-
Local and Regional Anesthesia 2024Acute postoperative pain is one of the major clinical problems that occurs in patients undergoing cesarean section with a prevalence of 89.8%. Postoperative pain causes...
OBJECTIVE
Acute postoperative pain is one of the major clinical problems that occurs in patients undergoing cesarean section with a prevalence of 89.8%. Postoperative pain causes discomfort and various complications for the mother. In addition, postoperative pain that is not handled properly can increase the risk of becoming chronic pain by 2.5 times. One of the methods recommended in the Enhanced Recovery After Caesarean Section (ERACS) protocol to prevent acute postoperative pain is the use of intrathecal long-acting opioids, with intrathecal morphine as the gold standard and Transversus Abdominis Plane (TAP) block. This study aims to assess the comparison of opioid needs as analgesic rescue between the administration of 0.1mg spinal morphine and TAP block with bupivacaine 0.2% 10mg in patients undergoing cesarean section.
METHODS
This study is an observational study in a single Tertiary Hospital in West Java - Indonesia. Patients were given patient-controlled anesthesia (PCA) with fentanyl as analgesic rescue. Statistical analysis of the numerical data used the unpaired -test and Chi-Square test for categorical data.
RESULTS
In the group that was given spinal morphine, the duration of additional opioids was longer (p < 0.05), and the total dose of additional opioids was less than the TAP block group (p < 0.05).
CONCLUSION
The spinal morphine requires fewer additional opioids than the TAP block.
PubMed: 38883999
DOI: 10.2147/LRA.S459530 -
Journal of Perianesthesia Nursing :... Jun 2024The purpose of this study was to compare the effect of ultrasound-guided continuous erector spinae plane block to continuous thoracic paravertebral block on...
PURPOSE
The purpose of this study was to compare the effect of ultrasound-guided continuous erector spinae plane block to continuous thoracic paravertebral block on postoperative analgesia in elderly patients who underwent thoracoscopic lobectomy.
DESIGN
Randomized controlled trial.
METHODS
Elderly patients (N = 50) who underwent nonemergent thoracoscopic lobectomy in the thoracic surgery department of our hospital from January 2019 to December 2020 were selected and randomly divided into continuous erector spinae block (ESPB; n = 25) group and continuous thoracic paravertebral block (TPVB; n = 25) group. The patients in the two groups were guided by ultrasound with ESPB or TPVB before anesthesia induction. The visual analog scale at rest and cough in 2 hours, 6 hours, 8 hours, 12 hours, 24 hours, 48 hours after surgery, the supplementary analgesic dosage of tramadol, time of tube placement, the stay time in postanesthesia care unit (PACU), the first ambulation time after surgery, the length of postoperative hospital stay and postoperative complications were recorded.
FINDINGS
There were no significant differences between the two groups in visual analog scale score at rest and cough at each time point and supplementary analgesic dosage of tramadol within 48 hours after surgery (P > .05). The time of tube placement and the postoperative hospital stay in ESPB group was significantly shorter than that in TPVB group (P < .05). There were no differences in PACU residence time and first ambulation time between the two groups (P > .05). There were 4 patients in TPVB group and 2 patients in ESPB group who had nausea and vomiting (P > .05), 1 case of pneumothorax and 1 case of fever in the TPVB group. There were no incision infections or respiratory depression requiring clinical intervention in either group.
CONCLUSIONS
Both ESPB and TPVB alleviated the patients postoperative pain effectively for elderly patients underwent thoracoscopic lobectomy. Compared with TPVB, patients with ESPB have a shorter tube placement time, fewer complications and faster postoperative recovery.
PubMed: 38878034
DOI: 10.1016/j.jopan.2024.01.001 -
Medicine Jun 2024Magnesium Sulfate (MgSO4) is a widely used adjuvant in anesthesia. Often administered with local anesthetics, it is known to reduce analgesic and opioid consumption... (Review)
Review
Magnesium Sulfate (MgSO4) is a widely used adjuvant in anesthesia. Often administered with local anesthetics, it is known to reduce analgesic and opioid consumption while extending the duration of analgesia. MgSO4 applications extend to orthopedic surgeries, cardiovascular and urogenital procedures, offering extended postoperative pain relief. While commonly administered through various routes, there is a research gap concerning the comparative efficacy of intrathecal (IT) and intravenous (IV) MgSO4 administration. This narrative review aims to provide a comparison between IT and IV administration of MgSO4 particularly following orthopedic procedures, where pain management is paramount. A comprehensive literature search was conducted across several electronic databases, trial registries, and gray literature from inception to 2023. Inclusion criteria encompassed studies investigating the effects of perioperative IT administration of magnesium compared to perioperative IV administration of MgSO4 in patients undergoing surgery, with no language restrictions. Our search identified 4326 articles, of which 9 randomized controlled trials met our inclusion criteria. We summarized these selected articles. Four studies discussed IT magnesium sulfate (MgSO4) administration, 2 focused on IT administration in orthopedic surgeries, and 3 explored both IV and IT administration of MgSO4 in orthopedic surgery. IT MgSO4 shows promise in postoperative pain management, delaying block onset and extending duration. Personalized administration choice, considering patient factors and surgery type, is crucial. Further research is needed to refine strategies for better patient outcomes, particularly following orthopedic surgeries.
Topics: Magnesium Sulfate; Humans; Pain, Postoperative; Orthopedic Procedures; Injections, Spinal; Administration, Intravenous; Pain Management; Analgesics
PubMed: 38875416
DOI: 10.1097/MD.0000000000038522 -
Cureus May 2024Percutaneous nephrolithotripsy (PCNL) is a minimally invasive procedure for treating large and complex kidney stones, often resulting in significant post-operative pain...
INTRODUCTION
Percutaneous nephrolithotripsy (PCNL) is a minimally invasive procedure for treating large and complex kidney stones, often resulting in significant post-operative pain and increased opioid use. This study aims to compare pain scores between patients undergoing PCNL who did and did not receive a preoperative single-shot thoracic paravertebral block (PVB) at the post-anesthesia care unit (PACU) as the primary outcome. Secondary outcomes were patient-controlled analgesia (PCA) usage on post-operative day 1 (POD 1), total opioid consumption on PACU and POD 1, and post-operative nausea and vomiting (PONV).
METHODS
A retrospective cohort study was conducted on the medical records of 341 patients who underwent PCNL from July 2014 to April 2016 in a single major academic center. PVB was administered at thoracic levels T7-9 using a volume of 20 cc of bupivacaine, ranging from 0.25% to 0.5%, to achieve the desired analgesic effect.
RESULTS
After excluding 34 patients, the study included 123 in the no block (NB) group and 149 in the regional anesthesia (RA) group. There were no differences in demographics, including age, sex, weight and height, BMI, and indication for PCNL. The results revealed that the RA group experienced a statistically significant reduction in PCA usage in both crude and adjusted models (adjusted logistic regression analysis: OR = 0.19, 95% CI = 0.05-0.60; p = 0.008). However, there were no significant changes in total opioid consumption, pain scores, or incidents of PONV.
CONCLUSION
The retrospective analysis did not reveal any discernible advantage in pain management associated with the use of PVB for post-PCNL analgesia, except for reducing the percentage of PCA narcotics used. Future investigations with larger sample sizes and meticulous control for surgical indications and complexity are imperative to accurately assess the efficacy of this block in the context of post-PCNL surgery.
PubMed: 38872686
DOI: 10.7759/cureus.60272 -
Journal of Perianesthesia Nursing :... Jun 2024The aim of this study was to compare the analgesic effect and adverse events of hydromorphone patient-controlled intravenous analgesia (PCIA) without background dose...
PURPOSE
The aim of this study was to compare the analgesic effect and adverse events of hydromorphone patient-controlled intravenous analgesia (PCIA) without background dose versus sufentanil PCIA with background dose in patients after surgery.
DESIGN
A retrospective analysis.
METHODS
From June 2020 to May 2021, 1,594 eligible postoperative patients who received PCIA were included in this study. According to the types of opioids, patients were divided into two groups: the sufentanil group and the hydromorphone group. The Numerical Rating Scale, Functional Activity Scale, and Level of Sedation were used to evaluate the analgesic effects between the two groups. In addition, total patient-controlled analgesia (PCA) use, effective number of PCA compressions, and adverse effects of PCIA were compared between the two groups.
FINDINGS
At 24 hours (h) after surgery, the Functional Activity Scale score in the sufentanil group was higher than that in the hydromorphone group (P < .05). Compared with the sufentanil group, total PCA use, total number of PCA compressions and effective number of PCA consumptions were significantly decreased in the hydromorphone group during a 48 hours period (P < .05). There were no statistical differences in Numerical Rating Scale score, Level of Sedation score, and adverse events between two groups at 24 hours and 48 hours after surgery.
CONCLUSIONS
Compared with sufentanil PCIA with a background dose, under a similar analgesic effect, hydromorphone PCIA without a background dose provided lower PCA use. Our findings may provide useful evidence for more future studies related to postoperative analgesia.
PubMed: 38864798
DOI: 10.1016/j.jopan.2023.12.031 -
The Journal of Pediatric Pharmacology... Jun 2024Smart pump interoperability is a newer technology integrating intravenous medication -infusion instructions from the electronic medical record into a smart pump. This...
OBJECTIVES
Smart pump interoperability is a newer technology integrating intravenous medication -infusion instructions from the electronic medical record into a smart pump. This technology has demonstrated significantly decreased medication errors in the adult population; however, this has not been reported in pediatrics. The purpose of this study was to compare the frequency and severity of infusion related errors before and after the implementation of smart pump interoperability at a pediatric institution.
METHODS
This was a retrospective study conducted at multiple institutions within the same health care system to assess the effect of smart pump interoperability on infusion errors. Data were retrospectively analyzed for a 6-month period prior to (January-June 2020) and after (January-June 2022) smart pump interoperability implementation. All who received medications via a smart pump were included in the analysis. Infusions were excluded if administered via a patient-controlled analgesia pump, epidural pump, or intravenously pushed without using a smart pump.
RESULTS
A total of 143,997 versus 165,343 infusions were administered in the before versus after interoperability group. There were significant decreases in mild, moderate, and severe harm averted events once interoperability was implemented (p < 0.001). Errors caught before administration decreased after interoperability implementation from 197 events to 20 events because of fewer overall errors (p < 0.001). The number of guardrail alert overrides was significantly reduced, from 23,751 to 5885 (p < 0.001), as was the number of high-risk overrides, from 5851 to 207 (p < 0.001).
CONCLUSION
Implementing smart pump interoperability significantly reduced the frequency and severity of infusion errors and high-risk overrides at a pediatric institution.
PubMed: 38863851
DOI: 10.5863/1551-6776-29.3.323 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jun 2024Effective pain management is vital in critical care settings, particularly post-surgery. Clinicians should maintain objective and efficient standards to assess pain in a... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Effective pain management is vital in critical care settings, particularly post-surgery. Clinicians should maintain objective and efficient standards to assess pain in a patient-centered manner, in order to effectively manage this complex issue. A newer technology, the nociception level (NOL) index, shows promise in achieving this task through its multi-parameter evaluation.
METHODS
This study was a prospective, controlled, randomized trial involving two groups of patients (n=30 each) in a diverse intensive care unit. Participants were over 18 years old with American Society of Anesthesiology scores ranging from I to III and were scheduled for critical care follow-up after general anesthesia. All subjects followed a standard analgesia protocol that included rescue analgesia. Drug administration was guided by a numeric rating scale and the critical care pain observation tool in the Control Group, while it was guided by nociception level index monitoring in the NOL Group.
RESULTS
Pain scores between the two groups did not significantly differ. However, within the NOL Group, pain scores and noci-ception values displayed a strong positive correlation. Notably, total analgesic consumption was significantly lower in the NOL Group (p=0.036).
CONCLUSION
Monitoring pain using the nociception level index is an effective method for detecting pain compared to standard pain scores utilized in critical care. Its guidance facilitates personalized analgesic titration. Additionally, the potential of nociception level index guidance to reduce the duration of intensive care and hospital stays may be linked to its effects on delirium, a connection that awaits further exploration in future studies.
Topics: Humans; Double-Blind Method; Male; Female; Pain Measurement; Prospective Studies; Middle Aged; Nociception; Critical Care; Adult; Pain Management; Prognosis; Intensive Care Units; Aged; Pain, Postoperative; Analgesics
PubMed: 38863294
DOI: 10.14744/tjtes.2024.95533 -
Cureus May 2024This article discusses the management of ventricular storm (VS), a condition characterized by recurrent episodes of sustained ventricular tachycardia or fibrillation,...
This article discusses the management of ventricular storm (VS), a condition characterized by recurrent episodes of sustained ventricular tachycardia or fibrillation, which poses a significant risk of mortality. Prompt intervention is crucial, yet surgical options are often limited due to the patient's unstable condition. This case report presents a 47-year-old female who experienced VS during a planned surgical procedure. Despite initial stabilization, she continued to experience life-threatening arrhythmias, prompting the implementation of simultaneous stellate ganglion block (SGB) and thoracic epidural analgesia (TEA) catheters. This combined approach successfully controlled the arrhythmias, allowing for subsequent surgical interventions. The article emphasizes the potential of SGB and TEA as a bridge to definitive therapies for refractory VS, highlighting the need for further research to solidify their role in clinical practice.
PubMed: 38854346
DOI: 10.7759/cureus.59867 -
BMC Anesthesiology Jun 2024Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists,... (Randomized Controlled Trial)
Randomized Controlled Trial
Analgesic effect of ultrasound-guided transversus abdominis plane block with or without rectus sheath block in laparoscopic cholecystectomy: a randomized, controlled trial.
BACKGROUND
Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores.
METHODS
The study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events.
RESULTS
There was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events.
CONCLUSION
Both RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality.
Topics: Humans; Cholecystectomy, Laparoscopic; Female; Male; Ultrasonography, Interventional; Nerve Block; Middle Aged; Pain, Postoperative; Abdominal Muscles; Ropivacaine; Adult; Anesthetics, Local; Pain Measurement; Rectus Abdominis; Patient Satisfaction; Analgesia, Patient-Controlled; Aged
PubMed: 38851689
DOI: 10.1186/s12871-024-02590-x -
Perioperative Medicine (London, England) Jun 2024The erector spinae plane block (ESPB) is a new analgesic method used in thoracic surgery. However, few studies have characterized their effects on perioperative opioid...
BACKGROUND
The erector spinae plane block (ESPB) is a new analgesic method used in thoracic surgery. However, few studies have characterized their effects on perioperative opioid consumption. We aimed to evaluate the effects of ESPB on perioperative opioid consumption in patients who underwent video-assisted thoracoscopic surgery (VATS).
METHODS
This was a randomized, observer-blinded clinical trial at a single-centre academic hospital. Eighty patients were scheduled for thoracoscopic segmentectomy or lobectomy by VATS for lung cancer. Forty participants were randomly assigned to ESPB or control group. All patients received intravenous patient-controlled postoperative analgesia. Perioperative opioid consumption, visual analogue scale (VAS) scores, and adverse events were recorded.
RESULTS
Intraoperative and postoperative opioid consumption and static/dynamic VAS scores were significantly lower in the early hours after VATS in the ESPB group (p < 0.05) than the control group. No significant differences were observed in adverse effects between the two groups.
CONCLUSIONS
ESPB reduced intraoperative opioid consumption and early postoperative pain in patients undergoing VATS. Our findings support the view that ESPB is a safe and highly effective option for regional analgesia for VATS.
TRIAL REGISTRATION
http://www.chictr.org.cn , ChiCTR1800019335.
PubMed: 38849882
DOI: 10.1186/s13741-024-00413-8