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1.
Medicine (Baltimore) ; 100(12): e25201, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761704

RESUMO

BACKGROUND: None of review has been conducted to compare the efficacy of interscalene blockade (ISB) with that of local infiltration analgesia (LIA) in patients undergoing total shoulder arthroplasty (TSA). We thus conduct a high-quality meta-analysis of randomized controlled trials (RCTs) to investigate which analgesic provides better pain relief. METHODS: A comprehensive search of the published literature in PUBMED, Scopus, EMBASE, and Cochrane Library databases will be performed. Only RCTs evaluating LIA versus ISB in TSA are included in this study. The primary outcome was pain score. Secondary outcome measures included opioid consumption, postoperative adverse event, and length of stay. The Cochrane risk of bias tool is used to evaluate the risk of bias of included RCTs by 2 independent reviewers. RESULTS: The results of this research will be delivered in a peer-reviewed journal. CONCLUSIONS: This study expects to provide credible and scientific evidence for the efficacy and safety of ISB and LIA for early postoperative pain control after TSA. SYSTEMATIC REVIEW REGISTRATION NUMBER: 10.17605/OSF.IO/S3MBP. ETHICAL APPROVAL: Since this study is on the basis of published or registered RCTs, ethical approval and informed consent of patients are not required.


Assuntos
Anestésicos Locais/administração & dosagem , Artroplastia do Ombro/efeitos adversos , Metanálise como Assunto , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Revisões Sistemáticas como Assunto , Plexo Braquial , Humanos , Músculo Esquelético , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
2.
Anesth Analg ; 132(4): 1138-1145, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33617181

RESUMO

BACKGROUND: Epidural block are often used for analgesia after open nephrectomy surgery. Subcostal anterior quadratus lumborum block may be an alternative. We therefore tested the hypothesis that the continuous subcostal anterior quadratus lumborum block is noninferior to epidural block for analgesia in patients having open partial nephrectomies. METHODS: Adults having open partial nephrectomies were randomly allocated to epidural or unilateral subcostal anterior quadratus lumborum block. The joint primary outcomes were opioid consumption measured in morphine equivalents and pain measured on a numeric rating scale (0-10) from postanesthesia care unit (PACU) until 72 hours after surgery. The noninferiority deltas were 30% for opioid consumption and 1 point on a 0-10 scale for pain. Secondary outcomes included patient global assessment of pain management on the third postoperative day, the number of antiemetic medication doses through the third postoperative day, duration of PACU stay, and postoperative duration of hospitalization. RESULTS: Twenty-six patients were randomized to anterior quadratus lumborum block and 29 to epidural analgesia. Neither pain scores nor opioid consumption in the quadratus lumborum patients were noninferior to epidural analgesia. At 72 hours, mean ± standard deviation pain scores in subcoastal anterior quadratus lumborum block and epidural group were 4.7 ± 1.8 and 4.1 ± 1.7, with an estimated difference in pain scores of 0.62 (95% confidence interval [CI], 0.74-1.99; noninferiority P = .21). The median [Q1, Q3] opioid consumption was more than doubled in quadratus lumborum patients at 70 mg [43, 125] versus 30 mg [18, 75] in the epidural group with an estimated ratio of geometric means of 1.69 (95% CI, 0.66-4.33; noninferiority P = .80). Patient global assessment and duration of PACU and hospital stays did not differ significantly in the 2 groups. CONCLUSIONS: We were unable to show that subcostal anterior quadratus lumborum block are noninferior to epidural analgesia in terms of pain scores and opioid consumption for open partial nephrectomies. Effectiveness of novel blocks should be rigorously tested in specific surgical setting before widespread adoption.


Assuntos
Analgesia Epidural , Nefrectomia , Bloqueio Nervoso , Dor Pós-Operatória/prevenção & controle , Idoso , Analgesia Epidural/efeitos adversos , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Ohio , Medição da Dor , Limiar da Dor/efeitos dos fármacos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(7): e24786, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607831

RESUMO

INTRODUCTION: Routine anesthesia modality for modified radical mastectomy (MRM) includes general anesthesia (GA), epidural blockade-combined GA and nerve blockade-combined GA. However, GA has been associated with postoperative adverse effects such as vertigo, postoperative nausea and vomiting and requirement for postoperative analgesia, which hinders recovery and prognosis. Moreover, combined blockade of thoracic paravertebral nerves or intercostal nerves and adjuvant basic sedation for massive lumpectomy provided perfect anesthesia and reduced opioid consumption, whereas the excision coverage did not attain the target of MRM. Regional anesthesia strategies involving supplementation of analgesics in ultrasound-guided multiple nerve blocks have garnered interests of clinicians. Nevertheless, the precise effects of intercostal nerves, brachial plexus and supraclavicular nerves in MRM in patients with breast cancer remain obscure. METHODS: Eighty female patients with breast cancer scheduled for MRM were recruited in the present trial between May, 2019 and Dec., 2019 in our hospital. The patients ranged from 30 to 65 years of age and 18∼30 kg/m2 in body-mass index, with the American Society of Anesthesiologists I or II. The patients were randomized to ultrasound-guided multiple nerve blocks group and GA group. The patients in multiple nerve blocks group underwent ultrasound guided multiple intercostal nerve blocks, interscalene brachial plexus and supraclavicular nerve blocks, (local anesthesia with 0.3% ropivacaine: 5 ml for each intercostal nerve block, 8 ml for brachial plexus block, 7 mL for supraclavicular nerve block) and basic sedation and intraoperative mask oxygen inhalation. The variations of hemodynamic parameters such as mean arterial pressure, heart rate (HR) and pulse oxygen saturation were monitored. The visual analog scale scores were recorded at postoperative 0 hour, 3 hour, 6 hour, 12 hour and 24 hour in resting state. The postoperative adverse effects, including vertigo, postoperative nausea, and vomiting, pruritus, and urinary retention and so on, as well as the analgesic consumption were recorded. CONCLUSIONS: The ultrasound guided multiple intercostal nerve blocks, brachial plexus and supraclavicular nerve blocks could provide favorable anesthesia and analgesia, with noninferiority to GA and the reduced incidence of adverse effects and consumption of postoperative analgesics.


Assuntos
Neoplasias da Mama/cirurgia , Sedação Consciente/métodos , Mastectomia Radical Modificada/métodos , Bloqueio Nervoso/métodos , Anestesia Geral/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/prevenção & controle , Ultrassonografia de Intervenção/métodos
4.
Anaesthesia ; 76 Suppl 1: 27-39, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33426662

RESUMO

Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non-anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at-risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.


Assuntos
Anestesia por Condução/efeitos adversos , Anestésicos Locais/efeitos adversos , Anestésicos Locais/toxicidade , Humanos , Complicações Intraoperatórias/induzido quimicamente , Complicações Intraoperatórias/terapia , Bloqueio Nervoso/efeitos adversos , Segurança do Paciente
5.
Anaesth Intensive Care ; 49(1): 70-73, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33504168

RESUMO

This case report describes a patient who developed allergic contact dermatitis to a chlorhexidine skin preparation applied for a transversus abdominis plane block, but not to a different chlorhexidine solution applied to the surgical field. The patient had presented for an elective inguinal hernia repair. He had a known history of anaphylaxis to non-steroidal anti-inflammatory medication but was otherwise well. The surgery was completed uneventfully. Three or four days postoperatively, the patient developed a rash at the site where chlorhexidine skin preparation had been used to prepare the skin for the transversus abdominis plane block. The rash had well-demarcated edges and exactly matched the distribution of the previously applied skin preparation. No rash was present at the surgical site, which had been prepared with a different chlorhexidine-containing solution. The rash gradually resolved over several weeks with the application of topical corticosteroids. The patient was otherwise completely well with no evidence of infection or any other systemic illness. The skin preparations differed in the dyes and alcohols that they contained. The dyes or alcohol in the preparation for the transversus abdominis plane block were therefore considered the likely cause of this patient's allergic reaction. Dyes and alcohols should be considered as a cause of skin allergy in the perioperative setting.


Assuntos
Dermatite Alérgica de Contato , Bloqueio Nervoso , Clorexidina/efeitos adversos , Corantes , Dermatite Alérgica de Contato/etiologia , Etanol , Humanos , Masculino , Bloqueio Nervoso/efeitos adversos
7.
Anesth Analg ; 132(2): 556-565, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33323786

RESUMO

BACKGROUND: Nerve damage can occur after peripheral nerve block (PNB). Ultrasound guidance does not eliminate the risk of intraneural injection or nerve injury. Combining nerve stimulation and injection pressure (IP) monitoring with ultrasound guidance has been suggested to optimize needle tip location in PNB. In this prospective observational study, we hypothesized that measured pairs of IP and minimum intensity of stimulation (MIS) might differentiate successive needle tip locations established by high-resolution ultrasound during PNB. METHODS: For this exploratory study, 240 observations for 40 ultrasound-guided PNBs were studied in 28 patients scheduled for orthopedic surgery. During the progression of the needle to the nerve observed by ultrasonography, the IP was measured continuously using a computerized pressure-sensing device with a low flow rate of solution. Stimulation thresholds and electrical impedance were obtained by an impedance analyzer coupled to the nerve stimulator at 6 successive needle positions. The median (quartile) or mean (95% confidence interval [CI]) was reported. A mixed model analysis was used, and the sample was also explored using a classification and regression tree (CART) algorithm. RESULTS: Specific combinations of IP and MIS were measured for subcutaneous, epimysium contact, intramuscular, nerve contact (231 mm Hg [203-259 mm Hg] and 1.70 mA [1.38-2.02 mA]), intraneural location (188 mm Hg [152-224 mm Hg] and 0.58 mA [0.46-0.70 mA]), and subparaneural location (47 mm Hg [41-53 mm Hg] and 1.35 mA [1.09-1.61 mA]). The CART algorithm shows that the optimal subparaneural needle tip position might be defined by the lowest pressure (<81.3 mm Hg) and MIS (<1.5 mA) cutoffs. CONCLUSIONS: Our exploratory study evaluated concepts to generate hypotheses. The combinations of IP and MIS might help the physician during a PNB procedure. A low IP and low MIS might confirm a subparaneural location, and a high IP and a low MIS might be an alert for the intraneural location of the needle tip.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio Nervoso , Nervos Periféricos/diagnóstico por imagem , Ultrassonografia de Intervenção , Anestésicos Locais/efeitos adversos , Estimulação Elétrica , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Agulhas , Bloqueio Nervoso/efeitos adversos , Procedimentos Ortopédicos , Pressão , Estudos Prospectivos , Transdutores de Pressão
10.
Niger J Clin Pract ; 23(11): 1523-1529, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33221776

RESUMO

Background: Acute postoperative pain after myomectomy can impair patient function. Like all other postoperative pain, it is a challenge requiring solution, particularly in developing countries. Ultrasound-guided transversus abdominis plane (TAP) block and wound infiltration (WI) are both known to be effective in managing postoperative pain. It is not certain if transversus abdominis plain block would be superior to wound infiltration. Aims: It was hypothesized that the TAP block has similar analgesic effectiveness to wound infiltration. Subjects and Methods: This study was a randomized controlled trial involving, seventy-four (74) patients scheduled for myomectomy at the University of Benin Teaching Hospital Benin City, Nigeria under the subarachnoid block, which were randomized into TAP and WI group preoperatively. The ultrasound-guided bilateral TAP block group and wound infiltration group (subfascial and subcutaneous infiltration) each used 40 mL of 0.25% of plain bupivacaine to achieve postoperative analgesia. The time to first analgesic request, numerical pain rating scale (NRS) score at rest, and movement were assessed. Data were analyzed using SPSS version 16 (Chicago Il, USA). Results: The time to first analgesic request was significantly delayed in the TAP block group compared to the wound infiltration group [240 (131, 375) min vs 170 (128, 187) minutes. P = 0.006]. The proportions of patients with NRS score ≤3 at the time of first analgesic requests were significantly more in the TAP block group (P < 0.001). The analgesic consumed by the TAP block group was significantly low compared to the WI group. There were no incidences of complications due to TAP block or wound infiltration. Conclusion: TAP block provided a longer duration of analgesia and a clinically superior quality of analgesia to wound infiltration.


Assuntos
Analgesia/métodos , Bupivacaína/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Ultrassonografia de Intervenção , Miomectomia Uterina/efeitos adversos , Músculos Abdominais/diagnóstico por imagem , Músculos Abdominais/inervação , Adulto , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Nigéria , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/etiologia , Resultado do Tratamento , Ultrassonografia/efeitos adversos , Adulto Jovem
11.
Curr Opin Anaesthesiol ; 33(6): 760-767, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33027077

RESUMO

PURPOSE OF REVIEW: Despite peripheral nerve blockade offering analgesic benefits and improving patient satisfaction, it has not been well adopted in ambulatory anesthesia. In this review, we aim to summarize the evidence underlying peripheral nerve blockade, local anesthetic adjuncts, continuous peripheral nerve blockade and novel analgesic modalities, with the objective to provide recommendations on postoperative analgesia optimization after peripheral nerve blockade in an ambulatory setting. RECENT FINDINGS: Barriers to the widespread use of peripheral nerve blockade in ambulatory anesthesia could include lack of education and training, and increased anesthetic induction time. Strategies that have demonstrated promise to increase duration of action and attenuate rebound pain phenomenon after peripheral nerve blockade include multimodal analgesia, local anesthetic adjuncts and continuous infusion of local anesthetic. Dexamethasone has been demonstrated to be the most effective local anesthetic adjunct. Continuous peripheral nerve blockade is a reasonable alternative but at the expense of additional costs and logistical reorganization. There is currently insufficient data to promote the ambulatory use of liposomal bupivacaine, cryoanalgesia and percutaneous peripheral nerve stimulation. SUMMARY: Educational programs and parallel processing may promote peripheral nerve blockade in an ambulatory setting, improving the patient experience in the postoperative period. Intravenous dexamethasone should be considered wherever appropriate as part of a multimodal analgesic strategy to optimize postoperative pain control.


Assuntos
Analgésicos/administração & dosagem , Anestesia por Condução , Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Humanos , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico
12.
Orthop Clin North Am ; 51(4): 527-532, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950222

RESUMO

Pulmonary comorbidities and ASA physical status class III and IV can significantly increase the rate of major complications after ISC placement. Patients with an underlying pulmonary comorbidity or lung disease (chronic obstructive pulmonary disease, asthma, or obstructive sleep apnea) have a 2.2-fold increased risk of having any complication and a 2.4-fold increased risk of having a major pulmonary complication compared to those without pulmonary comorbidities. Patients with pulmonary comorbidities may benefit from alternative pain management strategies to avoid complications in the early postoperative period.


Assuntos
Artroplastia do Ombro/efeitos adversos , Pneumopatias Obstrutivas/complicações , Bloqueio Nervoso/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cateteres de Demora/efeitos adversos , Humanos , Bloqueio Nervoso/instrumentação , Nervo Frênico , Complicações Pós-Operatórias/prevenção & controle
13.
Pain Physician ; 23(4S): S305-S310, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942790

RESUMO

BACKGROUND: A primary concern in the use of EBP in these patients is the possibility of seeding the virus in the CNS. Another important concern is related to the known hypercoagulable state in COVID-19 positive patients and associated organ dysfunction that may alter the metabolism of anticoagulants. The safety of the providers performing the EBP, the position of the patient and choices for image guidance (blind, fluoroscopic) are also key considerations to review. It is also important to explore the current state of knowledge about using allogenic instead of autologous blood as well as emerging techniques to eliminate the coronavirus from the blood. OBJECTIVES: In this article we pose the questions of how to manage PDPH in the COVID-19 positive patient and more specifically, the use of epidural blood patch (EBP). METHODS: Literature review. RESULTS: EBP is usually considered after the failure of conservative and pharmacological treatments. Because of the additional risks of EBP in COVID-19 patients it is important to also consider less traditional pharmacological treatments such as theophylinnes and cosyntropin that may offer some additional benefit for COVID-19 patient. Finally, other interventions other than EBP should also be considered including occipital nerve blocks, sphenopalatine ganglion blocks (infratemporal or transnasal). LIMITATIONS: A narrative review with paucity of literature. CONCLUSION: Going forward, an effective treatment for COVID-19 or a safe vaccine and a deeper understanding of the pathophysiology of the virus will certainly change the risk calculus involved in performing an EBP in a COVID-19 patient.


Assuntos
Placa de Sangue Epidural/métodos , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Cefaleia Pós-Punção Dural/terapia , Punção Espinal/efeitos adversos , Adulto , Betacoronavirus , Tratamento Conservador/métodos , Feminino , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Pandemias , Resultado do Tratamento
14.
Medicine (Baltimore) ; 99(37): e21956, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925729

RESUMO

BACKGROUND: Several studies reported short-term analgesic efficacy of obturator nerve block (ONB), as in comparison with the femoral nerve block (FNB) in the treatment of postoperative pain after the total knee replacement (TKR). The optimal method remains under debate. The purpose of our current work is to compare the safety and efficacy of FNB and ONB for postoperative analgesia after TKR. METHODS: This prospective, randomized, and controlled study was performed from January 2018 to December 2019. It was authorized via the Institutional Review Committee in NO.971 Hospital of the People's Liberation Army Navy (2019-PLAN-132).Two hundred patients were divided randomly into 2 groups, the control group (n = 100) and study group (n = 100). The experimental group received FNB and control groups received ONB. Primary outcome included pain at different time point (Visual Analogue Scale score of anterior knee pain at rest and in motion). The Visual Analogue Scale scores were marked by patients themselves on a paper with a graduated line starting at 0 (no pain) and ending at 10 (the most painful). Opioid consumption was converted to equivalents of oral morphine uniformly for statistical analysis. Secondary outcomes included the knee range of motion, the hospital stay length as well as the postoperative complications such as pulmonary embolism and deep vein thrombosis. RESULTS: Table 1 will show the clinical outcomes between the 2 groups. CONCLUSION: This trial would provide an evidence for the use of different types of peripheral nerve blocks in TKR.


Assuntos
Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Administração Oral , Analgésicos Opioides/administração & dosagem , Nervo Femoral , Humanos , Pessoa de Meia-Idade , Morfina/administração & dosagem , Debilidade Muscular/etiologia , Bloqueio Nervoso/efeitos adversos , Nervo Obturador , Manejo da Dor/métodos , Medição da Dor , Complicações Pós-Operatórias , Estudos Prospectivos , Músculo Quadríceps
15.
Br J Anaesth ; 125(4): 580-587, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32736825

RESUMO

BACKGROUND: Data on UK obstetric anaesthetic practice between 2009 and 2014 were collected by the Obstetric Anaesthetists' Association's National Obstetric Anaesthetic Database. This database provides information on workload, variation in practice, and complication rates. METHODS: During 2009-14, data were submitted by 190 UK hospitals. The number of hospitals that submitted data each year ranged between 114 and 145. During this 6 yr period, between 27 and 35 data items were requested, although not all hospitals submitted information on all data items. The dataset was assessed for quality and only those data items with acceptable quality were analysed. RESULTS: The dataset contains information on 3 030 493 deliveries, 770 545 Caesarean sections, 623 050 women with labour neuraxial analgesia, and 61 121 general anaesthetics for Caesarean section. There was increased use of patient-controlled regimens for labour neuraxial analgesia over the 6 yr period. The mean rate of general anaesthesia used for Caesarean section was 8.75% (95% confidence interval, 8.26-9.24%). The rate of failed intubation for general anaesthesia for Caesarean section was one in 379. Inadvertent dural puncture rates varied between hospitals with a mean of 1.2% (95% confidence interval, 1.02-1.37%). The rate of a high neuraxial block causing unconsciousness was one in 6667 for all blocks. CONCLUSIONS: This unique large dataset provides a valuable insight of obstetric anaesthetic activity in the UK. Although missing data may place limitations on interpretation, it provides comparative estimates for the rates of rare complications and highlights variations in practice in time and place.


Assuntos
Anestesia Obstétrica , Analgesia Obstétrica , Anestesia Geral , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Cesárea , Análise de Dados , Bases de Dados Factuais , Conjuntos de Dados como Assunto , Feminino , Humanos , Unidades de Terapia Intensiva , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Gravidez , Reino Unido
16.
Clin Interv Aging ; 15: 937-944, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606635

RESUMO

Background: Pectoral nerve block type I (PECS I Block) and type II (PECS II Block) with ropivacaine are relatively new analgesic methods for breast-cancer surgery. We evaluated the safety and efficacy of different concentrations of ropivacaine given in the same volume for the PECS II Block in patients undergoing modified radical mastectomy (MRM). Patients and Methods: One hundred and twenty women undergoing elective MRM who met inclusion criteria were divided randomly into four groups of 30: control group without PECS II Block and R0.2%, R0.3%, and R0.4% groups, who received general anesthesia plus the PECS II Block with ropivacaine at 0.2%, 0.3%, and 0.4%, respectively, in a volume of 40 mL. Results: The postoperative numerical rating scale (NRS) pain score at rest and active was significantly higher in the control group than that in the three ropivacaine groups (P<0.05 for all), and the postoperative NRS score in the R0.3% group and R0.4% group at 12, 24, and 48 h postoperatively were significantly lower than that in the R0.2% group (P<0.05 for all); there was no significant difference between the R0.3% group and R0.4% group. The time when pain was first felt after MRM, the total number of complaints during 3, 6, 12, 24, and 48 h after MRM, and the total analgesic requirement (tramadol consumption) during the first 24 h postoperatively in the R0.3% group and R0.4% group were significantly lower than those in the control group and R0.2% group (P<0.05 for all); there was no significant difference between the R0.3% group and R0.4% group. Conclusion: A dose of 0.3% ropivacaine was the optimal concentration for a PECS II Block for patients undergoing MRM because it provided efficacious analgesia during and >48 h after MRM. Increasing the ropivacaine concentration did not improve the analgesia of the PECS II Block significantly.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Ropivacaina/administração & dosagem , Nervos Torácicos/efeitos dos fármacos , Anestésicos Locais/efeitos adversos , Estudos de Casos e Controles , Feminino , Humanos , Mastectomia Radical Modificada/métodos , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/dietoterapia , Período Pós-Operatório , Ropivacaina/efeitos adversos
18.
J Vasc Interv Radiol ; 31(6): 1005-1009.e1, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32376174

RESUMO

Superior hypogastric nerve block (SHNB) decreases pain and use of narcotic pain medication following uterine artery embolization (UAE). The purpose of this retrospective study was to evaluate the effect of the addition of a corticosteroid (triamcinolone) to SHNB on analgesia following UAE. Records of 16 patients were reviewed for when pain occurred or acutely worsened after the procedure. No major complications were identified. Patients reported that pain began or worsened an average of 33.8 hours after the procedure, when their average pain increased from 0.6/10 to 5.9/10 (P < .001). This suggests that addition of triamcinolone to SHNB could result in prolonged analgesia following UAE.


Assuntos
Analgésicos/administração & dosagem , Glucocorticoides/administração & dosagem , Plexo Hipogástrico , Bloqueio Nervoso , Manejo da Dor/métodos , Dor/prevenção & controle , Triancinolona/administração & dosagem , Embolização da Artéria Uterina/efeitos adversos , Adulto , Analgésicos/efeitos adversos , Feminino , Glucocorticoides/efeitos adversos , Humanos , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/efeitos adversos , Medição da Dor , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Triancinolona/efeitos adversos
19.
Curr Opin Anaesthesiol ; 33(3): 311-315, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32324660

RESUMO

PURPOSE OF REVIEW: The objective of this review is to identify the potential of peripheral nerve blocks established over the last years for perioperative pain management in breast surgery. These new blocks will be discussed with respect to their clinical effect and necessity. RECENT FINDINGS: After case reports and cadaver studies for the Pecs block and its variations sufficient clinical data from randomized controlled trial (RCT) and meta-analyses exist now. The modified Pecs block or Pecs II leads to a reduction of postoperative 24-h opioid consumption. The recently invented Erector spine block addresses the intercostal nerves. The benefits in analgesia of this approach were tested in few RCTs and showed superiority to the control group in terms of requested postoperative morphine. Most studies showed low intraoperative opioid doses and no study more than low to moderate postoperative pain scores. SUMMARY: Taking the pain levels after breast surgery into account, the request of additional nerve blocks has to be pondered against the potential risks and resource requirement. To reduce or avoid intraoperative or postoperative opioids, an ultrasound-guided Pecs II block proves to be the best option for perioperative pain relief.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Mama/cirurgia , Mastectomia/métodos , Bloqueio Nervoso/métodos , Nervos Periféricos/efeitos dos fármacos , Nervos Torácicos , Analgésicos Opioides/uso terapêutico , Anestesia Local/efeitos adversos , Anestésicos Locais/efeitos adversos , Humanos , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/prevenção & controle
20.
Am J Sports Med ; 48(7): 1689-1695, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32343596

RESUMO

BACKGROUND: Patients often have quadriceps or hamstring weakness after anterior cruciate ligament reconstruction (ACLR), despite postoperative physical therapy regimens; however, little evidence exists connecting nerve blocks and ACLR outcomes. PURPOSE: To compare muscle strength at return to play in patients who received a nerve block with ACLR and determine whether a specific block type affected subjective knee function. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients were recruited 5 to 7 months after primary, isolated ACLR and completed bilateral isokinetic strength tests of the knee extensor/flexor groups as a single-session return-to-sport test. Subjective outcomes were assessed with the International Knee Documentation Committee (IKDC) score. Strength was expressed as torque normalized to mass (N·m/kg) and limb symmetry index as involved/uninvolved torque. Chart review was used to determine the type of nerve block and graft used. Nerve block types were classified as knee extensor motor (femoral nerve), knee flexor motor (sciatic nerve), or isolated sensory (adductor canal block/saphenous nerve). A 1-way analysis of covariance controlling for graft type was used. RESULTS: A total of 169 patients were included. Graft type distribution consisted of 102 (60.4%) ipsilateral bone-patellar tendon-bone (BTB) and 67 (39.6%) ipsilateral hamstring tendon. Nerve block type distribution consisted of 38 (22.5%) femoral, 25 (14.8%) saphenous, 45 (26.6%) femoral and sciatic, and 61 (36.1%) saphenous and sciatic. No significant difference was found in knee extensor strength (P = .113) or symmetry (P = .860) between patients with knee extensor motor blocks (1.57 ± 0.45 N·m/kg; 70.1% ± 15.3%) and those without (1.47 ± 0.47 N·m/kg; 69.6% ± 18.8%). A significant difference was found between patients with knee flexor motor blocks (0.83 ± 0.26 N·m/kg) and those without (0.92 ± 0.27 N·m/kg) for normalized knee flexor strength (P = .21) but not knee flexor symmetry (P = .592). Controlling for graft type, there were no differences in subjective knee function (IKDC score) between all nerve block groups (P = .57). CONCLUSION: Our data showed that use of a sciatic nerve block with ACLR in patients with hamstring and BTB grafts influences persistent knee flexor strength deficits at time of return to sports. Although the cause of postoperative muscular weakness is multifactorial, this study adds to the growing body of evidence suggesting that perioperative nerve blocks affect muscle strength and functional rehabilitation after ACLR.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Traumatismos em Atletas/cirurgia , Força Muscular/fisiologia , Debilidade Muscular/etiologia , Bloqueio Nervoso/efeitos adversos , Volta ao Esporte , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Reconstrução do Ligamento Cruzado Anterior/métodos , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Traumatismos em Atletas/fisiopatologia , Estudos de Coortes , Feminino , Nervo Femoral , Músculos Isquiossurais/fisiopatologia , Humanos , Masculino , Bloqueio Nervoso/métodos , Modalidades de Fisioterapia , Músculo Quadríceps/fisiopatologia , Nervo Isquiático , Torque , Adulto Jovem
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