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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(4): 448-454, 2024 Apr 15.
Article in Chinese | MEDLINE | ID: mdl-38632065

ABSTRACT

Objective: To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods: The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups ( P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results: There was no significant difference in the operation time between the two groups ( P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant ( P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group ( P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points ( P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups ( P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups ( P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation ( P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points ( P>0.05). Conclusion: In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.


Subject(s)
Arthroplasty, Replacement, Knee , Breakthrough Pain , Nerve Block , Humans , Analgesics, Opioid , Anesthesia, Local/adverse effects , Arthroplasty, Replacement, Knee/methods , Breakthrough Pain/complications , Nerve Block/adverse effects , Nerve Block/methods , Pain, Postoperative , Postoperative Complications , Prospective Studies
3.
Agri ; 35(2): 117-118, 2023 Apr.
Article in English | MEDLINE | ID: mdl-37052162

ABSTRACT

In this article, a cosmetic complication case secondary to bilateral supraorbital and supratrochlear nerve block with low dose local anesthetic and dexamethasone combination is presented.


Subject(s)
Anesthesia, Conduction , Nerve Block , Humans , Anesthetics, Local/adverse effects , Anesthesia, Local , Nerve Block/adverse effects
7.
Dis Markers ; 2022: 8692966, 2022.
Article in English | MEDLINE | ID: mdl-35990245

ABSTRACT

Objective: To investigate the effects of lumbar plexus block combined with infiltration anesthesia on anesthesia comfort scores and stress responses in elderly patients undergoing hip replacement. Methods: The materials of 100 elderly patients undergoing hip replacement who were treated in our hospital (January 2020-January 2021) were retrospectively analyzed, and they were equalized into the experimental group (n = 50) and control group (n = 50) according to the anesthesia methods. The experimental group received lumbar plexus block combined with infiltration anesthesia, and the control group received combined spinal-epidural anesthesia combined with infiltration anesthesia. The patients' anesthesia comfort scores, stress responses, and postoperative pain indexes were compared between the two groups. Results: Compared with the control group, the experimental group achieved much lower scores of mood change, shivering response, and traction reaction (P < 0.001), indicating that the anesthesia comfort in the experimental group was higher. Compared with the control group, the experimental group had much better perioperative stress response indexes (P < 0.05) and eminently lower pain scores at 12 and 24 hours after surgery (P < 0.05). Conclusion: Lumbar plexus block combined with infiltration anesthesia can relieve the stress responses and postoperative pain of elderly patients undergoing hip replacement and increase their anesthesia comfort. Therefore, this anesthesia method is translational in clinic.


Subject(s)
Anesthesia, Local , Nerve Block , Aged , Humans , Lumbosacral Plexus , Nerve Block/adverse effects , Nerve Block/methods , Pain, Postoperative/etiology , Retrospective Studies
8.
Trials ; 23(1): 652, 2022 Aug 13.
Article in English | MEDLINE | ID: mdl-35964122

ABSTRACT

BACKGROUND: While open hemorrhoidectomy under local anesthesia has been shown to be more cost-effective with shorter operation times and lower complication rates, local anesthesia is still not considered as a first-line technique in low-income countries like Uganda. The objective of this trial is to compare open hemorrhoidectomy using local anesthesia versus saddle block among patients with primary uncomplicated 3rd- or 4th-degree hemorrhoids in western Uganda. METHODS: The protocol for a prospective equivalence randomized, double-blind controlled trial was conducted among patients with primary uncomplicated 3rd- or 4th-degree hemorrhoids. Recruitment was started in December 2021 and is expected to end in May 2022. Consenting participants who require open hemorrhoidectomy indicated at Kampala International Teaching Hospital, Uganda, will be randomized into two groups of 29 patients per arm. DISCUSSION: The primary outcome of this study is to compare the occurrences of postoperative pain following open hemorrhoidectomy using the visual analog scale in an interval of 2, 4, and 6 h and 7 days postoperatively. Furthermore, the mean operative time from the induction of anesthesia to the end of the surgical procedure as well as the cost-effectiveness of the 2 techniques will be assessed in both groups. Open hemorrhoidectomy under local anesthesia has the potential to offer benefits to patients but most importantly expediting return to baseline and functional status, shorter hospital stay by meeting the faster discharge criteria, and reduction in costs associated with reduced length of stay and complications. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR202110667430356. Registered on 8 October 2021.


Subject(s)
Anesthesia, Local , Hemorrhoidectomy , Hemorrhoids , Nerve Block , Anesthesia, Local/adverse effects , Double-Blind Method , Equivalence Trials as Topic , Hemorrhoidectomy/adverse effects , Hemorrhoidectomy/methods , Hemorrhoids/surgery , Humans , Nerve Block/adverse effects , Prospective Studies , Randomized Controlled Trials as Topic , Uganda
9.
Anaesthesiologie ; 71(8): 638-645, 2022 08.
Article in German | MEDLINE | ID: mdl-35513729

ABSTRACT

BACKGROUND: Rebound pain as a side effect of regional anaesthesia is an excessive sensation of pain after the effect of local anaesthesia has subsided. This sensation goes well beyond the normal wound pain following a surgical intervention. This phenomenon has entered focus of research in the past 10 years now, but the specific causes are so far unclear and there are still no targeted treatment recommendations. OBJECTIVE: This review article is intended to give the readership an overview of the current state of research about rebound pain. The theories of pathophysiology are presented and prophylaxis as well as treatment strategies are explained. MATERIAL AND METHODS: For this review article, the publications about rebound pain that appeared from 2005 up to May 2021 in PubMed were reviewed and the authors' definitions of rebound pain as well as the assumptions on pathophysiology and treatment recommendations were summarized. RESULTS AND DISCUSSION: A total of 22 original papers from the years 2005-2021 were evaluated regarding the differences between the definitions of rebound pain, the assumption of its occurrence as well as possible treatment options. It turns out that there is no uniform definition by the professional societies, the pathophysiology has not yet been clearly identified and no clear recommendations for prophylaxis or treatment can be given to date; however, early administration of pain medication (e.g. NSAIDs) before the end of the nerve block has proven to be helpful. Likewise, dexamethasone as an adjuvant to regional anaesthesia shows positive effects regarding the occurrence of rebound pain. In any case, it makes sense to provide patients with comprehensive information about this special side effect of regional anaesthesia so that those affected can correctly classify the excessive pain reaction. Targeted studies to avoid severe pain after regional anaesthesia, e.g. through the addition of adjuvants, are necessary in order to keep side effects as low as possible and thereby improve patient comfort and the acceptance of regional anaesthesia.


Subject(s)
Anesthesia, Conduction , Nerve Block , Anesthesia, Conduction/adverse effects , Anesthesia, Local , Anesthetics, Local/therapeutic use , Humans , Nerve Block/adverse effects , Pain, Postoperative/etiology
10.
Medicine (Baltimore) ; 101(9): e28983, 2022 Mar 04.
Article in English | MEDLINE | ID: mdl-35244070

ABSTRACT

INTRODUCTION: The prevalence of lumbosacral radiculopathy is estimated to be approximately 3% to 5% in patient populations. Lumbosacral radiculopathy is largely caused by a complex interaction between biomechanical and biochemical factors. Nerve block therapy (NBT) mainly treats lumbosacral radiculopathy by improving the biochemical factors, whereas acupotomy mainly focuses on improving the biomechanical factors. Therefore, it is thought that synergistic effects may be obtained for the treatment of lumbosacral radiculopathy when both NBT and acupotomy are combined. However, no study in China and Korea, where acupotomy is majorly provided, has reported the effects of such a combination treatment. Therefore, this study aimed to evaluate the safety, effectiveness, and cost-effectiveness of the concurrent use of a deeply inserted acupotomy and NBT for the treatment of lumbosacral radiculopathy. METHODS/DESIGN: This is an open-label, parallel, assessor-blinded, randomized controlled trial, which will include 50 patients with lumbosacral radiculopathy. After patients voluntarily agree to participate in the study, they will be screened, and will undergo necessary examinations and tests according to the protocol. Those who satisfy the selection criteria will be randomly assigned to either the NBT + acupotomy or NBT groups in a 1:1 ratio. Both groups will undergo 2 NBTs once every 2 weeks from 1 week after the screening test. The treatment group will receive additional acupotomy twice a week for 4 weeks. The primary endpoint is the Oswestry Disability Index, whereas the secondary endpoints are the Numeral Rating Scale, European Quality of Life 5-dimension, McGill pain Questionnaire, Roland-Morris Disability Questionnaire, safety assessment, and economic feasibility evaluation. The measurements will be made at 0, 2, 4, and 8 weeks. ETHICS AND DISSEMINATION: This trial has received complete ethical approval from the Ethics Committee of Catholic Kwandong University International St. Mary's Hospital (IS20OISE0085). We intend to submit the results of the trial to a peer-reviewed journal and/or conferences.


Subject(s)
Acupuncture Therapy , Nerve Block , Radiculopathy/therapy , Acupuncture Therapy/adverse effects , Acupuncture Therapy/economics , Acupuncture Therapy/methods , Cost-Benefit Analysis , Humans , Nerve Block/adverse effects , Nerve Block/economics , Pilot Projects , Quality of Life , Randomized Controlled Trials as Topic , Treatment Outcome
11.
Minerva Anestesiol ; 88(7-8): 544-553, 2022.
Article in English | MEDLINE | ID: mdl-35199973

ABSTRACT

BACKGROUND: Optimal control of acute postoperative pain and prevention of chronic persistent pain in total knee arthroplasty (TKA) remain a challenge. METHODS: A randomized, non-inferiority clinical trial (385 patients) evaluated every hour immediate postoperative pain during 24 h, using a verbal rating 11-point scale for patient self-reporting of pain (VRS11). All patients received subarachnoid anesthesia and were randomly allocated in four groups: single shots femoral (FNB) or adductor canal blocks (ACB), both with dexamethasone (dex) and buprenorphine (bup). Patients received intravenous analgesia (metamizole magnesium, dexketoprofen) and rescue analgesia when needed: intravenous (paracetamol and morphine) and/or regional (femoral and sciatic nerve blocks). Demographics and adverse effects were also recorded. RESULTS: A 45.7% of patients had pain: bupACB 56.3%, bupFNB 50.0%, dexACB 40.6% and dexFNB 36.1% (P=0.022). Rescue analgesia was needed in 37.7% of patients (P=0.128). There were statistical differences in percentage of timepoints without pain (95.0±7.9%, P=0.014) and mean VRS11 (0.18±0.3, P=0.012) but no differences in distribution of intensity periods of pain. There were no significant differences in the need of rescue analgesia excepting the use of intravenous morphine (P=0.025). CONCLUSIONS: Buprenorphine is in the present trial inferior to dexamethasone by less than the established non-inferiority limit when used as perineural adjuvant in femoral nerve or adductor canal blocks in total knee arthroplasty analgesia. So, it could be considered an alternative in patients where dexamethasone is contraindicated, such as diabetics.


Subject(s)
Arthroplasty, Replacement, Knee , Buprenorphine , Nerve Block , Analgesics, Opioid/therapeutic use , Anesthetics, Local/therapeutic use , Arthroplasty, Replacement, Knee/adverse effects , Buprenorphine/therapeutic use , Dexamethasone/therapeutic use , Femoral Nerve , Humans , Morphine/therapeutic use , Nerve Block/adverse effects , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control
12.
Medicine (Baltimore) ; 100(51): e28384, 2021 Dec 23.
Article in English | MEDLINE | ID: mdl-34941168

ABSTRACT

BACKGROUND: Prostatic hyperplasia is a physiological aging process in men. After transurethral resection of prostate (TURP), visceral pain is the main cause. The effective postoperative analgesia can reduce the occurrence of postoperative complications. This study mainly studied the analgesic effect of quadratus lumborum block (QLB) on TURP. METHODS: We divided 62 patients undergoing TURP into 2 groups using a random number table method (QLB 2 group and non-QLB [control] group). Patients in the QLB group underwent ultrasound-guided posterior QLB with 20 mL of 0.25% ropivacaine on each side, and those in the control group received only general anesthesia. The primary outcome for this study was the consumption analgesic pump during 0 to 24 hours. The secondary outcomes included the first pressing time of analgesic pump during 0 to 24 hours, the pain at rest and when coughing at 1, 4, 8, 12, and 24 hours post-operation as measured with a visual analogue scale for pain, length of the hospital stay, and complications (nausea and vomiting, dizziness, and abdominal distension). RESULTS: Patients in the QLB group presented less consumption, later first pressing time of analgesic pump during 0 to 24 hours after surgery lower visual analogue scale scores at 1, 4, 8, 12, and 24 hours postsurgery than those in the control group. Moreover, their mean length of hospital stay was shorter (P = .023), and they experienced less postoperative complications than the patients in the control group. CONCLUSIONS: Ultrasound-guided QLB in TURP provided a significant analgesic effect in our patients the first day after surgery. This analgesic model may improve the postoperative recovery after TURP.


Subject(s)
Abdominal Muscles , Analgesia , Nerve Block , Pain, Postoperative/prevention & control , Transurethral Resection of Prostate/adverse effects , Aged , Aged, 80 and over , Anesthetics, Local , Humans , Male , Middle Aged , Nerve Block/adverse effects , Pain, Postoperative/etiology , Prospective Studies , Ultrasonography, Interventional
13.
Jt Dis Relat Surg ; 32(2): 290-298, 2021.
Article in English | MEDLINE | ID: mdl-34145803

ABSTRACT

OBJECTIVES: The aim of this study was to analyze the postoperative effects of extended nerve blocks and local infiltration analgesia (LIA) on postoperative pain control, muscle weakness, and blood loss after total knee arthroplasty (TKA). PATIENTS AND METHODS: Between February 24th 2020 and July 10th 2020, a total of 161 patients (55 males, 106 females; median age: 69.0 years [IQR 63.0-75.0], range, 41 to 81 years) who underwent primary TKA were randomly allocated into three parallel groups according to their concomitant procedure in a double-blind fashion: (i) those to whom nerve blockade was performed after competition of surgery under the duration of spinal anesthesia (n=50); (ii) those to whom LIA was performed during surgery (n=52), and (iii) control group (n=59). The content of LIA was 10-10 mL of 20 mg lidocaine with 0.01 mg adrenalin and 100 mg ropivacaine, 1 mL (30 mg) ketorolac, and 5 mL (500 mg) tranexamic acid was diluted by 50 mL 0.9% NaCl under aseptic conditions. Outcome parameters were the evaluation of pain until the evening of first postoperative day (24 to 36 h), mobilization, and blood loss within the first three postoperative days. RESULTS: The pain was maximal between 4 and 8 h postoperatively, when the effect of the spinal anesthetic drugs disappeared. During this critical period, tolerable pain (Numerical Rating Scale, NRS ≤3) was observed in 52%, 42%, and 19% of nerve blockade in LIA and control groups, respectively. None of the patients complained of high-intensity pain (NRS >8) in the LIA group, which was a significant difference from the block and control groups (10% and 14%, p<0.008, respectively). There was no significant muscle weakness associated with the use of this extended block. The decrease in hemoglobin level was significantly lower in the LIA group than in the control and block groups (odds ratio [OR]: 0.379, 95% confidence interval [CI]: 0.165-0.874 for nerve blockade vs. LIA, OR: 1.189, 95% CI: 0.491-2.880 for nerve blockade vs. control, OR: 0.319, 95% CI: 0.140-0.727, respectively). The common language effect size for pain in each referred interval in each group and for decrease of hemoglobin between the first and third postoperative days fell between 0.507 and 0.680. CONCLUSION: This study demonstrates that LIA technique offers a fast and safe treatment option for pain relief after TKA. No clinically relevant muscle weakness was observed among groups according to field block applications. Significant advantages were also achieved in blood loss.


Subject(s)
Analgesia/methods , Anesthesia, Local/methods , Arthroplasty, Replacement, Knee/adverse effects , Nerve Block/methods , Pain, Postoperative/prevention & control , Postoperative Hemorrhage/prevention & control , Adult , Aged , Aged, 80 and over , Anesthesia, Spinal , Anesthetics, Local , Anti-Inflammatory Agents, Non-Steroidal , Antifibrinolytic Agents/administration & dosage , Double-Blind Method , Epinephrine/administration & dosage , Female , Hemoglobins/metabolism , Humans , Ketorolac , Lidocaine , Male , Middle Aged , Muscle Weakness/etiology , Nerve Block/adverse effects , Pain Management/methods , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Prospective Studies , Ropivacaine , Tranexamic Acid/administration & dosage , Vasoconstrictor Agents/administration & dosage , Walking
14.
Facial Plast Surg ; 37(4): 446-453, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33878797

ABSTRACT

The location, severity, and associated injuries of the head and neck trauma dictate the type and treatment location needed for that particular patient. An in-depth knowledge of local and regional block options is vital to the proper management of facial wounds at the bedside, decreasing need for general anesthesia, anesthesia-related complication, length of hospital stay, and overall hospital costs. This article will discuss local and regional block options for the upper-face, midface, and lower face including dentition; complications of local and regional blocks and how to prevent them; and recent advances in local anesthesia. In addition, conscious sedation as an adjunct to local/regional blocks in children or patients with special needs will be discussed.


Subject(s)
Anesthesia, Conduction , Facial Injuries , Nerve Block , Anesthesia, Local , Child , Face/surgery , Facial Injuries/surgery , Humans , Length of Stay , Nerve Block/adverse effects
15.
Anesth Prog ; 68(1): 29-32, 2021 03 01.
Article in English | MEDLINE | ID: mdl-33827128

ABSTRACT

Local anesthesia techniques are widely used in dentistry because of their numerous advantages, including safety. Several articles have been published on local and systemic complications stemming from the use of local anesthesia, one of which is accidental intravascular injection, usually reported during inferior alveolar nerve blocks. A 58-year-old man presented to the dental office for extraction of the lower left first molar. During delivery of a supplemental injection in the buccal vestibular mucosa to anesthetize the buccal nerve, an accidental intra-arterial injection to the facial artery occurred, causing sudden sharp pain and immediate pallor along the course of the facial artery. The pallor resolved in approximately 20 minutes. Buccal infiltration was repeated successfully, and the tooth was extracted uneventfully. This case appears to be the first report in the literature to describe the accidental intravascular injection of local anesthetic involving the facial artery and discuss its clinical implications.


Subject(s)
Anesthesia, Dental , Nerve Block , Anesthesia, Dental/adverse effects , Anesthesia, Local , Anesthetics, Local/adverse effects , Arteries , Humans , Lidocaine , Male , Mandibular Nerve , Middle Aged , Nerve Block/adverse effects
16.
PLoS One ; 16(3): e0247781, 2021.
Article in English | MEDLINE | ID: mdl-33651806

ABSTRACT

BACKGROUND: Diagnosis of sacroiliac region pain is supported by a positive response to sacroiliac region analgesia (SIRA). Varying techniques have been described for SIRA; with clinician preference often dictating method. Potential complications following SIRA include ataxia and recumbency. No study has specifically evaluated the prevalence of complications. OBJECTIVES: To describe the complication prevalence following SIRA in a referral clinic. STUDY DESIGN: Retrospective cohort study. METHODS: Review of records from horses presented to two of the authors at Rossdales, Newmarket, between January 2014 and December 2018, that underwent SIRA. Injection was performed using a blind midline approach with 20 mL mepivacaine (Intra-Epicaine 20mg/ml; Dechra) infiltrated through a straight 18 gauge 8.9cm spinal needle subdivided into four sub-locations per block. RESULTS: 118 horses were included, with 167 individual blocks. One horse showed a mild hindlimb gait abnormality following SIRA, which resolved uneventfully over 3 hours; complication rate 1/118 horses (0.85%; 95% CI: 0,2.5%), 1/167 joints (0.60%; 95% CI: 0,1.8%). SIRA subjectively improved lameness/performance in 132/167 (79%) joints. 49/118 (42%) received bilateral SIRA with 53/118 (45%) evaluated ridden following SIRA. MAIN LIMITATIONS: Small population numbers with low complication prevalence rate. CONCLUSIONS: SIRA, using the described technique, has a low (0.85%) prevalence of complications.


Subject(s)
Anesthesia, Local/adverse effects , Anesthesia, Local/veterinary , Gait Ataxia/veterinary , Horse Diseases/drug therapy , Lameness, Animal/drug therapy , Nerve Block/adverse effects , Nerve Block/veterinary , Sacroiliac Joint/physiopathology , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Anesthetics, Local/therapeutic use , Animals , Gait Ataxia/chemically induced , Horses , Mepivacaine/administration & dosage , Mepivacaine/adverse effects , Mepivacaine/therapeutic use , Retrospective Studies
17.
Trials ; 22(1): 150, 2021 Feb 17.
Article in English | MEDLINE | ID: mdl-33596968

ABSTRACT

BACKGROUND: Spinal surgery can be associated with significant postoperative pain. Erector spinae plane (ESP) block is a new regional anaesthesia technique, which promises effective postoperative analgesia compared with systemically administered opioids, but has never been evaluated in terms of patient-centred outcomes such as quality of recovery and overall morbidity after major thoraco-lumbar spinal surgery. METHODS: We are conducting a prospective, randomised, double-blind trial in two hospitals in the Republic of Ireland. The sample size will be 50 patients (25 in the intervention group and 25 in the control group). Randomisation will be done using computer-generated concealed envelopes. Both patients and investigators collecting outcome data will be masked to group allocation. Participants will be male or female, aged 18 years and over, capable of providing informed consent and ASA grade I-IV. Patients scheduled to undergo posterior approach thoraco-lumbar decompression surgery involving 2 or more levels will be recruited to the study. Participants randomised to the intervention arm of the study will receive bilateral ultrasound-guided ESP block totalling 40 ml 0.25% levo-bupivcaine (20 ml each side), post induction of general anaesthesia and before surgical incision. The control group will not receive an ESP block. Both groups will receive the same standardised analgesic protocol both intra- and postoperatively. The primary outcome will be the quality of recovery at 24 h postoperatively as determined by the QoR-15 score. This score is determined by a questionnaire which measures patient responses to 15 subjective parameters, each response graded on a scale from 0 to 10. The maximum score achievable is 150 with a potential minimum score of 0. Higher scores indicate a higher quality of recovery experience. Secondary outcomes will include area under the curve (AUC) of VRS pain versus time at rest and on movement up to 24 h postoperatively, 24 h opioid consumption, time to first analgesia in recovery, length of stay (LOS), incidence and severity of postoperative complications as measured by the Comprehensive Complication Index (CCI) score. DISCUSSION: To the best of our knowledge, this will be the first randomised control trial to examine the efficacy and safety of the ESP block in terms of patient-centred outcomes in the setting of major spinal surgery. The QoR-15 is a validated means of assessing the quality of recovery after surgery and gives a more holistic assessment of the recovery experience from the patient's point of view. TRIAL REGISTRATION: This trial is pre-registered on ClinicalTrials.gov reference number NCT04370951 . Registered on 30 April 2020. All items from the World Health Organisation Trial Registration Data Set have been included.


Subject(s)
Nerve Block , Adolescent , Adult , Decompression , Female , Humans , Ireland , Male , Nerve Block/adverse effects , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Prospective Studies , Randomized Controlled Trials as Topic
18.
Acta Odontol Scand ; 79(1): 1-8, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32401086

ABSTRACT

OBJECTIVE: To compare the efficacy and safety of inferior alveolar nerve blocks (IANB) with additional buccal infiltration (standard technique) and of buccal and lingual anaesthetic infiltration (experimental technique) for lower third molar (L3M) extractions. STUDY DESIGN: A randomised, double-blind clinical trial involving 129 L3M extractions was conducted. In the IANB group, an IANB was performed using the conventional approach, followed by a buccal injection in the extraction area. In the infiltration group (INF), an infiltration was performed in the buccal and lingual areas of the lower second molar. A 4% articaine solution was employed in all cases. The main outcome variable was anaesthetic efficacy. Other variables like intraoperative and postoperative pain, onset time and adverse events were also recorded. Descriptive and bivariate analyses of the data were made. RESULTS: 120 patients were randomised. The IANB group showed significantly higher anaesthetic efficacy than the INF group (64.4 vs. 45.8%) (odds ratio = 0.47; 95% confidence interval = 0.22-0.97; p = 0.042). No complications were observed. CONCLUSIONS: IANB with additional buccal infiltration is more suitable than the experimental technique for achieving adequate analgesia in L3M extractions. Moreover, the standard method is safe and provides a shorter onset time and lower initial postoperative pain levels.


Subject(s)
Anesthesia, Dental , Nerve Block , Anesthesia, Local , Anesthetics, Local , Carticaine/adverse effects , Double-Blind Method , Humans , Lidocaine , Mandibular Nerve , Molar, Third/surgery , Nerve Block/adverse effects
19.
BMJ Case Rep ; 13(9)2020 Sep 07.
Article in English | MEDLINE | ID: mdl-32900723

ABSTRACT

Facial nerve palsy is a rare but known complication of dental local anaesthesia and may be underreported. We describe a case of a transient facial nerve palsy following the administration of an inferior alveolar nerve block and discuss the immediate practical management. Knowing the likely transient nature of this complication means the patient can be reassured and unnecessary referral avoided. While the blink reflex is inhibited, steps are needed in order to protect the cornea and prevent secondary infection and scarring.


Subject(s)
Anesthesia, Dental/adverse effects , Anesthesia, Local/adverse effects , Anesthetics, Local/adverse effects , Facial Paralysis/chemically induced , Nerve Block/adverse effects , Adult , Female , Humans , Mandibular Nerve , Time Factors
20.
J Int Med Res ; 48(5): 300060520925705, 2020 May.
Article in English | MEDLINE | ID: mdl-32436475

ABSTRACT

OBJECTIVE: Some patients have been found to develop intraoperative amaurosis under sub-Tenon's anesthesia. We explored whether these patients have poor surgical outcomes during mid- to long-term postoperative follow-up. METHODS: In this case series, 74 of 85 patients with macular diseases who underwent phacoemulsification combined with vitrectomy under sub-Tenon's anesthesia developed intraoperative amaurosis. The surgical outcomes at the 2- and 4-month follow-ups in these patients were investigated and compared with the outcomes in patients without amaurosis using best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and pattern visual evoked potential (PVEP). RESULTS: Both BCVA and the OCT-based macular structure in patients with intraoperative amaurosis showed significant postoperative improvement comparable with that of patients without amaurosis. The presence of intraoperative amaurosis was not associated with either macular hole closure or macular edema regression. PVEP revealed no significant changes in the wave latency or amplitude before and after surgery. CONCLUSION: Intraoperative amaurosis following sub-Tenon's block is commonly seen but does not predict a poor surgical prognosis. When a patient develops amaurosis during surgery, the surgeon should increase patient comfort through verbal communication rather than perform an additional intervention to help relieve the patient's anxiety.


Subject(s)
Anesthesia, Local/adverse effects , Blindness/epidemiology , Intraoperative Complications/epidemiology , Nerve Block/adverse effects , Phacoemulsification/adverse effects , Vitrectomy/adverse effects , Anesthesia, Local/methods , Blindness/etiology , Blindness/psychology , Blindness/rehabilitation , Evoked Potentials, Visual , Follow-Up Studies , Fovea Centralis/diagnostic imaging , Fovea Centralis/surgery , Humans , Incidence , Intraoperative Complications/etiology , Intraoperative Complications/psychology , Intraoperative Complications/rehabilitation , Nerve Block/methods , Phacoemulsification/methods , Postoperative Period , Protective Factors , Retinal Perforations/surgery , Tenon Capsule/innervation , Tomography, Optical Coherence , Treatment Outcome , Vitrectomy/methods
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