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Paediatric & Neonatal Pain Jun 2024Postoperative care pathways for adolescent idiopathic scoliosis patients undergoing posterior spinal fusion have demonstrated decreases in postoperative opioid...
Postoperative care pathways for adolescent idiopathic scoliosis patients undergoing posterior spinal fusion have demonstrated decreases in postoperative opioid consumption, improved pain control, and lead to decreased lengths of stay. Our objective was to implement postoperative steroids to reduce acute postoperative opioid consumption, pain scores, and length of stay. Dosing consisted of intravenous dexamethasone 0.1 mg/kg up to 4 mg per dose for a total of three doses at 8, 16, and 24 h postoperatively. As part of a quality initiative, we compared three cohorts of patients. The initial retrospective epidural cohort (EPI) ( = 59) had surgeon placed epidural catheters with infusion of ropivacaine 0.1% postoperatively for 18-24 h. Following an institutional change in postoperative care, epidural use was discontinued. A second cohort ( = 149), with prospectively collected data, received a surgeon placed erector spinae plane block and wound infiltration with a combination of liposomal and plain bupivacaine (LB). A third cohort ( = 168) was evaluated prospectively. This cohort received a surgeon placed erector spinae plane block and wound infiltration with liposomal and plain bupivacaine and additionally received postoperative dexamethasone for three doses (LB + D). Compared to the LB cohort, the LB + D cohort demonstrated statistically significant decreases in oral milligram morphine equivalents per kilogram at 0-24, 24-48, and 48-72 h. There was a statistically significant difference in median pain scores at 24-48 and 48-72 h in LB + D versus LB. The LB + D cohort's median length of stay in hours was significantly less compared to the LB cohort (52 h vs. 70 h, < 0.0001). Postoperative intravenous dexamethasone was added to an established postoperative care pathway for patients undergoing posterior spinal fusion for idiopathic scoliosis resulting in decreased VAS pain scores, opioid consumption, and shorter length of stay.
PubMed: 38863457
DOI: 10.1002/pne2.12117 -
Acute and Critical Care May 2024Patients with a fractured femur experience intense pain during positioning for neuraxial block for definitive surgery. Femoral nerve block (FNB) is therefore often given...
BACKGROUND
Patients with a fractured femur experience intense pain during positioning for neuraxial block for definitive surgery. Femoral nerve block (FNB) is therefore often given prior to positioning for analgesia. In our study, we compare the onset and quality of block of 0.25% bupivacaine, 0.5% ropivacaine, and 1.5% lignocaine for FNB in fracture femur patients.
METHODS
Seventy-five adult femur fracture patients were equally and randomly divided into three groups to receive 15 ml of either 0.25% bupivacaine (group B), 0.5% ropivacaine (group R), or 1.5% lignocaine (group L) for FNB prior to positioning for neuraxial blockade. Onset and quality of block were assessed, as well as improvement in visual analog scale (VAS) score, ease of positioning, and patient satisfaction.
RESULTS
Percentage decrease in VAS was found to be highest in group R (82.8%) followed by groups L and B. Time to achieve a VAS of less than 4 was found to be 26.2±2.4 minutes in group B, 8.5±1.9 minutes in group R, and 4.1±0.7 minutes in group L (P<0.001). In group B, 12 patients required additional fentanyl to achieve a VAS <4. Patient positioning was reported to be satisfactory in all patients in group R and L, while in B it was satisfactory in 13 (52%) patients only. Patient acceptance of FNB was 100% in group R and L, but only 64% in group B.
CONCLUSIONS
Based on our findings, 0.5% ropivacaine is a favorable choice for FNB due to early onset, ability to yield a good quality block, and good safety profile.
PubMed: 38863358
DOI: 10.4266/acc.2023.01606 -
International Journal of Surgery Case... Jul 2024Cleft lip and palate (CLP) are congenital anomalies of the craniofacial region, commonly found in low- and middle-income countries, including Indonesia. Surgical...
INTRODUCTION AND IMPORTANCE
Cleft lip and palate (CLP) are congenital anomalies of the craniofacial region, commonly found in low- and middle-income countries, including Indonesia. Surgical correction of clefts typically begins at around three months of age to support infant growth. An infraorbital nerve block is an option for regional anesthesia in CLP surgery. This case series aims to determine the effectiveness of infraorbital nerve block in pain management for pediatric CLP surgery.
CASE PRESENTATION
This case series includes five patients who fulfilled the Millard criteria for CLP surgery. All patients received general anesthesia followed by an infraorbital nerve block with 0.2 % ropivacaine in the infraorbital foramen area using the intraoral approach. Data were collected preoperatively, intraoperatively, and postoperatively.
DISCUSSION
The combination of general anesthesia and infraorbital nerve block resulted in stable hemodynamics, low delirium scores, low pain intensity, and adequate oral intake postoperatively.
CONCLUSION
Infraorbital nerve block with ropivacaine provides intraoperative hemodynamic stability, decreased delirium, and effective postoperative pain management in pediatric patients undergoing CLP surgery.
PubMed: 38861814
DOI: 10.1016/j.ijscr.2024.109893 -
The Journal of Craniofacial Surgery Jun 2024Although the maxillary nerve block (MNB) provides adequate pain relief in cleft palate surgery, it is not routinely used globally, and reported techniques are...
INTRODUCTION
Although the maxillary nerve block (MNB) provides adequate pain relief in cleft palate surgery, it is not routinely used globally, and reported techniques are heterogeneous. This study aims to describe relevant anatomy and to present the preferred technique of MNB administration based on the current literature and the expert opinion of the authors.
METHOD AND MATERIALS
First, a survey was sent to 432 registrants of the International Cleft Palate Master Course Amsterdam 2023. Second, MEDLINE (PubMed interface) was searched for relevant literature on maxillary artery (MA) anatomy and MNB administration in pediatric patients.
RESULTS
Survey response rate was 18% (n=78). Thirty-five respondents (44.9%) used MNB for cleft palate surgery before the course. A suprazygomatic approach with needle reorientation towards the ipsilateral commissure before incision was most frequently reported, mostly without the use of ultrasound. Ten and 20 articles were included on, respectively, MA anatomy and MNB administration. A 47.5% to 69.4% of the MA's run superficial to the lateral pterygoid muscle and 32% to 52.5% medially. The most frequently described technique for MNB administration is the suprazygomatic approach. Reorientation of the needle towards the anterior aspect of the contralateral tragus appears optimal. Needle reorientation angles do not have to be adjusted for age, unlike needle depth. The preferred anesthetics are either ropivacaine or (levo)bupivacaine, with dexmedetomidine as an adjuvant.
CONCLUSION
Described MNB techniques are heterogeneous throughout the literature and among survey respondents and not routinely used. Further research is required comparing different techniques regarding efficacy and safety.
PubMed: 38861198
DOI: 10.1097/SCS.0000000000010343 -
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 -
Journal of Clinical Anesthesia Jun 2024To determine if single-injection bilateral posterior quadratus lumborum block (QLB) with ropivacaine would improve postoperative analgesia in the first 24 h after...
Analgesic effects of ultrasound-guided preoperative posterior Quadratus Lumborum block in laparoscopic hepatectomy: A prospective double-blinded randomized controlled trial.
STUDY OBJECTIVE
To determine if single-injection bilateral posterior quadratus lumborum block (QLB) with ropivacaine would improve postoperative analgesia in the first 24 h after laparoscopic hepatectomy, compared with 0.9% saline.
DESIGN
Prospective, double blinded, randomized controlled trial.
SETTING
A single tertiary care center from November 2021 and January 2023.
PATIENTS
A total of 94 patients scheduled to undergo laparoscopic hepatectomy due to hepatocellular carcinoma.
INTERVENTIONS
Ninety-four patients were randomized into a QLB group (receiving 20 mL of 0.375% ropivacaine on each side, 150 mg in total) or a control group (receiving 20 mL of 0.9% saline on each side).
MEASUREMENTS
The primary outcome was the cumulative opioid consumption during the initial 24-h post-surgery. Secondary outcomes included pain scores and intraoperative and recovery parameters.
MAIN RESULTS
The mean cumulative opioid consumption during the initial 24-h post-surgery was 30.8 ± 22.4 mg in the QLB group (n = 46) and 34.0 ± 19.4 mg in the control group (n = 46, mean differences: -3.3 mg, 95% confidence interval, -11.9 to 5.4, p = 0.457). The mean resting pain score at 1 h post-surgery was significantly lower in the QLB group than in the control group (5 [4-6.25] vs. 7 [4.75-8], p = 0.035). No significant intergroup differences were observed in the resting or coughing pain scores at other time points or in other secondary outcomes.
CONCLUSIONS
Preoperative bilateral posterior QLB did not reduce cumulative opioid consumption during the first 24 h after laparoscopic hepatectomy.
PubMed: 38851003
DOI: 10.1016/j.jclinane.2024.111504 -
Medicine Jun 2024In this study, we analyzed whether scalp nerve block with ropivacaine can improve the quality of rehabilitation in patients after meningioma resection. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In this study, we analyzed whether scalp nerve block with ropivacaine can improve the quality of rehabilitation in patients after meningioma resection.
METHODS
We included 150 patients who were undergoing craniotomy in our hospital and categorized them into 2 groups - observation group (patients received an additional regional scalp nerve block anesthesia) and control group (patients underwent intravenous general anesthesia for surgery), using the random number table method approach (75 patients in each group). The main indicator of the study was the Karnofsky Performance Scale scores of patients at 3 days postoperatively, and the secondary indicator was the anesthesia satisfaction scores of patients after awakening from anesthesia. The application value of different anesthesia modes was studied and compared in the 2 groups.
RESULTS
Patients in the observation group showed better anesthesia effects than those in the control group, with significantly higher Karnofsky Performance Scale scores at 3 days postoperatively (75.02 vs 66.43, P < .05) and anesthesia satisfaction scores. Compared with patients in the control group, patients in the observation group had lower pain degrees at different times after the surgery, markedly lower dose of propofol and remifentanil for anesthesia, and lower incidence of adverse reactions and postoperative complications. In addition, the satisfaction score of the patients and their families for the treatment was higher and the results of all the indicators were better in the observation group than in the control group, with statistically significant differences (P < .05).
CONCLUSION
Scalp nerve block with ropivacaine significantly improves the quality of short-term postoperative rehabilitation in patients undergoing elective craniotomy for meningioma resection. This is presumably related to the improvements in intraoperative hemodynamics, relief from postoperative pain, and reduction in postoperative nausea and vomiting.
Topics: Humans; Nerve Block; Meningioma; Female; Male; Middle Aged; Scalp; Ropivacaine; Anesthetics, Local; Pain, Postoperative; Adult; Meningeal Neoplasms; Craniotomy; Patient Satisfaction; Aged; Karnofsky Performance Status
PubMed: 38847715
DOI: 10.1097/MD.0000000000038324 -
Journal of the College of Physicians... Jun 2024To investigate the efficacy of adding 0.5 micrograms/kg of dexmedetomidine to 0.2% ropivacaine in erector spinae plane block in terms of 24-hour opioid consumption after... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the efficacy of adding 0.5 micrograms/kg of dexmedetomidine to 0.2% ropivacaine in erector spinae plane block in terms of 24-hour opioid consumption after lumbar spine surgeries.
STUDY DESIGN
A randomised controlled trial. Place and Duration of the Study: The Security Forces Hospital, Riyadh, Saudi Arabia, from 30th November 2022 to 30th March 2023.
METHODOLOGY
Patients aged between 18-70 years, ASA 1-3 who were booked to undergo lumbar spine surgeries under general anaesthesia were inducted. Patients in the intervention group received erector spinae plane block (ESPB). Exclusion criteria were patient refusal, inability to give consent, patients with contraindications to regional anaesthesia, known allergy to study medications, inability to use patient-controlled analgesia (PCA), psychiatric disorders or patients using any psychiatric medications. The primary outcome measure of the study was 24-hour opioid consumption.
RESULTS
The numeric rating scale (NRS) pain scores were significantly decreased in the ESPB-D group at 30 minutes (p = 0.042), at 1 hour (p = 0.018), at 2 hours (p = 0.044), at 12 hours (p = 0.039), at 18 hours (p = 0.011), and at 24 hours (p = 0.020). Intraoperative use of remifentanil was also significantly lower in the ESPB-D group (p <0.01). ESPB using dexmedetomidine also reduced opioid consumption over a period of 24 hours (p <0.01). Median patient satisfaction score and median ease of mobility were also significantly better in the ESPB-D group.
CONCLUSION
Addition of dexmedetomidine in erector spinae plane block reduced pain scores and intraoperative and postoperative opioid consumption after lumbar spine surgery.
KEY WORDS
Dexmedetomidine, Erector spinae plane block, Lumbar spine surgery, Opioid consumption, Pain control.
Topics: Humans; Dexmedetomidine; Pain, Postoperative; Analgesics, Opioid; Nerve Block; Middle Aged; Female; Male; Adult; Lumbar Vertebrae; Ropivacaine; Adolescent; Pain Measurement; Young Adult; Aged; Saudi Arabia; Anesthetics, Local; Paraspinal Muscles
PubMed: 38840342
DOI: 10.29271/jcpsp.2024.06.636 -
Frontiers in Oncology 2024To observe the efficacy and safety of multimodal standardized analgesia in patients undergoing laparoscopic radical colorectal cancer surgery.
AIMS
To observe the efficacy and safety of multimodal standardized analgesia in patients undergoing laparoscopic radical colorectal cancer surgery.
METHODS
A prospective, double-blind, randomized study of patients who were admitted to our hospital between December 2020 and March 2022 with a diagnosis of colorectal cancer and who intended to undergo elective laparoscopic radical colorectal cancer surgery was conducted. The participants were randomly divided into two intervention groups, namely, a multimodal standardized analgesia group and a routine analgesia group. In both groups, the visual analogue scale (VAS) pain scores while resting at 6 h, 24 h, 48 h and 72 h and during movement at 24 h, 48 h and 72 h; the number of patient controlled intravenous analgesia (PCIA) pump button presses and postoperative recovery indicators within 3 days after surgery; the interleukin-6 (IL-6) and C-reactive protein (CRP) levels on the 1 and 4 days after surgery; and the incidence of postoperative adverse reactions and complications were recorded.
RESULTS
Compared with the control group, the multimodal standardized analgesia group had significantly lower VAS pain scores at different time points while resting and during movement (<0.05), significantly fewer PCIA pump button presses during the first 3 postoperative days (<0.05), and significantly lower IL-6 and CRP levels on the 1st postoperative day (<0.05). There was no statistically significant difference in the time to out-of-bed activity, the time to first flatus, the IL-6 and CRP levels on the 4th postoperative day or the incidence of postoperative adverse reactions and complications between the two groups (0.05).
CONCLUSION
For patients undergoing laparoscopic radical colorectal cancer surgery, multimodal standardized analgesia with ropivacaine combined with parecoxib sodium and a PCIA pump had a better analgesic effect, as it effectively inhibited early postoperative inflammatory reactions and promoted postoperative recovery and did not increase the incidence of adverse reactions and complications. Therefore, it is worthy of widespread clinical practice.
PubMed: 38835370
DOI: 10.3389/fonc.2024.1381809 -
BMC Anesthesiology Jun 2024Erector spinae plane block (ESPB) is a novel fascial plane block technique that can provide effective perioperative analgesia for thoracic, abdominal and lumbar... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Erector spinae plane block (ESPB) is a novel fascial plane block technique that can provide effective perioperative analgesia for thoracic, abdominal and lumbar surgeries. However, the effect of cervical ESPB on postoperative analgesia after arthroscopic shoulder surgery is unknown. The aim of this study is to investigate the analgesic effect and safety of ultrasound-guided cervical ESPB in arthroscopic shoulder surgery.
METHODS
Seventy patients undergoing arthroscopy shoulder surgery were randomly assigned to one of two groups: ESPB group (n = 35) or control group (n = 35). Patients in the ESPB group received an ultrasound-guided ESPB at the C7 level with 30 mL of 0.25% ropivacaine 30 min before induction of general anesthesia, whereas patients in the control group received no block. The primary outcome measures were the static visual analogue scale (VAS) pain scores at 4, 12, and 24 h after surgery. Secondary outcomes included heart rate (HR) and mean arterial pressure (MAP) before anesthesia (t1), 5 min after anesthesia (t2), 10 min after skin incision (t3), and 10 min after extubation (t4); intraoperative remifentanil consumption; the Bruggrmann comfort scale (BCS) score, quality of recovery-15 (QoR-15) scale score and the number of patients who required rescue analgesia 24 h after surgery; and adverse events.
RESULTS
The static VAS scores at 4, 12 and 24 h after surgery were significantly lower in the ESPB group than those in the control group (2.17 ± 0.71 vs. 3.14 ± 1.19, 1.77 ± 0.77 vs. 2.63 ± 0.84, 0.74 ± 0.66 vs. 1.14 ± 0.88, all P < 0.05). There were no significant differences in HR or MAP at any time point during the perioperative period between the two groups (all P > 0.05). The intraoperative consumption of remifentanil was significantly less in the ESPB group compared to the control group (P < 0.05). The scores of BCS and QoR-15 scale were higher in the ESPB group 24 h after surgery than those in the control group (P < 0.05). Compared to the control group, fewer patients in the ESPB group required rescue analgesia 24 h after surgery (P < 0.05). No serious complications occurred in either group.
CONCLUSIONS
Ultrasound-guided cervical ESPB can provide effective postoperative analgesia following arthroscopic shoulder surgery, resulting in a better postoperative recovery with fewer complications.
TRIAL REGISTRATION
Chictr.org.cn identifier ChiCTR2300070731 (Date of registry: 21/04/2023, prospectively registered).
Topics: Humans; Female; Male; Arthroscopy; Ultrasonography, Interventional; Pain, Postoperative; Middle Aged; Adult; Nerve Block; Shoulder; Ropivacaine; Anesthetics, Local; Pain Measurement; Paraspinal Muscles; Remifentanil
PubMed: 38831270
DOI: 10.1186/s12871-024-02586-7