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Wang Q, Wei S, Li S, Yu J, Zhang G, Ni C, Sun L, Zheng H. Comparison of the analgesic effect of ultrasound-guided paravertebral block and ultrasound-guided retrolaminar block in Uniportal video-assisted Thoracoscopic surgery: a prospective, randomized study. BMC Cancer 2021; 21:1229. [PMID: 34784889 PMCID: PMC8594110 DOI: 10.1186/s12885-021-08938-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background The optimal modality for postoperative analgesia after uniportal video-assisted thoracoscopic surgery (UVATS) for the treatment of lung cancer has not yet been determined. Both ultrasound-guided paravertebral block (PVB) and retrolaminar block (RLB) have been reported to be successful in providing analgesia after UVATS. However, which block technique provides superior analgesia after UVATS is still unclear. This randomized study was designed to compare the postoperative analgesic effects and adverse events associated with ultrasound-guided PVB and RLB after UVATS. Methods Sixty patients with lung cancer were randomized to undergo ultrasound-guided PVB (group P) or ultrasound-guided RLB (group R). In group P, 30 mL of 0.5% ropivacaine was injected at the T3 and T5 levels via ultrasound-guided PVB (15 mL at each level on the operative side). In group R, 30 mL of 0.5% ropivacaine was injected at the T3 and T5 levels via ultrasound-guided RLB (15 mL at each level on the operative side). The primary outcome was the numerical rating scale (NRS) score within 48 h after surgery. The secondary outcomes were total postoperative sufentanil consumption, time to first analgesic request and adverse events. Results At 3, 6, 12, 24, 36 and 48 h postoperatively, the NRS score at rest in group P was lower than that in group R (p < 0.05). At 3, 6, 12, 24 and 36 h postoperatively, the NRS score while coughing in group P was lower than that in group R (p < 0.05). The total postoperative sufentanil consumption in group P was significantly lower than that in group R (p < 0.001). Additionally, the time to first analgesic request was longer in group R than in group P (p < 0.0001). The incidence of nausea in group R was higher than that in group P (p < 0.05). Conclusions In patients with lung cancer undergoing UVATS, ultrasound-guided PVB with 0.5% ropivacaine provides better analgesia and results in less nausea than ultrasound-guided RLB. Compared with ultrasound-guided RLB, ultrasound-guided PVB seems to be a better technique for analgesia in UVATS. Trial registration The name of this study is the Effect And Mechanism Of Ultrasound-guided Multimodal Regional Nerve Block On Acute And Chronic Pain After Thoracic Surgery. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100044060). The date of registration was March 9, 2021.
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Affiliation(s)
- Qiang Wang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Shijing Wei
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Shuai Li
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Jie Yu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Guohua Zhang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Li Sun
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
| | - Hui Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
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Hamilton GM, MacMillan Y, Benson P, Memtsoudis S, McCartney CJL. Regional anaesthesia quality indicators for adult patients undergoing non-cardiac surgery: a systematic review. Anaesthesia 2021; 76 Suppl 1:89-99. [PMID: 33426666 DOI: 10.1111/anae.15311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 11/26/2022]
Abstract
Improvement in healthcare delivery depends on the ability to measure outcomes that can direct changes in the system. An overview of quality indicators within the field of regional anaesthesia is lacking. This systematic review aims to synthesise available quality indicators, as per the Donabedian framework, and provide a concise overview of evidence-based quality indicators within regional anaesthesia. A systematic literature search was conducted using the databases MEDLINE, Embase, CINAHL and Cochrane from 2003 to present, and a prespecified search of regional anaesthesia society websites and healthcare quality agencies. The quality indicators relevant to regional anaesthesia were subdivided into peri-operative structure, process and outcome indicators as per the Donabedian framework. The methodological quality of the indicators was determined as per the Oxford Centre for Evidence-Based Medicine's framework. Twenty manuscripts met our inclusion criteria and, in total, 68 unique quality indicators were identified. There were 4 (6%) structure, 12 (18%) process and 52 (76%) outcome indicators. Most of the indicators were related to the safety (57%) and effectiveness (19%) of regional anaesthesia and were general in nature (60%). In addition, most indicators (84%) were based on low levels of evidence. Our study is an important first step towards describing quality indicators for the provision of regional anaesthesia. Future research should focus on the development of structure and process quality indicators and improving the methodological quality and usability of these indicators.
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Affiliation(s)
- G M Hamilton
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, ON, Canada
| | - Y MacMillan
- Department of Medicine, University of Ottawa, ON, Canada
| | - P Benson
- Department of Medicine, University of Ottawa, ON, Canada
| | - S Memtsoudis
- Department of Anaesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - C J L McCartney
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, ON, Canada
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Vogelsang H, Lang A, Cevik B, Botteck NM, Weber TP, Herzog‐Niescery J. Incidence of infection in non-tunnelled thoracic epidural catheters after major abdominal surgery. Acta Anaesthesiol Scand 2020; 64:1312-1318. [PMID: 32521043 DOI: 10.1111/aas.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Thoracic epidural analgesia is beneficial after major abdominal surgery, though side-effects and complications are rare but potentially devastating. The incidence of catheter-related infection is approximately 5.5%. Several guidelines have been recommended to prevent complications during thoracic epidural catheterization. Tunnelling is often recommended to reduce the incidence of infections and dislocations. METHODS A retrospective, single-centre analysis of our acute pain service database was performed between 2010 and 2018. The hygiene measures of the German Society of Anaesthesiology have been incorporated in our standard operating protocol since 2009. The procedure remained constant, but the skin disinfectant was changed from propan-2-ol to propan-2-ol with octenidine in 2014. Tunnelling of catheters was not performed. We analysed the incidence of catheter-related infections (primary endpoint) and effect of the used disinfectant (secondary endpoint). RESULTS A total of 2755 patients underwent elective major abdominal surgery with thoracic epidural catheterization. Sixteen patients (0.6%) showed symptoms of mild catheter-related infection. Moderate or severe infections were not observed in any patient. The type of disinfectant did not show any significant effect on the incidence of infection. CONCLUSION The incidence of catheter-related infections was low, and only mild signs of infection were observed. Non-tunnelling could be an alternative to tunnelling, especially if hygiene protocols are followed, and the duration of catheter use is short. A comprehensive database and regular examinations by trained staff are essential for early detection of abnormalities and immediate removal of the catheter, if required.
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Affiliation(s)
- Heike Vogelsang
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Alexander Lang
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Bilal Cevik
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Nikolaj M. Botteck
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Thomas P. Weber
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
| | - Jennifer Herzog‐Niescery
- Department of Anaesthesiology and Intensive Care Medicine Ruhr‐University BochumSt. Josef‐Hospital Bochum Germany
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Malchow RJ, Gupta RK, Shi Y, Shotwell MS, Jaeger LM, Bowens C. Comprehensive Analysis of 13,897 Consecutive Regional Anesthetics at an Ambulatory Surgery Center. PAIN MEDICINE 2017; 19:368-384. [DOI: 10.1093/pm/pnx045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
PURPOSE OF REVIEW As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly patients will assume increased importance. RECENT FINDINGS Increasing evidence supports the expanded use of ambulatory surgery for managing elderly patients undergoing elective surgery procedures. SUMMARY This review article describes the demographics of ambulatory surgery in the elderly population. This review article describes the effects of aging on the responses of geriatric patients to anesthetic and analgesic drugs used during ambulatory surgery. Important considerations in the preoperative evaluation of elderly outpatients with co-existing diseases, as well as the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and recommendations regarding the management of common postoperative side-effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. Finally, we discuss the future challenges related to the continued expansion of ambulatory surgery practice in this growing segment of our surgical population. The role of anesthesiologists as perioperative physicians is of critical importance for optimizing surgical outcomes for elderly patients undergoing ambulatory surgery. Providing high-quality, evidence-based anesthetic and analgesic care for elderly patients undergoing elective operations on an ambulatory basis will assume greater importance in the future.
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Reisig F, Neuburger M, Zausig Y, Graf B, Büttner J. Erfolgreiche Infektionskontrolle bei Regionalanästhesieverfahren. Anaesthesist 2013; 62:105-12. [DOI: 10.1007/s00101-012-2122-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 12/04/2012] [Accepted: 12/05/2012] [Indexed: 11/28/2022]
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Abstract
The anesthesia team acts every day in a highly complex and high risk environment for the transmission of pathogenic organisms and the induction of infectious complications. With strict adherence to standard precautions and infection control practices in particular regular hand disinfection before and after direct patient contact and before performance of aseptic tasks during anesthesia and an optimized perioperative process the members of the anesthesia team can become infection control pioneers within the hospital. In order to be successful, structural and organizational resources in the form of training, personnel, materials and time, need to be adequate for the situation. This review summarizes the infection control recommendations for anesthesia practice based on the most recent literature and guidelines and offers practical advice for commonly observed mistakes.
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Upp J, Kent M, Tighe PJ. The evolution and practice of acute pain medicine. PAIN MEDICINE (MALDEN, MASS.) 2013; 14:124-44. [PMID: 23241132 PMCID: PMC3547126 DOI: 10.1111/pme.12015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In recent years, the field of acute pain medicine (APM) has witnessed a surge in its development, and pain has begun to be recognized not merely as a symptom, but as an actual disease process. This development warrants increased education of residents both in the performance of regional anesthesia as well as in the disease course of acute pain and the biopsychosocial mechanisms that define interindividual variability. REVIEW SUMMARY We reviewed the organization and function of the modern APM program. Following a discussion of the nomenclature of acute pain-related practices, we discuss the historical evolution and modern role of APM teams, including the use of traditional, as well as complementary and alternative, therapies for treating acute pain. Staffing and equipment requirements are also evaluated, in addition to the training requirements for achieving expertise in APM. Lastly, we briefly explore future considerations related to the essential role and development of APM. CONCLUSION The scope and practice of APM must be expanded to include pre-pain/pre-intervention risk stratification and extended through the phase of subacute pain.
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Affiliation(s)
- Justin Upp
- Staff Anesthesiologist, Walter Reed National Military Medical Center, Bethesda, MD
| | - Michael Kent
- Staff Anesthesiologist, Walter Reed National Military Medical Center, Bethesda, MD
| | - Patrick J. Tighe
- Assistant Professor of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
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Schulz-Stübner S, Czaplik M. [Quality management in regional anesthesia using the example of a Regional Anesthesia Surveillance System (RASS)]. Schmerz 2012; 27:56-66. [PMID: 23224262 DOI: 10.1007/s00482-012-1266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Regional anesthesia and regional analgesia techniques with or without a continuous catheter are frequently utilized in all areas of modern anesthesiology. There are individual and economic benefits but also risks involved with those techniques. While the incidence of severe complications is rare and preventive action not always possible, the consequences can be detrimental especially with hematoma or abscess formation associated with central neuraxial blocks. Therefore, it is important to create national and international databases with large case numbers utilizing standardized definitions of complications in order to allow realistic risk assessment and early discovery of potential dangers and preventive actions. This article shows the integration of standardized codes from the Regional Anesthesia Surveillance System with a software tool to allow high-quality data acquisition and the building of a foundation for national and international data collection and analysis as well as for feedback of institutional data for individual process optimization as part of a quality management system.
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Affiliation(s)
- S Schulz-Stübner
- Deutsches Beratungszentrum für Hygiene, Schnewlinstr. 10, 79098, Freiburg, Deutschland.
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White PF, White LM, Monk T, Jakobsson J, Raeder J, Mulroy MF, Bertini L, Torri G, Solca M, Pittoni G, Bettelli G. Perioperative care for the older outpatient undergoing ambulatory surgery. Anesth Analg 2012; 114:1190-215. [PMID: 22467899 DOI: 10.1213/ane.0b013e31824f19b8] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly will assume increased importance. Given the recent advances in anesthesia, surgery, and monitoring technology, the ambulatory setting offers potential advantages for elderly patients undergoing elective surgery. In this review article we summarize the physiologic and pharmacologic effects of aging and their influence on anesthetic drugs, the important considerations in the preoperative evaluation of elderly outpatients with coexisting diseases, the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and offer recommendations regarding the management of common postoperative side effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. We conclude with a discussion of future challenges related to the growth of ambulatory surgery practice in this segment of our surgical population. When information specifically for the elderly population was not available in the peer-reviewed literature, we drew from relevant information in other ambulatory surgery populations.
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Affiliation(s)
- Paul F White
- Department of Anesthesia, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Effectiveness of premature epidural catheter termination as a quality indicator in a developing country. Eur J Anaesthesiol 2010; 27:637-41. [DOI: 10.1097/eja.0b013e328338d56b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Benhamou D, Auroy Y, Amalberti R. Monitoring Quality and Safety in Anesthesia: Are Large Numbers Enough? Anesth Analg 2008; 107:1458-60. [DOI: 10.1213/ane.0b013e318189476b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tornero Tornero JC, Gómez Gómez M, Fabregat Cid G, Aliaga Font L, Roqués Escolar V, Escamilla Cañete B, Guerrí Cebollada A. [Complications after regional anesthesia]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:552-562. [PMID: 19086723 DOI: 10.1016/s0034-9356(08)70652-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In recent years, there has been a considerable increase in the number of procedures carried out under regional anesthesia. The techniques used can be associated with a number of complications, which should be understood so that they can be recognized and managed appropriately. The overall incidence of reported complications associated with these techniques is low and therefore, with currently available data, we can only have an approximate idea of their incidence. The objective of this study is to systematically describe the complications that may arise from the use of neuraxial and peripheral regional anesthesia techniques.
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Fernández-Meré LA, Sopena-Zubiria LA, Gil-Soria L, Alvarez-Blanco M. [Spinal anesthesia after brachial plexus block with the posterior approach]. ACTA ACUST UNITED AC 2008; 55:63-4. [PMID: 18333397 DOI: 10.1016/s0034-9356(08)70509-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:605-9. [DOI: 10.1097/aco.0b013e3282f355c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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