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Leite-Moreira AM, Correia A, Vale N, Mourão JB. Pharmacokinetics in regional anesthesia. Curr Opin Anaesthesiol 2024; 37:520-525. [PMID: 39011670 DOI: 10.1097/aco.0000000000001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW Pharmacokinetics of local anesthetics are one of the main determinants of success and safety of regional anesthesia and comprise local and systemic distribution phases. This review aims to summarize the latest research findings on this topic in the context of various regional blocks performed for different surgeries and patient populations. RECENT FINDINGS Research into local kinetics and systemic absorption of local anesthetics has chiefly been focused on novel fascial plane blocks, especially the erector spinae plane block, as these are increasingly adopted for regional anesthesia and pain management. As their clinical efficacy is very dependent on injection of large volumes of local anesthetic, doses over typically recommended limits are often administered. SUMMARY Fascial plane blocks are the regional anesthesia techniques in need of the most pharmacokinetic characterization, not only to better understand their complex mechanisms of action but also to avoid harm from excessive doses of local anesthetics. Further mapping of risk factors for systemic toxicity from administration in different block sites is crucial. Extremes of age and pregnancy are vulnerable patient populations but in whom regional anesthesia, including novel techniques, has been performed with few complications.
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Affiliation(s)
- André M Leite-Moreira
- Department of Anesthesiology, Unidade Local de Saúde São João
- UnIC@RISE
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto
| | - André Correia
- Department of Anesthesiology, Unidade Local de Saúde São João
| | - Nuno Vale
- PerMed Research Group, Center for Health Technology and Services Research
- CINTESIS@RISE, Faculty of Medicine
- Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana B Mourão
- Department of Anesthesiology, Unidade Local de Saúde São João
- UnIC@RISE
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto
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Pirri C, Torre DE, Stecco C. Fascial plane blocks: from microanatomy to clinical applications. Curr Opin Anaesthesiol 2024; 37:526-532. [PMID: 39108103 PMCID: PMC11356744 DOI: 10.1097/aco.0000000000001416] [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] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW In the last 20 years, advancements in the understanding of fasciae have significantly transformed anaesthesia and surgery. Fascial plane blocks (FPBs) have gained popularity due to their validated safety profile and relative ease. They are used in various clinical settings for surgical and nonsurgical indications. Growing evidence suggests a link between the microscopic anatomy of fasciae and their mechanism of action. As a result, knowledge of these aspects is urgently needed to better optimise pain management. The purpose of this review is to summarise the different microscopic aspects of deep/muscular fascia to expand our understanding in the performance of FPBs. RECENT FINDINGS There is ample evidence to support the role of FPBs in pain management. However, the exact mechanism of action remains unclear. Fasciae are composed of various structural elements and display complex anatomical characteristics at the microscopic level. They include various cell types embedded within an extracellular matrix abundant in collagens and hyaluronan. Increasingly, numerous studies demonstrated their innervation that contributes to their sensory functions and their role in proprioception, motor coordination and pain perception. Lastly, the diversity of the cellular and extracellular matrix, with their viscoelastic properties, is essential to understanding the FPBs' mechanism of action. SUMMARY Physicians must be aware of the role of fascial microscopic anatomy and better understand their properties to perform FPBs in a conscious manner and enhance pain management.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua
| | - Debora Emanuela Torre
- Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Surgery, Ospedale dell’Angelo, Venice Mestre, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua
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Lee S, Ko JS, Kang R, Choi GS, Kim JM, Gwak MS, Shin YH, Lee SM, Kim GS. Analgesic effects of ultrasound-guided preoperative posterior Quadratus Lumborum block in laparoscopic hepatectomy: A prospective double-blinded randomized controlled trial. J Clin Anesth 2024; 97:111504. [PMID: 38851003 DOI: 10.1016/j.jclinane.2024.111504] [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: 11/20/2023] [Revised: 05/01/2024] [Accepted: 05/19/2024] [Indexed: 06/10/2024]
Abstract
STUDY OBJECTIVE To determine if single-injection bilateral posterior quadratus lumborum block (QLB) with ropivacaine would improve postoperative analgesia in the first 24 h after laparoscopic hepatectomy, compared with 0.9% saline. DESIGN Prospective, double blinded, randomized controlled trial. SETTING A single tertiary care center from November 2021 and January 2023. PATIENTS A total of 94 patients scheduled to undergo laparoscopic hepatectomy due to hepatocellular carcinoma. INTERVENTIONS Ninety-four patients were randomized into a QLB group (receiving 20 mL of 0.375% ropivacaine on each side, 150 mg in total) or a control group (receiving 20 mL of 0.9% saline on each side). MEASUREMENTS The primary outcome was the cumulative opioid consumption during the initial 24-h post-surgery. Secondary outcomes included pain scores and intraoperative and recovery parameters. MAIN RESULTS The mean cumulative opioid consumption during the initial 24-h post-surgery was 30.8 ± 22.4 mg in the QLB group (n = 46) and 34.0 ± 19.4 mg in the control group (n = 46, mean differences: -3.3 mg, 95% confidence interval, -11.9 to 5.4, p = 0.457). The mean resting pain score at 1 h post-surgery was significantly lower in the QLB group than in the control group (5 [4-6.25] vs. 7 [4.75-8], p = 0.035). No significant intergroup differences were observed in the resting or coughing pain scores at other time points or in other secondary outcomes. CONCLUSIONS Preoperative bilateral posterior QLB did not reduce cumulative opioid consumption during the first 24 h after laparoscopic hepatectomy.
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Affiliation(s)
- Seungwon Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - RyungA Kang
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea.
| | - Gyu-Seong Choi
- Department of Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Jong Man Kim
- Department of Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Young Hee Shin
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Sangmin Maria Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
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Munasinghe BM. Is the 'loss of resistance' technique with hydrodissection during fascial plane blocks feasible? Eur J Anaesthesiol 2024; 41:790-791. [PMID: 39228240 DOI: 10.1097/eja.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
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Qian J, Wang X. Efficacy of erector spinae plane block for postoperative analgesia after liver surgeries: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:246. [PMID: 39033150 PMCID: PMC11264924 DOI: 10.1186/s12871-024-02635-1] [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: 03/02/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Data on the effectiveness of erector spinae plane block (ESPB) for patients undergoing liver surgeries is limited and inconclusive. We hereby aimed to systematically review if ESPB can provide adequate analgesia after liver surgery. METHODS PubMed, CENTRAL, Scopus, Embase, and gray literature were examined up to 25th April 2023 for randomized controlled trials (RCTs) comparing ESPB with control or spinal analgesia. RESULTS Nine RCTs were included of which three compared ESPB with spinal analgesia. 24-hour opioid consumption did not differ significantly between ESPB vs. control (MD: -35.25 95% CI: -77.01, 6.52 I2 = 99%) or ESPB vs. spinal analgesia (MD: 2.32 95% CI: -6.12, 10.77 I2 = 91%). Comparing pain scores between ESPB and control, a small but significant effect favoring ESPB was noted at 12 h and 48 h, but not at 6-8 h and 24 h. Pain scores did not differ between ESPB and spinal analgesia. The risk of postoperative nausea and vomiting was also not significantly different between ESPB vs. control or spinal analgesia. GRADE assessment shows moderate certainty of evidence. CONCLUSION ESPB may not provide any significant postoperative analgesia in liver surgery patients. There was a tendency of reduced opioid consumption with ESPB. Limited data also showed that ESPB and spinal analgesia had no difference in pain scores and 24-hour analgesic consumption.
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Affiliation(s)
- Jiajia Qian
- Day surgery ward, Huzhou Central Hospital, Affiliated Central Hospital of HuZhou University, 1558 Sanhuan North Road, Huzhou, Zhejiang Province, China
| | - Xueqin Wang
- Day surgery ward, Huzhou Central Hospital, Affiliated Central Hospital of HuZhou University, 1558 Sanhuan North Road, Huzhou, Zhejiang Province, China.
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Franklin AD, Tsao K, Barq R, Kelley-Quon LI, Veneziano G, Aldrink JH. Updates From the Other Side of the Drape: Recent Advances in Multimodal Pain Management and Opioid Reduction Among Pediatric Surgical Patients. J Pediatr Surg 2024; 59:1297-1303. [PMID: 38614947 DOI: 10.1016/j.jpedsurg.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
As the management of acute pain for children undergoing surgical procedures as well as recognition of the short and long term risks of exposure to opioids has evolved, multimodal and multidisciplinary approaches using organized pathways has resulted in improved perioperative outcomes and patient satisfaction. In this 2023 symposium held at the American Academy of Pediatrics on Surgery meeting, a multidisciplinary discussion on current enhanced recovery after surgery pathways, alternate methods of effective pain control and education and advocacy efforts for opioid reduction were discussed, and highlights are included in this article.
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Affiliation(s)
- Andrew D Franklin
- Division of Pediatric Anesthesia, Department of Anesthesia, Vanderbilt University Medical Center, Nashville, TN, USA
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA
| | - Rabab Barq
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giorgio Veneziano
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
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Forero M, Kamel RA. Letter to the editor: the importance of accurate imaging data in ultrasound-guided techniques used in cadaveric studies. Reg Anesth Pain Med 2024:rapm-2024-105756. [PMID: 38942424 DOI: 10.1136/rapm-2024-105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024]
Affiliation(s)
- Mauricio Forero
- Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rami Adel Kamel
- Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Polo-Paredes G, Soler M, Gil F, Laredo FG, Agut A, Carrillo-Flores S, Belda E. Description and Evaluation of Dye and Contrast Media Distribution of Ultrasound-Guided Rectus Sheath Block in Cat Cadavers. Animals (Basel) 2024; 14:1743. [PMID: 38929362 PMCID: PMC11200878 DOI: 10.3390/ani14121743] [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: 05/12/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
The rectus sheath block is an ultrasound-guided anaesthetic technique which aims to provide analgesia to the abdominal midline. This study aimed to assess the distribution of 0.4 mL kg-1 of a mixture of methylene blue and iopromide injected into each hemiabdomen in the internal rectus sheath in cat cadavers. We hypothesise that this technique would be feasible and would cover the rami ventrales of the last thoracic and the first lumbar spinal nerves. The study was divided into two phases. Phase 1 aimed to study the anatomical structures of the ventral abdominal wall (four cats were dissected). Phase 2 (ten cadavers) consisted of an ultrasound-guided injection of the mixture mentioned above and the assessment of its distribution by computed tomography and anatomical dissection. The results showed the staining of the cranioventral abdominal wall with a craniocaudal spread of four (three to eight) vertebral bodies. Methylene blue stained three (one to four) rami ventrales, affecting T10 (60%), T11 (100%), T12 (90%), T13 (50%) and L1 (5%). Based on these results, it could be stated that this technique could supply anaesthesia to the midline of the abdominal midline cranial to the umbilicus in clinical patients, but it may not be able to provide anaesthesia to the middle and caudal midline abdominal region.
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Affiliation(s)
- Gonzalo Polo-Paredes
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
- Escuela Internacional de Doctorado de la Universidad de Murcia, Programa en Ciencias Veterinarias, Universidad de Murcia, 30100 Murcia, Spain
| | - Marta Soler
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
| | - Francisco Gil
- Departamento de Anatomía y Anatomía Patológica Comparada, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain;
| | - Francisco G. Laredo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
| | - Amalia Agut
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
| | | | - Eliseo Belda
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
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Hunter C, Kendall MC, Chen TH, Apruzzese P, Maslow A. Serum Levels of Bupivacaine After Bilateral Ultrasound-Guided Deep Parasternal Intercostal Plane Block in Cardiac Surgery with Median Sternotomy. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00378-1. [PMID: 38908936 DOI: 10.1053/j.jvca.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To evaluate systemic levels of bupivacaine after bilateral ultrasound-guided deep parasternal intercostal plan (PIP) block in cardiac surgical patients undergoing median sternotomy. DESIGN Prospective, observational study SETTING: Single institution; academic university hospital PARTICIPANTS: Twenty-eight adult patients undergoing cardiac surgery with median sternotomy received a PIP block with 2.5 mg/kg bupivacaine with or without dexamethasone and dexmedetomidine. MEASUREMENTS Arterial blood samples were analyzed for total serum bupivacaine concentration at 5, 15, 30, 45, 60, 90, 120, and 150 minutes after placement of PIP. Local anesthetic volume, local anesthetic adjuncts, time to extubation, postoperative pain scores, and opioid consumption were recorded. MAIN RESULTS The mean peak bupivacaine concentration was 0.60 ± 0.62 µg/mL, and the mean time to maximum concentration (Tmax) was 16.92 ± 12.97 minutes. Two patients (7.1%) had a concentration >2.0 µg/mL within 15 minutes of block placement. The mean Tmax of bupivacaine was significantly greater in patients who did not receive additives compared to those patients who did (22.86 ± 14.77 minutes v 10.0 ± 5.22 minutes; p = .004). The times to extubation and postoperative pain were not improved with additives. CONCLUSIONS Bilateral PIP placed at the end of cardiac surgery resulted in low systemic bupivacaine levels. The inclusion of additives shortened Tmax without improving outcome.
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Affiliation(s)
- Caroline Hunter
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Mark C Kendall
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Tzong Huei Chen
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Andrew Maslow
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI.
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Dost B. Enhancing Perioperative Pain Management: Focus on Fascial Plane Blocks and Complication Management. J Perianesth Nurs 2024; 39:491-492. [PMID: 38823965 DOI: 10.1016/j.jopan.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Burhan Dost
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
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Bhushan S, Liu X, Jiang F, Wang X, Mao L, Xiao Z. A progress of research on the application of fascial plane blocks in surgeries and their future direction: a review article. Int J Surg 2024; 110:3633-3640. [PMID: 38935829 PMCID: PMC11175748 DOI: 10.1097/js9.0000000000001282] [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: 07/21/2023] [Accepted: 02/22/2024] [Indexed: 06/29/2024]
Abstract
Fascial plane blocks (FPBs) are gaining popularity in clinical settings owing to their improved analgesia when combined with either traditional regional anesthesia or general anesthesia during the perioperative phase. The scope of study on FPBs has substantially increased over the past 20 years, yet the exact mechanism, issues linked to the approaches, and direction of future research on FPBs are still up for debate. Given that it can be performed at all levels of the spine and provides analgesia to most areas of the body, the erector spinae plane block, one of the FPBs, has been extensively studied for chronic rational pain, visceral pain, abdominal surgical analgesia, imaging, and anatomical mechanisms. This has led to the contention that the erector spinae plane block is the ultimate Plan A block. Yet even though the future of FPBs is promising, the unstable effect, the probability of local anesthetic poisoning, and the lack of consensus on the definition and assessment of the FPB's success are still the major concerns. In order to precisely administer FPBs to patients who require analgesia in this condition, an algorithm that uses artificial intelligence is required. This algorithm will assist healthcare professionals in practicing precision medicine.
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Affiliation(s)
- Sandeep Bhushan
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Xian Liu
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Fenglin Jiang
- Department of Anesthesia and Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, People’s Republic of China
| | - Xiaowei Wang
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Long Mao
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
| | - Zongwei Xiao
- Department of Cardio-Thoracic Surgery, Chengdu Second People’s Hospital
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Chen K, Xiang G, Chen C, Liu Q, Jin J, Huang L, Yang D. Postsurgical Analgesic Effectiveness of Ultrasound-Guided Parasternal Block After Auricular Reconstruction Using Autologous Costal Cartilage in Pediatric Patients: A Randomized Controlled Trial. J Craniofac Surg 2024:00001665-990000000-01606. [PMID: 38758565 DOI: 10.1097/scs.0000000000010252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To study the efficacy of ultrasound-guided parasternal block (US-PSI) in pediatric patients undergoing auricular reconstruction surgery. METHODS For this study, the authors recruited 60 children between the ages of 5 and 12 years who underwent auricular reconstruction with autologous costal cartilage (ACC) to correct microtia. They were randomized to receive either ultrasound-guided modified parasternal block or periprostatic local infiltration anesthesia (PLIA), with 30 cases in each group. Ultrasound-guided parasternal block was administered following anesthesia induction, whereas PLIA was administered after ACC harvest. Lastly, following surgery, all children were provided with patient-controlled intravenous analgesia with sufentanil, and the numeric pain rating scale (NRS) was used to assess the intensity of pain. Our primary outcomes were the resting NRS pain scores and the NRS scores upon coughing at 1, 6, 12, 24, and 48 hours postsurgery. Sufentanil consumption within the first 24 hours of surgery, the mean duration to first ambulation, and the usage of rescue analgesics were our secondary outcomes. The authors also recorded the occurrence of undesirable side effects as well as more serious side effects like pneumothorax. RESULTS Pediatric patients who were administered US-PSI showed significantly reduced NRS chest pain scores at 6 and 12 hours postsurgery compared to those who received PLIA (P<0.05). In addition, sufentanil consumption within the first 24 hours postsurgery, duration to first ambulation, and use of rescue analgesics were significantly lower among patients in the US-PSI group when compared to those in the PLIA group (P<0.05). CONCLUSIONS This study found that US-PSI was a highly efficacious and safe technique for postsurgical analgesia following auricular reconstruction with ACC in pediatric patients. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
| | | | | | | | - Jing Jin
- Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shi Jing Shan, Beijing, China
| | - Lan Huang
- Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shi Jing Shan, Beijing, China
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Samerchua A, Leurcharusmee P, Supphapipat K, Unchiti K, Lapisatepun P, Maikong N, Kantakam P, Navic P, Mahakkanukrauh P. Optimal techniques of ultrasound-guided superficial and deep parasternal intercostal plane blocks: a cadaveric study. Reg Anesth Pain Med 2024; 49:320-325. [PMID: 37460213 DOI: 10.1136/rapm-2023-104595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/04/2023] [Indexed: 05/10/2024]
Abstract
INTRODUCTION The optimal techniques of a parasternal intercostal plane (PIP) block to cover the T2-T6 intercostal nerves have not been elucidated. This pilot cadaveric study aims to determine the optimal injection techniques that achieve a consistent dye spread over the second to sixth intercostal spaces after both ultrasound-guided superficial and deep PIP blocks. We also investigated the presence of the transversus thoracis muscle at the first to sixth intercostal spaces and its sonographic identification agreement, as well as the location of the internal thoracic artery in relation to the lateral border of the sternum. METHODS Ultrasound-guided superficial or deep PIP blocks with single, double, or triple injections were applied in 24 hemithoraces (three hemithoraces per technique). A total volume of dye for all techniques was 20 mL. On dissection, dye distribution over the first to sixth intercostal spaces, the presence of the transversus thoracis muscle at each intercostal space and the distance of the internal thoracic artery from the lateral sternal border were recorded. RESULTS The transversus thoracis muscles were consistently found at the second to sixth intercostal spaces, and the agreement between sonographic identification and the presence of the transversus thoracis muscles was >80% at the second to fifth intercostal spaces. The internal thoracic artery is located medial to the halfway between the sternal border and costochondral junction along the second to sixth intercostal spaces. Dye spread following the superficial PIP block was more localized than the deep PIP block. For both approaches, the more numbers of injections rendered a wider dye distribution. The numbers of stained intercostal spaces after superficial block at the second, fourth, and fifth intercostal spaces, and deep block at the third and fifth intercostal spaces were 5.3±1.2 and 5.7±0.6 levels, respectively. CONCLUSION Triple injections at the second, fourth, and fifth intercostal spaces for the superficial approach and double injections at the third and fifth intercostal spaces for the deep approach were optimal techniques of the PIP blocks.
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Affiliation(s)
- Artid Samerchua
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Prangmalee Leurcharusmee
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Excellence in Osteology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittitorn Supphapipat
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kantarakorn Unchiti
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Panuwat Lapisatepun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Naraporn Maikong
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Perada Kantakam
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pagorn Navic
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Excellence in Osteology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Perez-Herrero MA, Fajardo Perez M, Yamak Altinpulluk E, Ergonenc T. Usefulness of ultrasound-guided serratus-anterior block in prevention of postoperative pain after breast surgery. A cohort study. J Clin Anesth 2024; 93:111360. [PMID: 38118230 DOI: 10.1016/j.jclinane.2023.111360] [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: 09/01/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVE To evaluate superficial serratus anterior plane block's efficacy and side effects in preventing postoperative pain after breast cancer surgery. METHODOLOGY A prospective cohort study was conducted on 195 adult patients undergoing breast oncological surgery under general anesthesia (Group G, n = 96) or combined general anesthesia with superficial serratus anterior plane block (Group L, n = 99). Validated preoperative data, which are predictors of chronic postoperative pain of patients, were recorded (type of surgery, age, pain in the area of the intervention and the other regions; anesthetic-surgical data, analgesic doses used, duration of surgery; pain intensity (EVN scale) at immediate postoperative period, 24 h, seven days and one month after the surgery, and complications. RESULTS Pain intensity, measured by the EVN scale, had a mean of 1.02 +/- 1.656 in the Postoperative Unit; 1.20 +/- 1.448 at 24 h; 0.76 +/- 1208 seven days; and 0.34 +/- 0.757 one month after surgery. Patients were operated under general anesthesia (n = 96) or general anesthesia combined with the interfascial block (n = 99). Significant differences (p < 0.05) were found in age, height, and VAS scale in PACU. Ten complications were recorded, six in Group L and four in Group G. There were no differences between groups in complications. CONCLUSIONS Superficial serratus anterior plane blocks are effective and safe in pain control in the immediate postoperative period for breast cancer surgery as a part of the multimodal approach. No significant differences were found one week and one month after surgery.
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Affiliation(s)
- Maria A Perez-Herrero
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain; Anesthesiology and Reanimation Department, Clinical University Hospital in Valladolid, Spain; Human Anatomy and Radiology Department, Medicine University, Valladolid, Spain.
| | - Mario Fajardo Perez
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain; Human Anatomy Department, Universidad Autónoma, Madrid, Spain; Medical Doctoral Student, University of Rey Juan Carlos, Madrid, Spain
| | - Ece Yamak Altinpulluk
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain; Outcomes Research Consortium, Cleveland, OH, USA; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Tolga Ergonenc
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain; Republic of Turkey Ministry of Health Akyazi Hospital, Turkey
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15
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Coşarcan SK, Gürkan Y, Manici M, Özdemir İ, Kılıç M, Esen T, Erçelen Ö. The effect of ultrasound-guided rectus sheath block on postoperative analgesia in robot assisted prostatectomy: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e37975. [PMID: 38669407 PMCID: PMC11049694 DOI: 10.1097/md.0000000000037975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/26/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain. The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations. METHODS This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 µg fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded. RESULTS Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points. CONCLUSION RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.
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Affiliation(s)
- Sami Kaan Coşarcan
- Department of Anesthesiology, VKV American Hospital, Istanbul, Turkey
- Department of Anesthesiology and Reanimation, Koç University, School of Medicine, Istanbul, Turkey
| | - Yavuz Gürkan
- Department of Anesthesiology and Reanimation, Koç University Hospital, School of Medicine, Istanbul, Turkey
| | - Mete Manici
- Department of Anesthesiology and Reanimation, Koç University Hospital, School of Medicine, Istanbul, Turkey
| | - İrem Özdemir
- Department of Anesthesiology and Algology Clinic, Koç University Hospital, School of Medicine, Istanbul, Turkey
| | - Mert Kılıç
- Department of Urology, VKV American Hospital, Istanbul, Turkey
| | - Tarik Esen
- Department of Urology, VKV American Hospital, Istanbul, Turkey
- Department of Urology, Koç University Hospital, School of Medicine, Istanbul, Turkey
| | - Ömür Erçelen
- Department of Anesthesiology and Algology Clinic, Koç University Hospital, School of Medicine, Istanbul, Turkey
- Department of Anesthesiology and Algology Clinic, VKV American Hospital, Istanbul, Turkey
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16
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Steinfeldt T, Marx A, Dauster M. [Common and New Regional Anaesthesia Techniques Under Review - From Head to Abdomen]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:138-158. [PMID: 38513640 DOI: 10.1055/a-2065-7624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
By implementation of sonography regional anesthesia became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety during needle placement. Thereby new truncal blocks got enabled. Next to the blocking of specific nerve structures, plane blocks got established which can also be described as interfascial compartment blocks. The present review illustrates published and established blocks in daily practice concerning indications and the procedural issues. Moreover, the authors explain potential risks, complications and dosing of local anesthetics.
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17
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Fusco P, Pascarella G, Stecco C, Blanco R, Forero M, Pawa A, Tulgar S, Strumia A, Remore LM, DE Cassai A, Colantonio LB, Del Buono R, Fattorini F, Sepolvere G, Tedesco M, Petroni GM, Ciaschi W, Crassiti M, Costa F. Factors to consider for fascial plane blocks' success in acute and chronic pain management. Minerva Anestesiol 2024; 90:87-97. [PMID: 38197590 DOI: 10.23736/s0375-9393.23.17866-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
The outcome of fascial plane blocks (FPBs) has a certain variability that may depend on many factors, which can be divided into three main categories: operator-related, patient-related and drug-related. Operator-related factors include personal skills, choice of needle and injection modalities. Patient variables include anthropometric features, the type of targeted fascia, anatomical variants, patient positioning, muscle tone and breathing. Ultimately, efficacy, onset, and duration of fascial blocks may be affected by characteristics of the injected solution, including the type of local anesthetic, volume, concentration, pH, temperature and the use of adjuvants. In this article, we investigated all the factors that may influence the outcome of FPBs from a generic perspective, without focusing on any specific technique. Also, we provided suggestions to optimize techniques for everyday practitioners and insights to researchers for future studies.
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Affiliation(s)
- Pierfrancesco Fusco
- Unit of Anesthesia and Intensive Care, SS Filippo e Nicola Hospital, Avezzano, L'Aquila, Italy
| | - Giuseppe Pascarella
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Rafael Blanco
- Unit of Anesthesia and Intensive Care, King's College Hospital Dubai, Abu Dhabi, United Arab Emirates
| | - Mauricio Forero
- Faculty of Anesthesia and Pain Medicine, McMaster University, Hamilton, ON, Canada
| | - Amit Pawa
- Department of Anesthesia and Perioperative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Samsun Training and Research Hospital, Samsun University, Samsun, Türkiye
| | - Alessandro Strumia
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
| | - Luigi M Remore
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
| | - Alessandro DE Cassai
- Unit of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy
| | | | - Romualdo Del Buono
- Unit of Anesthesia, Resuscitation, Intensive Care and Pain Management, ASST Gaetano Pini, Milan, Italy
| | | | - Giuseppe Sepolvere
- Intensive Care Unit, Department of Anesthesia and Cardiac Surgery, San Michele Hospital, Maddaloni, Caserta, Italy
| | - Mario Tedesco
- Department of Anesthesia, Intensive Care and Pain Therapy, Mater Day Hospital, Bari, Italy
| | - Gian M Petroni
- Unit of Anesthesia and Intensive Care, S. Maria Hospital, Terni, Italy -
| | - Walter Ciaschi
- Unit of Anesthesia and Intensive Care, F. Spaziani Hospital, Frosinone, Italy
| | - Massimiliano Crassiti
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
| | - Fabio Costa
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
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Sepolvere G, Stecco C, Gentili L, Tedesco M, Fusco P, Tognù A, Scimia P. Defining the fascial blocks: lights and shadows. Minerva Anestesiol 2024; 90:99-101. [PMID: 37534886 DOI: 10.23736/s0375-9393.23.17623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- Giuseppe Sepolvere
- Cardiac Surgery Intensive Care Unit, Department of Anesthesiology, San Michele Hospital, Maddaloni, Caserta, Italy
| | - Carla Stecco
- Section of Human Anatomy, Department of Neuroscience (DNS), University of Padua, Padua, Italy
| | - Luca Gentili
- Intensive Care Unit, Department of Anesthesiology, S. Maria Goretti Hospital, Latina, Italy -
| | - Mario Tedesco
- Department of Anesthesiology and Intensive Care Unit and Pain Therapy, Mater Dei Hospital, Bari, Italy
| | - Pierfrancesco Fusco
- Intensive Care Unit, Department of Anesthesiology, S. Filippo e Nicola Hospital, Avezzano, L'Aquila, Italy
| | - Andrea Tognù
- Unit of Anesthesiology, Rizzoli Orthopedic Institute, Argenta, Ferrara, Italy
| | - Paolo Scimia
- Intensive Care Unit, Department of Anesthesiology, G. Mazzini Hospital, Teramo, Italy
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Bilge A, Başaran B. Postoperative quality of recovery with erector spinae plane block or thoracolumbar interfascial plane block after major spinal surgery: a randomized controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:68-76. [PMID: 37889327 DOI: 10.1007/s00586-023-07998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Major spinal surgery causes severe postoperative pain. The present randomized, controlled, prospective study tested the short- and long-term effects of thoracolumbar interfascial and erector spinae plane blocks on patient-centered outcomes for major lumbar spinal surgery. METHODS Sixty adult patients were randomly assigned to receive either bilateral thoracolumbar interfascial plane or erector spinae plane block after anesthesia induction using bupivacaine 0.25%, 20 mL. The primary outcome of this study was the Quality of Recovery-40 score in the postoperative 24th hour. Secondary outcomes were Comprehensive Complication Index scores, postoperative pain scores, opioid consumption, first rescue analgesic administration time, and complication incidence. RESULTS The recovery scores of both blocks at the postoperative 24th hour were similar, with a median thoracolumbar interfascial plane block of 178 (IQR 173-180) and an erector spinae plane block of 175 (IQR 168.7-182) (p = 0.717). Thoracolumbar interfascial plane block reduced area under the curve pain with movement over 24 h compared with erector spinae plane block (p = 0.024). The pain scores between the groups were similar at all time points (p > 0.05), except the 24th hour with movement in the thoracolumbar interfascial plane block compared with the erector spinae plane block [median 3 (IQR 2-4)] vs. 4 (IQR 3-5), respectively] (p = 0.019). No differences were recorded between the block groups regarding postoperative 24th-h oxycodone consumption, time to first opioid intake, and complication incidence (p > 0.05). CONCLUSIONS Both blocks resulted in similar quality of recovery in the postoperative 24-h period in major spinal surgery and were effective in terms of analgesia.
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Affiliation(s)
- Ayşegül Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Universite Mh. Sehit Omer Halis Demir Street, No:7, 70100, Karaman, Turkey.
| | - Betül Başaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Universite Mh. Sehit Omer Halis Demir Street, No:7, 70100, Karaman, Turkey
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20
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Boviatsis V, Triantopoulos A. Double-Edge, Single-Edge, and Intermediate-Edge Ultrasound Sign and Correlation With Fascial Plane Block Efficacy: An Experimental Study. Cureus 2024; 16:e51858. [PMID: 38205088 PMCID: PMC10781027 DOI: 10.7759/cureus.51858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/12/2024] Open
Abstract
Introduction Ultrasound-guided fascial plane blocks are nowadays the gold standard technique for regional anesthesia and postoperative analgesia. Despite their high success rate, cases of partial or total failure of this method have been reported. This experimental study aims to address the corresponding ultrasound signs and their association with fascial plane block efficacy. Methods After capturing the appropriate sonographic image that included muscle layers and their fasciae, an 18-gauge epidural needle penetrated the cadaveric porcine tissue and was forwarded until the tip of the needle reached the target fascial plane. The infusion of methylthioninium chloride or methylene blue dye was performed, causing tissue hydro dissection. The documentation of the generated ultrasound images was followed by surgical exposure of the tip of the needle. Results The distribution of the dye into the plane of interest (double-edge sign) was equivalent to block success, whereas the single-edge sign (accumulation of the dye between fascia and epimysium) indicated total block failure. The intermediate-edge sign, a combination of the previous ultrasound signs, is related to partial failure of block performance. Conclusion The identification of the three novel sonographic signs is an accurate predictive factor of peripheral nerve block efficacy. The respective data are expected to aid the rapid improvement of interfascial plane block accuracy and techniques, leading to their more effective execution and simultaneously eliminating the failure rates. Thereby, the amelioration of intra and postoperative analgesia will be accomplished, expediting the patient's hospital discharge and reducing or even avoiding opioid consumption.
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21
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Ocker A, Muafa H, Baratta JL. Regional anesthesia in cardiac surgery and electrophysiology procedures. Int Anesthesiol Clin 2024; 62:21-27. [PMID: 38063034 DOI: 10.1097/aia.0000000000000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Aaron Ocker
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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22
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Huang X, Zeng Y, Sandeep B, Yang J. Clinical impact of fascial plane blocks: defining the research agenda. Br J Anaesth 2023; 131:e180-e183. [PMID: 37770253 DOI: 10.1016/j.bja.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Xin Huang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Yan Zeng
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | - Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Sichuan, Chengdu, China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, China.
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Koehler P, Otero PE, Chiavaccini L, Romano M, Stern AW, Cavalcanti M, Portela DA. A non-inferiority study comparing the ultrasound-guided parasacral with a novel greater ischiatic notch plane approach in canine cadavers. Vet Anaesth Analg 2023; 50:439-445. [PMID: 37331905 DOI: 10.1016/j.vaa.2023.05.003] [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: 02/08/2023] [Revised: 05/05/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To describe the gross and ultrasound anatomy of the parasacral region and an ultrasound-guided greater ischiatic notch (GIN) plane approach aimed at staining the lumbosacral trunk (LST) in canine cadavers. To evaluate if the ultrasound-guided GIN plane approach is non-inferior to the previously described ultrasound-guided parasacral approach at staining the LST. STUDY DESIGN Prospective, randomized, non-inferiority experimental anatomic study. ANIMALS A total of 17 (23.9 ± 5.2 kg) mesocephalic canine cadavers. METHODS Anatomic and echographic landmarks, and the feasibility of performing a GIN plane technique were evaluated using two canine cadavers. The remaining 15 cadavers had each hemipelvis randomly assigned to be administered either parasacral or GIN plane injection of 0.15 mL kg-1 dye solution. The parasacral region was dissected after injections to assess the staining of LST, cranial gluteal nerve, pararectal fossa and pelvic cavity. The stained LST were removed and processed for histological evaluation of intraneural injections. A one-sided z-test for non-inferiority (non-inferiority margin -14%) was used to statistically evaluate the success of the GIN plane versus the parasacral approach. Data were considered statistically significant when p < 0.05. RESULTS The GIN plane and parasacral approach stained the LST in 100% and 93.3% of the injections, respectively. The success rate difference between treatments was 6.7% [95% confidence interval, -0.6 to 19.0%; p < 0.001 for non-inferiority]. The GIN plane and parasacral injections stained the LST for 32.7 ± 16.8 mm and 43.1 ± 24.3 mm, respectively (p = 0.18). No evidence of intraneural injection was found. CONCLUSIONS AND CLINICAL RELEVANCE The ultrasound-guided GIN plane technique resulted in nerve staining that was non-inferior to the parasacral technique and may be considered an alternative to the parasacral approach to block the LST in dogs.
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Affiliation(s)
- Perry Koehler
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Pablo E Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Marta Romano
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Adam W Stern
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Mariana Cavalcanti
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Diego A Portela
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
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Pan H, Fei G. RETRACTED: Erector spinae plane block for pain control after hip surgeries: A systematic review and meta-analysis. Scott Med J 2023:369330231193624. [PMID: 37551581 DOI: 10.1177/00369330231193624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Haiyan Pan
- Department of Orthopedics, The First People's Hospital of Huzhou, Huzhou City, Zhejiang Province, China
| | - Guofang Fei
- Department of Orthopedics, People's Hospital of Nanxun District, Huzhou City, Zhejiang Province, China
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Bilgin S, Aygun H, Genc C, Dost B, Tulgar S, Kaya C, Sertoz N, Koksal E. Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study. BMC Anesthesiol 2023; 23:246. [PMID: 37480008 PMCID: PMC10362577 DOI: 10.1186/s12871-023-02206-w] [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: 02/21/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Cesarean section is becoming increasingly common. Well-managed postoperative analgesia improves patient comfort while encouraging early ambulation and breastfeeding. The analgesic efficacy of transversalis facial plane block (TFPB) vs. anterior quadratus lumborum block (QLB) was compared in this study. METHODS We analyzed the data of 49 pregnant women (gestation, ≥ 37weeks; age, 18-45years) scheduled for elective cesarean delivery (CD) under general anesthesia. They were randomly divided into TFPB and anterior QLB groups. All blocks were administered bilaterally with 25mL of 0.25% bupivacaine under ultrasound guidance prior to extubation. Postoperative morphine consumption and numerical rating scale (NRS) pain scores (static and dynamic [during coughing]) were recorded at 1, 3, 6, 9, 12, 18, and 24h. RESULTS There was no difference in postoperative morphine consumption between the groups at the third, sixth, and ninth hours, but the anterior QLB group consumed less morphine at the 12th, 18th, and 24th hours. Except for the first hour, resting and dynamic NRS scores were comparable between the groups. The first-hour resting and dynamic NRS scores were lower in the TFPB group (resting NRS, anterior QLB group, median [interquartile range], 2 [2-3] vs. TFPB group, 2 [0-2], p = 0.046; dynamic NRS, anterior QLB group, median [interquartile range], 3 [2-4] vs. TFPB group 2 [0-3], p = 0.001). CONCLUSIONS In patients undergoing CD, anterior QLB decreased morphine consumption in the late period (9-24h) compared to TFPB, while pain scores were similar between both groups. The reduction in morphine consumption was statistically significant, but not clinically significant.
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Affiliation(s)
- Sezgin Bilgin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey, TR55139
| | - Hakan Aygun
- Department of Anesthesiology, Cigli Regional Training Hospital, Izmir, Turkey
| | - Caner Genc
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun, Turkey
| | - Burhan Dost
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey, TR55139.
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Samsun Training and Research Hospital, Samsun University, Samsun, Turkey
| | - Cengiz Kaya
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey, TR55139
| | - Nezih Sertoz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ersin Koksal
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey, TR55139
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Alfirevic A, Marciniak D, Duncan AE, Kelava M, Yalcin EK, Hamadnalla H, Pu X, Sessler DI, Bauer A, Hargrave J, Bustamante S, Gillinov M, Wierup P, Burns DJP, Lam L, Turan A. Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair: a randomised clinical trial. Br J Anaesth 2023; 130:786-794. [PMID: 37055276 DOI: 10.1016/j.bja.2023.02.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Minimally invasive cardiac surgery provokes substantial pain and therefore analgesic consumption. The effect of fascial plane blocks on analgesic efficacy and overall patient satisfaction remains unclear. We therefore tested the primary hypothesis that fascial plane blocks improve overall benefit analgesia score (OBAS) during the initial 3 days after robotically assisted mitral valve repair. Secondarily, we tested the hypotheses that blocks reduce opioid consumption and improve respiratory mechanics. METHODS Adults scheduled for robotically assisted mitral valve repairs were randomised to combined pectoralis II and serratus anterior plane blocks or to routine analgesia. The blocks were ultrasound-guided and used a mixture of plain and liposomal bupivacaine. OBAS was measured daily on postoperative Days 1-3 and were analysed with linear mixed effects modelling. Opioid consumption was assessed with a simple linear regression model and respiratory mechanics with a linear mixed model. RESULTS As planned, we enrolled 194 patients, with 98 assigned to blocks and 96 to routine analgesic management. There was neither time-by-treatment interaction (P=0.67) nor treatment effect on total OBAS over postoperative Days 1-3 with a median difference of 0.08 (95% confidence interval [CI]: -0.50 to 0.67; P=0.69) and an estimated ratio of geometric means of 0.98 (95% CI: 0.85-1.13; P=0.75). There was no evidence of a treatment effect on cumulative opioid consumption or respiratory mechanics. Average pain scores on each postoperative day were similarly low in both groups. CONCLUSIONS Serratus anterior and pectoralis plane blocks did not improve postoperative analgesia, cumulative opioid consumption, or respiratory mechanics during the initial 3 days after robotically assisted mitral valve repair. CLINICAL TRIAL REGISTRATION NCT03743194.
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Affiliation(s)
- Andrej Alfirevic
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA.
| | - Donn Marciniak
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Andra E Duncan
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Marta Kelava
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Esra Kutlu Yalcin
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Hassan Hamadnalla
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Xuan Pu
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Bauer
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Hargrave
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Sergio Bustamante
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery and Cleveland Clinic, Cleveland, OH, USA
| | - Per Wierup
- Department of Cardiothoracic Surgery, Lund University, Lund, Sweden
| | - Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery and Cleveland Clinic, Cleveland, OH, USA
| | - Louis Lam
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
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Lee SH, Kim HJ, Kim SH, Cho TH, Kwon HJ, O J, Hong JE, Nam SH, Hwang YI, Yang HM. Anatomical study of the adductor canal: three-dimensional micro-computed tomography, histological, and immunofluorescence findings relevant to neural blockade. Korean J Anesthesiol 2023; 76:252-260. [PMID: 36245345 DOI: 10.4097/kja.22499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/06/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND A precise anatomical understanding of the adductor canal (AC) and its neural components is essential for discerning the action mechanism of the AC block. We therefore aimed to clarify the detailed anatomy of the AC using micro-computed tomography (micro-CT), histological evaluation, and immunofluorescence (IF) assays. METHODS Gross dissections of 39 thighs provided morphometric data relevant to injection landmarks. Serial sectional images of the AC were defined using micro-CT and ultrasonography. The fascial and neural structures of the AC proper were histologically evaluated using Masson's trichrome and Verhoeff-Van Gieson staining, and double IF staining using choline acetyltransferase (ChAT) and neurofilament 200 antibodies. RESULTS The posteromedial branch insertion of the nerve to vastus medialis (NVM) into the lateral border of the AC proper was lower (14.5 ± 2.4 cm [mean ± SD] above the base of the patella) than the origin of the proximal AC. The AC consists of a thin subsartorial fascia in the proximal region and a thick aponeurosis-like vastoadductor membrane in the distal region. In the proximal AC, the posteromedial branch of the NVM (pmNVM) consistently contained both sensory and motor fibers, and more ChAT-positive fibers were observed than in the saphenous nerve (27.5 ± 11.2 / 104 vs. 4.2 ± 2.6 / 104 [counts/µm2], P < 0.001). CONCLUSIONS Anatomical differences in fascial structures between the proximal and distal AC and a mixed neural component of the neighboring pmNVM have been visualized using micro-CT images, histological evaluation, and IF assays.
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Affiliation(s)
- Shin Hyo Lee
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
- Translational Research Unit for Anatomy and Analgesia, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Kim
- Translational Research Unit for Anatomy and Analgesia, Yonsei University College of Medicine, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Hyung Kim
- Translational Research Unit for Anatomy and Analgesia, Yonsei University College of Medicine, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hyeon Cho
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
- Translational Research Unit for Anatomy and Analgesia, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Jin Kwon
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
- Translational Research Unit for Anatomy and Analgesia, Yonsei University College of Medicine, Seoul, Korea
| | - Jehoon O
- Center of Biohealth Convergence and Open Sharing System, Hongik University, Seoul, Korea
| | - Ju Eun Hong
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University MIRAE Campus, Wonju, Korea
| | - Seung Hyun Nam
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Il Hwang
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
- Translational Research Unit for Anatomy and Analgesia, Yonsei University College of Medicine, Seoul, Korea
- Surgical Anatomy Education Center, Yonsei University College of Medicine, Seoul, Korea
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Petiz C, Barbosa R, Ribeiro Boneco T, Pacheco J, Resende A. External Oblique Intercostal Block for Living Kidney Donor Open Nephrectomy: A Case Series. Cureus 2023; 15:e39139. [PMID: 37332413 PMCID: PMC10275393 DOI: 10.7759/cureus.39139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
The external oblique intercostal (EOI) block is a novel regional technique that provides analgesia for upper abdominal incisions. We performed single-injection and continuous EOI blocks in living kidney donors who underwent open nephrectomy. In this case series, we report our experience with pain management using this technique in five patients at our centre. EOI block resulted in good pain relief in our patients. The median (IQR) numerical rating scale score was 3 (1-6) at rest immediately after the end of the surgery, predominantly visceral. We want to highlight the benefits regarding pain management of the association of EOI block with conventional therapy.
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Affiliation(s)
- Catarina Petiz
- Anesthesiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Rita Barbosa
- Anesthesiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | | | - Jânia Pacheco
- Anesthesiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Alexandra Resende
- Anesthesiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
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29
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Ramanujam V, Tian L, Chow C, Kendall MC. Three-Dimensional Imaging of Commonly Performed Peripheral Blocks: Using a Handheld Point-of-Care Ultrasound System. Anesth Pain Med 2023; 13:e134797. [PMID: 37529139 PMCID: PMC10389033 DOI: 10.5812/aapm-134797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 08/03/2023] Open
Abstract
Background Handheld ultrasound devices have become popular among clinicians due to their affordability and compatibility with tablets and smartphones. Several handheld ultrasound devices have the capability to construct three-dimensional (3D) images using a traditional two-dimensional (2D) ultrasound transducer. Objectives The current study aimed to construct 3D images of common peripheral nerve and fascial plane blocks using a handheld ultrasound device with a 2D ultrasound probe. Methods A total of 10 patients who were scheduled to receive ultrasound-guided peripheral nerve blocks for outpatient surgery and classified as the American Society of Anesthesiologists physical status I or II with a body mass index of ≤ 30 kg/m2 were included in the study. Patients who presented with anatomical variations during the initial ultrasound scanning were excluded. Results This study successfully constructed 3D images of 10 peripheral nerve blocks. The average time to complete each 3D scan was less than 5 seconds per attempt, with fascial plane blocks requiring twice the amount of time to complete. All the nerve blocks provided effective postoperative analgesia without complications. The 3D images were successfully captured in all patients. Conclusions The 3D images provide clinicians with valuable information on the anatomical boundaries of the injectate that can further direct needle direction and placement of local anesthetic to achieve visual confidence of anesthetic spread.
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Affiliation(s)
- Vendhan Ramanujam
- The Department of Anesthesiology, the Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America
| | - Lee Tian
- The Department of Anesthesiology, the Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America
| | - Clarence Chow
- The Department of Anesthesiology, the Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America
| | - Mark C. Kendall
- The Department of Anesthesiology, the Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America
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Hargrave J, Grant MC, Kolarczyk L, Kelava M, Williams T, Brodt J, Neelankavil JP. An Expert Review of Chest Wall Fascial Plane Blocks for Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:279-290. [PMID: 36414532 DOI: 10.1053/j.jvca.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
The recent integration of regional anesthesia techniques into the cardiac surgical patient population has become a component of enhanced recovery after cardiac surgery pathways. Fascial planes of the chest wall enable single-injection or catheter-based infusions to spread local anesthetic over multiple levels of innervation. Although median sternotomy remains a common approach to cardiac surgery, minimally invasive techniques have integrated additional methods of performing cardiac surgery. Understanding the surgical approach and chest wall innervation is crucial to success in choosing the appropriate chest wall block. Parasternal intercostal plane techniques (previously termed "pectointercostal fascial plane" and "transversus thoracic muscle plane") provide anterior chest and ipsilateral sternal coverage. Anterolateral chest wall coverage is feasible with the interpectoral plane and pectoserratus plane blocks (previously termed "pectoralis") and superficial and deep serratus anterior plane blocks. The erector spinae plane block provides extensive coverage of the ipsilateral chest wall. Any of these techniques has the potential to provide bilateral chest wall analgesia. The relative novelty of these techniques requires ongoing research to be strategic, thoughtful, and focused on clinically meaningful outcomes to enable widespread evidence-based implementation. This review article discusses the key perspectives for performing and assessing chest wall blocks in a cardiac surgical population.
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Affiliation(s)
- Jennifer Hargrave
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Marta Kelava
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | | | - Jessica Brodt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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Zaballos M, Varela O, Fernández I, Rodríguez L, García S, Quintela O, Vázquez E, Anadón MJ, Almendral J. Assessment of cardiotoxicity and plasma ropivacaine concentrations after serratus intercostal fascial plane block in an experimental model. Sci Rep 2023; 13:47. [PMID: 36593251 PMCID: PMC9807569 DOI: 10.1038/s41598-022-26557-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023] Open
Abstract
Serratus intercostal fascial plane block (SIFPB) has emerged as an alternative to paravertebral block in breast surgery. It involves the administration of high volumes and doses of local anesthetics (LA) that can potentially reach toxic levels. Ropivacaine is widely used in thoraco-fascial blocks; however, there is no information on the plasma concentrations attained after SIPFB and whether they are associated with cardiotoxicity. Plasma concentrations of ropivacaine and its electrophysiological effects were evaluated in eight pigs after bilateral SIFPB with ropivacaine in doses of 3 mg/kg. Plasma concentrations, electrophysiological and hemodynamic parameters were measured sequentially for the following 180 min until the end of the study. The area under the curve, the maximum plasma concentration (Cmax) and the time to reach Cmax (tmax) were calculated. The median arterial ropivacaine concentration Cmax was, 2.34 [1.40 to 3.74] µg/ml. The time to reach the highest concentration was 15 [10 to 20] min. Twenty-five percent of the animals had arterial concentrations above the lower limit concentration of ropivacaine for LA systemic toxicity (3.4 µg/ml). No alterations were observed in the electrophysiological or electrocardiographic parameters except for a prolongation of the QTc interval, from 489 ± 30 to 544 ± 44 ms (Δ11.38 ± 6%), P = 0.01. Hemodynamic parameters remained in the physiological range throughout the study. SIFPB with ropivacaine in doses of 3 mg/kg has reached potentially toxic levels, however, it has not been associated with adverse electrophysiological or hemodynamic effects.
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Affiliation(s)
- Matilde Zaballos
- grid.4795.f0000 0001 2157 7667Department of Forensic Medicine, Psychiatry and Pathology, Complutense University, Madrid, Spain ,grid.410526.40000 0001 0277 7938Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, C/ Dr Esquerdo nº46, 28007 Madrid, Spain
| | - Olalla Varela
- grid.410526.40000 0001 0277 7938Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, C/ Dr Esquerdo nº46, 28007 Madrid, Spain
| | - Ignacio Fernández
- grid.410526.40000 0001 0277 7938Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, C/ Dr Esquerdo nº46, 28007 Madrid, Spain
| | - Lucía Rodríguez
- grid.410526.40000 0001 0277 7938Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, C/ Dr Esquerdo nº46, 28007 Madrid, Spain
| | - Sergio García
- grid.410526.40000 0001 0277 7938Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, C/ Dr Esquerdo nº46, 28007 Madrid, Spain
| | - Oscar Quintela
- grid.4795.f0000 0001 2157 7667Department of Forensic Medicine, Psychiatry and Pathology, Complutense University, Madrid, Spain
| | - Elena Vázquez
- grid.410526.40000 0001 0277 7938Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María-José Anadón
- grid.4795.f0000 0001 2157 7667Department of Forensic Medicine, Psychiatry and Pathology, Complutense University, Madrid, Spain
| | - Jesús Almendral
- grid.8461.b0000 0001 2159 0415Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain
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Kurdi MS, Agrawal P, Thakkar P, Arora D, Barde SM, Eswaran K. Recent advancements in regional anaesthesia. Indian J Anaesth 2023; 67:63-70. [PMID: 36970484 PMCID: PMC10034932 DOI: 10.4103/ija.ija_1021_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 12/21/2022] [Accepted: 12/31/2022] [Indexed: 01/20/2023] Open
Abstract
Patient safety, improved quality of care, and better patient satisfaction and functional outcomes are currently the topmost priorities in regional anaesthesia (RA) and all advancements in RA move in this direction. Ultrasonography-guided central neuraxial and peripheral nerve blocks, intracluster and intratruncal injections, fascial plane blocks, diaphragm-sparing blocks, use of continuous nerve block techniques, and continuous local anaesthetic wound infiltration catheters are now topics of popular clinical interest. The safety and efficacy of nerve blocks can be improved with the help of injection pressure monitoring and the incorporation of advanced technology in the ultrasound machine and needles. Novel procedure-specific and motor-sparing nerve blocks have come up. The anaesthesiologist of the current era, with a good understanding of the sonoanatomy of the target area and the microarchitecture of nerves, along with the backup of advanced technology, can be very successful in performing RA techniques. RA is rapidly evolving and revolutionising the practice of anaesthesia.
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Affiliation(s)
- Madhuri S. Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India
| | - Pushpa Agrawal
- Department of Anaesthesiology, Dr. Vaishampayan Memorial Govt. Medical College, Solapur, Maharashtra, India
| | - Parna Thakkar
- Department of Anaesthesia, Sir H.N.Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Divesh Arora
- Department of Anaesthesia, Asian Hospital, Faridabad, Haryana, India
| | - Saurabh M. Barde
- Department of Anaesthesia, RNH Hospital, Dhantoli, Nagpur, Maharashtra, India
| | - Kala Eswaran
- Department of Anaesthesiology, JK Women’s Hospital, Manav Kalyan Kendra, Dombivli, Maharashtra, India
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Ni Y, Zhong Y, Zhang Y, Tao Y, Pan J, Zhao Y, Zhang Z, Jin Y. Single ultrasound-guided thoracic paravertebral block with a large volume of anesthetic for microwave ablation of lung tumors. Front Oncol 2022; 12:955778. [PMID: 36387227 PMCID: PMC9659758 DOI: 10.3389/fonc.2022.955778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/12/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To compare single ultrasound-guided thoracic paravertebral block (TPVB) using a large volume of anesthetic with local anesthesia (LA) in computed tomography (CT)-guided pulmonary microwave ablation. Subjects and methods Eighty patients who underwent CT-guided microwave ablation of pulmonary tumors were randomly divided into the TPVB group and the LA group. Patients of the TPVB group were anesthetized with a single injection of a large volume (40 ml) of 0.375% ropivacaine injection at T4, and those of the LA group had local infiltration by the surgeon at the puncture site, and emergency rescue with propofol injection was administered when the patient could not tolerate pain in either group. The following variables were recorded in both groups: general conditions; volume of propofol injection for emergency rescue during ablation; visual analog scale (VAS) scores during ablation and at 0, 2, 12, and 24 h after ablation; the need to use analgesics for rescue within 24 h after ablation; number of ablations; number of punctures performed by the surgeon; patient’s movements during puncturing; and puncturing-associated complications. Results Compared with the TPVB group, the amount of emergency use of propofol injection was significantly more in the LA group (P < 0.05). There were no significant differences in the VAS scores recorded intraoperatively and at 0, 2, 12, and 24 h after ablation between the two groups (P > 0.05). There was a significant difference in the patient’s movements upon puncturing between the two groups (P < 0.05), but there were no significant differences in the numbers of punctures and ablations between the two groups (P > 0.05). The number of patients using analgesics within 24 h after the operation was also more in the LA group than in the TPVB group, and the difference between the two groups was statistically significant (P < 0.05). Conclusion Single ultrasound-guided TPVB with a large volume of anesthetic offers effective analgesia for microwave ablation of lung tumors, helping the patient cooperate with the operating surgeon to reduce injury from multiple lung punctures. Further studies are recommended to validate these findings.
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Affiliation(s)
- Yong Ni
- Pain Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yulong Zhong
- Pain Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Anesthesia Department, Sichuan Science City Hospital, Mianyang, China
| | - Yue Zhang
- Pain Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yifei Tao
- Pain Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Pan
- Pain Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiming Zhao
- Pain Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhicheng Zhang
- Pain Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yong Jin
- The Interventional Therapy Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Yong Jin,
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Campoy L. Development of Enhanced Recovery After Surgery (ERAS) protocols in veterinary medicine through a one-health approach: the role of anesthesia and locoregional techniques. J Am Vet Med Assoc 2022; 260:1751-1759. [DOI: 10.2460/javma.22.08.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Enhanced Recovery After Surgery (ERAS) is a new and emerging concept in human medicine that involves rethinking the preoperative, intraoperative, and postoperative periods. The ultimate, overarching aim is to improve patient outcome following surgery and, thus, return to a normal daily routine as soon as possible. The development and implementation of locoregional anesthetic techniques in humans is one of the key elements driving these protocols. In veterinary medicine, we are no exception: the rapidly growing interest, development, and refinement of these techniques in our veterinary species is changing the way we think of anesthesia and analgesia. The potential real benefits are yet to be determined, as this concept is implemented into our veterinary hospitals in general, and our surgical patients in particular, in a more systematic and routine way. In this article, we will introduce the reader to the concept of ERAS protocols and the role of regional anesthesia in some common surgical procedures.
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Affiliation(s)
- Luis Campoy
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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Ultrasound-guided erector spinae plane block improves analgesia after laparoscopic hepatectomy: a randomised controlled trial. Br J Anaesth 2022; 129:445-453. [DOI: 10.1016/j.bja.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
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Ultrasound-guided erector spinae plane block for postoperative analgesia in patients after liver surgery: A systematic review and meta-analysis on randomized comparative studies. Int J Surg 2022; 103:106689. [PMID: 35662584 DOI: 10.1016/j.ijsu.2022.106689] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the analgesic efficacy and feasibility of erector spinae plane block (ESPB) with non-block care or other blocks in patients undergoing liver surgery. METHOD A meta-analysis of randomized controlled trials (RCTs) that compared ESPB to non-block care or local infiltration analgesia (LIA), intrathecal morphine (ITM) and quadratus lumborum block (QLB) for postoperative analgesia in liver surgery patients. RESULTS Six RCTs containing 392 patients were included. This meta-analysis found that ESPB did not significantly reduce postoperative 8 h [mean standard (MD) 0.20; 95% (confidence interval) CI: -1.62, 2.01; P = 0.83; I2 = 99%] and 24 h [MD 0.10; 95% CI: -0.91, 1.11; P = 0.84; I2 = 97%] resting pain scores in patients undergoing liver surgery compared to control groups. Furthermore, ESPB had no effect on postoperative 24 h cumulative opioid consumption [MD 1.74; 95% CI: 3.43, 6.91; P = 0.51; I2 = 95%] or sleep quality [OR 1.00; 95% CI: 0.43, 2.35; P 0.99; I2 = 0%]. In contrast, ESPB reduced postoperative 48 h resting pain score [MD -0.77; 95% CI -1.56, 0.02; P = 0.05; I2 = 96%], the incidence of postoperative nausea and vomiting (PONV) [OR 0.29; 95% CI 0.18, 0.48; P = 0.001; I2 = 0%]. Interestingly, in two RCTs, ESPB showed a higher incidence of shoulder pain compared to ITM [OR 2.89; 95%CI 1.03 to 8.09; P = 0.04; I2 = 0%]. There have been no reports of complications from ESPB or other blocks. CONCLUSION Current literature supported that ESPB had no significant difference in analgesic efficacy in liver surgery patients compared to LIA, ITM, and QLB. More evidences, preferably from high quality RCTs are required to confirm these finding.
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Statzer NJ, Plackis AC, Woolard AA, Allen BFS, Siegrist KK, Shi Y, Shotwell M. Erector Spinae Plane Catheter Analgesia in Minimally Invasive Mitral Valve Surgery: A Retrospective Case-Control Study for Inclusion in an Enhanced Recovery Program. Semin Cardiothorac Vasc Anesth 2022; 26:266-273. [PMID: 35617152 DOI: 10.1177/10892532221104420] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. A retrospective case-control study was conducted to assess the feasibility of erector spinae plane (ESP) block as part of a multimodal enhanced recovery program for patients undergoing minimally invasive mitral valve replacement surgery. Methods. This retrospective analysis was conducted at a single center between January and August 2019. 61 patients were included; 23 received ESP and 38 did not. Erector spinae catheters (ESCs) were placed preoperatively, using a loading dose of 30 mL .5% ropivacaine, followed by an infusion of .2% ropivacaine at 10 mL/h throughout the study period. Primary outcome was 48-hour opioid consumption. Secondary outcomes included intraoperative morphine equivalents, extubation within 24 hours, reintubation, ICU length of stay and hospital length of stay and 30-day mortality. Results. Median [inter-quartile range] of the postoperative morphine milligram equivalents (MMEs) in the first 48 hours was 70[45-121] MMEs in the ESC) group, and 109[70-148] MMEs in the no ESC group (P-value = .16). No significant difference was observed in intraoperative morphine equivalents, extubation within 24 hours or ICU length of stay. The ESC group had shorter hospital length of stay (6.0 vs 7.0 days, P-value = .043). Conclusion. This study found a statistically insignificant, though potentially clinically significant reduction in postoperative opioid consumption. A reduced hospital length of stay as well as an acceptable safety profile was also observed in the ESC group. An adequately powered, prospective trial is warranted to accurately assess the potential role for ESP catheters for patients undergoing minimally invasive mitral valve surgery.
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Affiliation(s)
- Nicholas J Statzer
- Division of Multispecialty Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andreas C Plackis
- Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Austin A Woolard
- Division of Cardiothoracic Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian F S Allen
- Division of Multispecialty Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kara K Siegrist
- Division of Cardiothoracic Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yaping Shi
- Department of Biostatistics, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew Shotwell
- Department of Biostatistics, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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Gómez M, Izquierdo CE, Mayoral Rojals V, Pergolizzi Jr J, Plancarte Sanchez R, Paladini A, Varrassi G. Considerations for Better Management of Postoperative Pain in Light of Chronic Postoperative Pain: A Narrative Review. Cureus 2022; 14:e23763. [PMID: 35518528 PMCID: PMC9064707 DOI: 10.7759/cureus.23763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/02/2022] [Indexed: 12/02/2022] Open
Abstract
Chronic postoperative pain (CPOP) is prevalent, with particularly high rates in breast surgery, thoracotomy, and amputation. As the world emerges from the coronavirus disease 2019 (COVID-19) lockdowns, it is expected that there will be an increase in surgical procedures, elevating the importance of preventing CPOP in the coming years. Risk factors are emerging to better stratify patients at high risk for CPOP. Perioperative analgesia plays an important role in managing acute postoperative pain and in some cases may limit its transition to CPOP. Acute postoperative pain is adaptive, normal, expected, and has a well-defined trajectory, while CPOP is maladaptive and, as a form of chronic pain, is challenging to treat. Good analgesia, early ambulation, and rehabilitation efforts may be helpful in preventing CPOP following certain surgeries. Enhanced Recovery After Surgery (ERAS) protocols present guidance to help promote recovery and prevent CPOP.
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