Relation between neutrophil-to-lymphocyte ratio with epidural analgesia timing and thoracotomy pain.

OBJECTIVE: This study investigated the relationship of the pre-operative neutrophil/lymphocyte ratio (NLR) to the timing of epidural analgesia administration and post-operative acute and chronic pain in thoracotomy. MATERIALS AND METHODS: The study was conducted on 60 patients, with NLR ≥ 2 (Group A) and NLR < 2 (Group B). Each group was divided into subgroups pre-emptive analgesia (Group P) and control group (Group C). Epidural analgesic solution was administered as a bolus before the surgical incision in Group P and at the end of the operation in Group C. NRS was questioned postoperatively at the 2nd, 4th, 8th, 12th, 24th h, 1st, and 3rd months and also additional analgesic needs were recorded. RESULTS: In Group A, the pain scores of the patients who received pre-emptive epidural analgesia were lower at the post-operative 2nd, 4th, and 8th h and analgesic consumption was less in the post-operative first 24 h. CONCLUSION: It was observed that pre-emptive epidural analgesia reduced pain levels and additional analgesic consumption in the acute post-operative period in patients with pre-operative NLR ≥ 2.

OBJETIVO: Este estudio investigó la relación de la relación neutrófilos/linfocitos (NLR) preoperatoria con el momento de la administración de la analgesia epidural y el dolor agudo y crónico posoperatorio en la toracotomía. MATERIALES Y MÉTODOS: El estudio se realizó en 60 pacientes, como NLR ≥ 2 (Grupo A) y NLR < 2 (Grupo B). Cada grupo se dividió en subgrupos de analgesia preventiva (Grupo P) y grupo control (Grupo C). La solución analgésica epidural se administró en bolo antes de la incisión quirúrgica en el Grupo P y al final de la operación en el Grupo C. La NRS se cuestionó posoperatoriamente a las 2, 4, 8, 12, 24 horas, 1 y 3 meses también adicionales Se registraron las necesidades analgésicas. RESULTADOS: En el Grupo A, los puntajes de dolor de los pacientes que recibieron analgesia epidural preventiva fueron menores a las 2, 4 y 8 horas postoperatorias y el consumo de analgésicos fue menor en las primeras 24 horas postoperatorias. CONCLUSIÓN: Se observó que la analgesia epidural preventiva redujo los niveles de dolor y el consumo adicional de analgésicos en el postoperatorio agudo en pacientes con NLR preoperatorio ≥ 2.

Evaluation of a modified ultrasound-assisted technique for mid-thoracic epidural placement: a prospective observational study.

BACKGROUND: Although mid-thoracic epidural analgesia benefits patients undergoing major surgery, technical difficulties often discourage its use. Improvements in technology are warranted to improve the success rate on first pass and patient comfort. The previously reported ultrasound-assisted technique using a generic needle insertion site failed to demonstrate superiority over conventional landmark techniques. A stratified needle insertion site based on sonoanatomic features may improve the technique. METHODS: Patients who presented for elective abdominal or thoracic surgery requesting thoracic epidural analgesia for postoperative pain control were included in this observational study. A modified ultrasound-assisted technique using a stratified needle insertion site based on ultrasound images was adopted. The number of needle passes, needle skin punctures, procedure time, overall success rate, and incidence of procedure complications were recorded. RESULTS: One hundred and twenty-eight subjects were included. The first-pass success and overall success rates were 75% (96/128) and 98% (126/128), respectively. In 95% (122/128) of patients, only one needle skin puncture was needed to access the epidural space. The median [IQR] time needed from needle insertion to access the epidural space was 59 [47-122] seconds. No complications were observed during the procedure. CONCLUSIONS: This modified ultrasound-assisted mid-thoracic epidural technique has the potential to improve success rates and reduce the needling time. The data shown in our study may be a feasible basis for a prospective study comparing our ultrasound-assisted epidural placements to conventional landmark-based techniques.

Mindfetalness: un método cualitativo de autoevaluación de movimientos fetales / Mindfetalness: a qualitative method for self-assessment of fetal movements

Maternal perception of fetal movements is a subjective indicator of fetal well-being. Pregnant women's awareness of their importance remains a subject of discussion because they can increase maternal anxiety and lead to an increase in consultations about their reduction. Quantitative methods have classically been used for self-assessment, although a new qualitative method called mindfetalness has recently been proposed. Its practice has been shown to promote a better relationship with the fetus and to strengthen the maternal-fetal bond, with pregnant women preferring it to classical methods. Although consultations may increase due to decreased fetal movements, the rate of caesarean section, induction of labour, and newborns with low weight for gestational age decreases, resulting in improved maternal, fetal, and newborn management compared to not reporting fetal movements. It has been shown that pregnant women of lower sociocultural status have worse pregnancy outcomes despite its use. There may be other benefits of practicing mindfetalness such as decreased use of epidural analgesia and improved professional pregnancy care.(AU)

La percepción materna de movimientos fetales es un indicador subjetivo de bienestar fetal. La concienciación de las gestantes sobre su importancia sigue siendo objeto de discusión dado que puede aumentar la ansiedad materna y motivar un aumento de las consultas sobre su disminución. Clásicamente se han usado métodos cuantitativos para realizar su autoevaluación aunque recientemente se ha propuesto un nuevo método cualitativo denominado mindfetalness. Se ha demostrado que su práctica promueve el desarrollo de una mejor relación con el feto y fortalece el vínculo maternofetal, prefiriendo las gestantes este método a los clásicos. Aunque pueden aumentar las consultas por disminución de movimientos fetales disminuye la tasa de cesárea, de inducción del parto y de recién nacidos con bajo peso para la edad gestacional, lo que consigue una mejoría del manejo y resultado tanto materno como fetal o del recién nacido en comparación con no informar sobre la importancia de los movimientos fetales. Se ha demostrado que las gestantes con menor nivel sociocultural tienen peores resultados del embarazo a pesar de su uso. Pueden existir otros beneficios de la práctica de mindfetalness como la disminución del uso de analgesia epidural y la mejoría de la atención profesional del embarazo.(AU)

Utilidad de las terapias complementarias en el manejo de dolor durante el parto: una revisión integradora / Utility of complementary therapies in pain management during childbirth: an integrative literature review

Introducción: El dolor de parto es uno de los aspectos que más preocupan a las futuras madres. La enfermería vela por el bienestar de las pacientes en todas sus vertientes y cabe tener presente que existen diversas opciones complementarias a la analgesia epidural. Objetivo: Identificar las terapias complementarias que puedan aplicarse de forma efectiva y segura en embarazadas, analizar los factores que contribuyan a un mayor bienestar para la parturienta y evaluar su utilidad. Método: Revisión integradora de la literatura realizada mediante la búsqueda en las bases de datos online: PubMed, Scopus y Dialnet. Se incluyeron artículos cuya fecha de publicación no fuese superior a los 10 años previos a la búsqueda, redactados en inglés, español o portugués y de acceso abierto. Resultados: Se analizaron un total de 16 artículos cuya temática giraba en torno a la aplicación de diferentes terapias complementarias utilizadas con seguridad en mujeres embarazadas. Se tuvieron en cuenta los resultados de la aplicación de diferentes técnicas complementarias en estudios previos y se agruparon según tipología: intervenciones cuerpo-mente, práctica médica alternativa, métodos de curación manual, inmersión en agua y pelota suiza, aromaterapia y auriculoterapia y estimulación nerviosa eléctrica transcutánea. Conclusión: Se evidencia la variedad de terapias complementarias cuya aplicación resulta efectiva y segura en el momento del parto, así como su utilidad para disminuir los inconvenientes presentes durante esta etapa, acrecentando así, la experiencia positiva del parto. (AU)

Introduction: Labour pain is one of the most worrying things for future mothers. Nurses ensure the well-being of patients in all these aspects and it should be noted that there are various complementary options to epidural analgesia. Objective: To identify the complementary therapies that could be applied effectively and safely in pregnant women, to analyse the contributing factors of greater well-being for the parturient and to evaluate their utility. Method: this integrative review were carried out in online databases: PubMed, Scopus and Dialnet, Articles whose publication date was not more than ten years ago, written in English, Spanish or Portuguese and open access were included. Results: 16 studies about the application of different complementary therapies used safely in pregnant were included and analysed. The obtained results of the application of complementary techniques in previous studies were taken into account and agruped according to typology: body-mind interventions, alternative medical practice, manual healing methods, immersion in water and swiss ball, aromatherapy and auriculotherapy and transcutaneous electrical nerve stimulation. Conclusion: The variety of effective and safe complementary therapies on labour is evidencied, as well as their usefulness to reduce the possible incoveniences that may appear during this process, increasing the positive experience of labour. (AU)

Epidural analgesia in a patient with factor XI deficit.

FXI deficiency is a rare bleeding disorder characterised by a decreased level or activity of factor. Pregnant women are at increased risk of uterine bleeding during childbirth. Neuroaxial analgesia may increase the risk of epidural hematoma in these patients. However, there is no consensus on the anaesthetic management. We present the clinical case of a 36-year-old woman with a personal history of factor XI deficiency, pregnant with 38 weeks gestation who is scheduled to perform birth induction. Pre-induction factor levels were measured. They were less than 40%, so it was decided to transfuse 20 ml/kg of fresh frozen plasma. After the transfusion it had levels greater than 40%, so epidural analgesia was performed without incident. The patient had no complications secondary to epidural analgesia or transfusion of a high volume of plasma.

Analgesia epidural en paciente con déficit de factor XI / Epidural analgesia in a patient with factor XI deficit

El déficit de factorXI es una enfermedad hemorrágica rara que se caracteriza por presentar disminución del nivel o de la actividad del factor. Las mujeres embarazadas con esta patología presentan mayor riesgo de sangrado uterino durante el parto. El uso de analgesia neuroaxial en estas pacientes puede aumentar el riesgo de producir hematoma epidural. Es necesario realizar un seguimiento multidisciplinar en el que participen activamente anestesiólogos, hematólogos y ginecólogos. Actualmente disponemos de escasa bibliografía sobre el manejo anestésico de este tipo de patología. Presentamos el caso clínico de una mujer de 36años con antecedentes personales de déficit de factorXI, embarazada de 38 semanas de gestación que es programada para realización de inducción del parto. Previamente a la inducción se midieron los niveles del factor, y al ser inferiores al 40% se decidió transfundir 20ml/kg de plasma fresco congelado. Tras la transfusión presentó niveles superiores al 40%, por lo que se realizó analgesia epidural sin incidencias. La paciente no presentó complicaciones secundarias a la analgesia epidural ni a la transfusión de un volumen elevado de plasma.(AU)

Factor XI deficiency is a rare bleeding disorder characterized by a decreased level or activity of factor. Pregnant women are at increased risk of uterine bleeding during childbirth. Neuroaxial analgesia may increase the risk of epidural hematoma in these patients. However, there is no consensus on the anesthetic management. We present the clinical case of a 36-year-old woman with a personal history of factorXI deficiency, pregnant with 38weeks gestation who is scheduled to perform birth induction. Pre-induction factor levels were measured. They were less than 40%, so it was decided to transfuse 20mL/kg of fresh frozen plasma. After the transfusion it had levels greater than 40%, so epidural analgesia was performed without incident. The patient had no complications secondary to epidural analgesia or transfusion of a high volume of plasma.(AU)

The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review.

BACKGROUND: This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. METHODS: The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria. RESULTS: Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I2 = 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I2 = 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I2 = 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p = 0.05; I2 = 97%; GRADE: very low). CONCLUSIONS: Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.

Effects of neuraxial analgesia technique on labor and maternal-fetal outcomes: a retrospective study.

PURPOSE: To compare the effects of epidural analgesia (EA) and combined spinal epidural analgesia (SEA) on labor and maternal-fetal outcomes. METHODS: We retrospectively identified and included 1499 patients with a single cephalic fetus who delivered at the study center from January 2015 to December 2018 and received neuraxial analgesia at the beginning of the active phase of labor (presence of regular painful contractions and cervical dilatation between 4 and 6 cm). Data including analgesia, labor characteristics, and maternal-fetal outcomes were retrieved from the prospectively collected delivery room database and medical records. RESULTS: SEA was associated with a shorter first stage of labor than EA, with a median difference of 60 min. On multivariable ordinal logistic regression analysis, neuraxial analgesia, gestational age, fetal weight, labor induction, and parity were independently associated with the first stage length: patients in the EA group were 1.32 times more likely to have a longer first stage of labor (95% CI 1.06-1.64, p = 0.012) than those in the SEA group. Additionally, a significantly lower incidence of fundal pressure was performed among patients who underwent SEA (OR 0.55, 95% CI 0.34-0.9, p = 0.017). No associations were observed between the used neuraxial analgesia technique and other outcomes. CONCLUSIONS: SEA was associated with a shorter length of the first stage of labor and a lower rate of fundal pressure use than EA. Further studies confirming the effects of SEA on labor management and clarifying differences in maternal-fetal outcomes will allow concluding about the superiority of one technique upon the other.

Effects of epidural analgesia on breast-seeking behavior and breastfeeding during breast crawling in neonates / 中国实用护理杂志

Objective:To analyze the influence of epidural labor analgesia on neonatal breast-seeking behavior and first breastfeeding.Methods:This study was an observational study. According to the cross-sectional study formula and inclusion and exclusion criteria, 150 cases of puerperas and their full-term infants who underwent vaginal delivery in the Affiliated Hospital of Southwest Medical University from March to September 2020 were included as the research objects, and the time of breast searching behavior in newborn crawling was observed and recorded. According to whether epidural analgesia was used or not, the patients were divided into analgesic group and non-analgesic group (the specific names of the two groups), and the outcome variables were analyzed.Results:There were 81 cases of successful breast crawl, 69 cases of failure, including 94 cases of epidural analgesia, 56 cases of non-epidural analgesia. Epidural analgesia had no effect on breast crawl and the time of breast searching behavior ( P>0.05). For puerperas with epidural analgesia, the total score of Breastfeeding Assessment Tool (IBFAT) and the scores of its four dimensions such as feeding time, foraging, sucking and nipple holding behavior were 9(7, 10), 3(2, 3), 2(2, 3), 2(1, 2), 2(1, 2), which lower than those non-epidural analgesia puerperas, which were 10(8, 10), 3(3, 3), 3(2, 3), 2(2, 2), 2(1, 2), the differences were statistically significant ( Z values were -6.36- -4.32, all P<0.05). Conclusions:When epidural analgesia is used clinically, medical staff need to seize the best time of drug use, pay attention to continuous monitoring of drug use duration and dosage, while exerting drug analgesia effect, it is also necessary to minimize adverse outcomes and reduce the impact of analgesics on breastfeeding.

Programmed Intermittent Epidural Bolus in Comparison with Continuous Epidural Infusion for the Effects of Enhanced Recovery after Cesarean Section / 中山大学学报(医学科学版)

ObjectiveTo compare the effects of programmed intermittent epidural bolus （PIEB） and continuous epidural infusion （CEI） on enhanced recovery after cesarean section. MethodsTotally 120 women scheduled to undergo elective cesarean section under combined spinal and epidural anesthesia， aged 18-45 years， with single fetus， full-term pregnancy （≥37 weeks）， ASA grade II or III， were recruited， with 60 cases in each group. At the end of the surgery， after a similar epidural loading dose， patients were randomLy assigned to receive either PIEB （6 mL·h-1 beginning 30 minutes after the loading dose） or CEI （6 mL·h-1， beginning immediately after the loading dose） for the maintenance of analgesia with 0.1% ropivacaine. At 2， 6， 12， 24 and 36 h postoperatively， VAS score was used to evaluate the composite pain， and Bromage Score was used to evaluate the degree of lower extremity motor block. The time to first flatus， time to first ambulation and the satisfaction scores were also recorded. ResultsThe VAS scores at 12， 24 and 36 h postoperatively and the lower extremity motor block scores at 6， 12 and 24 h postoperatively in the PIEB group were significantly lower than those in the CEI group （P < 0.01）. The epidural analgesic dosage was less in the PIEB group than that of the CEI group （P=0.002）. The time to first flatus and time to first ambulation were significantly shorter than those in the CEI group （P < 0.05）. The satisfaction scores were significantly higher in the PIEB group than in the CEI group （P < 0.05）. There was no significant difference in the first urination time after urinary catheter removal and the length of hospital stay between the two groups （P > 0.05）. ConclusionCompared with CEI， PIEB provides better postoperative analgesia， less motor block scores， lower epidural analgesic dosage， shorter the time to first flatus and defecation and time to first ambulation， and greater patient satisfaction， which is more consistent with the ERAS concept of analgesia.

The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review

Abstract Background This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. Methods The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria. Results Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I2= 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I2= 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I2= 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p= 0.05; I2= 97%; GRADE: very low). Conclusions Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.

Effects of dezocine combined with sufentanil on continuous epidural analgesia after cesarean section / 中国基层医药

Objective:To investigate the effects of dezocine combined with sufentanil on continuous epidural analgesia after cesarean section.Methods:Eighty-six pregnant women who were scheduled for cesarean section in Guoyang Hospital of Traditional Chinese Medicine from February to December 2021 were included in this randomized controlled study. These women were divided into an observation group and a control group ( n = 43/group). The women in the observation group underwent epidural analgesia with dizocine, sufentanil, and ropivacaine, while those in the control group underwent epidural analgesia with dizocine and ropivacaine. The visual analogue score, Ramsay sedation score, Bruggrmann comfort scale score, and the incidence of adverse reactions were compared between the two groups. Results:At 4, 8, 12, 24 hours after surgery, the visual analogue score (VAS) in the observation group was significantly lower than that in the control group ( t = 2.34, 5.89, 15.36, 16.23, all P < 0.05). At 4, 8, 12, and 24 hours after surgery, Ramsay sedation score in the observation group was significantly higher than that in the control group ( t = -6.31, -7.64, -7.49, -7.41, all P < 0.001). At 4, 8, 12, and 24 hours after surgery, Bruggrmann comfort scale score in the observation group was significantly higher than that in the control group ( t = -7.60, -10.40, -14.53, -13.80, all P < 0.001). There was a significant difference in the number of effective analgesic pump compressions between the observation and control groups [(3.00 ± 1.41) times vs. (7.23 ± 1.31) times, t = 14.42, P < 0.001]. No adverse reactions were observed in the observation group within 24 hours after surgery. Conclusion:Dezocine combined with sufentanil for epidural analgesia can effectively improve the analgesic effects after cesarean section and is highly safe.

Analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids / 中国基层医药

Objective:To investigate the analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids. Methods:Fifty patients with uterine fibroids undergoing uterine artery embolization admitted to The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to December 2021 were included in this study. They were divided into an observation group and a control group ( n = 25/group). Patients in the observation group used an epidural analgesia pump for pain relief, while patients in the control group used an intravenous analgesia pump for pain relief. At 1, 6, 12, and 24 hours after surgery, pain severity was compared between the two groups using the Visual Analogue Scale. Comfort level was compared between the two groups using the Bruggemann Comfort scale. Before and after surgery, respiratory rate, heart rate, blood pressure, and adverse reactions were compared between the two groups. Results:At 1 hour after surgery, the Visual Analogue Scale score in the observation group was significantly lower than that in the control group [3.00 (2.00, 5.50) vs. 7.00 (6.00, 8.00), Z = -3.84, P < 0.05]. At 6, 12, and 24 hours after surgery, there was a significant difference in the Visual Analogue Scale score between the two groups (all P > 0.05). Within 24 hours after surgery, the use of opioid analgesics in the observation group was less than that in the control group [16.00% (4/25) vs. 88.00% (22/25), χ2 = 25.96, P < 0.001]. At 1 hour after surgery, the Bruggemann Comfort Scale score in the observation group was significantly higher than that in the control group [0.00 (0.00, 0.50) vs. 0.00 (0.00, 0.00), Z = 2.08, P < 0.05]. At 6, 12, and 24 hours after surgery, there was no significant difference in the Bruggemann Comfort Scale score between the two groups (all P > 0.05). After surgery, heart rate was significantly decreased in each group compared with before surgery (both P < 0.05). There were no significant differences in respiratory rate and mean arterial pressure between the two groups before and after surgery (both P > 0.05). There were no significant differences in the incidences of postoperative nausea, vomiting, and fever between the two groups (all P > 0.05). Conclusion:The epidural analgesia pump used for uterine artery embolization in the treatment of uterine fibroids has a better analgesic effect and provides more comfort and is safer than the intravenous analgesia pump. The former is worthy of clinical promotion.

Comparación del bloqueo del grupo de nervios pericapsulares (PENG) y la analgesia epidural después de una artroplastia total de cadera: análisis retrospectivo / Comparison of pericapsular nerve group (PENG) block and epidural analgesia following total hip arthroplasty: a retrospective analysis

Introducción y objetivos: La artroplastia total de cadera (THA) es un procedimiento traumatológico cada vez más común, que comporta dolor postoperatorio de moderado a severo. El bloqueo del grupo de nervios pericapsulares (PENG) es un bloqueo reciente que parece aportar analgesia adecuada sin bloqueo motor significativo. El objeto de este estudio es comparar retrospectivamente la eficacia analgésica y la seguridad del bloqueo PENG y la analgesia epidural, en pacientes sometidos a THA. Material y métodos: Se trata de un estudio retrospectivo observacional durante un periodo de un año de los pacientes sometidos a THA primaria, utilizando analgesia epidural o bloqueo PENG ecoguiado con inyección única. Los datos relativos a las características demográficas, técnicas quirúrgicas y anestésicas, puntuaciones de dolor, consumo de opioides, complicaciones y tiempo hasta el alta hospitalaria se recopilaron de los registros institucionales, comparándose entre los dos grupos (analgesia epidural vs. bloqueo PENG). Resultados: No se encontraron diferencias significativas en cuanto a las puntuaciones de dolor, el consumo de opioides y el tiempo medio hasta el alta hospitalaria entre los dos grupos. Las puntuaciones de dolor en reposo (1,2 epidural vs. 1,67 PENG) o con movimiento (3,95 epidural vs. 3,72 PENG) fueron similares entre ambos grupos. El número total de complicaciones fue superior en el grupo de analgesia epidural (50% epidural vs. 5% PENG). Se reportó parestesia en ambos grupos. Solo se reportaron bloqueo motor, sedación, náuseas y complicaciones relacionadas con el catéter en el grupo de analgesia epidural. Conclusiones: El bloqueo PENG parece ser equivalente a la analgesia epidural en cuanto a calidad de la analgesia postoperatoria para los pacientes sometidos a THA primaria, lo cual respalda el uso rutinario de este bloqueo en estos pacientes. La baja tasa de complicaciones reportadas limita las conclusiones sobre esta cuestión.(AU)

Introduction and objectives: Total hip arthroplasty (THA) is an increasingly common orthopedic pro-cedure, with moderate to severe postoperative pain. Pericapsular nerve group (PENG) block is a recent block that seems to provide adequate analgesia without significant motor blockade. The aim of this study is to retrospectively compare the analgesic efficacy and safety of PENG block with those of epidural analgesia, in patients undergoing THA. Material and methods: This is a retrospective observational study of patients who underwent primary THA, submitted to epidural analgesia or single-shot ultrasound-guided PENG block, during a one-year period. Data regarding demographic characteristics, surgery and anesthesia techniques, pain scores, opioid consumption, complications and time to hospital discharge were retrieved from institutional records and compared between the 2 groups (epidural analgesia vs PENG block). Results: No significant difference was found regarding pain scores, opioid consumption, and mean time to hospital discharge between the 2 groups. Pain scores at rest (1.20 epidural vs 1.67 PENG) or with movement (3.95 epidural vs 3.72 PENG) were similar between groups. Total number of complications was higher in the epidural analgesia group (50% epidural vs 5% PENG). Paresthesia was reported in both groups. Motor block, sedation, nausea and catheter-related complications were only found in the epidural analgesia group. Conclusions: PENG block seems to be equivalent to epidural analgesia regarding quality of postop-erative analgesia for patients subject to primary THA, supporting routine use of this block in these patients. The low rate of reported complications limits conclusions on this topic.(AU)

Comparison of pericapsular nerve group (PENG) block and epidural analgesia following total hip arthroplasty: A retrospective analysis.

INTRODUCTION AND OBJECTIVES: Total hip arthroplasty (THA) is an increasingly common orthopaedic procedure, with moderate to severe postoperative pain. Pericapsular nerve group (PENG) block is a recent block that seems to provide adequate analgesia without significant motor blockade. The aim of this study is to retrospectively compare the analgesic efficacy and safety of PENG block with those of epidural analgesia, in patients undergoing THA. MATERIAL AND METHODS: This is a retrospective observational study of patients who underwent primary THA, submitted to epidural analgesia or single-shot ultrasound-guided PENG block, during a one-year period. Data regarding demographic characteristics, surgery and anaesthesia techniques, pain scores, opioid consumption, complications and time to hospital discharge were retrieved from institutional records and compared between the 2 groups (epidural analgesia vs PENG block). RESULTS: No significant difference was found regarding pain scores, opioid consumption, and mean time to hospital discharge between the 2 groups. Pain scores at rest (1.20 epidural vs 1.67 PENG) or with movement (3.95 epidural vs 3.72 PENG) were similar between groups. Total number of complications was higher in the epidural analgesia group (50 % epidural vs 5% PENG). Paresthesia was reported in both groups. Motor block, sedation, nausea and catheter-related complications were only found in the epidural analgesia group. CONCLUSIONS: PENG block seems to be equivalent to epidural analgesia regarding quality of postoperative analgesia for patients subject to primary THA, supporting routine use of this block in these patients. The low rate of reported complications limits conclusions on this topic.

The association between intrapartum interventions and immediate and ongoing breastfeeding outcomes: an Australian retrospective population-based cohort study.

BACKGROUND: The use of intrapartum interventions is becoming increasingly common globally. Interventions during birth, including caesarean section (CS), epidural analgesia and synthetic oxytocin infusion, can be important in optimizing obstetric care, but have the potential to impact breastfeeding. This study aimed to identify whether women who have certain intrapartum interventions have greater odds of unfavourable breastfeeding outcomes, both the immediate post-partum period and in the months after birth. METHODS: This was a population-based cohort study of singleton livebirths at ≥37 weeks' gestation between 2010 and 2018 in Victoria, Australia using routinely-collected state-wide data from the Victorian Perinatal Data Collection (VPDC) and the Child Development Information System (CDIS). The interventions included were pre-labour CS, in-labour CS, epidural analgesia, and synthetic oxytocin infusion (augmentation and/or induction of labour). Outcomes were formula supplementation in hospital, method of last feed before hospital discharge and breastfeeding status at 3-months and 6-months. Descriptive statistics and multivariable logistic regression models adjusting for potential confounders were employed. RESULTS: In total, 599,191 women initiated breastfeeding. In-labour CS (aOR 1.96, 95%CI 1.93,1.99), pre-labour CS (aOR 1.75, 95%CI 1.72,1.77), epidural analgesia (aOR 1.45, 95%CI 1.43,1.47) and synthetic oxytocin infusion (aOR 1.24, 95%CI 1.22,1.26) increased the odds of formula supplementation in hospital. Long-term breastfeeding data was available for 105,599 infants. In-labour CS (aOR 0.79, 95%CI 0.76,0.83), pre-labour CS (aOR 0.73, 95%CI 0.71,0.76), epidural analgesia (aOR 0.77, 95%CI 0.75,0.80) and synthetic oxytocin infusion (aOR 0.89, 95%CI 0.86-0.92) decreased the odds of exclusive breastfeeding at 3-months post-partum, which was similar at 6-months. There was a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome. CONCLUSION: Common intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth. This confirms the importance of only undertaking interventions when necessary. When interventions are used intrapartum, an assessment and identification of women at increased risk of early discontinuation of breastfeeding has to be performed. Targeted breastfeeding support for women who have intrapartum interventions, when they wish to breastfeed, is important.

Analgesia epidural multimodal en isquemia arterial aguda / Multimodal epidural analgesia in acute arterial ischemia

La isquemia arterial aguda (IAA) es un síndrome causado por la interrupción brusca del aporte sanguíneo a un determinado territorio del orga-nismo, a consecuencia de la obstrucción súbita de la arteria que lo irriga. Puede ir acompañada de un intenso dolor que no responda a la anal-gesia convencional. La analgesia epidural multi-modal es la administración de un anéstesico lo-cal con un opioide en el espacio peridural para mantener al individuo libre de dolor. El uso de una técnica multimodal reduce la incidencia y gravedad de los trastornos fisiológicos que oca-siona el dolor agudo. Presentamos un caso de un paciente ingresado a cargo de la Unidad de hospitalización a Domicilio para control evoluti-vo y manejo del dolor por una IAA en miembro superior izquierdo. Tras intervencionismo, se realizó una analgesia epidural multimodal con fentanilo y bupivacaina con mejoría completa del mismo y sin incidencias clínicas.(AU)

Acute arterial ischemia (AAI) is a syndrome caused by the sudden interruption of the blood supply to a certain territory of the body, as a result of the sudden obstruction of the artery that supplies it. It can be accompanied by se-vere pain that does not respond to conventional analgesia. Multimodal epidural analgesia is the administration of a local anesthetic with an opi-oid into the epidural space to keep the individual pain free. The use of a multimodal technique re-duces the incidence and severity of physiologi-cal disorders caused by acute pain. We present a case of a patient admitted to the Home Hos-pitalization Unit for evolutionary control and pain management due to an AAI in the left upper limb. After intervention, a multimodal epidural analgesia with fentanyl and bupivacaine was performed with complete improvement of the same and without clinical incidences.(AU)

Comparison of analgesic modalities for patients undergoing midline laparotomy: a systematic review and network meta-analysis.

BACKGROUND: Midline laparotomy is associated with severe pain. Epidural analgesia has been the established standard, but multiple alternative regional anesthesia modalities are now available. We aimed to compare continuous and single-shot regional anesthesia techniques in this systematic review and network meta-analysis. METHODS: We included randomized controlled trials on adults who were scheduled for laparotomy with solely a midline incision under general anesthesia and received neuraxial or regional anesthesia for pain. Network meta-analysis was performed with a frequentist method, and continuous and dichotomous outcomes were presented as mean differences and odds ratios, respectively, with 95% confidence intervals. The quality of evidence was rated with the  grading of recommendations, assessment, development, and evaluation system. RESULTS: Overall, 36 trials with 2,056 patients were included. None of the trials assessed erector spinae plane or quadratus lumborum block, and rectus sheath blocks and transversus abdominis plane blocks were combined into abdominal wall blocks (AWB). For the co-primary outcome of pain score at rest at 24 hr, with a minimal clinically important difference (MCID) of 1, epidural was clinically superior to control and single-shot AWB; epidural was statistically but not clinically superior to continuous wound infiltration (WI); and no statistical or clinical difference was found between control and single-shot AWB. For the co-primary outcome of cumulative morphine consumption at 24 hr, with a MCID of 10 mg, epidural and continuous AWB were clinically superior to control; epidural was clinically superior to continuous WI, single-shot AWB, single-shot WI, and spinal; and continuous AWB was clinically superior to single-shot AWB. The quality of evidence was low in view of serious limitations and imprecision. Other results of importance included: single-shot AWB did not provide clinically relevant analgesic benefit beyond two hr; continuous WI was clinically superior to single-shot WI by 8-12 hr; and clinical equivalence was found between epidural, continuous AWB, and continuous WI for the pain score at rest, and epidural and continuous WI for the cumulative morphine consumption at 48 hr. CONCLUSIONS: Single-shot AWB were only clinically effective for analgesia in the early postoperative period. Continuous regional anesthesia modalities increased the duration of analgesia relative to their single-shot counterparts. Epidural analgesia remained clinically superior to alternative continuous regional anesthesia techniques for the first 24 hr, but reached equivalence, at least with respect to static pain, with continuous AWB and WI by 48 hr. TRIAL REGISTRATION: PROSPERO (CRD42021238916); registered 25 February 2021.

RéSUMé: CONTEXTE: La laparotomie médiane est associée à une douleur sévère. L'analgésie péridurale est la norme de soins établie, mais plusieurs modalités alternatives d'anesthésie régionale sont aujourd'hui disponibles. Dans cette revue systématique et méta-analyse en réseau, nous avons cherché à comparer les techniques d'anesthésie régionale continue et par injection unique. MéTHODE: Nous avons inclus les études randomisées contrôlées portant sur des adultes devant bénéficier d'une laparotomie avec une simple incision médiane sous anesthésie générale et qui ont reçu une anesthésie neuraxiale ou régionale pour la douleur. Une méta-analyse en réseau a été réalisée avec une méthode fréquentiste, et les résultats continus et dichotomiques ont été présentés sous forme de différences moyennes et de rapports de cotes, respectivement, avec des intervalles de confiance à 95 %. La qualité des données probantes a été évaluée avec le système GRADE (Grading of Recommendations Assessment, Development and Evaluation). RéSULTATS: Au total, 36 études portant sur 2056 patients ont été incluses. Aucune des études n'a évalué le bloc du plan des muscles érecteurs du rachis ou du carré des lombes. Les blocs de la gaine des grands droits et du plan des muscles transverses de l'abdomen ont été combinés en blocs de la paroi abdominale (BPA). Concernant le critère d'évaluation principal de score de douleur au repos à 24 heures, avec une différence minimale cliniquement pertinente (DMCP) de 1, l'analgésie péridurale était cliniquement supérieure au BPA de contrôle et par injection unique; l'analgésie péridurale était statistiquement mais non cliniquement supérieure à l'infiltration continue de la plaie; et aucune différence statistique ou clinique n'a été constatée entre le BPA de contrôle et par injection unique. Pour le deuxième critère d'évaluation principal portant sur la consommation cumulative de morphine à 24 heures, avec une DMCP de 10 mg, la péridurale et le BPA continu étaient cliniquement supérieurs au groupe contrôle; la péridurale était cliniquement supérieure à l'infusion continue de la plaie, au BPA par injection unique, à l'infiltration par injection unique de la plaie et à la rachianesthésie; et le BPA continu était cliniquement supérieur au BPA par injection unique. La qualité des données probantes était faible compte tenu d'importantes limites et d'imprécisions. De plus, le BPA par injection unique n'a fourni aucun avantage analgésique cliniquement pertinent au-delà de deux heures; l'infiltration continue de la plaie était cliniquement supérieure de 8 à 12 heures à l'infiltration de la plaie en injection unique; et une équivalence clinique a été observée entre la péridurale, le BPA continu et l'infiltration continue de la plaie en ce qui avait trait au score de douleur au repos, et entre la péridurale et l'infiltration continue de la plaie en ce qui touchait à la consommation cumulative de morphine à 48 heures. CONCLUSION: Les BPA par injection unique n'étaient cliniquement efficaces pour procurer une analgésie qu'au début de la période postopératoire. Les modalités d'anesthésie régionale continue ont augmenté la durée de l'analgésie par rapport aux modalités équivalentes par injection unique. L'analgésie péridurale est demeurée cliniquement supérieure aux techniques alternatives d'anesthésie régionale continue pendant les 24 premières heures, mais a atteint l'équivalence, au moins en ce qui concerne la douleur statique, avec les BPA et les infiltrations de lésions continus à 48 heures. Enregistrement de l'étude : PROSPERO (CRD42021238916); enregistrée le 25 février 2021.

Impacto del uso de analgesia peridural controlada por la paciente en la disminución del dolor durante el trabajo de parto en un hospital del suroccidente colombiano / Impact of the use of patient-controlled epidural analgesia on pain reduction during labor in a hospital in southwestern colombia

Introducción: La analgesia epidural controlada por la paciente (PCA) provee flexibilidad al permitir acomodar la analgesia de acuerdo con las necesidades crecientes del dolor a medida que progresa el trabajo de parto (TP). El propósito de este estudio es objetivar el impacto en el alivio del dolor y satisfacción materna en pacientes en TP con analgesia PCA.Pacientes y métodos: Estudio descriptivo prospectivo realizado en el segundo semestre del 2020. Se incluyeron gestantes con embarazo único con escala verbal numérica (EVN) mayor a 3 y se excluyeron a las pacientes con contraindicaciones para inserción de catéter. Posterior a la inserción, se valoró el dolor y se entregó un cuestionario para calificar el dolor a los 15 min y en el expulsivo.Resultados: La población estaba constituida por mujeres jóvenes, el 72 % con embarazo a término. El catéter peridural se insertó en la fase latente del trabajo de parto en el 53,4 % de los casos. Al momento de la inserción del catéter, la mediana de dolor fue de 8 (6-10), a los 15 minutos 2 (0-4) y en el expulsivo 5 (3-8). El 75 % de las maternas refirieron estar muy satisfechas y el 19 % satisfechas; un 3 % indicaron estar poco satisfechas y el 1 % restante, insatisfechas. La prevalencia náusea y vómito fue del 16 % y 15 %, respectivamente.Conclusiones: PCA como estrategia analgésica durante el trabajo de parto a través de bolos intermitentes a demanda logró un adecuado control del dolor en los primeros minutos posterior a la inserción sin un control óptimo durante el expulsivo, sin embargo, se obtuvo una satisfacción materna global alta.(AU)

Introduction: Patient-controlled analgesia (PCA) allows patients to accommodate analgesia according to increasing pain needs as labor progresses. This study aims to objectify the impact on pain relief and maternal satisfaction in labor patients with PCA analgesia.Patients and methods: A prospective descriptive study was carried out in the second semester of 2020. Pregnant women with a singleton pregnancy with a numerical rating scale (NRS) greater than three were included, and patients with contraindications for catheter insertion were excluded. After insertion, pain was assessed, and a questionnaire was given to rate pain at 15 min and during expulsion.Results: The population consisted of young women, 72 % of whom were pregnant at term. The epidural catheter was inserted in the latent phase of labor in 53.4 % of cases. At the time of catheter insertion, the median pain was 8 (6-10), at 15 minutes 2 (0-4), and expulsion 5 (3-8). Seventy-five percent of the mothers reported being very satisfied and 19 % satisfied; 3 % reported being slightly satisfied, and the remaining 1 % dissatisfied. The prevalence of nausea and vomiting was 16 % and 15 %, respectively.Conclusions: PCA as an analgesic strategy during labor through intermittent boluses on-demand achieved adequate pain control in the first minutes after insertion without optimal control during expulsion. However, high overall maternal satisfaction was obtained.(AU)

Optimization efficacy of nalbuphine mixed with ropivacaine for epidural labor analgesia in primiparas: comparison with sufentanil mixed with ropivacaine / 中华麻醉学杂志

Objective:To evaluate the optimization efficacy of ropivacaine mixed with nalbuphine for epidural labor analgesia through comparison with ropivacaine mixed with sufentanil in primiparas.Methods:Four hundred and forty primiparas with a singleton fetus in vertex presentation without abnormal fetus, aged 19-36 yr, at 37-42 weeks of gestation, who were suitable and volunteered to receive epidural labor analgesia, were selected and randomly divided into observation group (NR group, n=220) and conventional group (C group, n=220).Epidural labor analgesia solution contained nalbuphine 40 mg and ropivacaine 120 mg in 150 ml of normal saline in group NR.Epidural labor analgesia solution contained sufentanil 50 μg and ropivacaine 120 mg in 150 ml of normal saline in group C. The analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval, programmed intermittent bolus 10-15 ml/h and background infusion at 2 ml/h after an initial dose of 15 ml to maintain VAS score <3.The length of labor, adverse reactions during labor analgesia, neonatal Apgar score, parameters of umbilical artery blood gas analysis and neonatal behavioral neurological assessment score were recorded. Results:Compared with group C, the incidence of urinary retention, pruritus, nausea and vomiting and fever at birth was significantly decreased in group NR ( P<0.05).The duration of the first and second stages of labor, neonatal Apgar score, pH value of umbilical artery blood, lactate concentrations, and neonatal behavioral neurological assessment score were within the normal range in both groups, and there was no significant difference between the two groups ( P>0.05). Conclusions:Compared with conventional medication, nalbuphine mixed with ropivacaine has the same efficacy when used for epidural labor analgesia in primiparas, but it has a certain optimization efficacy in terms of safety.