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1.
Ulus Travma Acil Cerrahi Derg ; 28(5): 711-713, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35485473

RESUMO

After infratrochlear nerve block for nasolacrimal probing, sudden vision loss, proptosis, pain, loss of light reflexes, and a total limitation of ocular movement was observed in a 71-year-old female patient. She was diagnosed with retrobulbar hemorrhage and orbital compartment syndrome (OCS). Lateral canthotomy, cantholysis, and medial orbitotomy were performed on the patient. She was not taking any oral anticoagulant medication and did not have any disease other than hypothyroidism and systemic hy-pertension. All the clinical findings returned to normal right after the intervention except mild ptosis (~1 mm), which persisted for 2 months. All patients scheduled for periocular anesthesia should be questioned about using oral anticoagulant medications, and the possibility of serious complications should be kept in mind even for patients without any risk factors. Patients with OCS secondary to retrobulbar hemorrhage should be surgically managed within the critical window (90 min) to prevent any irrevers-ible optic nerve injury.


Assuntos
Síndromes Compartimentais , Bloqueio Nervoso , Hemorragia Retrobulbar , Idoso , Anticoagulantes , Síndromes Compartimentais/complicações , Síndromes Compartimentais/cirurgia , Feminino , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Bloqueio Nervoso/efeitos adversos , Hemorragia Retrobulbar/diagnóstico , Hemorragia Retrobulbar/etiologia , Hemorragia Retrobulbar/cirurgia
2.
BMJ Case Rep ; 15(4)2022 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-35387792

RESUMO

Dystrophic calcinosis cutis can be associated with severe pain, decreased mobility, increased risk of infection and significantly decreased quality of life. We report a case of recalcitrant calcinosis cutis on the background of eosinophilic fasciitis, which achieved rapid reduction in calcium deposits following a novel injecting protocol of intralesional sodium thiosulfate.


Assuntos
Calcinose , Bloqueio Nervoso , Dermatopatias , Calcinose/complicações , Calcinose/tratamento farmacológico , Humanos , Bloqueio Nervoso/efeitos adversos , Qualidade de Vida , Dermatopatias/tratamento farmacológico , Dermatopatias/etiologia , Tiossulfatos
3.
Exp Clin Transplant ; 20(Suppl 1): 83-85, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35384813

RESUMO

OBJECTIVES: In this report, we assessed the effectiveness of erector spinae plane block for postoperative analgesia after kidney transplant. MATERIALS AND METHODS: Our study included 28 total patients who underwent heterotopic kidney transplant from living related donors. In the retrospective control group, patients (n = 14) received conventional postoperative analgesia. In the study group, patients (n = 14) received continuous erector spinae plane block in addition to conventional analgesics. Study endpoints were pain intensity evaluated using numerical rating scale at rest and during movement, opioid consumption, and postoperative nausea and vomiting incidences during the first postoperative day. RESULTS: Patients in the study group demonstrated significantly less pain (2.1 ± 1.09 at rest and 3.8 ± 1.18 during movement per the numerical rating scale) compared with the control group (3.3 ± 1.17 and 5.2 ± 2.15, respectively) (P = .009 and P = .042) and less opioid requirements (15.9 ± 7.1 vs 4.7 ± 6.2 mg of morphine; P < .001). In addition, incidences of nausea and vomiting were less frequent in the study group. CONCLUSIONS: Continuous erector spinae plane block in combination with nonopioid analgesics provided adequate pain control and significantly reduced postoperative opioid requirements after kidney transplant.


Assuntos
Analgesia , Transplante de Rim , Bloqueio Nervoso , Analgesia/efeitos adversos , Analgésicos Opioides/efeitos adversos , Humanos , Transplante de Rim/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos
4.
BMC Anesthesiol ; 22(1): 99, 2022 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-35387585

RESUMO

BACKGROUND: The use of anesthetics and analgesic drugs and techniques in combination yields a multimodal effect with increased efficiency. In this case series, we aimed to evaluate the anesthetic effect of the thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) combination in patients, who underwent non-intubated video-assisted thoracoscopic surgery (NIVATS). METHODS: Medical records of 16 patients, who underwent NIVATS for wedge resection under the combination of ESPB and TPVB were reviewed retrospectively. Demographic data of patients, duration of the sensory block, amount of the anesthetic agent used for premedication and sedo-analgesia, any presence of perioperative cough, operative times, postoperative visual analog scale (VAS) scores in the postoperative follow-up period, the need for additional analgesia, and patient satisfaction were reviewed. RESULTS: Of the patients included in the study, 12 were men and 4 were women. The mean age was 48.6 years and the mean BMI was 24.7 kg/m2. The mean time needed for the achievement of the sensorial block was 14 min and the mean skin-to-skin operative time was 21.4 min. During the procedure, patients received 81.5 ± 27.7 mg of propofol and 30 ± 13.6 micrograms of remifentanil infusions, respectively. The mean dose of ketamine administered in total was 58.1 ± 12.2 mg. Only 2 patients needed an extra dose of remifentanil because of recurrent cough. No patients developed postoperative nausea vomiting. During the first 24 h, the VAS static scores of the patients were 3 and below, while VAS dynamic scores were 4 and below. Morphine consumption in the first postoperative 24 h was 13.2 mg. CONCLUSIONS: In conclusion, combined ESPB and TPVB with added intravenous sedo-analgesia in the presence of good cooperation between the surgical team and the anesthesiologist in the perioperative period can provide optimal surgical conditions including the prevention of cough in NIVATS. It is not sufficient to state that this combination is superior to alone ESPB or alone TPVB, as it is a preliminary study with a limited number of cases.


Assuntos
Bloqueio Nervoso , Cirurgia Torácica Vídeoassistida , Tosse/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Remifentanil/uso terapêutico , Estudos Retrospectivos
5.
Orthop Clin North Am ; 53(2): 179-186, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365262

RESUMO

Regional anesthesia, and in particular peripheral nerve block (PNB) techniques, complement existing anesthetic and pain management strategies and facilitate a comprehensively safer experience for the pediatric patient. Ultimately, the use of regional anesthesia cultivates a more satisfactory experience for all involved. Complication rates are very low, making PNBs a very safe option as proliferative incorporation of ultrasound technology has led to further enhancement of regional anesthesia safety and efficacy in the pediatric population.


Assuntos
Anestesia por Condução , Bloqueio Nervoso , Anestesia por Condução/efeitos adversos , Anestesia por Condução/métodos , Anestésicos Locais , Criança , Humanos , Injeções , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Nervos Periféricos/diagnóstico por imagem
6.
Pril (Makedon Akad Nauk Umet Odd Med Nauki) ; 43(1): 99-104, 2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35451299

RESUMO

Continuous peripheral nerve block, also known as "local anesthetic perineural infusion," refers to percutaneous placement of a catheter near a peripheral nerve or plexus followed by administration of a local anesthetic through a catheter to provide anesthesia, or analgesia for several days, in some cases even for a month. This report describes the case of a 7 year old boy with left elbow contracture with limited flexion and extension who was admitted to the Clinic of Pediatric Surgery for redressment of the elbow and physical therapy. An ultrasound-guided axillary brachial plexus block was performed, with placement of a non-tunneled perineural catheter. Redressment of the left elbow was performed twice and before each redressment boluses of local anesthetic were applied through the perineural catheter. Physical therapy was performed painlessly with continuous perineural infusion. On the 5th day of catheter placement, the perineural catheter was removed without any prior complications such as hematoma, infection, catheter dislocation or leakage of local anesthetic. Our goal is to minimize the psychological and physical trauma to the patient, no matter how immature the patient is. Continuous regional anesthesia in children is a safe technique in postoperative pain management that facilitates early mobilization due to its sufficient analgesia and better comfort. It can provide in-home treatment, with adequate education for patients and parents, and improve rehabilitation in children.


Assuntos
Anestésicos Locais , Bloqueio Nervoso , Criança , Humanos , Masculino , Bloqueio Nervoso/efeitos adversos , Manejo da Dor , Dor Pós-Operatória/etiologia , Modalidades de Fisioterapia/efeitos adversos
7.
Medicine (Baltimore) ; 101(9): e28983, 2022 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-35244070

RESUMO

INTRODUCTION: The prevalence of lumbosacral radiculopathy is estimated to be approximately 3% to 5% in patient populations. Lumbosacral radiculopathy is largely caused by a complex interaction between biomechanical and biochemical factors. Nerve block therapy (NBT) mainly treats lumbosacral radiculopathy by improving the biochemical factors, whereas acupotomy mainly focuses on improving the biomechanical factors. Therefore, it is thought that synergistic effects may be obtained for the treatment of lumbosacral radiculopathy when both NBT and acupotomy are combined. However, no study in China and Korea, where acupotomy is majorly provided, has reported the effects of such a combination treatment. Therefore, this study aimed to evaluate the safety, effectiveness, and cost-effectiveness of the concurrent use of a deeply inserted acupotomy and NBT for the treatment of lumbosacral radiculopathy. METHODS/DESIGN: This is an open-label, parallel, assessor-blinded, randomized controlled trial, which will include 50 patients with lumbosacral radiculopathy. After patients voluntarily agree to participate in the study, they will be screened, and will undergo necessary examinations and tests according to the protocol. Those who satisfy the selection criteria will be randomly assigned to either the NBT + acupotomy or NBT groups in a 1:1 ratio. Both groups will undergo 2 NBTs once every 2 weeks from 1 week after the screening test. The treatment group will receive additional acupotomy twice a week for 4 weeks. The primary endpoint is the Oswestry Disability Index, whereas the secondary endpoints are the Numeral Rating Scale, European Quality of Life 5-dimension, McGill pain Questionnaire, Roland-Morris Disability Questionnaire, safety assessment, and economic feasibility evaluation. The measurements will be made at 0, 2, 4, and 8 weeks. ETHICS AND DISSEMINATION: This trial has received complete ethical approval from the Ethics Committee of Catholic Kwandong University International St. Mary's Hospital (IS20OISE0085). We intend to submit the results of the trial to a peer-reviewed journal and/or conferences.


Assuntos
Terapia por Acupuntura , Bloqueio Nervoso , Radiculopatia/terapia , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/economia , Terapia por Acupuntura/métodos , Análise Custo-Benefício , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/economia , Projetos Piloto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
J Clin Anesth ; 79: 110770, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35334289

RESUMO

STUDY OBJECTIVE: Although combined thoracic paravertebral blockade (TPVB)-general anesthesia (GA) could improve pain control compared to GA alone after thoracoscopic lung cancer surgery, it has not been established whether this improvement in pain control could reduce associated adverse outcomes. Thus, this study aimed to explore the association between TPVB usage and adverse outcomes after thoracoscopic lung cancer surgery. DESIGN: Retrospective cohort study from a prospective database. SETTING: A high-volume thoracic center in China. PATIENTS: 13966 consecutive patients who received thoracoscopic lung cancer surgery from January 2016 to December 2018 in Shanghai Chest Hospital were enrolled. MEASUREMENTS: With a 1:1 propensity score matching (PSM) analysis, adverse outcomes between GA alone and GA-TPVB were investigated. Multivariate and multiple linear regression analysis were used to identify factors and calculate odds radio (OR) for adverse outcomes. RESULTS: The rate of TPVB usage was 14.8% (2070 out of 13,966). TPVB combined with GA was associated with lower rates of postoperative pulmonary complications (PPCs) (30.4% vs 33.5%, P = 0.005) and postoperative atrial fibrillation (POAF) (2.1% vs 2.9%, P = 0.041), and shorter length of hospital stay (LOS) (Median [IQR]; 5[4-5] vs 5[4-6]) days, P < 0.001) compared to GA alone. After a 1:1 PSM analysis, we investigated adverse outcomes in 2640 (1320 pairs) patients with or without TPVB usage, and this association remained existed, namely, the rates of PPCs (29.8% vs 34.2%, P = 0.014) and POAF (2.2% vs 3.6%, P = 0.028) were lower and LOS was shorter (5[4-5] vs 5[4-6] days, P < 0.001) in the GA-TPVB group. In multivariate analysis, the combination of GA plus TPVB was independent predictor for PPCs (OR = 0.879, 95%CI, 0.793-0.974, P = 0.014) and POAF (OR = 0.714, 95%CI, 0.516-0.988, P = 0.042), respectively. However, in multiple linear analysis, lower rates of PPCs and POAF associated with TPVB usage, rather than TPVB usage, were responsible for the reduced LOS. CONCLUSIONS: The usage of TPVB may be a feasible and adjustable approach to reduce the rates of PPCs and POAF and associated LOS in thoracoscopic lung cancer surgery.


Assuntos
Fibrilação Atrial , Neoplasias Pulmonares , Bloqueio Nervoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , China/epidemiologia , Humanos , Tempo de Internação , Neoplasias Pulmonares/cirurgia , Bloqueio Nervoso/efeitos adversos , Dor , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
10.
BMC Anesthesiol ; 22(1): 71, 2022 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-35296252

RESUMO

BACKGROUND: Rhomboid intercostal block (RIB) is a new regional anesthesia technique that provides postoperative analgesia for breast surgery and thoracoscopic surgery. The published papers are not yet fully integrated and do not adequately address the impact and safety of the RIB on postoperative pain. METHODS: The PubMed, Web of Science and Embase were searched from 2016 to 2021 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of RIB after thoracic surgery and breast surgery. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. The primary outcome was Postoperative Numerical Rating Scale (NRS) scores of patients at rest recorded 0-1, 6-8, 24 h after surgery. The secondary outcomes included rate of postoperative nausea and vomiting (PONV), postoperative fentanyl consumption and presence of complications of the block. RESULTS: From 81 records identified, four studies met our inclusion criteria, including 216 patients (RIB:108 patients; no block: 108 patients). In the primary outcome, RIB group showed significantly lower postoperative NRS at rest at first 0-1 h and 6-8 h (weighted mean difference [WMD] = -1.55; 95% confidence internal [CI] = -2.92 to -0.19; p < 0.05), (WMD = -0. 69; 95% CI = -1.29 to -0. 09; p < 0. 05). And there was no significant difference between groups in NRS at rest at 24 h (WMD = -0.78; 95% CI = -1.64 to -0.08; p = 0.77). Also, RIB group showed significantly lower postoperative NRS of breast surgery and thoracoscopic surgery at 0-1 h (WMD = -3.00; 95% CI = -3.13 to -2.87; p < 0.01), (WMD = -1.08; 95% CI = -1.98 to -0.18; p < 0.05). In the secondary outcome, the analysis also showed RIB group had significant lower of POVN rates (summary relative risk (RR) = 0.212;95%CI = 0.10 to 0.45; p < 0. 01) and the postoperative consumption of fentanyl (WMD = -57.52;95%CI = -106.03 to -9.02; p < 0. 05). CONCLUSION: This review shows that RIB was more effective in controlling acute pain after breast surgery and thoracoscopic surgery than general analgesia. And it is a trend that RIB may be a kind of effective and safe nerve bock technology and it requires further studies.


Assuntos
Analgesia , Neoplasias da Mama , Bloqueio Nervoso , Analgesia/métodos , Analgésicos Opioides/uso terapêutico , Feminino , Fentanila , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Toracoscopia
11.
J Int Med Res ; 50(3): 3000605221086737, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35301896

RESUMO

OBJECTIVE: Erector spinae plane (ESP) block is an alternative to neuraxial block for post-surgical pain in nephrectomy patients. However, no clinical trial has directly compared ESP block with a control group. METHODS: In a single-center, double-blind randomized comparative trial, patients undergoing nephrectomy with a subcostal flank incision under general anesthesia were divided into the following two groups: ESP block group (ESP block before anesthesia) and non-ESP (control) group (no intervention). The primary outcome measure was pain score (Numeric Rating Scale [NRS] 0 to 10). Secondary outcomes were postoperative opiate use, anesthetic and surgical complications, length of hospital stay, and patient-reported outcomes. RESULTS: Postoperatively (0 to 24 hours), the ESP block group experienced less pain and had lower NRS pain scores 0 to 24 hours postoperatively than the non-ESP group. Opioid consumption and the number of rescue analgesic doses decreased significantly in the ESP group compared with the non-ESP group. Patient-Reported Outcomes Information System (Quality of Recovery-15) scores significantly improved in the ESP group compared with the non-ESP block group. CONCLUSIONS: Patients receiving an ESP block for intraoperative and postoperative analgesia during radical nephrectomies experienced less postoperative pain 0 to 24 hours compared with the non-ESP group.


Assuntos
Anestesia por Condução , Bloqueio Nervoso , Anestesia por Condução/efeitos adversos , Humanos , Nefrectomia/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Ultrassonografia de Intervenção
12.
J Healthc Eng ; 2022: 8968805, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35356610

RESUMO

Objective: To investigate the anesthetic effect of anterior serratus muscle plane block under ultrasound guidance in arthroscopic shoulder surgery and its effect on postoperative analgesia. Methods: A total of 94 patients who received arthroscopic shoulder surgery in our hospital were selected as the research subjects, and they were divided into a control group and a study group according to the random number table method. The control group underwent brachial plexus block under ultrasound guidance, and the study group underwent anterior serratus plane block under ultrasound guidance. The visual analogue score (VAS) of pain at each time point, intraoperative anesthetic dosage, the use of postoperative analgesic, pain mediators and oxidative stress factors before and after surgery, and the occurrence of adverse reactions were compared between the two groups after surgery. Results: At 6, 12, 48, and 72 h after surgery, there was no obvious difference in the VAS score between the two groups (P > 0.05); 24 h after surgery, the VAS score of the study group was significantly lower than that of the control group (P < 0.05). The intraoperative dosage of propofol and remifentanil in the study group was significantly lower than that in the control group (P < 0.05). The number of effective compressions of analgesic pump and the total amount of sufentanil in the study group were significantly lower than those in the control group within 48 hours after operation, and the time of first compressions of analgesic pump was significantly longer than that in the control group (P < 0.05). Before surgery, there were no significant differences in CGRP, NPY, and MDA levels and SOD enzyme activity between the two groups (P > 0.05). After surgery, the levels of pain mediators CGRP and NPY in the study group were lower than those in the control group (P < 0.05). The level of MDA was lower than that of the control group, and SOD enzyme activity was higher than that of the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: Ultrasound-guided anterior serratus plane block for arthroscopic shoulder surgery has a good anesthesia effect and long action time. It can significantly reduce the dosage of opioids, enhance the postoperative analgesic effect, effectively inhibit postoperative pain and oxidative stress reaction, and has good safety.


Assuntos
Analgesia , Anestésicos , Bloqueio Nervoso , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Ombro/cirurgia , Ultrassonografia de Intervenção/métodos
13.
Hu Li Za Zhi ; 69(2): 32-43, 2022 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-35318631

RESUMO

BACKGROUND: Osteoarthritis is a common cause of inactivity and reduced quality of life in the elderly. Total knee replacement (TKR) surgery, a last-stage treatment option for osteoarthritis, often results in postoperative pain that influences knee flexion and the ability to perform prescribed rehabilitation exercises. PURPOSE: This study was designed to examine the effectiveness of single femoral nerve block (FNB) on pain level and knee mobility in patients with TKR. METHODS: A quasi-experimental, two-group, longitudinal study was designed. The participants were distributed into the FNB group (n = 86) and non-FNB group (n = 86). The outcome measurements included pain scale (Numerical Rating Scale) score and knee continuous passive motion knee flexion angle. The five assessments and followed-up times were as follows: admission day (T0) and post-surgery day 1, 2, 3, and 4. RESULTS: The results of the generalized estimating equations model showed that the pain level in the FNB group was significantly lower than in the non-FNB group, (p < .001). In terms of analgesics demand from post-surgery day 1 to day 4, the FNB group exhibited a significantly lower demand than the non-FNB group (p < .01). In addition, significant differences in the continuous passive motion rehabilitation exercise angle were found between the two groups from post-surgery day 1 through day 4 (p < .05). Finally, significant differences in knee flexion angles between the two groups were observed between hospital admission and discharge (p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings of this study support the positive effects of the femoral nerve block intervention on patients who receive total knee replacement surgery. The results were significant in terms of pain relief and knee mobility recovery. This intervention should be made available for use in the clinical care of TKR patients.


Assuntos
Artroplastia do Joelho , Bloqueio Nervoso , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/reabilitação , Nervo Femoral , Humanos , Estudos Longitudinais , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Qualidade de Vida
14.
A A Pract ; 16(3): e01572, 2022 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-35213408

RESUMO

An infraclavicular catheter is a very efficient technique to provide excellent perioperative anesthesia/analgesia for upper limb surgery. However, complications can occur and are dependent on the technique used. We report the inadvertent placement of an infraclavicular catheter in the interscalene region when an ultrasound-guided infraclavicular catheter was threaded cranially. We proposed some strategies to avoid the occurrence of complications when performing this block.


Assuntos
Plexo Braquial , Bloqueio Nervoso , Anestésicos Locais , Plexo Braquial/diagnóstico por imagem , Cateteres/efeitos adversos , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Ultrassonografia
15.
J Clin Anesth ; 79: 110691, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35220180

RESUMO

STUDY OBJECTIVE: Breast cancer is quite common in women, and surgery is the most effective treatment in most cases. This study compared the effects of ultrasound (US)-guided erector spinae plane block (ESPB) and pectoserratus plane block (PSPB) on the postoperative opioid consumption and acute and chronic pain in patients after breast cancer surgery. DESIGN: Prospective, randomized, single-blind. SETTING: University hospital. PATIENTS: This study included 90 patients (ASA I-II) who underwent segmental mastectomy and sentinel lymph node biopsy at the hospital of Ondokuz Mayis University, Samsun. INTERVENTIONS: The patients were divided into the ESPB group, PSPB group, and control group. Intraoperatively, all patients were administered intravenous tenoxicam (20 mg) and paracetamol (1 g) as part of multimodal analgesia. Intravenous morphine via patient-controlled analgesia was administered in all groups postoperatively. MEASUREMENTS: The primary outcome was the total morphine consumption in the first 24 h after surgery. The secondary outcomes included visual analog scale pain scores of the arm at rest and at abduction in the first 24 h and at 3 months postoperatively, intraoperative remifentanil consumption, number of patients requesting rescue analgesia, incidence of nausea and vomiting, time to the first request for analgesia via patient-controlled analgesia. MAIN RESULTS: Postoperative 24-h morphine consumption, visual analog scale scores at rest and at abduction, and intraoperative remifentanil consumption were lower in the ESPB and PSPB groups than in the control group. Time to the first request for analgesia via patient controlled analgesia was longer in the ESPB and PSPB groups than in the control group. In the PSPB group, none of the patients needed rescue analgesia. CONCLUSIONS: US-guided ESPB and PSPB performed in patients who underwent breast cancer surgery showed similar and modest analgesic effects on the postoperative opioid consumption and acute and chronic pain scores.


Assuntos
Neoplasias da Mama , Dor Crônica , Bloqueio Nervoso , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia/efeitos adversos , Derivados da Morfina , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Remifentanil , Método Simples-Cego
16.
Reg Anesth Pain Med ; 47(6): 353-358, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35173020

RESUMO

BACKGROUND: Pain management after total knee arthroplasty is essential to improve early mobilization, rehabilitation, and recovery. Continuous adductor canal (AC) block provides postoperative analgesia while preserving quadriceps strength. However, there have been inconsistencies regarding the optimal location for continuous catheter block. We compared continuous femoral triangle, proximal AC, and distal AC blocks for postoperative analgesia after total knee arthroplasty. METHODS: Patients undergoing unilateral total knee arthroplasty were randomly assigned to three groups: femoral triangle, proximal AC, or distal AC. The surgeon performed periarticular local anesthetic infiltration. After surgery, an ultrasound-guided perineural catheter insertion procedure was performed. The primary endpoint was pain scores at rest in the morning on the first postoperative day. Secondary endpoints included pain scores at rest and during activity at other time points, quadriceps strength, and opioid consumption. RESULTS: Ninety-five patients, 32 in the femoral triangle group, 31 in the proximal AC group, and 32 in the distal AC group, completed the study. Analysis of the primary outcome showed no significant difference in pain scores among groups. Secondary outcomes showed significantly lower pain scores at rest and during activity in the distal AC group than in the femoral triangle and proximal AC groups in the morning of the second postoperative day. Quadriceps strength and opioid consumption did not differ among groups. CONCLUSIONS: Continuous femoral triangle, proximal AC, and distal AC blocks in the setting of periarticular local anesthetic infiltration provide comparable postoperative analgesia after total knee arthroplasty. TRIAL REGISTRATION NUMBER: NCT04206150.


Assuntos
Analgesia , Artroplastia do Joelho , Bloqueio Nervoso , Analgesia/métodos , Analgésicos Opioides , Anestésicos Locais , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Cateteres , Nervo Femoral/diagnóstico por imagem , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle
17.
Artigo em Inglês | MEDLINE | ID: mdl-35162650

RESUMO

Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients' reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.


Assuntos
Nervo Mandibular , Bloqueio Nervoso , Anestésicos Locais/toxicidade , Humanos , Injeções , Mandíbula , Bloqueio Nervoso/efeitos adversos
18.
Pain Physician ; 25(1): E55-E65, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35051152

RESUMO

BACKGROUND: Lumpectomy is important for preventing malignant changes in benign tumors and diagnosing malignant tumors. Intercostal nerve blocks (ICNBs) are useful for breast lumpectomy as either the primary anesthetic or as an adjuvant anesthetic procedure. To our knowledge, no studies have evaluated the association between Horner syndrome and ICNB. OBJECTIVES: This study aimed to explore the characteristics of and related risk factors for Horner syndrome after ICNB. STUDY DESIGN: A prospective, nested case-control study. SETTING: Fudan University Shanghai Cancer Centre from April 2020 through July 2020. METHODS: Patients scheduled for breast lumpectomy under ICNB from April 2020 through July 2020 in our hospital were recruited. The ICNB was introduced at the intersection of the midaxillary line and the inferior border of the ribs, according to the location of the mass. Horner syndrome indicators were assessed one, 5, 10, 15, 30, 45, and 60 minutes and 3, 6, 12 and 24 hours after ICNB. Personal data (age, body mass index [BMI], ASA classes), data on anesthetic (the puncture points, dose of local anesthetics, duration of ICNB, Horner syndrome indicators, other complications) and data on postoperative recovery (postoperative activity time, postoperative feeding time) were recorded. Univariate and multivariate logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals. RESULTS: Ipsilateral Horner syndrome was found in 35 of 998 (3.5%) patients. Ipsilateral miosis, the first symptom to appear and last to disappear, occurred within 4 minutes and lasted 45 minutes to 240 minutes after ICNB. Seven patients showed obvious ipsilateral facial flushing. Logistic multivariate regression analysis showed that independent risk factors for Horner syndrome after ICNB were age <= 45 years, body mass index <= 18.5 kg/m2, and the need for a second ICNB. LIMITATIONS: Firstly, the patients in this study are all adult women, and the applicability of other populations is uncertain. Secondly, the flow trajectory of local anesthetics was not confirmed by imaging tracers. CONCLUSIONS: ICNB via an anterolateral approach promoted enhanced recovery after breast lumpectomy. The incidence of Horner syndrome following ICNB for breast lumpectomy was 3.5%. Horner syndrome occurred on the ipsilateral side of the ICNB and was reversible. Younger age, lower BMI, and the need for a second ICNB were risk factors for Horner syndrome after ICNB. KEY WORDS: Horner's syndrome, intercostal nerve block, breast lumpectomy, enhanced recovery.


Assuntos
Síndrome de Horner , Bloqueio Nervoso , Adulto , Estudos de Casos e Controles , China , Feminino , Síndrome de Horner/etiologia , Humanos , Nervos Intercostais , Mastectomia Segmentar , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Estudos Prospectivos
19.
Medicine (Baltimore) ; 101(2): e28525, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35029208

RESUMO

RATIONALE: Hemidiaphragmatic paralysis (HDP) is a frequent complication of the brachial plexus block, caused by unintentional blockade of ipsilateral phrenic nerve. HDP did not rise enough alarm and attention to most anesthesiologists, because most patients with no coexisting comorbid diseases are asymptomatic and able to tolerate it. However, it may cause severe respiratory complication for patients with preexisting compromised cardiorespiratory function. PATIENT CONCERNS: A 67-year-old woman with morbidly obesity was planned to receive opening reduction and internal fixation of right humeral shaft fracture under regional anesthesia considering less respiratory and cardiovascular system interference compared with general anesthesia. DIAGNOSES: After ultrasound guided supraclavicular brachial plexus block, the patient developed severe hypoxia and hypercapnia.Unintentional block of phrenic nerve and diaphragm paralysis was diagnosed by diaphragm ultrasound, which was considered as the main reason of severe hypoxia. INTERVENTIONS: It led to a conversion from regional anesthesia to general anesthesia with endotracheal intubation for patient's safety and smooth operation. OUTCOMES: The unintentional phrenic nerve block leads to a prolonged ventilation time, length of stay in intensive care unit and length of stay in hospital. LESSONS: This case report highlights the risk of diaphragm paralysis in morbidly obese patients. Though new diaphragm sparing brachial plexus block (BPB) methods were developed intended to reduce the risk of HDP, no approaches could absolutely spare phrenic nerve involvement. Therefore, clinicians should always consider the risk of HDP associated with BPBs. For each individual, a detailed preoperative evaluation and sufficient preparation are paramount to avoid serious complications.


Assuntos
Anestésicos Locais/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Plexo Braquial/efeitos dos fármacos , Dispneia/etiologia , Bloqueio Nervoso/efeitos adversos , Obesidade Mórbida , Paralisia/induzido quimicamente , Paralisia/diagnóstico , Nervo Frênico/efeitos dos fármacos , Paralisia Respiratória/complicações , Idoso , Clavícula/efeitos dos fármacos , Feminino , Humanos , Hipóxia , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Ultrassonografia de Intervenção
20.
Reg Anesth Pain Med ; 47(4): 217-221, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35039439

RESUMO

BACKGROUND AND OBJECTIVES: Ultrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks and transverse abdominis plane (TAP) blocks are widely used for postoperative analgesia in children undergoing inguinal hernia repair (IHR). Quadratus lumborum block (QLB) provides analgesia for both upper and lower abdominal surgery. Very few randomized controlled trials in children have assessed the efficacy of QLB in IHR. Thus, this study was designed to find the comparative effectiveness of QLB versus TAP and II/IH blocks in children undergoing open IHR. MATERIALS AND METHODS: Sixty children scheduled for open IHR were randomly allocated in groups of 20 to receive either ultrasound-guided TAP block with 0.4 mL/kg of 0.25% ropivacaine, II/IH nerve block with 0.2 mL/kg of 0.25% ropivacaine, or QLB with 0.4 mL/kg of 0.25% ropivacaine. Anesthesia was standardized for all patients, and an experienced anesthesiologist performed the blocks after anesthesia induction. PRIMARY OUTCOME: Time to first analgesia. SECONDARY OUTCOMES: Postoperative pain scores, intraoperative and postoperative opioid consumption, cumulative paracetamol usage, block performance time, and block-related complications. RESULTS: The median time to first analgesia was 360 (120), 480 (240), and 720 (240) min in the TAP block, II/IH block, and QLB groups, respectively; and was significantly longer in the QLB versus TAP (p<0.001) and II/IH (p<0.001) groups. The time to first analgesia was not significantly different between the TAP and II/IH groups (p=0.596). The mean postoperative tramadol consumption was 11 (12.7), 4 (7.16), and 3 (8) mg in the TAP, II/IH, and QLB groups, respectively (p=0.023); and it was lowest in the QLB group. No significant differences were found between the groups for other secondary outcomes. CONCLUSIONS: QLB provides a prolonged period of analgesia and leads to decreased opioid consumption compared with TAP blocks and II/IH nerve blocks in children undergoing open IHR. TRIAL REGISTRATION NUMBER: CTRI/2019/09/021377.


Assuntos
Hérnia Inguinal , Bloqueio Nervoso , Músculos Abdominais/diagnóstico por imagem , Analgésicos Opioides , Criança , Hérnia Inguinal/cirurgia , Humanos , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Ropivacaina , Ultrassonografia de Intervenção/efeitos adversos
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