2 ml/hr with bolus dose of 0.5 ml with a lock out time of 15 minutes for 2 days. The level of pain was assessed using a visual analogue scale (VAS) postoperative 2, 6, 12, 24 and 48 hours and the amounts of supplemental analgesics were recorded. RESULTS The VAS was significantly lower after 2, 6, 12 hours in Group 2 than in Group 1. In Group 3, the VAS was significantly lower all hours than in the other two groups. CONCLUSIONS The combination of fentanyl and ketorolac with ropivacaine did provide better postoperative analgesia than the other groups after arthroscopic shoulder surgery.
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Affiliation(s)
- Il Seok Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Keun Man Shin
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Sang Soo Kang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Ji Su Jang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Sung Jun Hong
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Yeong Joon Yoon
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Hee Je Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:388-94. [PMID: 17620851 DOI: 10.1097/aco.0b013e3282c3a878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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