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1.
Pain Manag ; 12(1): 105-116, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34551582

RESUMO

Total knee arthroplasty (TKA) is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Current postoperative pain management for TKA is insufficient, as it results in extensive opioid consumption and functional decline postoperatively. This study identifies the best practices for postoperative TKA pain management through a literature review of the last three years. Studies utilizing interventional techniques (local infiltration analgesia, nerve blocks) and pharmacologic options were reviewed on PubMed, Embase, Ovid Medline and Scopus. Primary outcomes analyzed were the effect of different analgesic approaches on pain reduction, opioid use reduction and improvements in functional mobility or quadriceps strength postoperatively. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.


Assuntos
Analgesia , Artroplastia do Joelho , Bloqueio Nervoso , Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
2.
Pain Manag ; 12(1): 5-12, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34284601

RESUMO

This article describes the use of an infiltration between the popliteal artery and capsule of the knee joint (IPACK) to diagnose an entrapment neuropathy of the tibial nerve (TN) in a patient presenting with chronic neuropathic pain in the medial posterior compartment of the left knee, with a previous electromyography showing no evidence of tibial or common peroneal nerve neuropathy. After a positive sciatic nerve block, the patient was evaluated for a TN block, cancelled due to the presence of an abnormal leash of vessels wrapping around the nerve. For this reason, the patient was submitted to a diagnostic IPACK. A negative IPACK suggested that a compression of the TN at the popliteal fossa was the most likely source of the symptoms. After surgical decompression of the TN nerve at the popliteal fossa, the patient's symptoms decreased substantially.


Assuntos
Artroplastia do Joelho , Bloqueio Nervoso , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Dor Pós-Operatória , Ultrassonografia de Intervenção
3.
Acta Clin Croat ; 60(2): 309-313, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34744283

RESUMO

The ultrasound-guided erector spinae plane (ESP) block is a novel interfascial plane block technique providing analgesic effects in different localizations of the body, in accordance with the level of administration. Although ESP block is usually performed in the thoracic region in pediatric patients, it is possible to achieve ESP block in the lumbar region as well. Postoperative pain management is essential in patients undergoing operative hip treatment, one of the most common procedures in pediatric orthopedic surgery. We report on a case of effective intraoperative analgesia achieved by ultrasound-guided lumbar ESP block and another case of effective intra- and postoperative analgesia accomplished with perineural catheter placement in addition to lumbar ESP block, both performed in children surgically treated for developmental hip disorders.


Assuntos
Analgesia , Bloqueio Nervoso , Cateteres , Criança , Humanos , Dor Pós-Operatória/prevenção & controle , Músculos Paraespinais
4.
A A Pract ; 15(11): e01543, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34752440

RESUMO

Erector spinae plane (ESP) continuous catheters are used for the management of postsurgical pain. The use of these catheters for acute nonsurgical abdominal pain is not well defined. This case describes a patient with refractory abdominal pain secondary to necrotizing pancreatitis despite escalating doses of opioids, ketamine, and dexmedetomidine. Our patient declined epidural analgesia. Bilateral ESP continuous catheters successfully controlled her pain, and she was weaned off of all analgesics during the week following catheter placement. This case demonstrates that ESP continuous catheters can be considered for patients with acute nonsurgical abdominal pain especially when thoracic epidural analgesia is contraindicated.


Assuntos
Bloqueio Nervoso , Pancreatite , Dor Abdominal/etiologia , Cateteres , Feminino , Humanos , Músculos Paraespinais
5.
Wiad Lek ; 74(9 cz 2): 2337, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34824180

RESUMO

OBJECTIVE: The aim: To demonstrate the onset of dexamethasone when added to lidocaine in ultrasound regional axillary brachial block. PATIENTS AND METHODS: Materials and methods: 30 patients participated in this study in Al-wasity hospital from June 1st to December 1st 2019; all were of ASA I-II type, aged 18-65 years old. All patients were scheduled for upper limb below elbow surgery with peripheral nerve block. They were divided randomly in to 2 groups: Group A: received 20 ml of lidocaine 1.5% with adrenaline 1:200000; Group 2 : received 20 ml of lidocaine with adrenaline and dexamethasone 8 mg. There was no significant differences among the groups regarding the change in pulse rate, MAP and Oxygen saturation. The group B was faster than group A (p value < 0.001) in both the time of cold sensory block onset and pinprick sensory block onset at all dermatome (C5,C6,C7,C8,T1). RESULTS: Results: A variety of adjuvants have been used with peripheral nerve block to decrease the onset time, improve block quality, and prolong analgesia. Steroids have been shown to be beneficial in improving block onset. CONCLUSION: Conclusions: Adding dexamethasone to lidocaine enhanced the onset time of the block with no hemodynamic effect.


Assuntos
Lidocaína , Bloqueio Nervoso , Adolescente , Adulto , Idoso , Anestésicos Locais , Dexametasona , Cotovelo , Epinefrina , Humanos , Pessoa de Meia-Idade , Ultrassonografia de Intervenção , Adulto Jovem
6.
Clin J Pain ; 37(12): 881-886, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34757340

RESUMO

OBJECTIVES: The aim was to compare the feasibility of ultrasound-guided multiple nerve blocks (fascia iliaca compartment block+sacral plexus block+superior cluneal nerve block) with general anesthesia in geriatric hip fracture patients. METHODS: Ninety-four patients were randomly divided into 2 groups: group N received ultrasound-guided multiple nerve blocks and group G received general anesthesia. Primary outcome measures included perioperative Pain Threshold Index (PTI) and Numerical Rating Scale. Secondary outcome measures comprised the following: (1) perioperative Delirium Index and Short Portable Mental Status Questionnaire; (2) perioperative Comfort Index; (3) perioperative opioid consumption (within 72 hours postoperatively); and (4) postoperative side effects (within 72 h postoperatively). RESULTS: Eighty-seven patients completed the study. Baseline PTI was comparable between the groups. However, intraoperative PTI was significantly lower in group N than in group G. Preoperative and postoperative Comfort Index scores were comparable between the groups. Moderate delirium (24 to 72 h postoperatively) was significantly higher than the baseline in group G. Early moderate delirium (24 h postoperatively) was significantly higher in group G than in group N. Severe delirium was comparable between the groups and within each group. High intraoperative PTI was associated with high opioid consumption. The intravenous sufentanil dose in group G was twice of that in group N. Incidence of nausea and vomiting was similar between the groups. DISCUSSION: Ultrasound-guided multiple nerve blockade may be an alternative to the common anesthetic procedures used for geriatric hip fracture patients. It provided satisfactory intraoperative pain management and reduced early postoperative cognitive disorders.


Assuntos
Anestésicos , Fraturas do Quadril , Bloqueio Nervoso , Idoso , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Dor Pós-Operatória , Ultrassonografia de Intervenção
8.
Artigo em Inglês | MEDLINE | ID: mdl-34723805

RESUMO

Spasticity is a common motor disorder following a variety of upper motor neuron lesions that seriously affects the quality of patient's life. We aimed to evaluate whether muscle spasms can be suppressed by blocking nerve signal conduction. A rat model of lower limb spasm was prepared and the conduction of pathological nerve signals were blocked to study the inhibitory effect of nerve signal block on muscle spasm. The experimental results showed that 4 weeks after the 9th segment of the rat's thoracic spinal cord was completely transacted, the H/M -ratio of the lower limbs increased, and rate-dependent depression was weakened. When the rat model was stimulated by external forces, the electromyography (EMG) signals of the spastic gastrocnemius muscles continued to erupt. After blocking the conduction of nerve signals in the rat sciatic nerve, the spastic EMG signal of the gastrocnemius muscle disappeared. The effective blocking time and blocking efficiency increased with increasing blocking signal amplitude, and the maximum blocking efficiency reached 73%. The experimental results of this study proved the feasibility of inhibiting lower limb spasticity by blocking nerve signal conduction.


Assuntos
Bloqueio Nervoso , Traumatismos da Medula Espinal , Animais , Eletromiografia , Espasticidade Muscular , Músculo Esquelético , Condução Nervosa , Ratos , Medula Espinal
9.
A A Pract ; 15(11): e01548, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34807870

RESUMO

The pudendal nerve (PN) block is an effective regional technique for providing analgesia to the perineum. However, when the surgical site involves dermatomal areas lateral to the PN dermatome, additional blocks are necessitated. We present a case report of a 6-year-old female who presented for surgical resection of widespread condylomata accuminata involving the perineum and buttocks. Analgesia was achieved using a combined PN and inferior cluneal nerve block. To our knowledge, this is the first report of this combined technique used for perioperative analgesia.


Assuntos
Bloqueio Nervoso , Nervo Pudendo , Nádegas , Criança , Feminino , Humanos , Dor , Períneo/cirurgia , Nervo Pudendo/cirurgia
10.
J Indian Soc Pedod Prev Dent ; 39(3): 299-302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34810348

RESUMO

Background: Pain control and proper anesthesia during pulp therapy is one of the most important aspects of behavior management in pediatric dentistry. Aims: This study compared the success rate of inferior alveolar nerve block (IANB) using 2% lidocaine and infiltration using 4% articaine for pulpotomy of mandibular primary second molars. Settings and Design: The present clinical trial was conducted on 40 children aged 5-8 referred to the Department of Pediatric Dentistry, Guilan University of Medical Sciences, who needed pulpotomy treatment in both mandibular second molars. The patients were randomly divided into two groups (A and B). Subjects and Methods: At the first session, Group A received articaine infiltration and Group B experienced IANB using lidocaine. At the next visit, this trend was reversed. Pain intensity was measured upon the initiation of the pulp exposure using a facial image scale (FIS) and the patients' behavior during pulpotomy was measured using sound eye motor (SEM). Statistical Analysis Used: Wilcoxon signed-rank test was used for the analysis of data. A significant level of differences was taken as P ≤ 0.05. Results: According to FIS, the pain upon the initiation of the pulp exposure was significantly lower in the lidocaine group (P = 0.028). Patients' behavior was also significantly better in the lidocaine group according to SEM (P = 0.028). Conclusions: IANB using lidocaine has higher anesthetic efficacy in the pulp therapy of the mandibular primary second molars compared to articaine infiltration.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Pulpite , Anestésicos Locais , Carticaína , Criança , Método Duplo-Cego , Humanos , Lidocaína , Nervo Mandibular , Dente Molar/cirurgia , Pulpotomia
11.
Anticancer Res ; 41(11): 5667-5676, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732440

RESUMO

BACKGROUND/AIM: Erector spinae plane block (ESP Block) was introduced in 2016 as a surgical post-operative analgesia procedure. The present prospective, randomized trial aimed to compare ESP Block with serratus plane block (SPB) plus pectoral nerve blocks (PECS I) during breast conserving surgery (BCS). PATIENTS AND METHODS: Between February 2019 and March 2021, 104 patients undergoing BCS were randomized to receive either ESP block (ESP group n=54) or SPB+PECS I (SPB group=49). Assessment of postoperative pain was recorded by the dynamic and static visual analog scale (VAS) and was compared between groups. RESULTS: Between-group two-way ANOVA did not reach a statistically significant difference in static and dynamic VAS (p=0.879; p=0.917, respectively). Despite ESP group requiring for higher value of patient-controlled analgesia (PCA) bolus, no statistically significant difference was found in PCA activation pattern between groups (p=0.109). ESP block was a faster technique when compared to SPB+PECS I (p=0.007) and no complications or opioid side-effects were recorded in all groups examined. CONCLUSION: ESP Block could represent a safe, faster alternative with a single injection to SPB+PECS I in BCS.


Assuntos
Músculos do Dorso/inervação , Neoplasias da Mama/cirurgia , Mastectomia Segmentar , Bloqueio Nervoso , Dor Pós-Operatória/prevenção & controle , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Itália , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
12.
Croat Med J ; 62(5): 472-479, 2021 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-34730887

RESUMO

AIM: To investigate the efficacy of intraoperative superior hypogastric plexus (SHP) block for postoperative pain relief in patients undergoing a cesarean section. METHODS: One hundred and fifteen pregnant women scheduled for an elective cesarean under general anesthesia were randomly divided into an SHP block (n=65) and a control group (n=50). SHP block was administered with bupivacaine injection. The controls received saline injection in the SHP area. Postoperative pain was assessed by the 10-cm visual analog scale (VAS). The presence of side effects and complications, including opioid or non-steroidal anti-inflammatory drugs (NSAID) requirement, gastrointestinal function, nausea, and vomiting were evaluated. RESULTS: The SHP block group had significantly lower VAS scores 2, 6, 24, and 48 hours postoperatively (P<0.001) and required a significantly lower rescue dose of NSAID or opioids (P=0.003, P<0.05, respectively). CONCLUSIONS: SHP block may be an effective and safe pain relief treatment after a cesarean section.


Assuntos
Plexo Hipogástrico , Bloqueio Nervoso , Estudos de Casos e Controles , Cesárea/efeitos adversos , Feminino , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Gravidez
13.
Saudi Med J ; 42(10): 1065-1071, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34611000

RESUMO

OBJECTIVES: To compare the efficacy of interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block with periarticular local infiltration analgesia (LIA) to assess postoperative pain control and enhanced recovery after total knee arthroplasty (TKA). METHODS: This research was carried out at King Saud University Medical City, Riyadh, Saudi Arabia, from September 2020 to March 2021. Eighty Patients scheduled for elective unilateral TKA were randomized to receive either iPACK or periarticular LIA along with adductor canal block under spinal anesthesia. The primary outcome was postoperative pain score, and secondary outcomes included physical rehabilitation, duration of surgery, length of post-anesthesia care unit stay, hemodynamics, and length of hospital stay. RESULTS: The pain score during activity in iPACK group was significantly lower compared to LIA group at 4 hours postoperatively, but no significant difference was observed at 24 or 48 hours. The timed up and go test took significantly longer for patients in LIA group at 4, 24, and 48 hours compared to those in iPACK group. No significant differences in knee range of motion were observed between the 2 groups at any point. CONCLUSION: Based on our findings, iPACK block is an effective technique in reducing pain in the immediate postoperative period without affecting motor function, resulting in enhanced recovery following primary TKA.


Assuntos
Analgesia , Artroplastia do Joelho , Bloqueio Nervoso , Humanos , Dor Pós-Operatória , Artéria Poplítea , Equilíbrio Postural , Estudos Prospectivos , Estudos de Tempo e Movimento
14.
Medicine (Baltimore) ; 100(39): e27335, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596137

RESUMO

RATIONALE: Functional abdominal pain is an intractable medical condition that often reduces quality of life. Celiac plexus block is a representative intervention for managing intractable abdominal pain. However, celiac plexus block can be technically difficult to perform and carries the risk of potential complications. During erector spinae plane block (ESPB), the injectate can enter the paravertebral space and reach the sympathetic chain. If local anesthetics spread to the sympathetic chain that supplies fibers to the splanchnic nerve, abdominal pain theoretically could be reduced. PATIENT CONCERNS: Three patients suffered from abdominal pain of unknown cause, and no medical abnormalities were found in various examinations. DIAGNOSIS: As a result of collaboration with related medical departments, the abdominal symptoms of the patients were suspected to be functional abdominal pain. INTERVENTIONS: We successfully controlled symptoms by performing ESPB at the lower thoracic level in 3 patients with functional abdominal pain. OUTCOMES: After the procedure, the patients' abdominal pain improved significantly over several months. LESSONS: We suggest that lower thoracic ESPB could be an option for management of functional abdominal pain.


Assuntos
Dor Abdominal/tratamento farmacológico , Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Músculos Paraespinais/inervação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
15.
Agri ; 33(4): 205-214, 2021 Oct.
Artigo em Turco | MEDLINE | ID: mdl-34671963

RESUMO

Epidural anesthesia and thoracic paravertebral blocks have been the mainstay of regional anesthesia for thoracic surgery for many years. Following introduction of ultrasound use during regional anesthesia practices, new blocks named interfascial plane blocks have been introduced into clinical practice. Although interfascial plane blocks fail to provide surgical anesthesia their contribution to providing analgesia is clinically important. In this review we mention the most commonly accepted blocks namely pectoral blocks, serratus anterior plane block, erector spinae plane block and rhomboid blocks.


Assuntos
Anestesia por Condução , Bloqueio Nervoso , Parede Torácica , Humanos , Dor Pós-Operatória , Ultrassonografia de Intervenção
16.
A A Pract ; 15(10): e01540, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34673657

RESUMO

Pain management options in neonates after thoracotomy have traditionally been limited to intravenous opioids and caudal catheters. However, because of increasing familiarity with ultrasound imaging, erector spinae and paravertebral nerve blocks are being performed more frequently. For thoracic procedures, we describe a case series of 4 neonates involving ropivacaine infusion via an extrathoracic chest wall catheter placed by the surgeon. This technique requires less time, is less invasive, does not require ultrasound, and enabled us to accomplish tracheal extubation in the operating room immediately after surgery, and decreased postoperative opioid use in the neonatal intensive care unit.


Assuntos
Analgesia , Bloqueio Nervoso , Cirurgia Torácica , Parede Torácica , Anestésicos Locais , Cateteres , Humanos , Recém-Nascido , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Parede Torácica/cirurgia
17.
J Coll Physicians Surg Pak ; 31(10): 1143-1147, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34601831

RESUMO

OBJECTIVES: To identify the precise position of adductor canal; and to determine median effective volume (EV50) for adductor canal block (ACB) by ultrasound. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Anesthesiology, the First Central Hospital of Baoding, China from January 2019 to December 2020. METHODOLOGY: One hundred and ninety subjects were recruited for mapping, the precise location of adductor canal. Twenty-four patients were scheduled to study the EV50 of ropivacaine. Ultrasound was used to identify the anatomical structure of femoral triangle as well as the cephalad and caudad end of adductor canal. By using the up-and-down method to study the effect of nerve block, the EV50 of 0.5% ropivacaine on ACB was quantified. RESULTS: The femoral triangle, the cephalad, and caudad end of adductor canal were clearly shown in the ultrasound images of all subjects. The midpoint between anterior superior iliac spine and the superior margin of patella is in femoral triangle. The cephalad edge of adductor canal is distal to the midpoint between anterior superior iliac spine and the superior margin of patella. The midpoint between the femoral trochanter and the superior margin of patella is in the adductor canal. EV50 of 0.5% Ropivacaine for ACB is 10.79 ml (95% CI, 10.10-11.52 ml). CONCLUSION: The midpoint between the femoral trochanter and the superior margin of patella is in the adductor canal. EV50 of 0.5% ropivacaine for ACB is 10.79 ml (95% CI, 10.10-11.52 ml). Key Words: Adductor canal, Location, Ultrasound, Median effective volume, Nerve block.


Assuntos
Artroplastia do Joelho , Bloqueio Nervoso , Anestésicos Locais , Nervo Femoral/diagnóstico por imagem , Humanos , Dor Pós-Operatória , Ropivacaina
18.
Zhonghua Yi Xue Za Zhi ; 101(37): 2993-2998, 2021 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-34638190

RESUMO

Objective: To determinate the block range of lumbar erector spinal plane (ESPB), and investigate the efficacy of ESPB in lumbar spine surgery. Methods: Forty patients who underwent posterior lumbar fusion in the Second Affiliated Hospital of Wenzhou Medical University from November 2019 to August 2020 were randomly divided into two groups (with n=20 in each group) using the random number table: the experimental group (group E) and control group (group C). All the patients received ultrasound-guided bilateral ESPB with 20 ml of 0.375% ropivacaine (group E) or equal volume of normal saline (group C) on each side before induction of general anesthesia. The range of weakened temperature sense in each patient was measured at 10 min, 20 min and 30 min after ESPB, respectively. Dosage of analgesic drug, visual analog scale (VAS), and incidence of adverse events were recorded and compared between the two groups. Results: In group E, the dermatomal distribution and area of weakened temperature sense at 10 min, 20 min, 30 min after ESPB were T9-S1 (222±16) cm2, T8-S2 (352±22) cm2, T8-S3 (481±24) cm2, respectively. The intraoperative dosage of remifentanil in group E was (0.76±0.02) mg, which was significantly lower than that of group C (0.97±0.06) mg (P<0.05). Oxycodone consumption in group E at 0-12 h and 12-24 h after surgery was (4.9±0.4) mg and (8.4±1.2) mg, respectively, which were lower than those in group C [(14.5±2.4) mg and (19.3±2.4) mg, respectively] (both P<0.05). The VAS during rest and movement within 24 h after operation in group E were significantly lower than those in group C (both P<0.05). The passive exercise in bed in group E started at (3.3±0.3) h postoperatively, which was earlier than that in group C (4.6±0.3) h (P<0.05). Conclusion: The blocking effects of T12-S1 segment after ultrasound-guided lumbar ESPB is definite, which can effectively decrease the amounts of analgesics during and after the lumbar fusion surgery, reduce postoperative rest and exercise VAS score, and contribute to a rapid recovery of the patients.


Assuntos
Bloqueio Nervoso , Humanos , Região Lombossacral , Dor Pós-Operatória , Ultrassonografia , Ultrassonografia de Intervenção
19.
Medicine (Baltimore) ; 100(43): e27621, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34713849

RESUMO

RATIONALE: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with the fatal course of muscle weakness. The published experience of anesthesia management in the cesarean section with ALS parturient is scant. PATIENT CONCERNS: A 34-year-old woman was admitted to our center complaining of obvious dysphagia together with atrophy and weakness of quadriceps at 24 weeks of her pregnancy. Cesarean was planned at 36 weeks' gestation due to the rapid deterioration of the mother. DIAGNOSES: The results of neurological examination, electromyography and spinal magnetic resonance imaging suggested ALS according to the EI Escorial World Federation of Neurology criteria. INTERVENTIONS: Ultrasound-guided transversus abdominis plane block with 0.6 minimum alveolar concentration sevoflurane was used in this ALS parturient during her cesarean section procedure. OUTCOMES: This anesthesia strategy successfully met the demands of the surgery, helped avoid prolonged ventilation and prevent maternal respiratory complications. LESSONS: Transversus abdominis plane block with subanesthetic concentrations of sevoflurane can provide effective and safe anesthesia in the cesarean section for a patient with ALS.


Assuntos
Esclerose Amiotrófica Lateral/complicações , Cesárea/métodos , Bloqueio Nervoso/métodos , Complicações na Gravidez/patologia , Músculos Abdominais/inervação , Adulto , Anestésicos Inalatórios , Feminino , Humanos , Gravidez , Sevoflurano , Ultrassonografia de Intervenção
20.
Int J Pharm ; 609: 121197, 2021 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-34666143

RESUMO

The present study aimed to optimize Needle-Free Liquid Jet Injection (NFLJI) for Mental Incisive Nerve Blocks (MINB) and evaluate its clinical safety and feasibility. A MINB protocol was developed and optimized by series of NFLJI experiments in soft tissue phantoms and cadavers, then validated in two pilot Randomized Controlled Trials (RCT). The NFLJI penetration depth was found to be directly proportional to the supply pressure and volume. High-pressure NFLJIs (620 kPa or above) created maximum force and total work significantly greater than needle injections. Low-pressure NFLJIs (413 kPa), however, produced results similar to those of needle injections. Additionally, high-pressure NFLJIs created jet impingement pressure and maximum jet penetration pressure higher than low-pressure NFLJIs. Pilot RCTs revealed that high-pressure NFLJI caused a high risk of discomfort (60%) and paresthesia (20%); meanwhile, low-pressure NFLJI was less likely to cause complications (0%). The preliminary success rates of MINB from cadavers using NFLJIs and needles were 83.3% and 87.5%. In comparison, those from RCTs are 60% and 70%, respectively. To conclude, NFLJI supply pressure can be adjusted to achieve effective MINB with minimal complications. Furthermore, the cadaver study and pilot RCTs confirmed the feasibility for further non-inferiority RCT.


Assuntos
Agulhas , Bloqueio Nervoso , Anestésicos Locais , Cadáver , Humanos , Injeções , Injeções a Jato
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