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Scholzen EA, Silva JB, Schroeder KM. Unique considerations in regional anesthesia for emergency department and non-or procedures. Int Anesthesiol Clin 2024; 62:43-53. [PMID: 38063037 DOI: 10.1097/aia.0000000000000426] [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)
- Elizabeth A Scholzen
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Zaki HA, Iftikhar H, Shallik N, Elmoheen A, Bashir K, Shaban EE, Azad AM. An integrative comparative study between ultrasound-guided regional anesthesia versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: A systematic review and meta-analysis. Heliyon 2022; 8:e12413. [PMID: 36590471 PMCID: PMC9800551 DOI: 10.1016/j.heliyon.2022.e12413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/19/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background Emergency physicians play a major role in managing patients with hip fractures. The most commonly used pain management option is parenteral opioids. However, parenteral opioids are subjected to several adverse effects. New pain management techniques such as regional anesthesia are used as alternatives to parenteral opioids. Anatomical landmarks were used to administer regional anesthesia; however, ultrasound guidance has shown promising results with regional anesthesia. Objective of the Review: The present study compares the efficacy of ultrasound-guided regional anesthesia (USGRA) to parenteral opioids in analgesia of hip fractures patients. Methods A literature search for original and relevant articles carried out through six electronic databases, yielded 710 articles which were then assessed using the eligibility criteria resulting in 8 studies eligible for inclusion. Results A Meta-analysis of the seven studies showed that ultrasound-guided femoral nerve block was more effective than parenteral opioids in relieving pain. Similarly, meta-analysis of data from two studies shows that US-guided FICB significantly reduced pain scores than parenteral opioids. A subgroup analysis of adverse events showed no significant difference in nausea/vomiting and respiratory complications. However, a subgroup analysis on hypotension showed that the incidence of hypotension was significantly lower in USGRA than parenteral opioids. The present study also revealed that patients in the USGRA group required less frequent rescue analgesia than the patients in the parenteral opioids group. Conclusion Results of the present study show that USGRA is superior to parenteral opioids in reducing pain and the need for rescue analgesia in patients with hip fractures.
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Affiliation(s)
- Hany A. Zaki
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Haris Iftikhar
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar,Corresponding author.
| | - Nabil Shallik
- Anesthesia Department, Hamad Medical Corporation, Doha, Qatar,College of Medicine, Qatar University, Doha, Qatar,Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Amr Elmoheen
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar,College of Medicine, Qatar University, Doha, Qatar
| | - Khalid Bashir
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar,College of Medicine, Qatar University, Doha, Qatar
| | - Eman E. Shaban
- Cardiology, Al Jufairi Diagnosis and Treatment, Doha, Qatar
| | - Aftab Mohammad Azad
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar,College of Medicine, Qatar University, Doha, Qatar,Weill Cornell Medical College in Qatar, Doha, Qatar
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Simić A, Nesek Adam V, Rošić D, Kočet N, Svetec M, Herceg A, Keranović A, Rašić Ž. PERIPHERAL NERVE BLOCKS FOR HIP FRACTURES
IN EMERGENCY MEDICINE. Acta Clin Croat 2022; 61:78-83. [PMID: 36304813 PMCID: PMC9536168 DOI: 10.20471/acc.2022.61.s1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hip fractures represent a major public health issue with increasing incidence as a population ages. The aim of this review is to describe peripheral nerve block techniques (the fascia iliaca compartment block and the pericapsular nerve group block) as pain management for hip fractures in emergency medicine, and to emphasize their benefits. Hip fractures are extremely painful injuries. The pain itself is unpleasant for patients and if left untreated it can lead to multiple complications during preoperative, operative and postoperative patient management. Pain management for elderly hip fracture patients is often challenging. Non-steroidal anti-inflammatory drugs are not recommended due to their side effects, the increased risk of gastrointestinal bleeding, renal function impairment and platelet aggregation inhibition. Paracetamol alone is often insufficient, and opioids have many potentially harmful side effects, such as delirium development. Peripheral nerve blocks for hip fractures are safe and effective, also in emergency medicine settings. The benefits for patients are greater pain relief, especially during movement, less opioid requirements and decreased incidence of delirium. Regional analgesia should be routinely used in hip fracture pain management.
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Affiliation(s)
- Anđela Simić
- Institute of Emergency Medicine Varaždin County;
| | - Višnja Nesek Adam
- University Hospital Sveti Duh, Emergency Medicine Department;,University Hospital Sveti Duh, University Department of Anesthesiology, Resuscitation and Intensive Care;,Josip Juraj Strossmayer University in Osijek, Medical School Osijek;,Libertas International University, Zagreb
| | - Damir Rošić
- Institute of Emergency Medicine of Primorje – Gorski Kotar County;,The Medical School of the Catholic University of Croatia;
| | - Nikola Kočet
- Institute of Emergency Medicine Varaždin County;
| | - Maja Svetec
- Institute of Emergency Medicine Varaždin County;
| | - Ana Herceg
- Institute of Emergency Medicine Varaždin County;
| | - Adis Keranović
- University Hospital Center Zagreb, Emergency Medicine Department;
| | - Žarko Rašić
- University Hospital Sveti Duh, University Department of Surgery;,University in Zagreb, School of Medicine
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The impact of loco-regional anaesthesia on postoperative opioid use in elderly hip fracture patients: an observational study. Eur J Trauma Emerg Surg 2021; 48:2943-2952. [PMID: 33961071 PMCID: PMC9360082 DOI: 10.1007/s00068-021-01674-4] [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: 11/15/2020] [Accepted: 04/15/2021] [Indexed: 12/04/2022]
Abstract
Purpose Hip fractures are a common health problem among the elderly with an increasing incidence. They are associated with high mortality and morbidity. Optimal pain management remains challenging and inadequate pain control is known for negatively affecting outcomes. Loco-regional anaesthetics (LRA) have been proven to benefit pain management and to lower the risks of opioid use and -related side effects. We aimed to evaluate the use and efficacy of different LRA in elderly hip fracture patients. Methods Single-center cohort study of elderly hip fracture patients, who were treated in central Switzerland. We compared patients who received LRA in the form of a femoral nerve block (FNB) or a continuous femoral nerve catheter (CFNC) with patients who did not receive LRA. Primary outcomes were pain—as measured in perioperative morphine use—hospital length of stay (HLOS), postoperative complications, postoperative falls and mortality. Results 407 patients were included for analysis. Mean age was 85.2 (SD6.3). There was a significant difference in intraoperative morphine use between the groups (p = 0.007). Postoperative morphine use differed significantly and was lowest in patients with FNB and highest in patients without LRA (p < 0.001). The use of LRA was a significant predictor for postoperative morphine use for postoperative morphine use at the recovery room and for postoperative morphine use 48 h after surgery. No significant differences were found in postoperative complications, a significant difference was found in 1-year mortality. Conclusions This article shows that LRA in the form of FNB and CFNC causes a significant decrease in postoperative opioid consumption. Differences between single-shot FNB or CFNC were minimal. There were no significant differences in clinical outcomes such as HLOS, delirium, 30-day and 90-day mortality and postoperative falls. We suggest that use of LRA should be incorporated in the perioperative treatment of elderly patients with a hip fracture. For future research, we recommend evaluating the number of postoperative complications and mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01674-4.
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Sustained Release of Levobupivacaine, Lidocaine, and Acemetacin from Electrosprayed Microparticles: In Vitro and In Vivo Studies. Int J Mol Sci 2020; 21:ijms21031093. [PMID: 32041361 PMCID: PMC7037341 DOI: 10.3390/ijms21031093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
In this study, we explored the release characteristics of analgesics, namely levobupivacaine, lidocaine, and acemetacin, from electrosprayed poly(D,L-lactide-co-glycolide) (PLGA) microparticles. The drug-loaded particles were prepared using electrospraying techniques and evaluated for their morphology, drug release kinetics, and pain relief activity. The morphology of the produced microparticles elucidated by scanning electron microscopy revealed that the optimal parameters for electrospraying were 9 kV, 1 mL/h, and 10 cm for voltage, flow rate, and travel distance, respectively. Fourier-transform infrared spectrometry indicated that the analgesics had been successfully incorporated into the PLGA microparticles. The analgesic-loaded microparticles possessed low toxicity against human fibroblasts and were able to sustainably elute levobupivacaine, lidocaine, and acemetacin in vitro. Furthermore, electrosprayed microparticles were found to release high levels of lidocaine and acemetacin (well over the minimum therapeutic concentrations) and levobupivacaine at the fracture site of rats for more than 28 days and 12 days, respectively. Analgesic-loaded microparticles demonstrated their effectiveness and sustained performance for pain relief in fracture injuries.
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Kim C, Cha H, Kang BS, Choi HJ, Lim TH, Oh J. A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos. J Digit Imaging 2018; 29:347-56. [PMID: 26620200 DOI: 10.1007/s10278-015-9849-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Our aim was to prove the feasibility of the remote interpretation of real-time transmitted ultrasound videos of dynamic and static organs using a smartphone with control of the image quality given a limited internet connection speed. For this study, 100 cases of echocardiography videos (dynamic organ)-50 with an ejection fraction (EF) of ≥50 s and 50 with EF <50 %-and 100 cases of suspected pediatric appendicitis (static organ)-50 with signs of acute appendicitis and 50 with no findings of appendicitis-were consecutively selected. Twelve reviewers reviewed the original videos using the liquid crystal display (LCD) monitor of an ultrasound machine and using a smartphone, to which the images were transmitted from the ultrasound machine. The resolution of the transmitted echocardiography videos was reduced by approximately 20 % to increase the frame rate of transmission given the limited internet speed. The differences in diagnostic performance between the two devices when evaluating left ventricular (LV) systolic function by measuring the EF and when evaluating the presence of acute appendicitis were investigated using a five-point Likert scale. The average areas under the receiver operating characteristic curves for each reviewer's interpretations using the LCD monitor and smartphone were respectively 0.968 (0.949-0.986) and 0.963 (0.945-0.982) (P = 0.548) for echocardiography and 0.972 (0.954-0.989) and 0.966 (0.947-0.984) (P = 0.175) for abdominal ultrasonography. We confirmed the feasibility of remotely interpreting ultrasound images using smartphones, specifically for evaluating LV function and diagnosing pediatric acute appendicitis; the images were transferred from the ultrasound machine using image quality-controlled telesonography.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyunmin Cha
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchun-ro(st), Guri-si, GyeongGi-do, 471-701, Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
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Kim C, Kang B, Park J, Ha Y. The Use of Clinician-Performed Ultrasonography to Determine the Treatment Method for Suspected Paediatric Appendicitis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate whether the clinician-performed ultrasonography based on the specific criteria for paediatric appendicitis could decrease the negative appendectomy rate without treatment failure. Methods The study was a retrospective review of paediatric patients with suspected appendicitis who presented at the emergency department of a teaching hospital over a period of 18 months. The clinicians performed the ultrasound and decided whether the patients with suspected appendicitis should be referred to surgery or managed conservatively. The determinative ultrasound criteria were the presence of periappendiceal fat infiltration and/or an obstructing appendicolith. Results The 166 paediatric patients with suspected appendicitis underwent ultrasonography performed by clinicians on weekdays; forty (24.1%) cases with an obstructing appendicolith and/or periappendiceal fat infiltration were treated surgically, and none had a pathologically negative appendectomy, which was significantly lower than the number in the computed tomography scan group (10.4%, 11/106) on weeknights or weekends. The remaining 126 (75.8%) patients without obstructing appendicolith or periappendiceal fat infiltration were treated conservatively, regardless of their appendiceal diameter, and no patients experienced a treatment failure. Conclusions The clinician-performed ultrasonography bases on the strict use of above specific ultrasound criteria to determine treatment strategies for suspected paediatric appendicitis can reduce the negative appendectomies without treatment failure. (Hong Kong j.emerg.med. 2015;22:31-40)
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Affiliation(s)
| | | | - Jb Park
- Seoul Hospital, Department of Emergency Medicine, Soonchunhyang University College of Medicine, Republic of Korea
| | - Yr Ha
- Daejin Medical Center Bundang Jesaeng General Hospital, Department of Emergency Medicine, Republic of Korea
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