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Medicine Jun 2024Supraclavicular and infraclavicular nerve block are commonly used for the analgesia of distal arm surgeries, and this meta-analysis aims to compare their analgesic... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
Supraclavicular and infraclavicular nerve block are commonly used for the analgesia of distal arm surgeries, and this meta-analysis aims to compare their analgesic efficacy for distal arm surgeries.
METHODS
We searched several databases including PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases, and selected the randomized controlled trials exploring the analgesic efficacy of supraclavicular block versus infraclavicular block for distal arm surgeries. This meta-analysis was conducted using the random-effect or fixed-effect model based on the heterogeneity.
RESULTS
Six randomized controlled trials were included in this meta-analysis. Compared with infraclavicular nerve block for distal arm surgeries, supraclavicular nerve block was associated with substantially reduced complete sensory block (odds ratio [OR] = 0.41; 95% confidence interval [CI] = 0.19-0.88; P = .02) and block performance time (standard mean difference [SMD] = -3.06; 95% CI = -5.82--0.31; P = .03), but had no effect on duration of analgesia (SMD = -0.15; 95% CI = -0.49-0.18; P = .36), time to sensory block (SMD = -0.41; 95% CI = -2.28-1.47; P = .67), vascular puncture (OR = 1.03; 95% CI = 0.11-10.05; P = .98) or adverse events (OR = 0.70; 95% CI = 0.12-4.04; P = .69).
CONCLUSIONS
Infraclavicular nerve block may be superior to supraclavicular nerve block for the analgesia of distal arm surgeries but needs increased block performance time.
Topics: Humans; Randomized Controlled Trials as Topic; Arm; Pain, Postoperative; Brachial Plexus Block; Nerve Block
PubMed: 38875365
DOI: 10.1097/MD.0000000000038195 -
Physiological Reports Jun 2024Basal metabolic rate (BMR) measurement is time consuming and requires specialized equipment. Prediction equations allow clinicians and researchers to estimate BMR;...
Basal metabolic rate (BMR) measurement is time consuming and requires specialized equipment. Prediction equations allow clinicians and researchers to estimate BMR; however, their accuracy may vary across individuals with chronic spinal cord injury (SCI). The objective of this study was to investigate the validity of SCI-specific equations as well as able-bodied (AB) prediction equations in individuals with upper motor neuron (UMN), lower motor neuron (LMN), and females with SCI. Twenty-six men and women with chronic SCI (n = 12 innervated males, n = 6 innervated females, n = 8 denervated males) participated in this cross-sectional study. BMR values were measured by indirect calorimetry. Body composition (dual-energy X-ray absorptiometry and anthropometrics) assessment was conducted. AB-prediction equations [Cunningham, Nelson, Owen, Harris and Benedict, Mifflin, Schofield, Henry] and SCI-specific equations [Chun and Nightingale & Gorgey] were used to estimate and validate BMR. The accuracy of AB-specific FFM equations in predicting BMR was evaluated using Bland-Altman plots, paired t-tests, and error metrics. Measured BMR for innervated males, females, and denervated males was 1436 ± 213 kcal/day, 1290 ± 114, and 1597 ± 333 kcal/day, respectively. SCI-specific equations by Chun et al., Nightingale & Gorgey, and AB-specific FFM equations accurately predicted BMR for innervated males. For the denervated males, Model 4 equation by Nightingale & Gorgey was not different (p = 0.18), and Bland-Altman analyses showed negative mean bias but similar limits of agreement between measured and predicted BMR for the SCI-specific equations and AB-specific FFM equations. We demonstrated that SCI-specific equations accurately predicted BMR for innervated males but underpredicted it for denervated males. The Model 4 equation by Nightingale & Gorgey accurately estimated BMR in females with SCI. Findings from the current study will help to determine caloric needs in different sub-groups of SCI.
Topics: Humans; Spinal Cord Injuries; Male; Female; Adult; Basal Metabolism; Middle Aged; Body Composition; Cross-Sectional Studies; Chronic Disease
PubMed: 38872507
DOI: 10.14814/phy2.16099 -
BioRxiv : the Preprint Server For... Jun 2024Previous studies indicate that CNS administration of oxytocin (OT) reduces body weight in high fat diet-induced obese (DIO) rodents by reducing food intake and...
Sympathetic innervation of interscapular brown adipose tissue is not a predominant mediator of oxytocin-elicited reductions of body weight and adiposity in male diet-induced obese mice.
Previous studies indicate that CNS administration of oxytocin (OT) reduces body weight in high fat diet-induced obese (DIO) rodents by reducing food intake and increasing energy expenditure (EE). We recently demonstrated that hindbrain (fourth ventricular [4V]) administration of OT elicits weight loss and elevates interscapular brown adipose tissue temperature (T , a surrogate measure of increased EE) in DIO mice. What remains unclear is whether OT-elicited weight loss requires increased sympathetic nervous system (SNS) outflow to IBAT. We hypothesized that OT-induced stimulation of SNS outflow to IBAT contributes to its ability to activate BAT and elicit weight loss in DIO mice. To test this hypothesis, we determined the effect of disrupting SNS activation of IBAT on the ability of 4V OT administration to increase T and elicit weight loss in DIO mice. We first determined whether bilateral surgical SNS denervation to IBAT was successful as noted by ≥ 60% reduction in IBAT norepinephrine (NE) content in DIO mice. NE content was selectively reduced in IBAT at 1-, 6- and 7-weeks post-denervation by 95.9±2.0, 77.4±12.7 and 93.6±4.6% ( <0.05), respectively and was unchanged in inguinal white adipose tissue, pancreas or liver. We subsequently measured the effects of acute 4V OT (1, 5 µg ≈ 0.99, 4.96 nmol) on T in DIO mice following sham or bilateral surgical SNS denervation to IBAT. We found that the high dose of 4V OT (5 µg ≈ 4.96 nmol) elevated T similarly in sham mice as in denervated mice. We subsequently measured the effects of chronic 4V OT (16 nmol/day over 29 days) or vehicle infusions on body weight, adiposity and food intake in DIO mice following sham or bilateral surgical denervation of IBAT. Chronic 4V OT reduced body weight by 5.7±2.23% and 6.6±1.4% in sham and denervated mice ( <0.05), respectively, and this effect was similar between groups ( =NS). OT produced corresponding reductions in whole body fat mass ( <0.05). Together, these findings support the hypothesis that sympathetic innervation of IBAT is not necessary for OT-elicited increases in BAT thermogenesis and reductions of body weight and adiposity in male DIO mice.
PubMed: 38854021
DOI: 10.1101/2024.05.29.596425 -
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 Orthopaedic Surgery and... Jun 2024Continuous peripheral nerve blocks are widely used for anesthesia and postoperative analgesia in lower limb surgeries. The authors aimed to develop a novel continuous...
BACKGROUND
Continuous peripheral nerve blocks are widely used for anesthesia and postoperative analgesia in lower limb surgeries. The authors aimed to develop a novel continuous sacral plexus block procedure for analgesia during total knee arthroplasty.
METHODS
The study comprised two stages. In Stage I, the authors built upon previous theories and technological innovations to develop a novel continuous sacral plexus block method, ultrasound-guided continuous parasacral ischial plane block (UGCPIPB) and subsequently conducted a proof-of-concept study to assess its effectiveness and feasibility. Stage II involved a historical control study to compare clinical outcomes between patients undergoing this new procedure and those receiving the conventional procedure.
RESULTS
The study observed a 90% success rate in catheter placement. On postoperative day (POD) 1, POD2, and POD3, the median visual analog scale (VAS) scores were 3 (range, 1.5-3.5), 2.5 (1.6-3.2), and 2.7 (1.3-3.4), respectively. Furthermore, 96.3% of the catheters remained in place until POD3, as confirmed by ultrasound. The study revealed a significant increase in skin temperature and peak systolic velocity of the anterior tibial artery on the blocked side compared with those on the non-blocked side. Complications included catheter clogging in one patient and leakage at the insertion site in two patients. In Stage II, the novel technique was found to be more successful than conventional techniques, with a lower catheter displacement rate than the conventional procedure for continuous sciatic nerve block.
CONCLUSION
UGCPIPB proved to be an effective procedure and safe for analgesia in total knee arthroplasty.
CHINESE CLINICAL TRIAL REGISTRY NUMBER
ChiCTR2300068902.
Topics: Humans; Pain, Postoperative; Arthroplasty, Replacement, Knee; Nerve Block; Male; Female; Aged; Ultrasonography, Interventional; Middle Aged; Proof of Concept Study; Lumbosacral Plexus; Feasibility Studies; Pain Management; Aged, 80 and over; Ischium; Pain Measurement
PubMed: 38849964
DOI: 10.1186/s13018-024-04822-9 -
BMC Musculoskeletal Disorders Jun 2024Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like...
BACKGROUND
Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like pain and restore function. The aim of this systematic review is to assess the patient reported and functional outcomes of the most common surgical interventions in patients with posttraumatic wrist osteoarthritis. This overview can help clinicians select the best treatment and manage patient's expectations.
METHODS
A literature search was performed in Pubmed, Embase and Cochrane for articles published between 1990 and November 2022 according to the PRISMA guidelines. The study protocol has been registered in the PROSPERO database (CRD42017080427). Studies that describe patient reported outcomes (pain and Disability of Arm, Shoulder and Hand (DASH) -score) and functional outcomes (range of motion (ROM) and grip strength) after surgical intervention with a minimal follow-up of 1 year were included. The identified surgical procedures included denervation, proximal row carpectomy, interpositional- and total arthroplasty, and midcarpal-, radiocarpal- and total arthrodesis. The pre-and postoperative outcomes were pooled and presented per salvage procedure.
RESULTS
Data from 50 studies was included. Pain score improved after all surgeries except denervation. Flexion/extension decreased after radiocarpal arthrodesis, did not show significant changes after proximal row carpectomy, and improved for all other surgeries. DASH score improved after arthroplasty, proximal row carpectomy and midcarpal arthrodesis. Grip strength improved after interposition arthroplasty and partial arthrodesis.
CONCLUSION
Evidence from this review did not support the indication for denervation in this particular patient population. In patients with SLAC/SNAC II, proximal row carpectomy might be favourable to a midcarpal arthrodesis solely based on better FE ROM of the radiocarpal joint after proximal row carpectomy. In terms of radiocarpal mobility, total wrist arthroplasty might be preferred to radiocarpal arthrodesis in patients with osteoarthritis after a distal radius fracture. More uniform measurements of outcomes would improve the understanding of the effect of surgical treatments of the posttraumatic osteoarthritic wrist.
Topics: Humans; Osteoarthritis; Wrist Joint; Range of Motion, Articular; Patient Reported Outcome Measures; Salvage Therapy; Arthrodesis; Hand Strength; Treatment Outcome; Wrist Injuries; Recovery of Function; Denervation
PubMed: 38849773
DOI: 10.1186/s12891-024-07527-6 -
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 -
Nigerian Journal of Clinical Practice May 2024The need of a neurostimulator for a successful nerve block was questioned in different block types after ultrasound had become standard. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The need of a neurostimulator for a successful nerve block was questioned in different block types after ultrasound had become standard.
AIM
To determine the effect of neurostimulator use on block success in the costoclavicular block (CCB).
METHODS
Sixty patients undergoing upper limb surgery were enrolled in the study. Patients using ultrasound and injection pressure manometer were divided as Group USP, and those using ultrasound, injection pressure manometer, and neurostimulator were divided as Group USPN. After block was applied, sensory and motor block levels were measured on a numeric scale. The block was considered successful when the desired score was reached or general anesthesia was not required intraoperatively. The number of successful and unsuccessful blocks for each group was summed up. The successful block rate was compared as the primary objective. Block application time, time to readiness for surgery, the number of needle passes, diaphragm paralysis rate, and complication rate were compared as secondary goals.
RESULTS
Block success rate was 90% (27/30) in Group USP and 96.7% (29/30) in Group USPN. There was no statistical difference in terms of block success rate. Block application time was significantly shorter in Group USP (207.2 ± 32.7 s) when compared to Group USPN (280.9 ± 70.1 s). Other secondary outcomes were similar.
CONCLUSION
Neurostimulator use did not affect block success in the CCB. Neurostimulator utilization prolonged block application time explicitly and did not change the complication rate. Ultrasound and injection pressure manometer are sufficient for a safe and successful CCB.
Topics: Humans; Female; Male; Adult; Middle Aged; Nerve Block; Treatment Outcome; Anesthetics, Local; Young Adult; Ultrasonography, Interventional; Aged
PubMed: 38842706
DOI: 10.4103/njcp.njcp_476_23 -
Effect of Renal Sympathetic Denervation on Ventricular Electrical Activity in Myocardial Infarction.The Tohoku Journal of Experimental... Jun 2024
PubMed: 38839358
DOI: 10.1620/tjem.2024.J039 -
Frontiers in Physiology 2024The influence of vagus nerve stimulation (VNS) parameters on provoked cardiac effects in different levels of cardiac innervation is not well understood yet. This study...
INTRODUCTION
The influence of vagus nerve stimulation (VNS) parameters on provoked cardiac effects in different levels of cardiac innervation is not well understood yet. This study examines the effects of VNS on heart rate (HR) modulation across a spectrum of cardiac innervation states, providing data for the potential optimization of VNS in cardiac therapies.
MATERIALS AND METHODS
Utilizing previously published data from VNS experiments on six sheep with intact innervation, and data of additional experiments in five rabbits post bilateral rostral vagotomy, and four isolated rabbit hearts with additionally removed sympathetic influences, the study explored the impact of diverse VNS parameters on HR.
RESULTS
Significant differences in physiological threshold charges were identified across groups: 0.09 ± 0.06 μC for intact, 0.20 ± 0.04 μC for vagotomized, and 9.00 ± 0.75 μC for isolated hearts. Charge was a key determinant of HR reduction across all innervation states, with diminishing correlations from intact ( = 0.7) to isolated hearts ( = 0.44). An inverse relationship was observed for the number of pulses, with its influence growing in conditions of reduced innervation (intact = 0.11, isolated = 0.37). Frequency and stimulation delay showed minimal correlations ( < 0.17) in all conditions.
CONCLUSION
Our study highlights for the first time that VNS parameters, including stimulation intensity, pulse width, and pulse number, crucially modulate heart rate across different cardiac innervation states. Intensity and pulse width significantly influence heart rate in innervated states, while pulse number is key in denervated states. Frequency and delay have less impact impact across all innervation states. These findings suggest the importance of customizing VNS therapy based on innervation status, offering insights for optimizing cardiac neuromodulation.
PubMed: 38835728
DOI: 10.3389/fphys.2024.1379936