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Strumia A, Pascarella G, Sarubbi D, Di Pumpo A, Costa F, Conti MC, Rizzo S, Stifano M, Mortini L, Cassibba A, Schiavoni L, Mattei A, Ruggiero A, Agrò FE, Carassiti M, Cataldo R. Rectus sheath block added to parasternal block may improve postoperative pain control and respiratory performance after cardiac surgery: a superiority single-blinded randomized controlled clinical trial. Reg Anesth Pain Med 2024:rapm-2024-105430. [PMID: 38876800 DOI: 10.1136/rapm-2024-105430] [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: 02/27/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The population undergoing cardiac surgery confronts challenges from uncontrolled post-sternotomy pain, with possible adverse effects on outcome. While the parasternal block can improve analgesia, its coverage may be insufficient to cover epigastric area. In this non-blinded randomized controlled study, we evaluated the analgesic and respiratory effect of adding a rectus sheath block to a parasternal block. METHODS 58 patients undergoing cardiac surgery via median sternotomy were randomly assigned to receive parasternal block with rectus sheath block (experimental) or parasternal block with epigastric exit sites of chest drains receiving surgical infiltration of local anesthetic (control). The primary outcome of this study was pain at rest at extubation. We also assessed pain scores at rest and during respiratory exercises, opiate consumption and respiratory performance during the first 24 hours after extubation. RESULTS The median (IQR) maximum pain scores (on a 0-10 Numeric Rate Scale (NRS)) at extubation were 4 (4, 4) in the rectus sheath group and 5 (4, 5) in the control group (difference 1, p value=0.03). Rectus sheath block reduced opioid utilization by 2 mg over 24 hours (IC 95% 0.0 to 2.0; p<0.01), reduced NRS scores at other time points, and improved respiratory performance at 6, 12, and 24 hours after extubation. CONCLUSION The addition of a rectus sheath block with a parasternal block improves analgesia for cardiac surgery requiring chest drains emerging in the epigastric area. TRIAL REGISTRATION NUMBER NCT05764616.
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Affiliation(s)
- Alessandro Strumia
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giuseppe Pascarella
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Domenico Sarubbi
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Annalaura Di Pumpo
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Fabio Costa
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Maria Cristina Conti
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Stefano Rizzo
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Mariapia Stifano
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Lara Mortini
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Alessandra Cassibba
- Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy
| | - Lorenzo Schiavoni
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Alessia Mattei
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Alessandro Ruggiero
- Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy
| | - Felice E Agrò
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy
| | - Massimiliano Carassiti
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy
| | - Rita Cataldo
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy
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Chen Z, Gao C, Zhang Y, Gao Y, Zhang L, Zhao S, Zhang H, Zhao X, Jin Y. Effects of Ultrasound-Guided Thoracic Paravertebral Nerve Block Combined with Perineural or IV Dexmedetomidine on Acute and Chronic Pain After Thoracoscopic Resection of Lung Lesions: A Double-Blind Randomized Trial. Drug Des Devel Ther 2024; 18:2089-2101. [PMID: 38882043 PMCID: PMC11177863 DOI: 10.2147/dddt.s457334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/22/2024] [Indexed: 06/18/2024] Open
Abstract
Background Thoracic paravertebral block (TPVB) analgesia can be prolonged by local anesthetic adjuvants such as dexmedetomidine. This study aimed to evaluate the two administration routes of dexmedetomidine on acute pain and chronic neuropathic pain (NeuP) prevention compared with no dexmedetomidine. Methods A total of 216 patients were randomized to receive TPVB using 0.4% ropivacaine alone (R Group), with perineural dexmedetomidine 0.5 μg·kg-1 (RD0.5 Group) or 1.0 μg·kg-1 (RD1.0 Group), or intravenous (IV) dexmedetomidine 0.5 μg·kg-1·h-1 (RDiv Group). The primary outcome was the incidence of chronic NeuP, defined as a Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain score > 12 points at 3-month after surgery. Results (1) For the primary outcome, RD0.5 Group and RD1.0 Group demonstrated a decreased incidence of chronic NeuP at 3-month after surgery; (2) Compared with R Group, RDiv Group, RD0.5 Group, and RD1.0 Group can reduce VAS scores at rest and movement and Prince-Henry Pain scores at 12 and 24-h after surgery, the consumption of oral morphine equivalent (OME) and improve QOD-15 at POD1; (3) Compared with RDiv Group, RD0.5 Group and RD1.0 Group can reduce VAS scores at rest and movement and Prince-Henry Pain scores at 12 and 24-h after surgery, the consumption of postoperative OME and improve QOD-15 at POD1; (4) Compared with RD0.5 Group, RD1.0 Group effectively reduced VAS scores at rest at 12 and 24-h after surgery, VAS scores in movement and Prince-Henry Pain scores at 12-h after surgery. However, RD1.0 Group showed an increased incidence of drowsiness. Conclusion Perineural or IV dexmedetomidine are similarly effective in reducing acute pain, but only perineural dexmedetomidine reduced chronic NeuP. Moreover, considering postoperative complications such as drowsiness, perineural dexmedetomidine (0.5 μg·kg-1) may be a more appropriate choice. Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR2200058982).
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Affiliation(s)
- Zheping Chen
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Changli Gao
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Department of Anesthesiology, Laoling People Hospital, Laoling, People's Republic of China
| | - Yingchao Zhang
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Department of Anesthesiology, Shouguang People Hospital, Weifang, People's Republic of China
| | - Yongxu Gao
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Department of Anesthesiology, Jinan Third People's Hospital, Laoling, People's Republic of China
| | - Le Zhang
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Shanshan Zhao
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - He Zhang
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Xin Zhao
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Yanwu Jin
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
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Soh PQP, Wong WHT, Roy T, Tam WWS. Effectiveness of non-pharmacological interventions in improving sleep quality after cardiac surgery: A systematic review and meta-analysis. J Clin Nurs 2024; 33:2084-2098. [PMID: 38477050 DOI: 10.1111/jocn.17115] [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: 07/06/2023] [Revised: 10/21/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Sleep disturbance is highly prevalent among post-operative cardiac patients, with negative impacts on surgical recovery and rehabilitation. Post-operative pain and anxiety commonly seen in cardiac surgery patients are associated with poor sleep. Sleep medications commonly used are not ideal with prolonged usage, and non-pharmacological interventions can be good alternatives or complements. AIM To examine effectiveness of non-pharmacological interventions in post-operative cardiac settings on sleep quality, pain intensity and anxiety. DESIGN Systematic review and meta-analysis. METHODS PubMed, CENTRAL, Embase, CINAHL, Scopus, CNKI and ProQuest Dissertations and Theses were searched on 12 October 2022. Randomised controlled trials of non-pharmacological interventions examining sleep quality for adult post-operative cardiac patients were included. Included studies were appraised using Cochrane Risk of Bias tool version 1. Meta-analysis was conducted using RevMan version 5.4.1, and heterogeneity was assessed using I2 statistics and Cochran Q's test. RESULTS Eighteen studies involving 1701 participants were identified. Coronary artery bypass graft was most common. Non-pharmacological interventions varied in types and duration. All intervention groups were compared to usual care, placebo, no interventions or active comparators. Statistically significant improvement in sleep quality (SMD = -.91, 95% CI = -1.17 to -.65) was found among intervention groups that explored cognitive behavioural therapy, relaxation techniques, exercise, massage, acupressure, aromatherapy, music, eye mask and earplugs. Pain intensity was reduced (SMD = -.63, 95% CI = -1.05 to -.20) with cognitive behavioural therapy, relaxation techniques, massage, music and eye mask. Anxiety was improved (SMD = -.21, 95% CI = -.38 to -.04) with exercise and music. CONCLUSION The overall use of non-pharmacological interventions can optimise sleep after cardiac surgery. Further research with greater methodological rigour is needed to investigate different intervention-related characteristics while considering potential confounders. RELEVANCE TO CLINICAL PRACTICE Post-operative cardiac settings can consider incorporating non-pharmacological interventions. Patients and healthcare providers can be better informed about the use of such interventions to improve sleep. REGISTRATION PROSPERO CRD42022384991.
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Affiliation(s)
- Pei Qi Peggy Soh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Hao Timothy Wong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Tanushri Roy
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Wu Z, Chen L, Guo W, Wang J, Ni H, Liu J, Jiang W, Shen J, Mao C, Zhou M, Wan M. Oral mitochondrial transplantation using nanomotors to treat ischaemic heart disease. NATURE NANOTECHNOLOGY 2024:10.1038/s41565-024-01681-7. [PMID: 38802669 DOI: 10.1038/s41565-024-01681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024]
Abstract
Mitochondrial transplantation is an important therapeutic strategy for restoring energy supply in patients with ischaemic heart disease (IHD); however, it is limited by the invasiveness of the transplantation method and loss of mitochondrial activity. Here we report successful mitochondrial transplantation by oral administration for IHD therapy. A nitric-oxide-releasing nanomotor is modified on the mitochondria surface to obtain nanomotorized mitochondria with chemotactic targeting ability towards damaged heart tissue due to nanomotor action. The nanomotorized mitochondria are packaged in enteric capsules to protect them from gastric acid erosion. After oral delivery the mitochondria are released in the intestine, where they are quickly absorbed by intestinal cells and secreted into the bloodstream, allowing delivery to the damaged heart tissue. The regulation of disease microenvironment by the nanomotorized mitochondria can not only achieve rapid uptake and high retention of mitochondria by damaged cardiomyocytes but also maintains high activity of the transplanted mitochondria. Furthermore, results from animal models of IHD indicate that the accumulated nanomotorized mitochondria in the damaged heart tissue can regulate cardiac metabolism at the transcriptional level, thus preventing IHD progression. This strategy has the potential to change the therapeutic strategy used to treat IHD.
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Affiliation(s)
- Ziyu Wu
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, China
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lin Chen
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, China
| | - Wenyan Guo
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, China
| | - Jun Wang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Haiya Ni
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianing Liu
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wentao Jiang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian Shen
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, China
| | - Chun Mao
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, China.
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China.
| | - Mimi Wan
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, China.
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Wang W, Yang W, Liu A, Liu J, Yuan C. The Analgesic Effect of Ultrasound-guided Erector Spinae Plane Block in Median Sternotomy Cardiac Surgery in Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00349-5. [PMID: 38890084 DOI: 10.1053/j.jvca.2024.05.019] [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: 01/18/2024] [Revised: 05/04/2024] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES To assess the analgesic effect of erector spinae plane block in adults undergoing median sternotomy cardiac surgery. DESIGN AND SETTING The Cochrane, Embase, and PubMed databases from inception to January 2024 were searched. The study has been registered in the International Prospective Register of Systematic Reviews (CRD42023470375). PARTICIPANTS Eight randomized controlled trials involving 543 patients, comparing with no block or sham block, were included, whether it was a single injection or continuous. MEASUREMENTS AND MAIN RESULTS The primary outcomes were pain scores and opioid consumption. Erector spinae plane block reduced pain scores immediately after extubation (mean difference [MD], -1.19; 95% confidence interval [CI], -1.67 to -0.71; p for heterogeneity = 0.10), at 6 hours after extubation (MD, -1.96; 95% CI, -2.85 to -1.08; p for heterogeneity < 0.0001), and at 12 hours after extubation (MD, -0.98; 95% CI, -1.55 to -0.40; p for heterogeneity < 0.00001). The decrease in pain scores reached the minimal clinically important difference within 6 hours. Opioid consumption 24 hours after surgery decreased by 35.72 mg of oral morphine equivalents (95% CI, -50.88 to -20.57; p for heterogeneity < 0.0001). Sensitivity analysis confirmed the stability of results. The quality of primary outcomes was rated as very low to moderate. CONCLUSIONS Erector spinae plane block decreased pain scores within 12 hours after extubation, reached the minimal clinically important difference within 6 hours, and decreased opioid consumption 24 hours after surgery, based on data of very low to moderate quality. However, high-quality randomized controlled trials are necessary to validate these findings.
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Affiliation(s)
- Wenzhu Wang
- Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Weilin Yang
- Department of Anesthesiology, Deyang People's Hospital, Deyang, Sichuan, China
| | - Ang Liu
- Department of Anesthesiology, Heze Municipal Hospital, Heze, Shandong, China
| | - Jian Liu
- Department of Emergency Surgery, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Changxiu Yuan
- Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong, China.
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Malvindi PG, Bifulco O, Berretta P, Galeazzi M, Alfonsi J, Cefarelli M, Zingaro C, Zahedi HM, Munch C, Di Eusanio M. The Enhanced Recovery after Surgery Approach in Heart Valve Surgery: A Systematic Review of Clinical Studies. J Clin Med 2024; 13:2903. [PMID: 38792445 PMCID: PMC11121940 DOI: 10.3390/jcm13102903] [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: 03/14/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Enhanced recovery after surgery (ERAS) protocols aim to reduce postoperative complications and promote earlier recovery. Although it is well established in noncardiac surgery fields, the ERAS approach has only recently been adopted in cardiac surgery. The aim of this review is to evaluate the status and implementation of ERAS protocols in patients undergoing heart valve surgery and to summarise associated clinical results. Methods: A literature search for the period January 2015 and January 2024 was performed through online databases. Clinical studies (randomised controlled trials and cohort studies) on patients undergoing heart valve surgical procedures and comparing ERAS and conventional approaches were included. The data extracted covered studies and populations characteristics, early outcomes and the features of each ERAS protocol. Results: There were 14 studies that fulfilled the final search criteria and were ultimately included in the review. Overall, 5142 patients were identified in the 14 studies, with 2501 in ERAS groups and 2641 patients who were representative of control groups. Seven experiences exclusively included patients who underwent heart valve surgery. Twelve out of fourteen protocols involved multiple interventions from the preoperative to postoperative phase, while two studies reported actions limited to intraoperative and postoperative care. We found high heterogeneity among the included protocols regarding key actions targeted for improvement and measured outcomes. All the studies showed that ERAS pathways can be safely adopted in cardiac surgery and in most of the experiences were associated with shorter mechanical ventilation time, reduced postoperative opioid use and reduced ICU and hospital stays. Conclusions: As demonstrated in noncardiac surgery, the adoption of structured ERAS protocols has the potential to improve results in patients undergoing heart valve surgery. Further evidence based on larger populations is needed, including more homogenous pathways and reporting further outcomes in terms of patient satisfaction, recovery and quality of life after surgery.
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Affiliation(s)
- Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Michele Galeazzi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Carlo Zingaro
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Hossein M. Zahedi
- Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, 60121 Ancona, Italy
| | - Christopher Munch
- Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, 60121 Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60121 Ancona, Italy
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Kim S, Song SW, Jeon YG, Song SA, Hong S, Park JH. Evaluating the Efficacy of the Erector Spinae Plane Block as a Supplementary Approach to Cardiac Anesthesia during Off-Pump Coronary Bypass Graft Surgery via Median Sternotomy: A Randomized Clinical Trial. J Clin Med 2024; 13:2208. [PMID: 38673480 PMCID: PMC11051109 DOI: 10.3390/jcm13082208] [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: 03/01/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Pain control after off-pump coronary artery bypass graft (OPCAB) facilitates mobilization and improves outcomes. The efficacy of the erector spinae plane block (ESPB) after cardiac surgery remains controversial. Methods: We aimed to investigate the analgesic effects of ESPB after OPCAB. Precisely 56 patients receiving OPCAB were randomly divided into ESPB and control groups. The primary outcome was visual analog scale (VAS) pain scores at 6, 12, 24, and 48 h postoperatively. Secondary outcomes were the dose of rescue analgesics in terms of oral morphine milligram equivalents, the dose of antiemetics, the length of intubation time, and the length of stay in the intensive care unit (ICU). Results: The VAS scores were similar at all time points in both groups. The incidence of severe pain (VAS score > 7) was significantly lower in the ESPB group (50% vs. 15.4%; p = 0.008). The dose of rescue analgesics was also lower in the ESPB group (19.04 ± 18.76, 9.83 ± 12.84, p = 0.044) compared with the control group. The other secondary outcomes did not differ significantly between the two groups. Conclusions: ESPB provides analgesic efficacy by reducing the incidence of severe pain and opioid use after OPCAB.
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Affiliation(s)
- Sujin Kim
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Seung Woo Song
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Yeong-Gwan Jeon
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Sang A. Song
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Soonchang Hong
- Department of Cardiovascular Surgery, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea;
| | - Ji-Hyoung Park
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
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Pieri M, Dormio S, Morosato M, Belletti A, Silvestri D, Montorfano M, Monaco F. Shaping the Anesthetic Approach to TricValve Implantation: Insights From a Case Series. J Cardiothorac Vasc Anesth 2024; 38:911-917. [PMID: 38281824 DOI: 10.1053/j.jvca.2024.01.003] [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: 07/03/2023] [Revised: 11/29/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Caval valve implantation (CAVI) represents a minimally invasive strategy for managing severe tricuspid regurgitation in high-risk patients unsuitable for surgical or transcatheter tricuspid valve implantation. This case series aimed to assess the anesthesia management challenges and outcomes associated with this procedure, seeking to generate insights that can inform and refine anesthesia protocols. DESIGN A case series. SETTING At a cardiac catheterization laboratory of a teaching hospital. PARTICIPANTS Eight patients undergoing CAVI with the Tricvalve system INTERVENTIONS: The anesthetic protocol included preprocedural planning, fast-track general anesthesia, and postprocedural debriefing. Intraoperative management involved anesthesia depth monitoring, real-time guidance via transesophageal echocardiography, and hemodynamic stability maintenance. Postoperative analgesia involved preemptive intravenous paracetamol and morphine as needed. MEASUREMENTS AND MAIN RESULTS No anesthesia-related or implantation-related complications were observed, with a mean procedure duration of 112 ± 44 minutes. The median hospital stay was 4 days, and only 1 patient required brief intensive care unit monitoring. Postoperative right shoulder pain was reported by half of the patients, and was managed with morphine bolus administration (average dose 4.75 ± 3.6 mg). All patients had the device correctly positioned, as confirmed by postoperative transthoracic echocardiograms. None of the patients required outpatient analgesic therapy upon discharge. CONCLUSIONS The authors' study demonstrated the potential of TricValve implantation in effectively managing severe tricuspid regurgitation with no procedure-related complications and a 100% survival rate. A collaborative, interdisciplinary approach and targeted anesthesia management proved crucial for this success. Postoperative shoulder pain emerged as a frequent complication, whose pathogenesis is still not clear, and successfully was managed using targeted analgesic therapy.
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Affiliation(s)
- Marina Pieri
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Dormio
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Morosato
- Cardiothoracic Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Belletti
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dario Silvestri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Vita-Salute San Raffaele University, Milan, Italy; Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Yue Y, Ji H, Wang S, Cheng H, Wang R, Qu H, Li J. Evaluation of Analgesic Drug Therapy for Postoperative Pain Management in Cardiovascular Surgery. CURRENT THERAPEUTIC RESEARCH 2024; 100:100744. [PMID: 38803585 PMCID: PMC11128826 DOI: 10.1016/j.curtheres.2024.100744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/14/2024] [Indexed: 05/29/2024]
Abstract
Background Cardiovascular surgery is usually associated with higher degree of postoperative pain that influences a patient's physical recovery. Multiple clinical measures have been taken to avoid overuse of opioid agents for postoperative pain management, which led to the development of clinical pathways for analgesic drug treatment using a multimodal approach. Objective To evaluate the effectiveness and safety of a multimodal postoperative analgesic drug pathway (ADP) for pain management following cardiovascular surgery. Methods This retrospective, controlled, nonrandomized study evaluated a postoperative ADP in patients undergoing cardiovascular surgery in a tertiary general hospital in Qingdao, China. Effectiveness and safety outcomes were compared before and after the implementation of the ADP. Outcome indicators included postoperative pain scores, consumption of opioids in analgesic pumps, and incidence of adverse events. Results Patients who underwent cardiovascular surgery from September to November 2021 before the implementation of the ADP (n = 193) and from September to November 2022 after the implementation of the ADP (n = 218) were enrolled. Pain scores were reduced on day 1, 3, and 5 after surgery and the reduction was most significant in mild pain (P < .001). Opioids in analgesic pumps consumption was also significantly reduced and there was decreased incidence of adverse events such as nausea and vomiting (P = .026), respiratory inhibition (P = .027), and dizziness and headache (P = .028) in cardiovascular surgery patients after implementation of the ADP. Conclusions Improved effectiveness and safety were observed following the implementation of the ADP. Multimodal analgesic ADP methodology can be effectively used for postoperative pain management in patients undergoing cardiovascular surgery.
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Affiliation(s)
- Yue Yue
- School of Pharmacy, Qingdao University, Qingdao, Shandong, China
| | - Hongyan Ji
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shizhong Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Huawei Cheng
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Rongmei Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haijun Qu
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jing Li
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Schmedt J, Oostvogels L, Meyer-Frießem CH, Weibel S, Schnabel A. Peripheral Regional Anesthetic Techniques in Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2024; 38:403-416. [PMID: 38044198 DOI: 10.1053/j.jvca.2023.09.043] [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: 01/30/2023] [Revised: 08/14/2023] [Accepted: 09/29/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE The aim of this systematic review was to investigate postoperative pain outcomes and adverse events after peripheral regional anesthesia (PRA) compared to no regional anesthesia (RA), placebo, or neuraxial anesthesia in children and adults undergoing cardiac surgery. DESIGN A systematic review and meta-analysis with an assessment of the risk of bias (Cochrane RoB 1) and certainty of evidence (Grading of Recommendations, Assessment, Development, and Evaluation). SETTING Randomized controlled trials (RCTs). PARTICIPANTS Adults and children undergoing heart surgery. INTERVENTIONS Any kind of PRA compared to no RA or placebo or neuraxial anesthesia. MEASUREMENTS AND MAIN RESULTS In total, 33 RCTs (2,044 patients) were included-24 of these had a high risk of bias, and 28 were performed in adults. Compared to no RA, PRA may reduce pain intensity at rest 24 hours after surgery (mean difference [MD] -0.81 points, 95% CI -1.51 to -0.10; I2 = 92%; very low certainty evidence). Peripheral regional anesthesia, compared to placebo, may reduce pain intensity at rest (MD -1.36 points, 95% CI -1.59 to -1.13; I2 = 54%; very low certainty evidence) and during movement (MD -1.00 points, 95% CI -1.34 to -0.67; I² = 72%; very low certainty evidence) 24 hours after surgery. No data after pediatric cardiac surgery could be meta-analyzed due to the low number of included trials. CONCLUSIONS Compared to no RA or placebo, PRA may reduce pain intensity at rest and during movement. However, these results should be interpreted cautiously because the certainty of evidence is only very low.
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Affiliation(s)
- Julian Schmedt
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - Lisa Oostvogels
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - Christine H Meyer-Frießem
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, BG-Universitätsklinikum Bergmannsheil gGmbH, Medical Faculty of Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, Bochum, Germany
| | - Stephanie Weibel
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Alexander Schnabel
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany.
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11
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Sudin A, Chong C, Hassan R. Incidence and Factors Associated With Post-Sternotomy Pain Syndrome in the National Heart Institute, Malaysia. J Cardiothorac Vasc Anesth 2024; 38:466-474. [PMID: 38114372 DOI: 10.1053/j.jvca.2023.11.014] [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: 08/24/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To determine the incidence of poststernotomy pain syndrome (PSPS) after open cardiac surgery in 2021. To determine characteristics and assess the severity of symptoms in patients diagnosed with PSPS. To identify factors that can be associated with patients who were positive for PSPS. DESIGN AND METHODOLOGY This study used a retrospective observational approach. Logistic regression analysis was employed to identify factors associated with the positive group. SETTING This study included all adult patients who underwent open cardiac surgery at the National Heart Institute, Malaysia, in 2021. PARTICIPANTS A total of 1,395 patients were enrolled. INTERVENTIONS The study involved conducting phone interviews to assess the presence of PSPS, followed by administering the Brief Pain Inventory questionnaire in the positive group to identify characteristics and severity of chronic pain. MEASUREMENTS AND MAIN RESULTS The incidence of PSPS after open cardiac surgery in 2021 was 20.35%. A total of 17.7% of patients reported that pain affected their daily activities, sleep, or emotions. Univariate analysis identified factors associated with PSPS, including age <60 years old, body mass index >30 kg/m2, history of previous percutaneous coronary intervention, ejection fraction <50%, the absence of chronic kidney disease (CKD), and internal mammary artery harvesting (p < 0.05). Multivariate analysis revealed that 4 independent factors were associated with PSPS: age <60 years old, history of previous percutaneous coronary intervention, ejection fraction <50%, and the absence of CKD (as compared with CKD) (p < 0.05). CONCLUSIONS Poststernotomy pain syndrome is a complex issue affected by various factors. Although the pain score may not be as severe as previously believed, it remains crucial to recognize PSPS because a significant proportion of patients are affected.
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Affiliation(s)
- Arif Sudin
- Anesthesia & Intensive Care department, National Heart Institute (IJN), Kuala Lumpur, Malaysia.
| | - Collins Chong
- Department of Anaesthesia & Intensive Care, Faculty of Medicine & Health Science, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rozaini Hassan
- Anesthesia & Intensive Care department, National Heart Institute (IJN), Kuala Lumpur, Malaysia
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12
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Maghami M, Pour-Abbasi MS, Yadollahi S, Maghami M, Azizi-Fini I, Afazel MR. Pain and sleep after open-heart surgery-inhalation peppermint essence: double-blind randomized clinical trial. BMJ Support Palliat Care 2024; 13:e1318-e1325. [PMID: 37536755 DOI: 10.1136/spcare-2023-004214] [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: 02/06/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effect of inhaling peppermint essence on pain relief and sleep quality after open-heart surgery. METHODS In a double-blind randomised clinical trial carried out in Iran in 2020, 64 cardiac patients were selected by convenience sampling and randomly allocated to aromatherapy (n=32) and placebo (n=32) groups. The aromatherapy and control groups received inhaled aromatherapy using peppermint essence and distilled water, respectively. Data gathering tools were the Numeric Pain Rating Scale and St Mary's Hospital Sleep Questionnaire. Data were analysed using an independent t-test, χ2 test, Mann-Whitney U test and generalised estimating equation analysis. RESULTS The mean severity of pain in the aromatherapy and placebo groups was 3.22±0.88 and 4.56±0.90, respectively, which was a statistically significant difference (p=0.0001). The mean sleep scores after the intervention on day 1 were 20.10±4.90 and 25.76±6.36 in the aromatherapy and placebo groups, respectively, and 18.63±5.56 and 22.62±5.69, respectively, on day 2. The difference between the two groups was statistically significantly different after the intervention in terms of sleep quality (p<0.05). CONCLUSION Aromatherapy attenuated pain and improved sleep quality after open-heart surgery. Peppermint essence aromatherapy is therefore recommended after surgery.
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Affiliation(s)
- Mahla Maghami
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Safoura Yadollahi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahboobeh Maghami
- Biostatics and Epidemiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ismail Azizi-Fini
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad-Reza Afazel
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Patel A, Shah A, Apigo A, Lin HM, Ouyang Y, Huang K, Friedman S, Yimen M, Puskas JD, Bhatt HV. Perioperative Implementation of Low-Dose Pregabalin in an Enhanced Recovery After Cardiac Surgery Protocol: A Pre-Post Observational Study. J Cardiothorac Vasc Anesth 2024; 38:183-188. [PMID: 37940456 DOI: 10.1053/j.jvca.2023.09.045] [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: 04/07/2023] [Revised: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Determine the effect of low-dose pregabalin in the perioperative enhanced recovery after cardiac surgery protocol. DESIGN Pre-post observational study. SETTING Tertiary care hospital. PARTICIPANTS Patients undergoing off-pump coronary artery bypass graft procedures. INTERVENTIONS Pregabalin 75 mg BID for 48 hours postoperatively versus no pregabalin in a perioperative setting. MEASUREMENTS AND MAIN RESULTS Perioperative opioid use, pain scores, length of stay, time to extubation, and mortality were all measured. Descriptive data were presented as mean (SD), median (IQR), or N (%). Ordinal and continuous data used the t-test or Kruskal-Wallis test. Categorical data were compared between groups using the chi-square test or Fisher's exact test, as appropriate. Low-dose pregabalin administration (75 mg twice daily for 48 hours after surgery) was associated with a clinically significant reduction in opioid consumption on postoperative day 0 by 30.6%, with a median requirement of 318 (233, 397) morphine milligram equivalents (MME) in the pregabalin group compared with 458 (375, 526) MME in the control group (p < 0.001). There was no significant difference in pain scores between the groups with the exception at 0-to-12 hours, during which the pregabalin group had greater pain scores (median 3.32 [1.65, 4.36] v 2.0 [0, 3.25], p = 0.013) (Table 3). Moreover, there was no significant difference in pain scores on postoperative day 1 (p = 0.492), day 2 (p = 0.442), day 3 (p = 0.237), and day 4 (p = 0.649). The difference in average Richmond Agitation Sedation Score scores was also not statistically significant between groups at 12 hours (p = 0.954) and at 24 hours (p = 0.301). The pregabalin group had no increased incidence of adverse events or any significant differences in intensive care unit length of stay, time to extubation, or mortality. CONCLUSIONS In this evaluation of perioperative pregabalin administration for patients requiring cardiac surgery, pregabalin reduced postoperative opioid use, with significant reductions on postoperative day 0, and without any significant increase in adverse reactions. However, no differences in intensive care unit length of stay, time to extubation, or mortality were noted. The implementation of low-dose perioperative pregabalin within an Enhanced Recovery After Cardiac Surgery protocol may be effective at reducing postoperative opioid use in the immediate postoperative period, and may be safe with regard to adverse events. Ideal dosing strategies have not been determined; thus, further randomized control trials with an emphasis on limiting confounding factors need to be conducted.
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Affiliation(s)
- Alopi Patel
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Morningside Medical Center, New York, NY.
| | - Ami Shah
- Department of Pharmacy, Mount Sinai Morningside Medical Center, New York, NY; Department of Cardiothoracic Surgery and Critical Care, Mount Sinai Morningside Medical Center, New York, NY
| | - Anthony Apigo
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Morningside Medical Center, New York, NY
| | - Hung-Mo Lin
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Yuxia Ouyang
- Department of Population Health Science and Policy, Mount Sinai Hospital, New York, NY
| | - Kristy Huang
- Department of Pharmacy, Mount Sinai Morningside Medical Center, New York, NY
| | - Seana Friedman
- Department of Cardiothoracic Surgery and Critical Care, Mount Sinai Morningside Medical Center, New York, NY
| | - Mekeleya Yimen
- Department of Cardiothoracic Surgery and Critical Care, Mount Sinai Morningside Medical Center, New York, NY
| | - John D Puskas
- Department of Cardiothoracic Surgery and Critical Care, Mount Sinai Morningside Medical Center, New York, NY
| | - Himani V Bhatt
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Morningside Medical Center, New York, NY
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Demir ZA, Aydin ME, Balci E, Ozay HY, Ozgok A, Ahiskalioglu A. Ultrasound-guided erector spinae plane block in coronary artery bypass surgery: the role of local anesthetic volume-a prospective, randomized study. Gen Thorac Cardiovasc Surg 2024; 72:1-7. [PMID: 37414972 DOI: 10.1007/s11748-023-01953-4] [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: 04/18/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Erector spinae plane block has been shown to help with pain management in different regions and many areas with different indications. However, the effectiveness of this block in cardiac surgery has been shown in the literature, the optimal volume remains unclear. The aim of this study is to determine the analgesic efficacy of two different volumes of local anesthetic injection used in ultrasound-guided bilateral-thoracic erector spinae plane block in patients undergoing coronary artery bypass graft. METHODS This study was conducted on adult patients undergoing surgery with coronary artery bypass graft, and 70 patients were analyzed in each group. Group 20 received erector spinae plane block with 20 ml of 0.25% bupivacaine, Group 30 received 30 ml of 0.25% bupivacaine bilaterally. Postoperative sternotomy and chest tube-related pain were evaluated using the numerical rating scale (NRS) at rest and during movement. RESULTS There were significant differences between the groups regarding rescue tramadol consumption was higher in Group 20 than in Group 30 (25/35 vs. 2/35, p < 0.001). In addition, there were substantial differences between the two groups concerning the time of the first-rescue analgesic requirement. The mean time ± standard deviation was 11.26 ± 9.57 h and 24.03 ± 4.12 h in Groups 20 and 30 (p < 0.001). The median scores, both at sternotomy and chest tubes, were significantly lower in Group 30 than in Group 20 at the different time points after the surgery (p < 0.05). CONCLUSIONS In coronary artery bypass graft surgery, erector spinae plane block performed with 30 ml instead of 20 ml on each side resulted in less pain in the sternum and chest tube region, less need for rescue analgesics, and delayed first-rescue analgesic requirement.
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Affiliation(s)
- Zeliha Asli Demir
- Anesthesiology Department, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Muhammed Enes Aydin
- Department of Anaesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey.
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey.
| | - Eda Balci
- Anesthesiology Department, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Hulya Yigit Ozay
- Anesthesiology Department, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Aysegul Ozgok
- Anesthesiology Department, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Ali Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey
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Fadhlurrahman AF, Setiawan P, Sumartono C, Perdhana F, Husain TA. The effect of pectointercostal fascial block on stress response in open heart surgery. Saudi J Anaesth 2024; 18:70-76. [PMID: 38313701 PMCID: PMC10833016 DOI: 10.4103/sja.sja_349_23] [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: 04/27/2023] [Revised: 05/19/2023] [Accepted: 06/04/2023] [Indexed: 02/06/2024] Open
Abstract
Background Activation of the hypothalamus-pituitary-adrenal (HPA) axis and inflammatory processes are common forms of stress response. The increased stress response is associated with a higher chance of complications. Open hearth surgery is one of the procedures with a high-stress response. Pectointercostal fascial block (PIFB), as a new pain management option in sternotomy, has the potential to modulate the stress response. Objective To determine the effect of PIFB on stress response in open heart surgery. Methods This study was a Randomized Controlled Trial on 40 open heart surgery. Patients were divided into two groups, control (20 patients) and PIFB (20 patients). Primary parameters included basal and postoperative TNF-α, basal and post sternotomy ACTH, and basal, 0, and 24 hours postoperative NLR. Secondary parameters include the amount of opioid use, length of the post-operative ventilator, length of ICU stay, and Numeric Rating Scale (NRS) 6, 12, 24, and 48 hours postoperative. Results The PIFB group had a decrease in ACTH levels with an average change that was not significantly different from the control group (-57.71 ± 68.03 vs. -129.78 ± 140.98). The PIFB group had an average change in TNFα levels and an average increase in NLR 0 hours postoperative that was not significantly lower than the control group (TNFα: -0.52 ± 1.31 vs. 0.54 ± 1.76; NLR: 12.80 ± 3.51 vs. 14.82 ± 4.23). PIFB significantly reduced the amount of opioid use during surgery, NRS at 6, 12, and 24 hours, and the length of post-operative ventilator use (P < 0.05, CI: 95%). Conclusion PIFB has a good role in reducing the stress response of open heart surgery and producing good clinical outcomes.
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Affiliation(s)
- Ahmad Feza Fadhlurrahman
- Department of Anesthesiology and Intensive Therapy, Medical Faculty of Airlangga University, Surabaya, Indonesia
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Philia Setiawan
- Division of Cardiovascular and Thoracic Anesthesia, Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Christijogo Sumartono
- Division of Regional Anesthesia, Department of Anesthesiology and Intensive Theraoy, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Fajar Perdhana
- Division of Cardiovascular and Thoracic Anesthesia, Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Teuku Aswin Husain
- Division of Cardiovascular and Thoracic Anesthesia, Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
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He Y, Xu M, Li Z, Deng L, Kang Y, Zuo Y. Safety and feasibility of ultrasound-guided serratus anterior plane block and intercostal nerve block for management of post-sternotomy pain in pediatric cardiac patients: A prospective, randomized trial. Anaesth Crit Care Pain Med 2023; 42:101268. [PMID: 37364851 DOI: 10.1016/j.accpm.2023.101268] [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: 12/11/2022] [Revised: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Postoperative analgesia in the cardiothoracic ICU has traditionally relied on intravenous opioids. Thoracic nerve blocks are attractive alternatives for analgesia that reduce the requirement for opioids, but their safety and feasibility remain unclear. METHODS Sixty children were allocated randomly to three groups: group C received intravenous opioids alone, while group SAPB (deep serratus anterior plane block) and group ICNB (intercostal nerve block) received opioids combined with ultrasound-guided regional nerve blocks (0.2% ropivacaine 2.5 mg.kg-1) after patients were transferred to the ICU. The primary outcome was opioid requirement in the first 24 h after surgery. Other outcomes included the postoperative FLACC scale value, tracheal extubation time, and plasma ropivacaine concentrations after the block. RESULTS The mean [sd] cumulative dose of opioids administered postoperatively within 24 h in the SAPB (168.6 [76.9] μg.kg-1) and ICNB groups (170.0 [86.8] μg.kg-1) were significantly lower by nearly 53% than those in group C (359.3 [125.3] μg.kg-1, p = 0.000). The tracheal extubation time was shorter in the regional block groups than that in the control group, but the difference was not statistically significant (p = 0.177). The FLACC scale values at 0, 1, 3, 6, 12, and 24 h post-extubation were similar in the three groups. The mean peak plasma ropivacaine concentrations in the SAP and ICNB groups were 2.1 [0.8] and 1.8 [0.7] mg.L-1, respectively, 10 min post-block and then slowly decreased. No noticeable complications associated with regional anesthesia were observed. CONCLUSIONS Ultrasound-guided SAPB and ICNB provided safe and satisfactory early postoperative analgesia while reducing opioid consumption following sternotomy in pediatric patients. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry ChiChiCTR2100046754.
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Affiliation(s)
- Yi He
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, China.
| | - Mingzhe Xu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, China.
| | - Zhi Li
- Department of Critical Care Medicine, Cheng Du Shang Jin Nan Fu Hospital, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Lijing Deng
- Department of Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Yi Kang
- Department of Anesthesiology and Translational Neuroscience Center, Laboratory of Anesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, China.
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17
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Fan L, He Y, Li Y, Li X, Liu D, Wang R. Efficacy and safety of traditional Chinese medicine nursing intervention in postoperative patients after gastrectomy. Oncol Lett 2023; 26:537. [PMID: 38020302 PMCID: PMC10655047 DOI: 10.3892/ol.2023.14124] [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: 07/31/2022] [Accepted: 08/04/2023] [Indexed: 12/01/2023] Open
Abstract
Gastrectomy is a technically demanding procedure for gastric cancer patients that is associated with different degrees of postoperative complications (POCs). Perioperative traditional Chinese medicine (TCM) nursing intervention presents benefits for improving the survival of patients with gastric cancer. However, the effects of TCM nursing intervention on POCs and the prognosis of patients with gastric cancer following surgery are far from clear. In the present study, the effects of TCM nursing intervention on POCs, postoperative physical capacity, metal status, long-term survival and recurrence were investigated in patients with gastric cancer after gastrectomy. In total, 1,032 patients with gastric cancer were included in the study. The patients underwent a gastrectomy and were randomly divided into two groups: The TCM nursing intervention group (TCM group; n=520) and the routine nursing intervention group (control group; n=512). Postoperative pain score, hospital stay, POCs, postoperative gastrointestinal function, frequency of postoperative symptoms, inflammatory index, quality of life, physical capacity, mental status, survival and recurrence were compared after gastrectomy in the TCM and control groups. The treatment-related adverse events of TCM in patients after gastrectomy were recorded in the TCM nursing intervention group. The outcomes showed that TCM nursing intervention decreased the postoperative pain score and hospital stay, improved gastrointestinal function, and decreased the POCs and the inflammation index compared with the control group. In addition, TCM nursing intervention improved physical capacity, quality of life, depression, anxiety, immune activity, long-term survival and recurrence in patients with gastric cancer after gastrectomy. Furthermore, TCM nursing intervention was only associated with a low number of adverse events. In conclusion, outcomes in this study indicate that perioperative TCM nursing intervention improves POCs, mental status, long-term survival and reduces the recurrence of patients with gastric cancer, suggesting that TCM nursing intervention is efficacious and safe with regard to improving the prognosis in these patients after gastrectomy (Retrospective clinical trial registration number, 2015001CW1; name of the register, The First Hospital of Harbin; date of registration, May 7, 2015).
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Affiliation(s)
- Lizhi Fan
- Cadre Ward (Geriatric), The First Hospital of Harbin, Harbin, Heilongjiang 150000, P.R. China
| | - Ying He
- Department of Ultrasonography, Hongqi Hospital Affiliated to Mudanjiang Medical College, Mudanjiang, Heilongjiang 157000, P.R. China
| | - Yufeng Li
- Department of Thoracic Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical College, Mudanjiang, Heilongjiang 157000, P.R. China
| | - Xinxin Li
- Intensive Care Unit, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, P.R. China
| | - Dan Liu
- Department of General Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical College, Mudanjiang, Heilongjiang 157000, P.R. China
| | - Rui Wang
- Department of General Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical College, Mudanjiang, Heilongjiang 157000, P.R. China
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Ünver S, Yildirim M, Eyı S, Hüseyın S. Pain-related fear among adult patients undergoing open-heart surgery: an interpretative phenomenological analysis. Contemp Nurse 2023; 59:462-477. [PMID: 37608646 DOI: 10.1080/10376178.2023.2249127] [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: 09/06/2022] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND One of the sources of anxiety and fear among patients undergoing open-heart surgery is the possibility of experiencing pain, such as sternotomy-related chest pain. Giving them the chance to express their feelings about the potential pain may be effective in reducing their anxiety and may support their coping strategies. OBJECTIVES To examine pain-related fear among patients undergoing open-heart surgery and to understand the underlying reasons of their fears. METHODS A qualitative interview based on Heidegger's interpretative phenomenological approach was conducted adhering to the COREQ guidelines. Sixteen patients who were undergoing open-heart surgery in the following day were interviewed at the cardiovascular surgery ward of a university hospital. The organization and mapping of the qualitative data was done by using ATLAS.ti 8.0. RESULTS The patients who were afraid of experiencing pain after surgery seemed to be more concerned about open-heart surgery itself (such as pain from sternotomy and chest tubes) and the possibility of prolongation of postoperative pain. To cope with these fears, the patients employed a variety of social and self-coping strategies. Trusting the healthcare team, having a high pain tolerance, and having personal thoughts that take precedence over pain-related fear were the key factors explaining not being afraid of experiencing pain. CONCLUSIONS This study provides a deeper understanding of the underlying reasons and the needs of patients in controlling their pain-related fears before open-heart surgery. Trusting the healthcare professionals is one of the main factors for patients to control their pain-related fears. To develop a supportive sense of trust and to help patients in controlling their pain-related fears, surgical nurses must dedicate enough time for understanding patients' concerns while planning their nursing care plans. Future studies may focus on exploring the role of nursing interventions and multidisciplinary team approaches on the management of preoperative pain-related fear.
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Affiliation(s)
- Seher Ünver
- Faculty of Health Sciences, Department of Surgical Nursing, Trakya University, Edirne, Turkey
| | - Meltem Yildirim
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Semra Eyı
- Faculty of Health Sciences, Department of Surgical Nursing, Osmangazi University, Eskişehir, Turkey
| | - Serhat Hüseyın
- Medicine Faculty, Department of Cardiovascular Surgery, Trakya University, Edirne, Turkey
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Phelan R, Petsikas D, Shelley J, Hopman WM, DuMerton D, Parry M, Payne D, Allard R, Cummings M, Parlow JL, Tanzola R, Wang LTS, Stewart C, Saha TK. Retraction speed and chronic poststernotomy pain: A randomized controlled trial. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01113-3. [PMID: 38042399 DOI: 10.1016/j.jtcvs.2023.11.037] [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: 07/24/2023] [Revised: 10/24/2023] [Accepted: 11/19/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES Approximately 30% of patients develop chronic poststernotomy pain (CPSP) following cardiac surgery with sternal retraction. Risk factors have been described but no causal determinants identified. Investigators hypothesized that opening the sternum slowly would impart less force (and thereby less nerve/tissue damage) and translate to a reduced incidence of CPSP. The main objectives were to determine whether or not slower sternal retraction would reduce the incidence of CPSP and improve health-related quality of life. METHODS Patients undergoing coronary artery bypass graft surgery were recruited to this randomized controlled trial. Patients were randomized to slow or standard retraction (ie, sternum opened over 15 minutes vs 30 seconds, respectively). Although the anesthesiologist and surgeon were aware of the randomization, the patients, assessors, and postoperative nursing staff remained blinded. Sternotomy pain and analgesics were measured in hospital. At 3, 6, and 12 months postoperatively, all patients completed the Medical Outcomes Survey Short Form and reported on CPSP and complications requiring rehospitalization. Thirty-day rehospitalizations and mortality were recorded. RESULTS In total, 326 patients consented to participate and 313 were randomized to slow (n = 159) versus standard retraction (n = 154). No clinically relevant differences were detected in acute pain, analgesic consumption, or the incidence of CPSP or health-related quality of life. Although the slow group had significantly more hospitalizations at 3 and 12 months postoperatively, the reasons were unrelated to retraction speed. No differences were observed in 30-day rehospitalizations or mortality. CONCLUSIONS All outcomes were consistent with previous reports, but no clinically significant differences were observed with retraction speed.
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Affiliation(s)
- Rachel Phelan
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dimitri Petsikas
- Division of Cardiac Surgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Jessica Shelley
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Wilma M Hopman
- Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Deborah DuMerton
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Rene Allard
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Michael Cummings
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Joel L Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Robert Tanzola
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Louie T S Wang
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Craig Stewart
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Tarit K Saha
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
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Urrutia R, Espejo D, Evens N, Guerra M, Sühn T, Boese A, Hansen C, Fuentealba P, Illanes A, Poblete V. Clustering Methods for Vibro-Acoustic Sensing Features as a Potential Approach to Tissue Characterisation in Robot-Assisted Interventions. SENSORS (BASEL, SWITZERLAND) 2023; 23:9297. [PMID: 38067671 PMCID: PMC10708300 DOI: 10.3390/s23239297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
This article provides a comprehensive analysis of the feature extraction methods applied to vibro-acoustic signals (VA signals) in the context of robot-assisted interventions. The primary objective is to extract valuable information from these signals to understand tissue behaviour better and build upon prior research. This study is divided into three key stages: feature extraction using the Cepstrum Transform (CT), Mel-Frequency Cepstral Coefficients (MFCCs), and Fast Chirplet Transform (FCT); dimensionality reduction employing techniques such as Principal Component Analysis (PCA), t-Distributed Stochastic Neighbour Embedding (t-SNE), and Uniform Manifold Approximation and Projection (UMAP); and, finally, classification using a nearest neighbours classifier. The results demonstrate that using feature extraction techniques, especially the combination of CT and MFCC with dimensionality reduction algorithms, yields highly efficient outcomes. The classification metrics (Accuracy, Recall, and F1-score) approach 99%, and the clustering metric is 0.61. The performance of the CT-UMAP combination stands out in the evaluation metrics.
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Affiliation(s)
- Robin Urrutia
- Instituto de Acústica, Facultad de Ciencias de la Ingeniería, Universidad Austral de Chile, Valdivia 5111187, Chile; (R.U.); (V.P.)
- Audio Mining Laboratory (AuMiLab), Instituto de Acústica, Universidad Austral de Chile, Valdivia 5111187, Chile;
| | - Diego Espejo
- Audio Mining Laboratory (AuMiLab), Instituto de Acústica, Universidad Austral de Chile, Valdivia 5111187, Chile;
| | - Natalia Evens
- Instituto de Anatomia, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia 5111187, Chile; (N.E.); (M.G.)
| | - Montserrat Guerra
- Instituto de Anatomia, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia 5111187, Chile; (N.E.); (M.G.)
| | - Thomas Sühn
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany;
- SURAG Medical GmbH, 39118 Magdeburg, Germany;
| | - Axel Boese
- INKA Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Christian Hansen
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany;
| | - Patricio Fuentealba
- Instituto de Electricidad y Electrónica, Facultad de Ciencias de la Ingeniería, Universidad Austral de Chile, Valdivia 5111187, Chile;
| | | | - Victor Poblete
- Instituto de Acústica, Facultad de Ciencias de la Ingeniería, Universidad Austral de Chile, Valdivia 5111187, Chile; (R.U.); (V.P.)
- Audio Mining Laboratory (AuMiLab), Instituto de Acústica, Universidad Austral de Chile, Valdivia 5111187, Chile;
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Chen X, Hu Y, Fan J, Li Y. Post-Operative Poor Sleep Quality and Its Associated Factors Among Non-Small Cell Lung Cancer Patients: A Cross-Sectional Study. Cancer Manag Res 2023; 15:1283-1295. [PMID: 38027239 PMCID: PMC10657758 DOI: 10.2147/cmar.s430436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The study aimed to determine the post-operative prevalence and factors associated to poor sleep quality in non-small cell lung cancer (NSCLC) patients in China. Methods NSCLC patients (n=307) who underwent thoracoscopic surgery at the Department of Thoracic Surgery of Shanghai Pulmonary Hospital were enrolled in this study. The Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Prince Henry Hospital Pain Score and the Six-Minute Walk Test (6MWT), and Forced Expiratory Volume in one second (FEV-1) were used to assess the factors that could lead to poor sleep quality. All assessments were carried out between April 1 and May 30, 2023. Descriptive analyses and stepwise factor regression were employed to determine the impact of various factors on sleep quality. The factors predictive of poor sleep quality were used to develop a predictive nomogram. The Hosmer-Lemeshow test was used to assess the predictive value of the nomogram. Results The median PQSI score was 8 (interquartile range (IQR) 5-12), and 74.6% of patients had poor sleep quality. The median anxiety and depression scores were 6 (IQR 3-9) and 4 (IQR 2-7), respectively. The PSQI latency dimension had the highest score, while the use of sleep medications dimension had the lowest score. The multivariate analysis revealed that patients who were female (OR, 2.38; 95% CI, 1.40-4.05; P <0.01), had post-secondary education (OR, 0.42; 95% CI, 0.19-0.92; P =0.03), tertiary education (OR, 0.38; 95% CI, 0.17-0.84; P =0.02), comorbidities (OR, 2.57; 95% CI, 1.51-4.39; P <0.01), a pain score 1 (OR, 4.22; 95% CI, 2.37-7.50; P <0.01), and cough (OR, 2.97; 95% CI, 1.63-5.40; P <.001) were more like to experience poor sleep quality. The positive predictive value of the nomogram was 79.80% (p=0.390). Conclusion Sociodemographic variables, comorbidities, and pain could be used to predict the post-operative sleep quality in NSCLC patients.
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Affiliation(s)
- Xinxin Chen
- Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Yachen Hu
- Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Jiaxin Fan
- Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Yumei Li
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People’s Republic of China
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22
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Eid Aburuz M, Al-Dweik G, Ahmed FR. The Effect of Listening to Holy Quran Recital on Pain and Length of Stay Post-CABG: A Randomized Control Trial. Crit Care Res Pract 2023; 2023:9430510. [PMID: 37965250 PMCID: PMC10643035 DOI: 10.1155/2023/9430510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/02/2023] [Accepted: 10/21/2023] [Indexed: 11/16/2023] Open
Abstract
Background Nearly, 75% of patients post-CABG complain of moderate to severe pain during their hospital stay. Nonpharmacological interventions have been investigated; however, the effect of Holy Quran recital post-CABG is still not well studied, especially in developing Islamic countries. Objective To investigate the effect of listening to the Holy Quran recital on pain and length of stay post-CABG. Methods This was a randomized control trial on 132 patients recruited from four hospitals in Amman, Jordan. The intervention group listened to the Holy Quran recited for 10 minutes twice daily while the control group received the usual care. Data were analyzed using paired and independent samples t-tests. Results Paired t-test testing showed that there was a significant reduction in the pain level, (M [SD], 6.82 [2.27] vs. 4.65 [2.18], t = 23.65, p < 0.001) for the intervention group. In addition, the intervention group had shorter LoS in the ICU and in the hospital compared to the control group, (M [SD], 5.0 [4.02] vs. 6.58 [4.18], t = -2.1, p < 0.05), (M [SD], 10.15 [9.21] vs. 15.01 [13.14], t = -2.6, p < 0.05), respectively. Conclusions Listening to the Quran was significantly effective in improving pain intensity among post-CABG patients and shortening their hospital/ICU stay. This trial is registered with NCT05419554.
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Affiliation(s)
- Mohannad Eid Aburuz
- Clinical Nursing Department, Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Ghadeer Al-Dweik
- Nursing Administration, Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Fatma Refaat Ahmed
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Critical Care and Emergency Nursing, Alexandria University, Alexandria, Egypt
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Yayık AM, Çelik EC, Aydın ME, Oral Ahıskalıoğlu E, Dost B, Altıparmak B, Narayanan M, Cassai AD, Tulgar S, Ahıskalıoğlu A. The Shining Star of the Last Decade in Regional Anesthesia Part-II: Interfascial Plane Blocks for Cardiac, Abdominal, and Spine Surgery. Eurasian J Med 2023; 55:9-20. [PMID: 37916997 DOI: 10.5152/eurasianjmed.2023.23015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
The sine qua non of enhanced recovery after surgery protocols designed to improve the perioperative experiences and outcomes of patients is to determine the most appropriate analgesia management. Although many regional techniques have been tried over the years in this purpose, interfacial plane blocks have become more popular with the introduction of ultrasound technology into daily practice and they have great potential to support effective postoperative pain management in many surgeries. The current article focuses on the benefits, techniques, indications, and complications of interfascial plane blocks applied in cardiac, abdominal, and spine surgeries.
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Affiliation(s)
- Ahmet Murat Yayık
- Department of Anesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Erkan Cem Çelik
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Atatürk University School of Medicine, Erzurum, Turkey
| | - Muhammed Enes Aydın
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Atatürk University School of Medicine, Erzurum, Turkey
| | - Elif Oral Ahıskalıoğlu
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Atatürk University School of Medicine, Erzurum, Turkey
| | - Burhan Dost
- Department of Anaesthesiology and Reanimation, On Dokuz Mayıs University School of Medicine, Istanbul, Turkey
| | - Başak Altıparmak
- Department of Anaesthesiology and Reanimation, Sıtkı Koçman University School of Medicine, Mugla, Turkey
| | - Madan Narayanan
- Department of Anaesthesia, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Alessandro De Cassai
- Department of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Ali Ahıskalıoğlu
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Atatürk University School of Medicine, Erzurum, Turkey
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Pérez Lucendo A, Piñeiro Otero P, Matía Almudévar P, Alcántara Carmona S, López López E, Ramasco Rueda F. Individualised analgesia, sedation, delirium and comfort management strategies in the ICU: a narrative review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:509-535. [PMID: 37742996 DOI: 10.1016/j.redare.2023.03.003] [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: 01/16/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023]
Abstract
This group is a product of the collaboration agreement signed by SOMIAMA (Sociedad de Medicina Intensiva de Madrid) and SAR MADRID (Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid) under which the organisations agreed to create joint working groups to improve critical patient care. Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness.Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort.
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Affiliation(s)
- A Pérez Lucendo
- Servicio de Medicina Intensiva, Hospital Universitario de La Princesa, Madrid, Spain.
| | - P Piñeiro Otero
- Servicio de Anestesiología y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - P Matía Almudévar
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - S Alcántara Carmona
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E López López
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Ramasco Rueda
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
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Xiao MZX, Khan JS, Dana E, Rao V, Djaiani G, Richebé P, Katz J, Wong D, Clarke H. Prevalence and Risk Factors for Chronic Postsurgical Pain after Cardiac Surgery: A Single-center Prospective Cohort Study. Anesthesiology 2023; 139:309-320. [PMID: 37192204 DOI: 10.1097/aln.0000000000004621] [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: 05/18/2023]
Abstract
BACKGROUND Chronic postsurgical pain is a common complication of surgery. The role of psychologic risk factors like depression and anxiety is substantially understudied in cardiac surgery. This study sought to identify perioperative factors associated with chronic pain at 3, 6, and 12 months after cardiac surgery. The authors hypothesize that baseline psychologic vulnerabilities have a negative influence on chronic postsurgical pain. METHODS The authors prospectively collected demographic, psychologic, and perioperative factors in a cohort of 1,059 patients undergoing cardiac surgery at the Toronto General Hospital between 2012 and 2020. Patients were followed and completed chronic pain questionnaires at 3, 6, and 12 months after surgery. RESULTS The study included 767 patients who completed at least one follow-up questionnaire. The incidence of postsurgical pain (more than 0 out of 10) at 3, 6, and 12 months after surgery was 191 of 663 (29%), 118 of 625 (19%), and 89 of 605 (15%), respectively. Notably, among patients reporting any pain, the incidence of pain compatible with a neuropathic phenotype increased from 56 of 166 (34%) at 3 months to 38 of 97 (39%) at 6 months and 43 of 67 (64%) at 12 months. Factors associated with postsurgical pain scores at 3 months include female sex, pre-existing chronic pain, previous cardiac surgery, preoperative depression, baseline pain catastrophizing scores, and moderate-to-severe acute pain (4 or more out of 10) within 5 postoperative days. CONCLUSIONS Nearly one in three patients undergoing cardiac surgery reported pain at 3 months of follow-up, with approximately 15% reporting persistent pain at 1 yr. Female sex, pre-existing chronic pain, and baseline depression were associated with postsurgical pain scores across all three time periods. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Maggie Z X Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - James S Khan
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Elad Dana
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada; Department of Anesthesia, Intensive Care and Pain Medicine, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vivek Rao
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Canada
| | - George Djaiani
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Research Center of the Integrated University Health and Social Services Center of the East-Island of Montreal, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Canada
| | - Joel Katz
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada; Department of Psychology, York University, Toronto, Canada; Transitional Pain Service, Toronto General Hospital, Toronto, Canada
| | - Dorothy Wong
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada; Transitional Pain Service, Toronto General Hospital, Toronto, Canada
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Md Ali NA, El-Ansary D, Abdul Rahman MR, Ahmad S, Royse C, Huat CT, Muhammad Nor MA, Dillon J, Royse A, Haron H, Ismail MI, Abdul Manaf MR, Katijjahbe MA. E arly S u p ervised I ncremental R es istance T raining ( ESpIRiT) following cardiac surgery via a median sternotomy: a study protocol of a multicentre randomised controlled trial. BMJ Open 2023; 13:e067914. [PMID: 37451709 PMCID: PMC10351238 DOI: 10.1136/bmjopen-2022-067914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/21/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION There is no consistency in current practice pertaining to the prescription and progression of upper limb resistance exercise following cardiac surgery via median sternotomy. The aim of this study is to investigate whether less restrictive sternal precautions with the addition of early-supervised resistance training exercise improves upper limb function and facilitates recovery following median sternotomy. METHODS AND ANALYSIS This is double-blind randomised controlled trial, with parallel group, concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. 240 adult participants who had median sternotomy from eight hospitals in Malaysia will be recruited. Sample size calculations were based on the unsupported upper limb test. All participants will be randomised to receive either standard or early supervised incremental resistance training. The primary outcomes are upper limb function and pain. The secondary outcomes will be functional capacity, multidomain recovery (physical and psychological), length of hospital stay, incidence of respiratory complications and quality of life. Descriptive statistics will be used to summarise data. Data will be analysed using the intention-to-treat principle. The primary hypothesis will be examined by evaluating the change from baseline to the 4-week postoperative time point in the intervention arm compared with the usual care arm. For all tests to be conducted, a p value of <0.05 (two tailed) will be considered statistically significant, and CIs will be reported. The trial is currently recruiting participants. ETHICS AND DISSEMINATION The study was approved by a central ethical committee as well as the local Research Ethics Boards of the participating sites (UKM:JEP-2019-654; Ministry of Health: NMMR-50763; National Heart Centre: IJNREC/501/2021). Approval to start was given prior to the recruitment of participants commencing at any sites. Process evaluation findings will be published in peer-reviewed journals and presented at relevant academic conferences. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trials Number (ISRCTN17842822).
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Affiliation(s)
- Nur Ayub Md Ali
- Cardiothoracic Unit, Surgery Department, Faculty of Medicine, UKM, Cheras, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
| | - Doa El-Ansary
- School of Biomedical and Health Sciences, RMIT, Victoria, Melbourne, Australia
- Department of Physiotherapy, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Ramzisham Abdul Rahman
- Cardiothoracic Unit, Surgery Department, Faculty of Medicine, UKM, Cheras, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
| | - Suriah Ahmad
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
- Department of Physiotherapy, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Colin Royse
- Department of Surgery, The University of Melbourne, Victoria, Melbourne, Australia
- Cardiothoracic Surgery, Royal Melbourne Hospital, Victoria, Melbourne, Australia
- Australian Director, Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chong Tze Huat
- Department of Surgery, Hospital Serdang, Cheras, Selangor, Malaysia
| | | | - Jeswant Dillon
- Department of Cardiothoracic and Vascular Surgery, National Institute Heart Centre, Kuala Lumpur, Malaysia
| | - Alistair Royse
- Department of Surgery, The University of Melbourne, Victoria, Melbourne, Australia
- Cardiothoracic Surgery, Royal Melbourne Hospital, Victoria, Melbourne, Australia
| | - Hairulfaizi Haron
- Cardiothoracic Unit, Surgery Department, Faculty of Medicine, UKM, Cheras, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
| | - Muhamad Ishamudin Ismail
- Cardiothoracic Unit, Surgery Department, Faculty of Medicine, UKM, Cheras, Kuala Lumpur, Malaysia
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Md Ali Katijjahbe
- Heart and Lung Centre, Hospital Canselor Tuanku Muhriz, UKM, Cheras, Kuala Lumpur, Malaysia
- Department of Physiotherapy, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Düzel B, Çam Yanik T, Kanat C, Altun Uğraş G. The effect of acupressure on pain level and hemodynamic parameters after coronary angiography: a randomized controlled study. Front Cardiovasc Med 2023; 10:1173363. [PMID: 37522084 PMCID: PMC10374945 DOI: 10.3389/fcvm.2023.1173363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
Background Subsequent to coronary angiography, procedures performed to prevent bleeding may cause pain in the patient. In this study, we aimed to determine the effect of acupressure on pain level and hemodynamic parameters in patients undergoing coronary angiography. Method In this prospective, a two-arm (1:1), randomized controlled trial was conducted, with 124 patients undergoing coronary angiography included. The randomly assigned study group (n = 62) received acupressure on the LI4 (on the dorsum of the hand, between the 1st and 2nd metacarpal bones), PC6 (three fingers above the wrist), and LI11 (at the lateral end of the transverse cubital crease) points for 15 min 2 h after angiography, while the control group (n = 62) received no acupressure. Data were collected using the visual pain scale (VAS) and hemodynamic parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2)], monitoring form before, immediately after, and at 10, 20, and 30 min after acupressure. Results In the study, it was found that patients had moderate pain after coronary angiography (study group: 5.02 ± 2.27; control group: 3.98 ± 1.82). When the groups were compared, it was found that the VAS score of the study group before angiography was significantly higher than that of the control group, but lower than the control group immediately after acupressure, and at 10, 20, and 30 min after acupressure. In addition, it was determined that acupressure was significantly higher in DBP and RR in the study group compared to the control group at 20 and 30 min; it was not effective in terms of SBP, HR, and SpO2 values. Conclusion The results of the study indicated that patients reported moderate pain after coronary angiography, and that acupressure was effective in reducing the pain level, but affected only the DBP and RR hemodynamic parameters. Since the study was single-centered and followed for a short time, it is recommended to conduct new studies with a longer duration.
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Affiliation(s)
- Barış Düzel
- Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Türkiye
| | - Tuğba Çam Yanik
- Faculty of Nursing, Department of Surgical Nursing, Mersin University, Mersin, Türkiye
| | - Canan Kanat
- Faculty of Nursing, Department of Surgical Nursing, Mersin University, Mersin, Türkiye
| | - Gülay Altun Uğraş
- Faculty of Nursing, Department of Surgical Nursing, Mersin University, Mersin, Türkiye
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Hsieh M, Kim D, Peng D, Schisler T, Cook RC. Regional Anesthesia With Paravertebral Blockade Is Associated With Improved Outcomes in Patients Undergoing Minithoracotomy Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:357-364. [PMID: 37585808 PMCID: PMC10478324 DOI: 10.1177/15569845231190638] [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: 08/18/2023]
Abstract
OBJECTIVE Severe postoperative pain has been shown to affect many patients following minimally invasive cardiac surgeries (MICS). Multimodal pain management with regional anesthesia, particularly by delivery of local anesthetics using a paravertebral catheter (PVC), has been shown to reduce pain in operations involving thoracotomy incisions. However, few studies have reported high-quality safety and efficacy outcomes of PVCs following MICS. METHODS Patients who underwent MICS at Vancouver General Hospital between 2016 and 2019 (N = 123) were reviewed for perioperative opioid-narcotic use. Primary outcomes were postoperative opioid use and hospital length of stay (LOS). Statistical analyses were performed using univariate and multivariable regression models to determine independent risk factors. RESULTS A total of 54 patients received routine systemic analgesia (control), 53 patients received a paravertebral catheter (PVC), and 16 patients received another mode of regional analgesia (non-PVC). The mean hospital LOS was significantly different in patients in the PVC group at 5.8 ± 2.0 days versus 8.3 ± 7.1 days in the control and 6.6 ± 2.3 days in the non-PVC group (P = 0.033). The percentage of patients who did not require postoperative oxycodone was significantly higher in the PVC group (48.1%), compared with the control (24.5%) and non-PVC (37.5%; P = 0.043) groups. CONCLUSIONS The administration of regional anesthesia using PVCs was associated with reduced need for opioids and a shorter LOS. The reduction in postoperative opioids may reduce the risk of potential opioid dependency in this population. Future studies should involve randomized controlled trials with systematic evaluation of pain scores to verify current study results.
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Affiliation(s)
- Monica Hsieh
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Diane Kim
- University of British Columbia, Vancouver, BC, Canada
| | - Defen Peng
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Richard C. Cook
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, BC, Canada
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Zhou K, Li D, Song G. Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis. Front Cardiovasc Med 2023; 10:1078756. [PMID: 37283577 PMCID: PMC10239891 DOI: 10.3389/fcvm.2023.1078756] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Background Patients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear. Methods Five databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality. Results This meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016-0.55), shortened the time to tracheal extubation (MD = -181.55, 95% CI: -243.05 to -121.33) and the duration of hospital stay (MD = -0.73, 95% CI: -1.22 to -0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques. Conclusions TEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, ID: CRD42021276645.
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Affiliation(s)
- Ke Zhou
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dongyu Li
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Zou M, Ruan W, Liu J, Xu J. Preemptive parasternal intercostal nerve block for patients undergoing off-pump coronary artery bypass grafting: a double-blind, randomized, controlled trial. Front Cardiovasc Med 2023; 10:1188518. [PMID: 37273884 PMCID: PMC10233104 DOI: 10.3389/fcvm.2023.1188518] [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: 03/17/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Background Parasternal intercostal nerve block has been increasingly used for postoperative analgesia and has shown that this technique can provide effective postoperative analgesia. This study aimed to investigate the effect of preemptive parasternal intercostal nerve block on the opioid and vasoactive drug dose required for intraoperative hemodynamic stability and postoperative analgesia in patients undergoing off-pump coronary artery bypass grafting. Methods In this prospective, randomized controlled study, 64 participants aged 45-75 years scheduled for off-pump coronary artery bypass grafting at The Second Xiangya Hospital of Central South University. Patients were randomized into two groups and preoperatively administered ropivacaine (group R) and saline (group S), in the parasternal intercostal spaces with ultrasound-guided bilateral nerve block. Results The primary outcome was intraoperative sufentanil and vasopressor dosage. The secondary outcomes were intraoperative hemodynamics, postoperative pain scores, and anesthesia recovery, postoperative use of rescue dezocine, stay in intensive care unit, and length of hospital stay. The consumption of intraoperative sufentanil and vasopressor was significantly lower in group R than in group S. The visual analog score in group R was significantly lower than that in group S up to 12 h postoperatively. The time to anesthesia recovery was significantly less in group R than in group S. Most patients in group S required rescue dezocine, whereas most patients in group R did not. The hemodynamic variables were stable in all patients. Conclusions A preemptive parasternal intercostal nerve block effectively reduced the required intraoperative sufentanil and norepinephrine dose and provided adequate analgesia for the first 12 h after surgery. Therefore, a preemptive parasternal intercostal nerve block is a good option for patients undergoing off-pump coronary artery bypass grafting. Clinical trial registration chictr.org.cn, identifier ChiCTR1800017210.
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Affiliation(s)
- Mengmeng Zou
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wei Ruan
- Department of Anesthesiology, The Second XiangYa Hospital of Central South University, Hunan, China
| | - Jintao Liu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Junmei Xu
- Department of Anesthesiology, The Second XiangYa Hospital of Central South University, Hunan, China
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Rosen JL, Yost CC, Prochno KW, Komlo CM, Mandel JL, Wu M, Guy TS. A New Frontier: No Working Port for Robotic Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:200-203. [PMID: 37036096 DOI: 10.1177/15569845231165311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
A 61-year-old male presented via referral for mitral regurgitation and was deemed an appropriate robotic surgery candidate for complex mitral valve repair with the maze procedure and patent foramen ovale and left atrial appendage closures, using all percutaneous cannulation. We report upon the first case in the literature that describes the use of only 4 robotic ports, with no working port used.
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Affiliation(s)
- Jake L Rosen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Colin C Yost
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kyle W Prochno
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Caroline M Komlo
- Division of Cardiac Surgery, Department of Surgery, Yale New Haven Hospital, CT, USA
| | - Jenna L Mandel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Meagan Wu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - T Sloane Guy
- ivision of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Elbardan IM, Ahmed Sayed Shehab AS, Mabrouk IM. Comparison of transversus thoracis muscle plane block and pecto-intercostal fascial plane block for enhanced recovery after pediatric open-heart surgery. Anaesth Crit Care Pain Med 2023; 42:101230. [PMID: 37031816 DOI: 10.1016/j.accpm.2023.101230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/18/2023] [Accepted: 03/19/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Effective analgesia after cardiac surgery contributes to enhanced recovery. AIM To compare the perioperative analgesic effectiveness of Transversus Thoracis Muscle Plane Block (TTPB) and Pecto-Intercostal-Fascial Plane Block (PIFB) for controlling post-sternotomy pain in the pediatric population for ultrafast track cardiac surgery. METHODS Double-blind randomized study of 60 children, 2-12 years old, undergoing cardiac surgery via median sternotomy in whom a bilateral ultrasound-guided TTPB or TIBP block was performed preemptively. RESULTS Epidemiologic data of both groups were comparable. TTPB group had a lower median Modified Objective Pain Score (MOPS) all over the time postoperatively. Fentanyl consumption was significantly lower in TTBP group compared with PIFB group, only 4/30 received supplemental fentanyl during surgery in the TTPB group vs. 11/30 in the PIFB group (p = 0.033). The median [interquartile] values of postoperative fentanyl consumption were significantly lower in the TTBP compared with PIFB group: 12.0 [10.0-12.0] vs. 15.0 [15.0-16.0] µg/kg (p < 0.001), respectively. First rescue analgesia was later in the TTPB group compared to the PIFB group with median times of 7.25 and 5.0 hours, respectively (p < 0.001). Both groups had a comparable ICU length of stay (p = 0.919), with a median of 3 days. Furthermore, in the PIFB group, the incidence of non-sternal wound chest pain (53.3%) was significantly higher than in the TTPB group (3.3%) (p < 0.05). CONCLUSION TTPB and PIFB are safe regional blocks that could enhance recovery after pediatric cardiac surgery. In our series, TTPB provided better and longer-lasting postoperative analgesia with less incidence of non-sternal wound pain than PIFB.
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Affiliation(s)
- I M Elbardan
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Alexandria University, Champollion Street, 21521 Azaritta, Alexandria, Egypt.
| | - A S Ahmed Sayed Shehab
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Alexandria University, Champollion Street, 21521 Azaritta, Alexandria, Egypt.
| | - I M Mabrouk
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Alexandria University, Champollion Street, 21521 Azaritta, Alexandria, Egypt.
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Ultrasound Guided Parasternal Block for Perioperative Analgesia in Cardiac Surgery: A Prospective Study. J Clin Med 2023; 12:jcm12052060. [PMID: 36902846 PMCID: PMC10003888 DOI: 10.3390/jcm12052060] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Ultrasound guided parasternal block is a regional anaesthesia technique targeting the anterior branches of intercostal nerves, which supply the anterior thoracic wall. The aim of this prospective study is to assess the efficacy of parasternal block to manage postoperative analgesia and reduce opioid consumption in patients undergoing cardiac surgery throughout sternotomy. A total of 126 consecutive patients were allocated to two different groups, receiving (Parasternal group) or not (Control group) preoperative ultrasound guided bilateral parasternal block with 20 mL of 0.5% ropivacaine per side. The following data were recorded: postoperative pain expressed by a 0-10 numeric rating scale (NRS), intraoperative fentanyl consumption, postoperative morphine consumption, time to extubation and perioperative pulmonary performance at incentive spirometry. Postoperative NRS was not significantly different between Parasternal and Control groups with a median (IQR) of 2 (0-4.5) vs. 3 (0-6) upon awakening (p = 0.07); 0 (0-3) vs. 2 (0-4) at 6 h (p = 0.46); 0 (0-2) vs. 0 (0-2) at 12 h (p = 0.57). Postoperative morphine consumption was similar among groups. However, intraoperative fentanyl consumption was significantly lower in the Parasternal group [406.3 ± 81.6 mcg vs. 864.3 ± 154.4, (p < 0.001)]. Parasternal group showed shorter times to extubation [(191 ± 58 min vs. 305 ± 72 min, (p)] and better performance at incentive spirometer with a median (IQR) of 2 raised balls (1-2) vs. 1 (1-2) after awakening (p = 0.04). Ultrasound guided parasternal block provided an optimal perioperative analgesia with a significant reduction in intraoperative opioid consumption, time to extubation and a better postoperative performance at spirometry when compared to the Control group.
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Ata F, Yılmaz C. Retrospective Evaluation of Fascial Plane Blocks in Cardiac Surgery With Median Sternotomy in a Tertiary Hospital. Cureus 2023; 15:e35718. [PMID: 37016643 PMCID: PMC10066868 DOI: 10.7759/cureus.35718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND AND AIM Cardiac surgery typically causes moderate to severe postoperative pain and discomfort. Inadequate pain management in the early postoperative period leads to pulmonary complications. The length of intensive care unit (ICU) stay and the hospital is typically prolonged. As a component of multimodal analgesia regimens, fascial plane blocks have become more popular. In our clinic, serratus anterior plane blocks (SAPB), pectoral nerve blocks (PECS I-II), and pectointercostal nerve fascial plane blocks (PIFB) are performed by ultrasonography. We wished to evaluate the postoperative visual pain scale, initial additional analgesic agent requirement time, extubation time, morbidity and mortality in patients who underwent open heart surgery with fascial plane blocks. MATERIALS AND METHODS Forty-eight patients over 18 years who underwent open heart surgery with sternotomy between 01 September 2021 and 15 June 2022 were evaluated retrospectively. Only patients with chest wall blocks placed at the end of surgery were included in the study. In Group 1, the PECS II block was placed on the chest tube side and bilateral PIFBs were placed at the end of surgery in the operating room. In Group 2, SAPB was placed on the chest tube side and bilateral PIFBs were placed at the end of surgery. Data regarding patient demographics, anesthesia method applied, amount of opioid used intraoperatively, cardiopulmonary bypass time, anesthesia and surgery time, postoperative extubation time, mechanical ventilation time, Visual Analogue Scale (VAS) of patients at rest and movement at 6th, 12th, 18th, 24th, 48th hours post-extubation, time to and type of first postoperative analgesic, postoperative complications, length of cardiac intensive care unit (CICU) stay and hospital length of stay were recorded from hospital records. RESULTS The data of a total of 46 patients (Group 1: PECS II block + PIFB, n=20; Group 2: SAPB+ PIFB, n=26) were analyzed retrospectively. There was no difference in demographic variables between the groups. Intraoperative opioid usage, operation time, Cardiopulmonary bypass time, postoperative mechanical ventilation time, extubation time, ICU discharge time, and length of hospital stay were not statistically different between the groups. The first rescue analgesic requirement time was longer in group 2 than in group 1 but not statistically significant (18.76±15.36 h vs 12.62±10.61 h, p=0.162). The post-extubation VAS scores at rest and movement at the 6th hour were significantly lower in group 2 than in group 1 (1.73±1.28 vs 3.15±2.10, respectively, p=0.02). CONCLUSION In our study, the VAS scores at the 6th hour were lower in SAPB + PIFB group than in PECS II + PIFB group. As these blocks can be easy to apply, we thought these combinations could be an alternative for pain relief in cardiac surgery. Prospective randomized studies are needed with a large number of patients.
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Thanasarn B, Pibul W, Kulchanarat C, Piathip D, Yuenyongchaiwat K. A Prospective Study of 73 Patients to Compare Forward Head Angle, Forward Shoulder Angle, Maximal Inspiratory Pressure, and Self-Reported Breathing-Related Symptoms Before and After Open-Heart Surgery. Med Sci Monit Basic Res 2023; 29:e938802. [PMID: 36849799 PMCID: PMC9921079 DOI: 10.12659/msmbr.938802] [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] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Patients who undergo open-heart surgery often experience widespread musculoskeletal and pulmonary complications. These can interfere with their functioning, resulting in soft tissue changes, worsening postural changes, and poor respiratory performance. Therefore, the prospective study aimed to compare forward head angle (FHA) and forward shoulder angle (FSA), maximal inspiratory pressure (MIP), and self-reported breathing dysfunction before and after open-heart surgery. MATERIAL AND METHODS In a prospective observational study of 106 patients, men and women scheduled for open-heart surgery were enrolled. Prior to surgery and before discharge from the hospital, all patients were required to assess FHA and FSA using 2-dimensional motion analysis software, MIP using a respiratory pressure meter, and breathing dysfunction using the 25-item Self Evaluation of Breathing Questionnaire (SEBQ). Paired t test was used to compare differences between before and after surgery. To evaluate associations, logistic regression analysis was performed. RESULTS Of the 106 patients recruited, 73 completed the study. FHA (-Δ6.55±4.77, P.
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Affiliation(s)
- Bussakorn Thanasarn
- Department of Physiotherapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand,Department of Rehabilitation Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Wittawat Pibul
- Department of Surgery, Rajavithi Hospital, Bangkok, Thailand
| | - Chitima Kulchanarat
- Center of Physical Therapy, Thammasat Medical Hospital, Pathumthani, Thailand
| | - Dusarkorn Piathip
- Cardiovascular Thoracic Surgery (CVT) Unit, Thammasat Medical Hospital, Pathumthani, Thailand
| | - Kornanong Yuenyongchaiwat
- Department of Physiotherapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand,Thammasat University Research Unit in Physical Therapy in Cardiovascular and Respiratory Systems, Thammasat University, Pathumthani, Thailand
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Lu Y, Zhou Q, Fu Y, Wen Z, Lv X. Ultrasound-Guided Bilateral Sequential Thoracic Paravertebral Block for Simultaneous Bilateral Uniportal Video-Assisted Thoracoscopic Surgery: Study Protocol for a Randomized Controlled Trial. J Pain Res 2023; 16:373-381. [PMID: 36762369 PMCID: PMC9904215 DOI: 10.2147/jpr.s398349] [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: 12/01/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose Simultaneous bilateral pulmonary resection via uniportal video-assisted thoracoscopic surgery (UVATS) was safe and feasible for the treatment of bilateral multiple pulmonary nodules. But, it should be noted that considerable postoperative pain at the bilateral surgical site was a crucial issue. The safety and efficacy of bilateral thoracic paravertebral block (TPVB) have been reported for postoperative analgesia. But, whether bilateral sequential TPVB can be safely and effectively used in simultaneous bilateral UVATS remains unknown. Therefore, this study aimed to determine the analgesic efficacy and safety of bilateral sequential TPVB after simultaneous bilateral UVATS. Study Design and Methods In this study, 80 participants scheduled for UVATS will be randomly allocated to the bilateral sequential TPVB group (G2) and the control group (G1). The patient of G2 will be performed bilateral TPVB at 2 time-points: before the start of the first side of pulmonary resection and before the start of the contralateral pulmonary resection. G1 will only receive standard analgesia protocol. The primary outcome is the numeric rating scale score during coughing at 24 h postoperatively. The secondary outcomes include the Prince Henry Pain Score scores, sufentanil consumption, postoperative nausea and vomiting, levels of inflammatory factors, and the Quality of Recovery-40 scores at different time points, as well as chronic pain at postoperative day (POD) 90. Discussion This is the first prospective trial to determine the safety and effectiveness of ultrasound-guided bilateral sequential TPVB for postoperative analgesia following simultaneous bilateral UVATS. This study also intended to evaluate the effect of this intervention on postoperative quality of recovery and inflammation levels. The final results will provide clinical evidence related to bilateral sequential TPVB, and promote the application of that acting as a more appropriate analgesic method for simultaneous bilateral UVATS.
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Affiliation(s)
- Yugang Lu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Qing Zhou
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Yu Fu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Zongmei Wen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China,Correspondence: Zongmei Wen; Xin Lv, Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, People’s Republic of China, Tel/Fax +86 21 65115006, Email ;
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
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Bernhofer EI. Practical Ethics of Pain Care in the Perioperative Environment. J Perianesth Nurs 2023; 38:155-158. [PMID: 36517339 DOI: 10.1016/j.jopan.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Esther I Bernhofer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.
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38
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Pakzad Moghadam SH, Pourparizi M, Mirzaei T, Ravari A, Mirzaeikhalilabadi S. Analgesic Effect of Preoperative Intravenous Administration of Paracetamol on Post-cesarean Pain: A Randomized Clinical Trial. Anesth Pain Med 2023; 13:e134316. [PMID: 37404264 PMCID: PMC10317030 DOI: 10.5812/aapm-134316] [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: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 07/20/2023] Open
Abstract
Background Pain control after every surgery, especially cesarean section, is very important, and physicians strive to discover pain control methods using the least amount of opioids. Paracetamol is a non-opioid analgesic with few complications. Objectives The present study aimed to investigate the analgesic effect of preoperative intravenous administration of paracetamol on post-cesarean pain. Methods This randomized, double-blind clinical trial was conducted on 240 pregnant women under spinal anesthesia who were candidates for elective cesarean section. The patients' weight, height, age, and body mass index (BMI) were recorded, and patients were randomly divided into 2 equal groups (n = 120). In the first group, 10 mg/kg paracetamol in 100 mL of normal saline (paracetamol group) and, in the second group, 100 mL normal saline (control group) were administered 15 minutes before surgery intravenously. Blood pressure, pulse rate, chills, and nausea were recorded during and 1 hour after surgery; in addition, the visual analogue scale (VAS) and the need for additional analgesics were recorded 1, 2, 4, 6, 12, and 24 hours after surgery. Results Mean pain scores were significantly lower in the paracetamol group (4.01 ± 2.22) than in the control group 6 hours (4.83 ± 2.35; P = 0.008) and 24 hours (2.26 ± 1.85 and 2.67 ± 1.80, respectably; P = 0.038) after surgery. Mean meperidine consumption was lower in the paracetamol group than in the control group, but it was not significant. No significant difference was found between the 2 groups in the frequency of chills and nausea (P > 0.05). Conclusions Within the limitations of the current study, preoperative intravenous administration of paracetamol significantly reduced post-cesarean pain within 24 hours.
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Affiliation(s)
| | - Masoud Pourparizi
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tayebeh Mirzaei
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Ravari
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Sakineh Mirzaeikhalilabadi
- Department of Obstetrics and Gynecology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Jin X, Laxminarayan S, Nagaraja S, Wallqvist A, Reifman J. Development and validation of a mathematical model to simulate human cardiovascular and respiratory responses to battlefield trauma. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3662. [PMID: 36385572 DOI: 10.1002/cnm.3662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/01/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Mathematical models of human cardiovascular and respiratory systems provide a viable alternative to generate synthetic data to train artificial intelligence (AI) clinical decision-support systems and assess closed-loop control technologies, for military medical applications. However, existing models are either complex, standalone systems that lack the interface to other applications or fail to capture the essential features of the physiological responses to the major causes of battlefield trauma (i.e., hemorrhage and airway compromise). To address these limitations, we developed the cardio-respiratory (CR) model by expanding and integrating two previously published models of the cardiovascular and respiratory systems. We compared the vital signs predicted by the CR model with those from three models, using experimental data from 27 subjects in five studies, involving hemorrhage, fluid resuscitation, and respiratory perturbations. Overall, the CR model yielded relatively small root mean square errors (RMSEs) for mean arterial pressure (MAP; 20.88 mm Hg), end-tidal CO2 (ETCO2 ; 3.50 mm Hg), O2 saturation (SpO2 ; 3.40%), and arterial O2 pressure (PaO2 ; 10.06 mm Hg), but a relatively large RMSE for heart rate (HR; 70.23 beats/min). In addition, the RMSEs for the CR model were 3% to 10% smaller than the three other models for HR, 11% to 15% for ETCO2 , 0% to 33% for SpO2 , and 10% to 64% for PaO2 , while they were similar for MAP. In conclusion, the CR model balances simplicity and accuracy, while qualitatively and quantitatively capturing human physiological responses to battlefield trauma, supporting its use to train and assess emerging AI and control systems.
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Affiliation(s)
- Xin Jin
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Srinivas Laxminarayan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Sridevi Nagaraja
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Anders Wallqvist
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, Maryland, USA
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40
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Muacevic A, Adler JR. The Osteopath's Imprint: Osteopathic Medicine Under the Nanoscopic Lens. Cureus 2023; 15:e33914. [PMID: 36660241 PMCID: PMC9846863 DOI: 10.7759/cureus.33914] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/19/2023] Open
Abstract
Scientific literature demonstrates how osteopathic manipulative treatments (OMT) are able to improve various somatic functional parameters, change somato-visceral and viscero-somatic reflexes toward a more physiological mechano-metabolic environment and, consequently, bring benefits to patients. These benefits can be long-lasting or short-lived. Multiple reasons can be found to explain the positive responses to OMT, ranging from neurological, vascular, lymphatic, and endocrine explanations. Not only the techniques, but the touch of the clinician prove to be important factors for a favorable adaptation by the patient. Another science capable of explaining the change in cellular status and from which reflections that pave the way for observing the human body in a different light can be extrapolated is quantum physics. The latter is rarely taken into consideration to obtain possible explanations of the physical events that occur between the clinician and the patient. The article tries to put the effects of OMT under the light of a new lens: the nanoscopic.
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41
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Ward CT, Moll V, Boorman DW, Ooroth L, Groff RF, Gillingham TD, Pyronneau L, Prabhakar A. The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery. J Cardiothorac Surg 2022; 17:342. [PMID: 36581941 PMCID: PMC9801617 DOI: 10.1186/s13019-022-02067-3] [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: 07/11/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The Enhanced Recovery after Surgery Cardiac Society recommends using multimodal analgesia (MMA) for postoperative pain however, evidence-based guidelines have yet to be established. This study examines the impact of a standardized postoperative MMA pathway in reducing opioid consumption and related complications after cardiothoracic surgery (CTS). METHODS Within a multicenter healthcare system, a postoperative MMA pathway was developed and implemented at two CTS intensive care units (ICU) while the other CTS ICU opted to maintain the existing opioid-based pathway. A retrospective chart review was conducted on patients admitted to a CTS ICU within this healthcare system after conventional coronary artery bypass grafting and/or valve surgery from September 1, 2018, to June 30, 2019. Comparative analysis was conducted on patients prescribed MMA versus those managed with an opioid-based pathway. The primary outcome was total opioid consumption, converted to morphine milligram equivalents, 72-h post-surgery. Secondary outcomes included mobility within one-day post-surgery, ICU length of stay (LOS), time to first bowel movement (BM), and time to first zero Richmond Agitation-Sedation Scale (RASS). RESULTS Seven hundred sixty-two adults were included for final analysis. The MMA group had a higher body mass index, higher percentage of females, were more likely classified as African American and had higher scores for risk-adjusted complications. General Linear Model analysis revealed higher opioid consumption in the MMA group (Est. 0.22, p < 0.0009); however, this was not statistically significant after adjusting for differences in fentanyl usage. The MMA group was more likely to have mobility within one-day post-surgery (OR 0.44, p < 0.0001), have longer time to first BM (OR 1.93, p = 0.0011), and longer time to first zero RASS (OR 1.62, p = 0.0071). The analgesia groups were not a predictor for ICU LOS. CONCLUSIONS Opioid consumption was not reduced secondary to this postoperative MMA pathway. The MMA group was more likely to have mobility within one-day post-surgery. Patients in the MMA group were also more likely to have prolonged time to first BM and first zero RASS. Development and evaluation of a perioperative MMA pathway should be considered.
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Affiliation(s)
- Ceressa T. Ward
- Convergent Genomics, 425 Eccles Avenue, South San Francisco, CA 94080 USA ,grid.505042.6Potrero Medical, Hayward, CA USA
| | - Vanessa Moll
- grid.189967.80000 0001 0941 6502Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA USA ,grid.505042.6Potrero Medical, Hayward, CA USA
| | - David W. Boorman
- grid.189967.80000 0001 0941 6502Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA USA
| | - Lijo Ooroth
- grid.259906.10000 0001 2162 9738Mercer University College of Pharmacy, Atlanta, GA USA
| | - Robert F. Groff
- grid.189967.80000 0001 0941 6502Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA USA
| | - Trent D. Gillingham
- grid.462222.20000 0004 0382 6932Office of Quality, Emory Healthcare, Atlanta, GA USA
| | | | - Amit Prabhakar
- grid.189967.80000 0001 0941 6502Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA USA
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Dost B, De Cassai A, Balzani E, Tulgar S, Ahiskalioglu A. Effects of ultrasound-guided regional anesthesia in cardiac surgery: a systematic review and network meta-analysis. BMC Anesthesiol 2022; 22:409. [PMID: 36581838 PMCID: PMC9798577 DOI: 10.1186/s12871-022-01952-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The objective of this systematic review and network meta-analysis was to compare the effects of single-shot ultrasound-guided regional anesthesia techniques on postoperative opioid consumption in patients undergoing open cardiac surgery. METHODS This systematic review and network meta-analysis involved cardiac surgical patients (age > 18 y) requiring median sternotomy. We searched PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science. The effects of the single-shot ultrasound-guided regional anesthesia technique were compared with those of placebo and no intervention. We conducted a risk assessment of bias for eligible studies and assessed the overall quality of evidence for each outcome. RESULTS The primary outcome was opioid consumption during the first 24 h after surgery. The secondary outcomes were pain after extubation at 12 and 24 h, postoperative nausea and vomiting, extubation time, intensive care unit discharge time, and length of hospital stay. Fifteen studies with 849 patients were included. The regional anesthesia techniques included pecto-intercostal fascial block, transversus thoracis muscle plane block, erector spinae plane (ESP) block, and pectoralis nerve block I. All the regional anesthesia techniques included significantly reduced postoperative opioid consumption at 24 h, expressed as morphine milligram equivalents (MME). The ESP block was the most effective treatment (-22.93 MME [-34.29;-11.56]). CONCLUSIONS In this meta-analysis, we concluded that fascial plane blocks were better than placebo when evaluating 24 h MMEs. However, it is still challenging to determine which is better, given the paucity of studies available in the literature. More randomized controlled trials are required to determine which regional anesthesia technique is better. TRIAL REGISTRATION PROSPERO; CRD42022315497.
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Affiliation(s)
- Burhan Dost
- grid.411049.90000 0004 0574 2310Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, Samsun, TR55139 Turkey
| | - Alessandro De Cassai
- grid.411474.30000 0004 1760 2630UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Eleonora Balzani
- grid.7605.40000 0001 2336 6580Department of Surgical Science, University of Turin, Turin, Italy
| | - Serkan Tulgar
- grid.510471.60000 0004 7684 9991Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Ali Ahiskalioglu
- grid.411445.10000 0001 0775 759XDepartment of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey ,grid.411445.10000 0001 0775 759XClinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
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The effects of lavandula aromatherapy on pain relief after coronary artery bypass graft surgery: A randomized clinical trial. Appl Nurs Res 2022; 68:151638. [PMID: 36473717 DOI: 10.1016/j.apnr.2022.151638] [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: 03/03/2022] [Revised: 08/17/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Coronary artery bypass graft surgery (CABG) is a primary treatment in coronary artery disease (CAD). Patients experience pain after CABG. Pain may increase postoperative complications and decrease quality of life (QoL). This study aims to determine the lavandula aromatherapy effect on patients' pain after CABG. METHODS 98 patients undergoing CABG were randomly assigned to intervention and placebo groups. The intervention group inhaled 5-drops of 20 % lavandula essential oil (LEO) and the placebo group was exposed to 5-drop of distilled water. LEO or distilled water were dropped into a sterile gauze converted to the form of a necklace. The subjects wore necklace for three consecutive days and intervention was performed each 24 h. The pain intensity, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before each intervention and 30 min after it. Also, the mean analgesic intake was recorded. SPSS version 16 was used to analyze the data. RESULTS The mean pain score measured in the intervention group showed a more decrease than that obtained in the placebo group after the first and second interventions. Additionally, the mean pain score in the intervention group demonstrated a significant decrease than the placebo group after the second intervention (P=0.008). Moreover, mean SBP after the second intervention (P=0.046) and mean DBP after the first intervention (P=0.029) revealed a significant difference between two groups. Moreover, the intervention group received less analgesic than the placebo group. CONCLUSIONS Lavandula aromatherapy can reduce pain and received analgesic dose after CABG.
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King M, Stambulic T, Hassan SMA, Norman PA, Derry K, Payne DM, El Diasty M. Median sternotomy pain after cardiac surgery: To block, or not? A systematic review and meta-analysis. J Card Surg 2022; 37:3729-3742. [PMID: 36098374 DOI: 10.1111/jocs.16882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Inadequate pain control after median sternotomy leads to reduced mobilization, increased respiratory complications, and longer hospital stays. Typically, postoperative pain is controlled by opioid analgesics that may have several adverse effects. Parasternal intercostal block (PSB) has emerged as part of a multimodal strategy to control pain after median sternotomy. However, the effectiveness of this intervention on postoperative pain control and analgesic use has not been fully established. METHODS AND RESULTS We conducted a meta-analysis to assess the effect of PSB on postoperative pain and analgesic use in adult cardiac surgery patients undergoing median sternotomy. PubMed, Embase, Google Scholar, and the Cochrane database were searched with the following search strategy: ([postoperative pain] or [pain relief] OR [analgesics] or [analgesia] or [nerve block] or [regional block] or [local block] or [regional anesthesia] or [local anesthetic] or [parasternal block] and [sternotomy]) and (humans [filter]). Inclusion criteria were: patients who underwent cardiac surgery via median sternotomy, age >18 and parasternal block (continuous and single dose). Exclusion criteria were: noncardiac surgery, nonparasternal nerve blocks, and the use of NSAIDS in parasternal block. Quality assessment was performed by three independent reviewers via the Cochrane risk of bias assessment tool. Of 1165 total citations, 18 were found to be relevant. Of these 18 citations, 7 citations (N = 2223 patients) reported postoperative pain scores in an extractable format and 11 citations (N = 2155 patients) reported postoperative opioid use in an extractable format. For postoperative opioid use, morphine equivalent doses were calculated for all studies and postoperative pain scores were standardized to a 10-point visual analog scale for comparison between studies; both these were reported as total opioid use or cumulative score ranging from 24 to 72 h postoperative. All data analyses were run using a random effects model, using a restricted maximum likelihood estimator, to obtain summary standardized mean differences with 95% confidence interval (CI's). For studies which only reported median and interquatile range (IQR), the median was standard deviation was estimated by IQR/1.35. Following median sternotomy both postoperative pain (SMD [95% CI] -0.49 [-0.92 to -0.06]) and postoperative morphine equivalent use (SMD [95% CI] -1.68 [-3.11 to -0.25]) were significantly less in the PSB group. CONCLUSION Our meta-analysis suggests that parasternal nerve block significantly reduces postoperative pain and opioid use.
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Affiliation(s)
- Morgan King
- Queen's School of Medicine, Kingston, Ontario, Canada
| | | | | | - Patrick A Norman
- Kingston General Health Research Institute, Kingston, Ontario, Canada
| | - Kendra Derry
- Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada
| | - Darrin M Payne
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Mohammad El Diasty
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
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45
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The influence of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery. Sci Rep 2022; 12:16464. [PMID: 36183003 PMCID: PMC9526739 DOI: 10.1038/s41598-022-20870-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Patients undergoing cardiac surgery represent a challenge in terms of pain management due to multiple factors relating to the patients and to the procedure itself. Our aim was to identify the influence of levels of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery and explore associations between preoperative anxiety, postoperative pain, analgesic requirements, and sex. We present a prospective cohort study of 116 patients undergoing cardiac surgery between January and April 2020. Preoperative anxiety was evaluated using the State-Trait Anxiety Inventory and the amount of morphine needed to keep pain intensity below 4 on the verbal numerical rating scale was recorded for 48 h post-surgery. Given the extracorporeal circulation time, type of surgery and body surface, it was observed that every percentile increase in preoperative state anxiety led to an extra 0.068 mg of morphine being administered. For each extra year of age, the amount of morphine needed decreased by 0.26 mg, no difference was observed between men and women in terms of preoperative anxiety or postoperative analgesics requirements. It may be concluded that in cardiac surgery, postoperative analgesic requirements increased with higher levels of preoperative state anxiety and decreased for every extra year of age.
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46
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Gohari J, Grosman-Rimon L, Arazi M, Caspi-Avissar N, Granot D, Gleitman S, Badarny J, Lubovich A, Sudarsky D, Rimon J, Carasso S, Birati EY, Kachel E. Clinical factors and pre-surgical depression scores predict pain intensity in cardiac surgery patients. BMC Anesthesiol 2022; 22:204. [PMID: 35787245 PMCID: PMC9252086 DOI: 10.1186/s12871-022-01740-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background Severe pain is prevalent in cardiac surgery patients and can increase cardiac complications, morbidity and mortality. The objectives of the study were to assess perioperative pain intensity and to assess predictors of pain post-cardiac surgery, including clinical characteristics and depression. Methods A total of 98 cardiac surgery patients were included in the study. Pain intensity was assessed using a Numerical Rating System. Pain was measured one day pre-operatively and recorded daily from Post-operative Day 2 to Day 7. Clinical data were recorded and depression scores were assessed using the Center for Epidemiological Study of Depression (CES-D). Results Pain intensity increased significantly during hospitalization from pre-operative levels, surging at 2 days post-operatively. Predictors of high pain intensity were high pre-operative CES-D scores, female gender, cardiac function, smoking and high body mass index (BMI). Significantly higher pre-operative CES-D scores were found in patients with severe pain compared to patients with no pain to moderate pain (18.23 ± 1.80 vs 12.84 ± 1.22, p = 0.01 pre-operatively). Patients with severe pain (NRS 7–10) had significantly higher levels of white blood cells (WBC) compared to patients with no pain-moderate pain (NRS 0–6), (p = 0.01). However, CES-D scores were only weakly correlated maximum WBC levels perioperatively. Conclusion Pain intensity significantly increased following surgery, and was associated with depressive symptoms, female sex, cardiac function, BMI, and smoking. These factors may serve as a basis for identification and intervention to help prevent the transition from acute pain to chronic pain.
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Affiliation(s)
- Jacob Gohari
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Creedmoor Psychiatric Center, Queens Village, New York City, NY, USA
| | - Liza Grosman-Rimon
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel.,The Academic College at Wingate, Wingate Institute, Netanya, Israel
| | - Mattan Arazi
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Cardiac Surgery, Leviev HeartCenter, Sheba Medical Center, Tel Hashomer, Israel
| | - Noa Caspi-Avissar
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel
| | - Dina Granot
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel
| | - Sagi Gleitman
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel
| | - Jawdat Badarny
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel
| | - Alla Lubovich
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Doron Sudarsky
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Jordan Rimon
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel.,Faculty of Health, York University, Toronto, Canada
| | - Shemy Carasso
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Edo Y Birati
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Erez Kachel
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh Poriya Medical Center, Tiberias, Israel. .,Department of Cardiac Surgery, Leviev HeartCenter, Sheba Medical Center, Tel Hashomer, Israel. .,The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel.
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Quintero-Cifuentes IF, Camilo Clement J, Cruz-Suárez GA, Chaparro-Mendoza K, Holguín-Noreña A, Vélez-Esquivia MA. Bilateral continuous erector spinae plane block for cardiac surgery: case series. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.5554/22562087.e1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Multimodal analgesia in cardiac surgery sternotomy includes bilateral continuous erector spinae plane block (BC-ESPB). However, the effectiveness of the local anesthetic regimens is still uncertain.
The purpose of this study was to assess pain control achieved with a multimodal analgesia regimen including BC-ESPB at the level of T5 with PCA with a 0.125 % bupivacaine infusion and rescue boluses.
This is a descriptive case series study which recruited 11 adult patients undergoing cardiac surgery through sternotomy in whom multimodal analgesia including BC-ESPB was used, between February and April 2021, at a fourth level institution.
All patients reported pain according to the numeric rating scale (NRS) ≤ 3 both at rest and in motion, at extubation and then 4 and 12 hours after surgery. After 24 hours the pain was NRS ≤ 3 in 100 % of the patients at rest and in 63.6 % in motion. At 48 h 81 % of the patients reported pain NRS ≤ 3 at rest and in motion. At 72h all patients reported pain NRS ≤ 3 at rest and 82 % in motion. The average intraoperative use of fentanyl was 2.35 µg/kg and postoperative hydromorphone was 5.3, 4.1 and 3.3 mg at 24, 48 and 72 hours, respectively.
Hence, bilateral ESP block in continuous infusion plus rescue boluses allows for proper control of acute intra and post-operative pain.
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Sepolvere G, Scialdone VR. Single shot serratus anterior plane block for post-thoracotomy pain management in cardiac surgery: could it be enough? Minerva Anestesiol 2022; 88:748-749. [PMID: 35612949 DOI: 10.23736/s0375-9393.22.16467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giuseppe Sepolvere
- Intensive Care Unit, Department of Anesthesia and Cardiac Surgery, San Michele Hospital, Maddaloni, Caserta, Italy -
| | - Valeria R Scialdone
- Intensive Care Unit, Department of Anesthesia and Cardiac Surgery, San Michele Hospital, Maddaloni, Caserta, Italy
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Fernando RJ, Graulein D, Hamzi RI, Augoustides JG, Khalil S, Sanders J, Sibai N, Hong TS, Kiwakyou LM, Brodt JL. Buprenorphine and Cardiac Surgery: Navigating the Challenges of Pain Management. J Cardiothorac Vasc Anesth 2022; 36:3701-3708. [PMID: 35667956 DOI: 10.1053/j.jvca.2022.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Division, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| | | | - Rawad I Hamzi
- Department of Anesthesiology, Regional Anesthesia and Acute Pain Management, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Suzana Khalil
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health Systems, Detroit, MI
| | - Joseph Sanders
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health Systems, Detroit, MI
| | - Nabil Sibai
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health Systems, Detroit, MI
| | - Tracey S Hong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University,Palo Alto, CA
| | - Larissa M Kiwakyou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University,Palo Alto, CA
| | - Jessica L Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University,Palo Alto, CA
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Álvarez-Baena L, Hervías M, Ramos S, Cebrián J, Pita A, Hidalgo I. Continuous thoracic paravertebral analgesia after minimally invasive atrial septal defect closure surgery in pediatric population: Effectiveness and safety analysis. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:259-265. [PMID: 35643760 DOI: 10.1016/j.redare.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/28/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Lateral thoracotomy is replacing traditional median sternotomy for atrial septal defect (ASD) closure in children in order to improve cosmetic outcomes. Continuous paravertebral block has been described as an effective and safe analgesic technique in children. The aim of this study is to assess pain management by continuous perfusion of local anesthetic through a thoracic paravertebral catheter (PVC) in a pediatric population after thoracotomy closure of ASD, and its effectiveness in a fast-track program. METHODS Descriptive cross-sectional study. Analgesic effectiveness, perioperative and safety-related data were analyzed in 21 patients who underwent thoracotomy closure of ASD with PVC. In the postoperative period, patients received continuous perfusion of bupivacaine 0.125% and fentanyl (1 mcg.ml-1) at 0.2 ml.kg-1.h-1 through the PVC. RESULTS The median of mean pain scale score for each patient was 1.5. All patients were extubated in the operating theatre. No patient with PVC required opioid rescue. The median length of stay in the Pediatric Intensive Care Unit was 48 hours. There were 3 adverse events related to PVC: 1 due to malposition and 2 due to accidental removal. No other complications or cases of local anesthetic toxicity were recorded. CONCLUSIONS PVC provides effective, safe, opioid-saving analgesia in the postoperative period of ASD closure by thoracotomy in the context of a fast-track protocol.
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Affiliation(s)
- L Álvarez-Baena
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain.
| | - M Hervías
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain
| | - S Ramos
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain
| | - J Cebrián
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain
| | - A Pita
- Servicio de Cirugía Cardiaca, Sección de Cirugía Cardiaca infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Hidalgo
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain
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