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1.
Br J Anaesth ; 126(4): 881-888, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33546844

RESUMO

BACKGROUND: Peripheral nerve blocks (PNBs) are increasingly popular in acute ankle fracture surgery but rebound pain may outweigh the benefits. The AnAnkle Trial was designed to assess the postoperative pain profile of PNB anaesthesia compared with spinal anaesthesia (SA). METHODS: The AnAnkle Trial was a randomised, two-centre, blinded outcome analysis trial. Eligible adults booked for primary ankle fracture surgery were randomised to PNB or SA. The PNBs were ultrasound-guided popliteal sciatic and saphenous blocks with ropivacaine and SAs were with hyperbaric bupivacaine. Postoperatively, all subjects received paracetamol, ibuprofen, and patient-controlled i.v. morphine for pain. The primary endpoint was 27 h Pain Intensity and Opioid Consumption (PIOC) score. Secondary endpoints included longitudinal pain scores and morphine consumption separately, and questionnaires on quality of recovery. RESULTS: This study enrolled 150 subjects, and the PNB success rate was >94%. PIOC was lower with PNB anaesthesia (median, -26.5% vs +54.3%; P<0.001) and the probability of a better PIOC score with PNB than with SA was 74.8% (95% confidence interval, 67.0-82.6). Pain scores and morphine consumption analysed separately also yielded a clear benefit with PNB, despite substantial rebound pain when PNBs subsided. Quality of recovery scores were similar between groups, but 99% having PNB vs 90% having SA would choose the same anaesthesia form again (P=0.03). CONCLUSIONS: PNB anaesthesia was efficient and provided a superior postoperative pain profile compared with SA for acute ankle fracture surgery, despite potentially intense rebound pain after PNB. CLINICAL TRIAL REGISTRATION: Clinicaltrialsregister.eu, EudraCT number: 2015-001108-76.


Assuntos
Fraturas do Tornozelo/cirurgia , Bloqueio Nervoso Autônomo/métodos , Medição da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fraturas do Tornozelo/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/efeitos dos fármacos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Método Simples-Cego , Adulto Jovem
2.
Br J Anaesth ; 126(4): 862-871, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33390261

RESUMO

BACKGROUND: Rebound pain is a common, yet under-recognised acute increase in pain severity after a peripheral nerve block (PNB) has receded, typically manifesting within 24 h after the block was performed. This retrospective cohort study investigated the incidence and factors associated with rebound pain in patients who received a PNB for ambulatory surgery. METHODS: Ambulatory surgery patients who received a preoperative PNB between March 2017 and February 2019 were included. Rebound pain was defined as the transition from well-controlled pain (numerical rating scale [NRS] ≤3) while the block is working to severe pain (NRS ≥7) within 24 h of block performance. Patient, surgical, and anaesthetic factors were analysed for association with rebound pain by univariate, multivariable, and machine learning methods. RESULTS: Four hundred and eighty-two (49.6%) of 972 included patients experienced rebound pain as per the definition. Multivariable analysis showed that the factors independently associated with rebound pain were younger age (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.97-0.99), female gender (OR 1.52 [1.15-2.02]), surgery involving bone (OR 1.82 [1.38-2.40]), and absence of perioperative i.v. dexamethasone (OR 1.78 [1.12-2.83]). Despite a high incidence of rebound pain, there were high rates of patient satisfaction (83.2%) and return to daily activities (96.5%). CONCLUSIONS: Rebound pain occurred in half of the patients and showed independent associations with age, female gender, bone surgery, and absence of intraoperative use of i.v. dexamethasone. Until further research is available, clinicians should continue to use preventative strategies, especially for patients at higher risk of experiencing rebound pain.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Medição da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Nervos Periféricos/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/tendências , Bloqueio Nervoso Autônomo/tendências , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Nervos Periféricos/efeitos dos fármacos , Estudos Retrospectivos , Adulto Jovem
3.
Medicine (Baltimore) ; 99(27): e20987, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629714

RESUMO

BACKGROUND: This study will appraise the effectiveness and safety of suprascapular nerve block (SNB) for the treatment of frozen shoulder (FS). METHODS: This study will incorporate studies relevant to SNB on FS. Articles will be searched in the electronic databases (MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Cochrane Library, WANGFANG, and CNKI) from inception to the present. In addition, this study will also retrieve conference proceedings and reference lists of included studies. All literature source searches will not be restricted by date and language. The Cochrane Risk of Bias Tool will be utilized to evaluate the quality of retrieved trials. Data will be collected independently by 2 authors. All collected data will be analyzed by RevMan 5.3 software. RESULTS: This study will synthesize the most recent published high quality trials on assessing the effectiveness and safety of SNB in treating FS. CONCLUSION: The findings of this study will provide a genuine understanding and helpful evidence to determine whether SNB is effective or not in treating FS. STUDY REGISTRATION NUMBER: INPLASY202050084.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Bursite/terapia , Humanos , Revisões Sistemáticas como Assunto , Resultado do Tratamento
4.
Sci Rep ; 10(1): 10950, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32616939

RESUMO

Skin conductance monitoring is one of the promising methods for objectively evaluating pain. However, skin conductance might possibly increase in response to sympathetic stimulation other than pain. In this study, we aimed to test whether skin conductance monitoring can distinguish physical pain stimulation (heat, mechanical and cold stimulation) from other sympathetic stimuli (stimulation by noise and painful images). Twenty-three healthy volunteers participated in this prospective observational study. The number of fluctuations in skin conductance (NFSC) and normalized skin conductance level (nSCL) were measured and compared with pain scores on a self-reported pain scale (numerical pain scale [NPS]). Both NFSC and nSCL increased during mechanical stimulation. Further, nSCL, but not NFSC, well reflected heat stimulus intensity, suggesting its ability to quantitatively evaluate pain. nSCLs during physical pain stimulation were greater than those during other sympathetic stimulations. However, NFSC was not able to completely distinguish between the stimuli. These results suggest that nSCL could better differentiate physical pain stimuli from other sympathetic stimuli than NFSC. In comparisons between subjective and objective pain assessment in the same individual, nSCL correlated better with NPS score, indicating the possibility of being able to monitor the transition of pain. Monitoring changes in skin conductance using nSCL might be useful for objectively detecting physical pain.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Resposta Galvânica da Pele , Monitorização Fisiológica , Medição da Dor/métodos , Dor/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Física , Estudos Prospectivos , Fenômenos Fisiológicos da Pele , Adulto Jovem
5.
Medicine (Baltimore) ; 99(18): e20023, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358380

RESUMO

RATIONALE: Migraine is a recurrent, disabling neurovascular headache disorder. The patient's quality of life can be severely impaired by migraine attacks. Stellate ganglion block (SGB) can be used to relieve pain in the head, neck, and upper extremities. In the present cases, we performed SGB in 2 patients with migraine that responds poorly to drugs. PATIENT CONCERNS: Patients 1 and 2 suffered from chronic, bilateral pulsating headache, accompanied by nausea and vomiting. Patient 1 presented with headache of 8 on the visual analog scale (VAS), and 37 on the migraine disability assessment (MIDAS). Patient 2 reported headache of 7 on the VAS, and 32 on the MIDAS. DIAGNOSIS: The patients were diagnosed with migraine without aura based on the International Classification of Headache Disorders version 3. INTERVENTIONS: Patient 1 was treated with bilateral SGB every week for a month and then every month for 3 months. Patient 2 received bilateral SGB every 2 weeks for a month and then every month for 3 months. OUTCOMES: Four months after SGB, patient 1 reported pain intensity of 4 on VAS and 6 on MIDAS and patient 2 rated pain intensity of 3 on VAS, and 6 on MIDAS, respectively. LESSONS: The SGB can be an effective option to improve headache-related disability and relieve pain intensity in the patients with refractory migraine.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Transtornos de Enxaqueca/tratamento farmacológico , Gânglio Estrelado , Adulto , Avaliação da Deficiência , Esquema de Medicação , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Náusea/etiologia , Qualidade de Vida , Escala Visual Analógica , Vômito/etiologia
6.
Reg Anesth Pain Med ; 45(10): 831-834, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32447292

RESUMO

The recent joint statement from the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anesthesia and Pain Therapy (ESRA) recommends neuraxial and peripheral nerve blocks for patients with coronavirus disease 2019 (COVID-2019) illness. The benefits of regional anesthetic and analgesic techniques on patient outcomes and healthcare systems are evident. Regional techniques are now additionally promoted as a mechanism to reduce aerosolizing procedures. However, caring for patients with COVID-19 illness requires rapid redefinition of risks and benefits-both for patients and practitioners. These should be fully considered within the context of available evidence and expert opinion. In this Daring Discourse, we present two opposing perspectives on adopting the ASRA/ESRA recommendation. Areas of controversy in the literature and opportunities for research to address knowledge gaps are highlighted. We hope this will stimulate dialogue and research into the optimal techniques to improve patient outcomes and ensure practitioner safety during the pandemic.


Assuntos
Anestesia por Condução/métodos , Bloqueio Nervoso Autônomo/métodos , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anestesia por Condução/efeitos adversos , Anestesia por Condução/tendências , Anestésicos Locais/administração & dosagem , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/tendências , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
7.
Pain Pract ; 20(6): 626-638, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32255250

RESUMO

BACKGROUND: Evaluating the effectiveness of stellate ganglion blockades (SGBs) proves challenging, since the criteria defining a successful blockade are controversial. This may be one reason for the scarcity of studies on this topic, thus forcing clinical guidelines to remain conservative in recommending SGBs. Moreover, factors to predict which patients will benefit from blockade series are not yet available. OBJECTIVES: The objectives of this study were to evaluate through a clinical approach SGBs' effectiveness performed under ultrasound guidance (us-SGB) and to identify factors to predict effectiveness. METHODS: We retrospectively analyzed 809 us-SGBs in 105 patients with complex regional pain syndrome (CRPS) and neuropathic pain syndromes (all potentially including sympathetically maintained pain) regarding pain reduction. Volume and type of local anesthetics, magnitude of pain, temperature of the dorsal hands, heart rate, blood pressure, and occurrence of Horner's syndrome or complications were assessed. RESULTS: Pain reduction after a blockade series was highly significant and showed no significant correlation with change of temperature, vital signs, or Horner's syndrome. For patients with neuropathic pain, the predictive potential for pain reduction following a blockade series lies within the range of pain reduction after the first blockade. In a literature comparison, incidences of complications (hoarseness 3.9%, dysphagia 3.4%, hematoma 0.6%) were lower than in non-ultrasound-guided techniques. CONCLUSIONS: Data indicate that us-SGBs are safe and effective in reducing sympathetically maintained pain in patients with CRPS and neuropathic pain syndromes. Pain reduction after the first blockade may predict total pain reduction after a blockade series. Other clinical measures seem unsuitable to predict effectiveness.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Síndromes da Dor Regional Complexa/terapia , Neuralgia/terapia , Gânglio Estrelado , Adulto , Síndromes da Dor Regional Complexa/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Estudos Retrospectivos , Gânglio Estrelado/efeitos dos fármacos , Ultrassonografia de Intervenção/métodos
8.
J Orthop Surg Res ; 15(1): 41, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32028972

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is usually associated with moderate to severe postoperative pain. Peripheral nerve block (PNB) and local infiltration analgesia (LIA) are two major methods for postoperative analgesia. Femoral nerve block (FNB) leads to residual posterior knee pain; thus, currently sciatic nerve block (SNB) and LIA are two major options for supplementing FNB. However, the efficacy and safety of LIA compared with combined femoral and sciatic nerve block still remain controversial. Here, we conducted a study to analyze the postoperative analgesic efficacy of these two methods. METHOD: Two hundred six patients undergoing TKA were enrolled in a retrospective cohort study. The patients received either PNB or LIA. All patients in PNB group were conducted combined femoral and sciatic nerve block. All patients were encouraged to use patient-controlled analgesia (PCA) after surgery. The postoperative visual analog scale (VAS) at rest or with movement during the first 24 h and 48 h was recorded. We analyzed the VAS of 24 h, VAS of 48 h, opioid consumption, and adverse effects between PNB group and LIA group. Chi-square test and nonparametric test were used in this study. RESULTS: There were 82 patients in the PNB group and 124 patients in the LIA group. The patients' characteristics such as age, height, weight, and ASA showed no significant difference (P > 0.05). No significant differences were found (P > 0.05) between the two groups regarding VAS score at rest or with movement. The LIA group had less opioid consumption than the PNB group but without significant difference (P > 0.05). In both groups, the most common side effect was nausea, and the side effects showed no significant differences between groups (P > 0.05). CONCLUSION: Local infiltration analgesia provided a similar analgesic effect and complications compared with combined femoral and sciatic nerve block in the short term. Considering less opioid consumption with local infiltration analgesia though without significant difference and its convenience, local infiltration analgesia provided better postoperative analgesia.


Assuntos
Anestesia Local/métodos , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Artroplastia do Joelho/tendências , Estudos de Coortes , Terapia Combinada/métodos , Feminino , Nervo Femoral/efeitos dos fármacos , Nervo Femoral/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Nervo Isquiático/efeitos dos fármacos , Nervo Isquiático/fisiologia
9.
Anesthesiology ; 132(4): 854-866, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31996555

RESUMO

BACKGROUND: The basic perineural catheter design has changed minimally since inception, with the catheter introduced through or over a straight needle. The U.S. Food and Drug Administration recently cleared a novel perineural catheter design comprising a catheter attached to the back of a suture-shaped needle that is inserted, advanced along the arc of its curvature pulling the catheter past the target nerve, and then exited through the skin in a second location. The authors hypothesized that analgesia would be noninferior using the new versus traditional catheter design in the first two days after painful foot/ankle surgery with a primary outcome of average pain measured with the Numeric Rating Scale. METHODS: Subjects undergoing painful foot or ankle surgery with a continuous supraparaneural popliteal-sciatic nerve block 5 cm proximal to the bifurcation were randomized to either a suture-type or through-the-needle catheter and subsequent 3-day 0.2% ropivacaine infusion (basal 6 ml/h, bolus 4 ml, lockout 30 min). Subjects received daily follow-up for the first four days after surgery, including assessment for evidence of malfunction or dislodgement of the catheters. RESULTS: During the first two postoperative days the mean ± SD average pain scores were lower in subjects with the suture-catheter (n = 35) compared with the through-the-needle (n = 35) group (2.7 ± 2.4 vs. 3.4 ± 2.4) and found to be statistically noninferior (95% CI, -1.9 to 0.6; P < 0.001). No suture-style catheter was completely dislodged (0%), whereas the tips of three (9%) traditional catheters were found outside of the skin before purposeful removal on postoperative day 3 (P = 0.239). CONCLUSIONS: Suture-type perineural catheters provided noninferior analgesia compared with traditional catheters for continuous popliteal-sciatic blocks after painful foot and ankle surgery. The new catheter design appears to be a viable alternative to traditional designs used for the past seven decades.


Assuntos
Anestesia por Condução/métodos , Bloqueio Nervoso Autônomo/métodos , Cateteres de Demora , Dor Pós-Operatória/prevenção & controle , Nervo Isquiático/diagnóstico por imagem , Técnicas de Sutura , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/efeitos dos fármacos , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico por imagem , Nervo Isquiático/cirurgia , Ultrassonografia de Intervenção/métodos
10.
Eur J Pharmacol ; 867: 172836, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31811858

RESUMO

Excessive sympathetic activity is associated with heart failure and ventricular arrhythmias, which regulated by enhanced cardiac sympathetic afferent reflex, which can be blunted by resiniferatoxin, a selective receptor agonist of transient vanilloid potential 1 (TRPV1) + primary sensory afferents. The present study is aimed to determine whether intrathecal resiniferatoxin application affect cardiac sympathetic tone and electrophysiology, furtherly create a new effective strategy to prevent lethal arrhythmias in chronic heart failure. Four weeks after coronary artery occlusion to induce heart failure in rats, RTX (2µg/10 µl) or vehicle was injected intrathecally into the T2/T3 interspace. Cardiac sympathetic nerve activities (CSNA) and cardiac electrophysiology were evaluated two weeks later. Intrathecal resiniferatoxin significantly and selectively abolished the afferent markers expression (TRPV1 and calcitonin gene-related peptide) in dorsal horn and reduced overactivated CSNA. Electrophysiological studies revealed that resiniferatoxin administration intrathecally significantly reversed the prolongation of action potential duration (APD) and APD alternan, reduced the inducibilities of ventricular arrhythmias. Moreover, the over-activated calcium handling related protein CaMKII and RyR2 in heart failure was reversed by resiniferatoxin administration. In conclusion, these results firstly demonstrate that central chemo-ablation of the TRPV1+ afferents in spinal cord prevent heart from ventricular arrhythmias in heart failure via selectively blunting cardiac sympathetic afferent projection into spinal cord, which suggest a novel promising therapeutic method for anti-arrhythmia in heart failure.


Assuntos
Arritmias Cardíacas/prevenção & controle , Bloqueio Nervoso Autônomo/métodos , Diterpenos/administração & dosagem , Gânglios Simpáticos/efeitos dos fármacos , Insuficiência Cardíaca/terapia , Potenciais de Ação/efeitos dos fármacos , Potenciais de Ação/fisiologia , Animais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina/metabolismo , Modelos Animais de Doenças , Gânglios Simpáticos/fisiopatologia , Coração/efeitos dos fármacos , Coração/inervação , Coração/fisiopatologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Injeções Espinhais , Masculino , Neurônios Aferentes/efeitos dos fármacos , Neurônios Aferentes/fisiologia , Ratos , Canal de Liberação de Cálcio do Receptor de Rianodina/metabolismo , Corno Dorsal da Medula Espinal/efeitos dos fármacos , Corno Dorsal da Medula Espinal/metabolismo , Canais de Cátion TRPV/agonistas , Canais de Cátion TRPV/metabolismo
11.
World Neurosurg ; 134: e346-e352, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31634623

RESUMO

BACKGROUND: Due to suboptimal pain control under conventional local anesthesia, percutaneous endoscopic interlaminar discectomy is typically performed under general anesthesia. The purpose of this study was to develop a stepwise approach of local anesthesia for endoscopic interlaminar discectomy and evaluate its efficacy. METHODS: A stepwise local anesthesia was developed, which mainly includes 3 steps: conventional local anesthesia from skin to laminae, epidural injection, and nerve root block. From June 2015 to May 2017, consecutive patients who underwent endoscopic interlaminar discectomy were included. Local anesthesia or general anesthesia was used based on patients' preference. Anesthetic effectiveness was evaluated as excellent, good, or poor, and adverse events were recorded. Hospitalization expense was compared between the 2 groups. Clinical outcomes were assessed using the Visual Analog Scale and the Oswestry Disability Index. RESULTS: There were 98 patients included in the study. Among them, 48 received stepwise local anesthesia and the other 50 received general anesthesia. In the stepwise local anesthesia group, 40 (83.3%) patients rated anesthetic effectiveness as excellent, 7 (14.6%) as good, and 1 (2.1%) as poor. Nine patients had complications that may be associated with local anesthesia, including dyspnea, temporary paresis of legs, and temporary worsened dysesthesia or numbness in legs. After surgery, the patients' leg pain and Oswestry Disability Index significantly improved in both groups. On average, hospitalization expense was approximately 20% less when local anesthesia was used, as compared with using general anesthesia. CONCLUSIONS: The stepwise local anesthesia can achieve satisfactory pain control and seems to be a good choice for endoscopic interlaminar discectomy.


Assuntos
Anestesia Epidural/métodos , Anestesia Local/métodos , Bloqueio Nervoso Autônomo/métodos , Discotomia Percutânea/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Discotomia Percutânea/efeitos adversos , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/efeitos adversos , Neuroendoscopia/métodos , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico por imagem , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
12.
Prostate Cancer Prostatic Dis ; 23(1): 74-80, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31160805

RESUMO

BACKGROUND: To determine the efficacy and safety of a periprostatic nerve block combined with perineum subcutaneous anaesthesia and intrarectal lidocaine gel for transrectal ultrasound-guided transperineal prostate biopsy (TPBx) through a prospective randomised controlled trial. METHODS: In total, 216 patients from May 2018 to November 2018 were randomly assigned to the experimental group and the control group at a ratio of 1:1. The experimental group received a periprostatic nerve block combined with subcutaneous perineal anaesthesia and intrarectal lidocaine gel. The control group received total intravenous anaesthesia. A visual analogue scale (VAS) score (0-10) was used to evaluate pain at different stages. The operative time, duration of hospitalisation, intraoperative vital signs, perioperative complications and clinicopathological features were recorded. RESULTS: The overall detection rate of prostate cancer was 40.74%, and the median Gleason score was 8 for all patients diagnosed with prostate cancer. No significant differences in terms of detection rates, Gleason scores and ISUP/WHO Grade Groups were found between the two groups (P > 0.05). The experimental group had no pain or just met the criteria for mild pain during the biopsy, which was significantly alleviated after the biopsy, and had a shorter operation time compared with that of the control group (P < 0.05). Compared with the control group, the experimental group had more stable haemodynamics and respiratory status and fewer surgical complications (P < 0.05). CONCLUSIONS: In multiple aspects, a periprostatic nerve block combined with subcutaneous perineal anaesthesia and intrarectal lidocaine gel is a safer and more efficient approach to local anaesthesia for TPBx that can almost replace total intravenous anaesthesia and is worthwhile applying in the clinical setting.


Assuntos
Anestesia Local , Bloqueio Nervoso Autônomo , Biópsia Guiada por Imagem/métodos , Neoplasias da Próstata/diagnóstico , Ultrassom Focalizado Transretal de Alta Intensidade , Anestesia Local/efeitos adversos , Anestesia Local/métodos , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Gerenciamento Clínico , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Dor/diagnóstico , Dor/etiologia , Manejo da Dor , Complicações Pós-Operatórias , Ultrassom Focalizado Transretal de Alta Intensidade/métodos
13.
Best Pract Res Clin Anaesthesiol ; 33(4): 539-551, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31791569

RESUMO

PURPOSE: of review: Novel motor-sparing peripheral nerve blocks in hip and knee procedures are desirable. RECENT FINDINGS: The application of ultrasound (US) in fascial plane blocks has improved the efficacy and effectiveness of obturator nerve block, lateral femoral cutaneous nerve block, and quadratus lumborum block. The improved performance of these fascial plane blocks has led to additional clinical applications to the hip and knee procedures. SUMMARY: Recent advancements in US have transformed the clinical performance of fascial layer blocks, evidenced in their novel indications in hip, knee, and spine analgesia. The combination of various motor-sparing fascial plane blocks providing different areas of innervation is particularly useful in fast-track hip and knee surgeries.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Fáscia , Nervo Femoral/cirurgia , Articulação do Quadril/cirurgia , Articulação do Joelho/cirurgia , Anestésicos Locais/administração & dosagem , Fáscia/diagnóstico por imagem , Nervo Femoral/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Dor Pós-Operatória/diagnóstico por imagem , Dor Pós-Operatória/prevenção & controle
14.
Pain Physician ; 22(6): E627-E633, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31775416

RESUMO

BACKGROUND: Cervical vertigo commonly concurs in patients with neck pain, but the concurrent mechanism of these 2 symptoms still remains unclear. We previously reported a bidirectional segmental nerve fiber connection between cervical spinal and sympathetic ganglia, which provided a hypothesis that this connection between the 2 ganglia may be the anatomic basis for the concurrence of neck pain and cervical vertigo. However, this concurrent mechanism needs biochemical and functional evidence. OBJECTIVES: This study aimed to investigate a possible noradrenergic pathway between cervical spinal and sympathetic ganglia. STUDY DESIGN: We performed both clinical and laboratory research. Clinical observation was a prospective case-control study. SETTING: Clinical study took place in our hospital; laboratory study was in an orthopedic laboratory. METHODS: Cervical lamina block therapy used in patients with cervical vertigo was clinically evaluated; norepinephrine (NE) expressions in cervical sympathetic ganglia were analyzed using immunohistochemical staining after electrical stimulation to the cervical spinal ganglia; the influence of phentolamine local injection to the vertebrobasilar artery flow was experimentally measured. RESULTS: Cervical lamina block therapy could significantly shorten the clinical hospital stays of patients with cervical vertigo (P = 0.000) and improve vertebral artery flow (P < 0.05). NE expressions in superior cervical sympathetic ganglia (SCG) or inferior cervical sympathetic ganglia (ICG) increased significantly when ipsilateral C2 to C3 or C6 to C8 spinal ganglia were electrically stimulated, respectively. Adrenergic receptor block with phentolamine significantly inhibited the decrease of basilar artery (BA) flow induced by electrical stimulation of the cervical spinal ganglia. The change range of BA flow caused by stimulations of C2 to C3 and C6 to C8 spinal ganglia was more than that of C4 and C5. LIMITATIONS: The inpatients observed in this clinical study might be influenced by some factors including emotion, diet, sleep, and others. The limitations of the laboratory study included animal species and small sample size. CONCLUSIONS: Adrenergic system could play a part in cervical spinal ganglia altering the vertebrobasilar artery system. It could provide a neurochemical foundation between neck pain and vertigo, and that segmental functional connections exist between cervical spinal and sympathetic ganglia. KEY WORDS: Cervical vertigo, neck pain, cervical sympathetic ganglia, cervical spinal ganglia, noradrenaline.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Gânglios Espinais/fisiologia , Gânglios Simpáticos/fisiologia , Cervicalgia/tratamento farmacológico , Vertigem/tratamento farmacológico , Adulto , Animais , Estudos de Casos e Controles , Vértebras Cervicais/efeitos dos fármacos , Vértebras Cervicais/inervação , Vértebras Cervicais/fisiologia , Feminino , Gânglios Espinais/efeitos dos fármacos , Gânglios Simpáticos/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/epidemiologia , Cervicalgia/fisiopatologia , Estudos Prospectivos , Coelhos , Distribuição Aleatória , Vertigem/epidemiologia , Vertigem/fisiopatologia
15.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770265

RESUMO

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Assuntos
Bloqueio Nervoso Autônomo , Complicações Intraoperatórias , Lidocaína , Convulsões , Gânglio Estrelado , Inconsciência , Artéria Vertebral , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Erros Médicos/prevenção & controle , Transtornos de Enxaqueca/cirurgia , Assistência ao Paciente/métodos , Convulsões/etiologia , Convulsões/terapia , Gânglio Estrelado/diagnóstico por imagem , Gânglio Estrelado/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Inconsciência/etiologia , Inconsciência/terapia , Artéria Vertebral/anatomia & histologia , Artéria Vertebral/lesões
16.
Pain Manag ; 9(6): 543-550, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31729281

RESUMO

Aim: To determine the long-term effect of ethanol relative to the re-occurrence of pain in postneurolytic celiac plexus block (NCPB) patients. Patients & methods: A noninterventional study on 31 patients who had undergone NCPB to illustrate the average change of pain score over time. Results: All NCPB patients reported a pain score decrease of 83.8% right after the procedure. 73% of patients reported 50-66% decrease in pain 80-100 days postprocedure. The temporal threshold for the return of pain scores to average preblock level was determined to be 103 post-NCPB procedure days. Conclusion: In this study, NCPB patients demonstrate return of pain to baseline subsequent to the analgesic effects of ethanol after a mean 103 days.


Assuntos
Bloqueio Nervoso Autônomo , Plexo Celíaco/fisiopatologia , Manejo da Dor/métodos , Limiar da Dor , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueio Nervoso Autônomo/métodos , Etanol , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(44): e17790, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689853

RESUMO

RATIONALE: Stellate Ganglion Block (SGB) provides a blockade of sympathetic signals from the sympathetic chain and appears to be a promising method of controlling refractory ventricular arrhythmias, but there are scanty data in the literature. PATIENT CONCERNS: Herein, we describe a 59-year-old male patient with a history of non-ischemic cardiomyopathy and suffering from frequent VT episodes, who received ICD implantation and regular amiodarone medication control. DIAGNOSES: Monomorphic VT refractory to standard medication control and focal extensive catheter ablation. INTERVENTIONS: Left Stellate Ganglion Block (LSGB) was performed under ultrasound-assisted injection at the C6 level using a 10 ml solution of 0.4% lidocaine and 0.5% bupivacaine. OUTCOMES: In our case, refractory VT subsided and sinus rhythm was retained immediately after LSGB. There were no VT episodes for at least 3 hours during the inter-hospital transfer, which did not involve any specific complications. LESSONS: LSGB may provide effective VT control and play an important role in rescue and bridge therapy before catheter ablation.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Cardiomiopatias/terapia , Gânglio Estrelado , Taquicardia Ventricular/terapia , Cardiomiopatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/complicações , Resultado do Tratamento
18.
Anesthesiology ; 131(5): 1025-1035, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31634246

RESUMO

BACKGROUND: Adverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality). METHODS: The authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes. RESULTS: The authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, -$1,421; 95% CI, -$1,579 to -$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed. CONCLUSIONS: Receipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.


Assuntos
Bloqueio Nervoso Autônomo/tendências , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Tempo de Internação/tendências , Vigilância da População , Idoso , Idoso de 80 Anos ou mais , Bloqueio Nervoso Autônomo/métodos , Estudos de Coortes , Feminino , Humanos , Masculino , Ontário/epidemiologia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Vigilância da População/métodos , Estudos Retrospectivos , Resultado do Tratamento
19.
Pain Physician ; 22(5): E417-E424, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31561653

RESUMO

BACKGROUND: Sympathetic block is commonly performed in clinical practice for management of intractable pain conditions. However, stellate ganglion block (SGB) alone often does not achieve sufficient sympatholysis of the upper extremity. The paravertebral space continues up to the cervical sympathetic chain and includes the stellate ganglion. We compared the sympatholytic and analgesic effect of paravertebral block performed at the T2 level (T2 PVB) with that of SGB in patients with complex regional pain syndrome (CRPS) of the upper extremity. OBJECTIVES: The aim of this study was to compare the sympatholytic property of T2 PVB with that of the conventional SGB in patients with CRPS of the upper extremity. STUDY DESIGN: Prospective, randomized cross-over trial. SETTING: University hospital pain center in Korea. METHODS: Fifteen patients with upper extremity CRPS were randomly assigned to 1 of 2 intervention methods (SGB or T2 PVB). After effects of the first block receded, the patients were crossed over to the second procedure. A difference in temperature increase between the treated side and the opposite side (DeltaT) DeltaT greater than or equal to1.5°C was considered as a successful primary outcome. Rate of successful primary outcome, degree of pain reduction, duration of effect, and patient satisfaction scores were compared between the 2 intervention methods. RESULTS: Rate of successful primary outcome (DeltaT greater than or equal to 1.5°C) was significantly higher in the T2 PVB cases than in the SGB cases (80.0% vs. 20.0%; P = 0.003). Numeric Rating Scale scores after the procedure were significantly lower in the T2 PVB group. Patient satisfaction scores were significantly higher, and the duration of the block was significantly longer in the T2 PVB cases than in the SGB cases. LIMITATIONS: The relatively small sample size from a single center, and the lack of standardization of the injected volume of T2 PVB and SGB were limitations. CONCLUSIONS: T2 PVB showed superior sympatholytic effect than SGB; other clinical outcomes were also better with T2 PVB than with SGB. T2 PVB can be a useful option for producing sympatholytic and analgesic effect in patients with CRPS of the upper extremity. KEY WORDS: Sympathetic block, Complex Regional Pain Syndrome, paravertebral block, stellate ganglion block.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Adulto , Síndromes da Dor Regional Complexa , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição Aleatória , República da Coreia , Gânglio Estrelado/efeitos dos fármacos , Sistema Nervoso Simpático , Extremidade Superior
20.
Circ Arrhythm Electrophysiol ; 12(9): e007118, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31514529

RESUMO

BACKGROUND: Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied. METHODS: This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications. RESULTS: Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%; P=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (P<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%; P=0.03) and recurrent VA within 24 hours (85.7% versus 26.1%; P=0.009). There were no procedure-related major complications. CONCLUSIONS: SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Eletrocardiografia , Frequência Cardíaca/fisiologia , Gânglio Estrelado/fisiopatologia , Taquicardia Ventricular/terapia , Feminino , Fluoroscopia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Gânglio Estrelado/diagnóstico por imagem , Taquicardia Ventricular/fisiopatologia , Ultrassonografia
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