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3.
Anticancer Res ; 40(1): 253-259, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892574

RESUMO

BACKGROUND/AIM: The aim of the study was to compare the MDA (malonidialdehyde) plasma concentrations versus CAT (catalase)/NT (nitrotyrosine) plasma concentrations, patient satisfaction and pain score at rest/pressure to the wound area in laparotomy patients with rectus sheath block (RSB) analgesia. PATIENTS AND METHODS: Initially, 56 patients were randomized to four groups; control group (n=12), single-dose (n=16), repeated-dose (n=12) and continuous infusion (n=16) RSB analgesia groups. The plasma concentrations of CAT, NT and MDA markers were measured just before, immediately after and 24 h after operation. RESULTS: The RSB analgesia enhanced significantly patient satisfaction (p=0.001). The plasma MDA decreased immediately after operation (POP1) and the postoperative decrease between the preoperative and the POP1 values in the MDA marker were statistically significant (p<0.001). In linear mixed model, the time effect in both the single group and in the benign group in plasma NT biomarker was statistically significant (p=0.001, p=0.013, respectively). The median plasma MDA concentrations (ng/ml) following surgery were significantly lower in patients with cancer versus patients with benign disease (589 vs. 852, p=0.021). Jitterplots of the individual plasma NT versus plasma MDA showed that there was significant correlation in benign and cancer patients (r=0.347, p<0.001). CONCLUSION: Plasma MDA decreased significantly after operation in all patients and cancer patients had significantly lower MDA concentrations following surgery than patients with benign disease.


Assuntos
Analgesia , Laparotomia , Malondialdeído/sangue , Neoplasias/sangue , Bloqueio Nervoso , Catalase/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tirosina/análogos & derivados , Tirosina/sangue
5.
Br J Anaesth ; 124(1): 92-100, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31711605

RESUMO

BACKGROUND: Intravenous dexamethasone is thought to prolong the duration of peripheral nerve block, but the dose-response relationship remains unclear. The aim of this volunteer study was to evaluate the dose-response effect of i.v. dexamethasone on the prolongation of median nerve block. METHODS: In a double-blind, randomised controlled study, 18 volunteer subjects received two median nerve blocks separated by a washout period. One block was conducted alongside an infusion of saline and the other alongside i.v. dexamethasone 2, 4, or 8 mg. The primary outcome was time to return of normal pinprick sensation. Secondary outcomes included thermal quantitative sensory testing (QST) for the time to return of cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), area under QST curves, grip strength, and the incidence of adverse effects. RESULTS: The primary outcome, time to recovery of pinprick sensation, was similar between volunteers receiving saline or i.v. dexamethasone, regardless of dose (P=0.99). The time to recovery of QST milestones was similar between groups, although area under QST curves indicated prolongation of CDT (0 vs 8 mg, P=0.002) and WDT (0 vs 2 mg, P=0.008; 0 vs 4 mg, P=0.001; 0 vs 8 mg, P<0.001). There was no difference in motor recovery or adverse effects. CONCLUSIONS: Intravenous dexamethasone failed to significantly prolong the duration of pinprick anaesthesia regardless of dose. However, area under QST curve analysis indicated a dose-independent prolongation of CDT and WDT, the clinical significance of which is unclear. CLINICAL TRIAL REGISTRATION: NCT02864602 (clinicaltrials.gov).


Assuntos
Adjuvantes Anestésicos , Dexametasona , Bloqueio Nervoso/métodos , Nervos Periféricos , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/efeitos adversos , Administração Intravenosa , Adulto , Estudos Cross-Over , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Força da Mão , Voluntários Saudáveis , Humanos , Masculino , Nervo Mediano , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Limiar da Dor/efeitos dos fármacos , Sensação/efeitos dos fármacos , Sensação Térmica/efeitos dos fármacos , Adulto Jovem
6.
Br J Anaesth ; 124(1): 84-91, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31591018

RESUMO

BACKGROUND: Efforts to prolong interscalene block (ISB) analgesia include the use of local anaesthetic adjuvants such as dexamethasone. Previous work showing prolonged block duration suggests that both perineural and intravenous (i.v.) routes can both prolong analgesia. The superiority of either route is controversial given the design of previous studies. As perineural dexamethasone is an off-label use, anaesthesiologists should be fully informed of the clinical differences, if any, on block duration. This study was designed to test whether perineural vs i.v. dexamethasone administration are equivalent. METHODS: We randomised 182 eligible patients scheduled for arthroscopic shoulder surgery to receive low-dose ISB (0.5% ropivacaine 5 ml) with perineural or i.v. dexamethasone 4 mg. Subjects, anaesthesiologists, and research personnel were blinded. All subjects also received a standardised general anaesthetic and multimodal analgesia. The primary outcome was duration of analgesia analysed as an equivalence outcome (2 h equivalency margin) using the two one-sided test (TOST) method. RESULTS: For the primary outcome, duration of analgesia, and perineural and i.v. administration of dexamethasone were not equivalent. The upper and lower bounds of the 90% confidence interval were 1 h (P=0.12) and -2.5 h (P=0.01), respectively. The observed difference in mean block duration was not clinically relevant (0.75 h longer for i.v. dexamethasone). There were no other clinically significant differences between groups. CONCLUSION: In the context of low-volume ISB with ropivacaine, perineural and i.v. dexamethasone were not equivalent in terms of their effects on block duration. However, there were no clinically significant differences in outcomes, and there is no advantage of perineural over intravenous dexamethasone. WWW.CLINICALTRIALS. GOV REGISTRATION: NCT02322242.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/farmacologia , Bloqueio do Plexo Braquial/métodos , Plexo Braquial , Dexametasona/administração & dosagem , Dexametasona/farmacologia , Bloqueio Nervoso/métodos , Administração Intravenosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia/métodos , Método Duplo-Cego , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Ombro/cirurgia , Adulto Jovem
8.
Int Endod J ; 53(2): 145-153, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31306506

RESUMO

AIM: To investigate the effect of magnesium sulphate used as an adjuvant to lidocaine with epinephrine local anaesthetic on the success of inferior alveolar nerve blocks (IANB) in patients with symptoms of irreversible pulpitis undergoing root canal treatment. METHODOLOGY: In a double-blind clinical trial, following power calculation, 124 patients with symptoms of irreversible pulpitis in mandibular molar teeth were selected, and initial pain data were collected using a Heft-Parker (Pain, 19, 1984 and 153) visual analogue scale. The first group (control) received IANB with 1.8 mL of a local anaesthetic solution containing 1.8% lidocaine with 1 : 88 000 epinephrine while the second group (test) received IANB with 1.8 mL of an anaesthetic solution containing 1% magnesium sulphate, and 1.8% lidocaine with 1 : 88 000 epinephrine. Pain data were collected after access cavity and penetration of files in the canals using a Heft-Parker visual analogue scale. Two patients were not included in the study as they did not consent, and a further 54 patients were excluded as they did not report lip numbness within 15 min after IANB administration; thus, the data presented in this study are related to 68 patients. The data were analysed using chi-square and t-test (α = 0.05). RESULTS: The success of pulpal anaesthesia with IANB was 82% for the magnesium sulphate group and 53% for the control group. There was a significant difference in the effectiveness of the IANB between the two groups (P < 0.001). There was no significant difference between the magnesium sulphate and control groups regarding gender (P = 0.598) or age (P = 0.208) or initial pain scores (P = 0.431). CONCLUSIONS: The addition of 1% magnesium sulphate to 1.8% lidocaine with 1 : 88 000 epinephrine resulted in a positive impact for the success of IANB in patients with a diagnosis of irreversible pulpitis related to mandibular molar teeth undergoing root canal treatment. Thus magnesium sulphate may be used as adjuvant for achieving profound pulpal anaesthesia in challenging cases. However, more studies with larger sample size and different concentration doses must be carried out to establish an appropriate conclusion before its routine clinical use.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Pulpite , Anestésicos Locais , Método Duplo-Cego , Humanos , Lidocaína , Sulfato de Magnésio , Nervo Mandibular , Estudos Prospectivos
9.
Anaesthesia ; 75(1): 72-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506918

RESUMO

Technology that facilitates performance of deep peripheral nerve blocks is of clinical interest. The Onvision™ is a new device for ultrasonographic needle tip tracking that incorporates an ultrasound sensor on the needle tip that is then represented by a green circle on the ultrasound screen. The primary aim of this study was to investigate the effect of needle tip tracking on procedural time in the first human volunteer study. Secondary outcome measures included: number of hand movements; hand movement path length; block success rate; block onset time; block duration; discomfort experienced by the volunteers; and the anaesthetists' confidence as to whether their block would be successful. Two anaesthetists performed ultrasound-guided lumbar plexus blocks with an out-of-plane technique, with and without the use of needle tip tracking. In total, data from 25 volunteers were studied. Mean (SD) procedural time was 163 (103) s with needle tip tracking and 216 (117) s without (p = 0.10). Hand motion analysis showed that needle tip tracking was associated with a significant decrease in the mean (SD) number of intended needling hand movements (39 (29) vs. 59 (36); p = 0.03) and path lengths (3.2 (3.1) m vs. 5.5 (4.5) m; p = 0.03). No differences were found for any other secondary outcomes. The use of Onvision needle tip tracking did not reduce procedural time for out-of-plane ultrasound-guided lumbar plexus block but did reduce the number of hand movements and path lengths. This may indicate improved needle control but further studies are needed to confirm this finding.


Assuntos
Anestésicos Locais/administração & dosagem , Agulhas , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Estudos Cross-Over , Feminino , Humanos , Plexo Lombossacral , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Anaesthesia ; 75(1): 80-88, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506921

RESUMO

Visibility of the needle tip is difficult to maintain during ultrasound-guided nerve block. A new needle has been developed that incorporates a piezo element 2-2.3 mm from the tip, activated by ultrasound. The electrical signal manifests as a coloured circle surrounding the needle tip, and allows real-time tracking. We hypothesised that novice regional anaesthetists would perform nerve block better with the tracker turned on rather than off. Our primary objective was to evaluate the new needle by measuring the performance of novice anaesthetists conducting simulated sciatic block on the soft embalmed Thiel cadaver. Training consisted of a lecture, scanning in volunteers and practice on cadavers. Testing entailed scanning the sciatic nerve of a cadaver and conducting 20 in-plane sciatic blocks in the mid-to-upper thigh region. Subjects were randomised equally, in groups of five, according to the sequence: tracker on/off/on/off; or tracker off/on/off/on. Video recordings were assessed by six raters for steps performed correctly and errors committed. Eight subjects were recruited and 160 videos were analysed. Using the tracking needle, five correct steps improved and one error reduced. The benefits included: better identification of the needle tip before advancing the needle, OR (95%CI) 3.4 (1.6-7.7; p < 0.001); better alignment of the needle to the transducer, 3.1 (1.3-8.7; p = 0.009); and better visibility of the needle tip 3.0 (1.4-7.3; p = 0.005). In conclusion, use of the tracker needle improved the sciatic block performance of novices on the soft embalmed cadaver.


Assuntos
Anestesia por Condução/instrumentação , Agulhas , Bloqueio Nervoso/instrumentação , Nervo Isquiático , Ultrassonografia de Intervenção/métodos , Anestesia por Condução/métodos , Cadáver , Humanos , Bloqueio Nervoso/métodos
11.
Anaesthesia ; 75(1): 89-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31523801

RESUMO

Quadratus lumborum block has been shown to provide satisfactory analgesia after caesarean section performed under neuraxial anaesthesia. However, its efficacy has not been demonstrated in patients who have received intrathecal morphine. The aim of this study was to assess the efficacy of quadratus lumborum block as part of a multimodal analgesic regimen including intrathecal morphine. This was a prospective, double-blind, placebo-controlled trial. Participants were randomly allocated to receive bilateral quadratus lumborum block (40 ml levobupivacaine 0.25%) or sham block (control) after undergoing elective caesarean section under spinal anaesthesia. The primary outcome was 24-h morphine consumption measured by patient-controlled analgesia. Secondary outcomes included pain scores and quality of recovery. Data from 86 women were analysed. Median (IQR [range]) 24-h morphine consumption was similar in patients receiving quadratus lumborum block and sham block (12 (8-29 [0-68]) mg vs. 14 (5-25 [0-90]) mg, respectively; p = 0.986). There was a reduction in median (IQR [range]) visual analogue scale pain scores at 6 h with quadratus lumborum block compared with sham block both at rest (6 (0-14 [0-98]) mm vs. 14 (3-23 [0-64]) mm (p = 0.019); and on movement: 23 (10-51 [0-99]) mm vs. 44 (27-61 [2-94]) mm; (p = 0.014)). There was no difference in pain scores at any other time-point up to 48 h. When used in conjunction with intrathecal morphine and spinal anaesthesia, bilateral quadratus lumborum block does not reduce 24-h morphine consumption after caesarean section.


Assuntos
Anestésicos Locais/administração & dosagem , Cesárea , Levobupivacaína/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Método Duplo-Cego , Feminino , Humanos , Gravidez , Estudos Prospectivos , Resultado do Tratamento
15.
Rev Med Liege ; 74(12): 662-666, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31833277

RESUMO

For about twenty years, peripheral nervous blocks have become the gold standard in postoperative analgesia for knee and foot surgery. The development of echography adapted to anesthesia gave anesthesiologists the opportunity to perform distal, mostly sensitive nerve blocks. Proximal nervous blocks associated analgesia used to be better than general (intravenous or oral) analgesia. Most of all it was associated with fewer side effects (nauseas, vomiting, drowsiness…). They reached an analgesia level comparable to central nerve blocks (epidural) with also fewer side effects (hypotension, bradycardia, lateralization...). A main problem with those blocks was that they involved motor blockade, impeding fast revalidation and walking restart. Distal nerve blocks, without motor blockade, offer as efficient analgesia as produced by proximal nerve blocks, without impeding motricity. Using those new techniques, it is now possible, with optimal analgesia, to allow almost immediate walking after a total knee replacement, and to perform most surgical foot operations in a one-day procedure.


Assuntos
Analgesia , Artroplastia do Joelho , Bloqueio Nervoso , Humanos , Extremidade Inferior , Dor Pós-Operatória
16.
Anticancer Res ; 39(12): 6751-6757, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810940

RESUMO

BACKGROUND/AIM: Our original hypothesis was that the rectus sheath block (RSB) analgesia could enhance patient satisfaction and decrease pain following midline laparotomy. PATIENTS AND METHODS: Initially, 56 patients were randomized into four groups; control group (n=12), single-dose (n=16), repeated-dose (n=12) and continuous infusion (n=16) RSB analgesia groups. The BPI (Brief Pain Inventory) survey was conducted preoperatively and at one and four weeks and 12 months postoperatively. The patients pain 24 h postoperatively and satisfaction 48 h postoperatively was filled on an 11-point numeric rating scale (NRS). RESULTS: The repeated-dose group had lower BPI severity score (p=0.045) and BPI interference score (p=0.043) mean values postoperatively compared to the three other groups separately. Also, the time effect on the linear mixed model in BPI interference score mean values was statistically significant (p=0.008), which means that in the repeated dose group preoperative BPI severity score [2.7 (3.9)] and interference score [4.3 (4.2)] mean (SD) values were significantly higher than the BPI severity score [1.3 (0.8)] and interference score [1.5 (1.8)] mean (SD) values following surgery. CONCLUSION: The higher elevation in BPI severity score and decrease in interference score values in the repeated dose group and also the time effect in a linear mixed model in BPI interference score were statistically significant.


Assuntos
Laparotomia/efeitos adversos , Bloqueio Nervoso/métodos , Medição da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Atividades Cotidianas , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Laparotomia/métodos , Satisfação do Paciente , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Reto do Abdome/inervação , Índice de Gravidade de Doença
17.
Indian J Dent Res ; 30(5): 692-696, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31854358

RESUMO

Introduction: Despite the enhancing effects of hyaluronidase (HYAL) over duration of anesthesia, this enzyme could cause adverse effects when injected concomitantly with local anesthetics in dental blocks. Objective: This study aimed to assess the tissue alterations caused by a local anesthetic protocol consisting of a late HYAL injection and confirm its functional effectiveness. Materials and Methods: The protocol efficacy was proved by evaluating sensory and motor functions in rats. The sciatic nerve was blocked with 2% lidocaine (LID) with epinephrine (n = 25). Thirty minutes later, 75 TRU/ml HYAL was injected into the same site (experimental group, LID/HYAL). One week later, this protocol was repeated in the contralateral hindlimb, injecting only HYAL's vehicle (control group, LID/vehicle [LID/V]). To observe the integrity of the local tissues, histological specimens were obtained 1, 24, 48, and 72 h after treatment with LID/HYAL or LID/V (n = 16 each) and stained with hematoxylin/eosin and picrosirius red. Results: Local inflammation was similar in both groups. The integrity of the nerve fibers was preserved, in spite of some inflammation-associated injuries in the surrounding tissues. The reversible tissue disorganization caused by HYAL, probably facilitated the diffusion of the residual anesthetic to the nerve, resulting in a prolonged anesthetic effect (P < 0.05). Conclusions: No irreversible morphological alterations are caused by the administration of HYAL prior the end of the LID-induced block. Moreover, this protocol prolongs LID's anesthetic effect.


Assuntos
Anestesia Local , Bloqueio Nervoso , Animais , Hialuronoglucosaminidase , Lidocaína , Ratos , Nervo Isquiático
18.
Medicine (Baltimore) ; 98(50): e18356, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852139

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is accompanied by moderate to severe postoperative pain. Multimodal analgesia, such as femoral nerve block, periarticular infiltration analgesia (PIA), and patient-controlled intravenous analgesia, have been used for postoperative analgesia. Recently, randomized controlled trials have compared the efficacy of the adductor canal block (ACB) and the PIA in patients undergoing TKA. However, there is no definite answer as to the efficacy and safety of the ACB compared with the PIA. METHOD: Randomized controlled trials about relevant studies were searched from PubMed (1996 to May 2019), Embase (1980 to May 2019), and Cochrane Library (CENTRAL, May 2019). Five studies which compared the ACB with the PIA methods were included in our meta-analysis. RESULTS: Five studies containing 413 patients met the inclusion criteria. There were no significant differences between the ACB and the PIA group in visual analog scale (VAS) score at rest (P = .14) and movement (P = .18), quadriceps muscle strength (P = .95), complications (P = .78), length of stay (LOS) (P = .54), and time up and go (TUG) test (P = .09), While patients in the ACB group had less equivalent morphine consumption (P < .05) compared with the PIA group. CONCLUSIONS: Our pooled data indicated the ACB group reduced the equivalent morphine consumption compared with the PIA group, with no statistically significant differences in the VAS score, quadriceps muscle strength, TUG test, complications, and LOS.


Assuntos
Analgesia/métodos , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Anestesia por Condução/métodos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Força Muscular/efeitos dos fármacos , Dor Pós-Operatória/etiologia , Músculo Quadríceps/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Coxa da Perna , Resultado do Tratamento
19.
Wiad Lek ; 72(11 cz 1): 2108-2112, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860856

RESUMO

OBJECTIVE: Introduction: The recent recommendations have luck of information about regional anesthesia as one of the ERAS key component within the structure of multimodal analgesia in obese patients .The Ultrasound- guided Transversus abdominis plane blockade (USG- TAP-blockade) is a new regional anesthetic technique to reduce peri-operative pain for many abdominal surgeries. The aim of this study is to assess the efficiency of analgetic action of USG- TAP-blockade in morbid obese (MO) patients undergoing laparoscopic surgery (LS). PATIENTS AND METHODS: Materials and methods: 90 MO patients were assigned to one of two equal groups; The first group (n1=45) included patients who underwent LS surgery in the lower abdomen and in the pelvis, second group (n2=45) included patients, who underwent LS surgery in the upper and middle part of the abdominal cavity. All patients had bilateral USG- TAPblockade with systemic analgesia .The primary efficacy end point- reduction of the intraoperative dose of opioids, the need for rescue analgesia in the first 6 postoperative hours. RESULTS: Results: The fentanyl intravenous dose in n1=55 was considerably decreased : 1.34 ±0.15 µg / kg /h vs 2.2±0.18 µg / kg /h in second group , (р=0.032). The pain level by VAS in patients in both groups, in average, did not exceed 4 points within the first post-operative day, and there was no need in life-saving analgesia with narcotic analgetics. CONCLUSION: Conclusion: The USG- TAP-blockade has analgetic and opioid-sparing advantages in MO patients undergoing laparoscopic surgery in the lower abdomen and in the pelvis and may be a part of the efficient multimodal analgesia within ERAS in that patient's group.


Assuntos
Laparoscopia , Bloqueio Nervoso , Obesidade Mórbida , Músculos Abdominais , Analgésicos Opioides , Humanos , Dor Pós-Operatória
20.
Medicine (Baltimore) ; 98(52): e18448, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876726

RESUMO

BACKGROUND: This study aimed to compare the quadratus lumborum block (QLB) method with transversus abdominis plane block (TAPB) for postoperative pain management in patients undergoing laparoscopic colorectal surgery. METHODS: Seventy-four patients scheduled for laparoscopic colorectal surgery were randomly assigned into 2 groups. After surgery, patients received bilateral ultrasound-guided single-dose of QLB or TAPB. Each side was administered with 20 ml of 0.375% ropivacaine. All patients received sufentanil as patient-controlled intravenous analgesia (PCIA). Resting and moving numeric rating scale (NRS) were assessed at 2, 4, 6, 24, 48 hours postoperatively. The primary outcome measure was sufentanil consumption at predetermined time intervals after surgery. RESULTS: Patients in the QLB group used significantly less sufentanil than TAPB group at 24 and 48 hours (P < .05), but not at 6 hours (P = .33) after laparoscopic colorectal surgery. No significant differences in NRS results were found between the two groups at rest or during movement (P > .05). Incidence of dizziness in the QLB group was lower than in TAPB group (P < .05). CONCLUSIONS: The QLB is a more effective postoperative analgesia as it reduces sufentanil consumption compared to TAPB in patients undergoing laparoscopic colorectal surgery.


Assuntos
Músculos Abdominais/inervação , Músculos Abdominais Oblíquos/inervação , Cirurgia Colorretal/métodos , Laparoscopia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Anestésicos Locais/administração & dosagem , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Ropivacaina/administração & dosagem , Sufentanil/administração & dosagem , Ultrassonografia de Intervenção
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