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1.
Medicine (Baltimore) ; 99(1): e18673, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895835

RESUMO

The documents on the median effective concentration of local analgesic were many in primiparas during labor analgesia. However, the studies were fewer in multiparas. To explore the analgesic requirements in multiparas during epidural labor analgesia, we investigated the median effective concentration of ropivacaine with 2 µg/mL fentanyl for epidural labor analgesia in multiparas.Sixty-two women were recruited and assigned to the primipara group and multipara group in this prospective study. All the parturients received ropivacaine combined with 2 µg/mL fentanyl for epidural labor analgesia. The concentration of ropivacaine was determined by the up and down method and an initial concentration was set as 0.1% with a 0.01% interval. Effective analgesia was defined as the visual analog scale (VAS) ≤3 within 30 minutes after epidural administration when cervical dilatation is about 2 cm. The median effective concentration of ropivacaine was calculated by the up and down sequential method. The pain intensity was assessed using VAS. Hemodynamic parameters, the labor stages, and neonatal Apgar scores were recorded. Umbilical artery blood was drawn to analyze. The side effects, if any, were also recorded.The median effective concentration of ropivacaine was 0.057% (95% confidence interval [CI], 0.051-0.064%) in primiparas during epidural labor analgesia, and 0.068% (95% CI, 0.063-0.072%) in multiparas during epidural labor analgesia, there was significant difference between the groups (P = .02).This study indicated that the median effective concentration of ropivacaine with fentanyl for epidural labor analgesia was 0.068% (95% CI, 0.063-0.072%) and increased in multiparas compared with the primiparas (www.chictr.org.cn, registration number: ChiCTR-1800016486).


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Anestésicos Locais/administração & dosagem , Paridade , Ropivacaina/administração & dosagem , Adulto , Feminino , Humanos , Gravidez
2.
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
3.
Int J Nanomedicine ; 14: 7891-7901, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31632006

RESUMO

Purpose: The improvement of postoperative pain control plays an important role in recovery outcomes and patient satisfaction. Multilamellar vesicles ropivacaine, MVR, is being developed to sustain the release of ropivacaine in situ while maintaining the local concentration of ropivacaine within the therapeutic window. Methods: These studies summarized the processes of MVR formulation development and the evaluation of its releasing profile in vitro and the pharmacokinetics and anesthetic effect in vivo. Results: The MVR demonstrates a sustained-release profile in an in vitro serum environment model after 24 hrs of incubation which translates in the in vivo rat pharmacokinetic profile of ropivacaine as a prolonged half-life that is 10-fold longer in duration than plain ropivacaine solution. The anesthetic effect of single-dose MVR is apparent by providing a prolonged analgesia effect compared to plain ropivacaine solution in an in vivo guinea pig pin-prick wheal model after a single intracutaneous injection. From a safety evaluation, MVR is well tolerated after a subcutaneously injection at a dose level of 20 mg/kg in rats, with no observable changes in clinical observation, body weight, organ weight, hematology and serum chemistry analysis. Conclusion: These results suggest that single administration of MVR is a promising candidate in postoperative pain management.


Assuntos
Portadores de Fármacos/química , Composição de Medicamentos , Manejo da Dor , Ropivacaina/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacocinética , Anestésicos Locais/uso terapêutico , Animais , Liberação Controlada de Fármacos , Feminino , Cobaias , Humanos , Concentração de Íons de Hidrogênio , Masculino , Tamanho do Órgão , Dor Pós-Operatória/tratamento farmacológico , Ratos Sprague-Dawley , Ropivacaina/administração & dosagem , Ropivacaina/efeitos adversos , Ropivacaina/farmacocinética , Fatores de Tempo
4.
Anaesthesia ; 74(11): 1381-1388, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31402449

RESUMO

Following abdominal surgery, the provision of postoperative analgesia with local anaesthetic infusion through both transmuscular quadratus lumborum block and pre-peritoneal catheter have been described. This study compared these two methods of postoperative analgesia following laparotomy. Eighty-two patients 18-85 years of age scheduled to undergo elective surgery were randomly allocated to receive either transmuscular quadratus lumborum block or pre-peritoneal catheter block. In the transmuscular quadratus lumborum group, an 18-gauge Tuohy needle was passed through the quadratus lumborum muscle under ultrasound guidance to reach its anterior aspect. A 20-ml bolus of ropivacaine 0.375% was administered and catheters placed bilaterally. In the pre-peritoneal catheter group, 20 ml of ropivacaine 0.375% was infiltrated at each of three subcutaneous sub-fascial levels, and pre-peritoneal plane catheters were placed bilaterally. Both groups received an infusion of ropivacaine 0.2% at 5 ml.h-1 , continued up to 48 h along with a multimodal analgesic regime that included regular paracetamol and patient-controlled analgesia with fentanyl. The primary end-point was postoperative pain score on coughing, assessed using a numerical rating score (0-10). Secondary outcomes were pain score at rest, fentanyl usage until 48 h post-operation, satisfaction scores and costs. There was no treatment difference between the two groups for pain score on coughing (p = 0.24). In the transmuscular quadratus lumborum group, there was a reduction in numerical rating score at rest (p = 0.036) and satisfaction scores on days 1 and 30 (p = 0.004, p = 0.006, respectively), but fentanyl usage was similar. In the transmuscular quadratus lumborum group, the highest and lowest blocks observed in the recovery area were T4 and L1, respectively. The transmuscular quadratus lumborum technique cost 574.64 Australian dollars more per patient than the pre-peritoneal catheter technique.


Assuntos
Abdome/cirurgia , Cateteres de Demora , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/administração & dosagem , Ultrassonografia de Intervenção/métodos , Músculos Abdominais/efeitos dos fármacos , Músculos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
5.
Vet Anaesth Analg ; 46(5): 673-681, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31371195

RESUMO

OBJECTIVE: To assess the effects of ultrasound-guided lumbar plexus and sciatic nerve blocks on perianesthetic analgesia and recovery quality in dogs undergoing tibial plateau leveling osteotomy (TPLO). ANIMALS: A group of twenty 20 dogs. STUDY DESIGN: Prospective, randomized, blinded, clinical study. METHODS: Dogs were administered lumbar plexus and sciatic nerve blocks with ropivacaine (1.5 mg kg-1; group RA) or sham blocks with saline (group CON). Dogs were administered hydromorphone (0.2 mg kg-1) and atropine (0.02 mg kg-1) subcutaneously before anesthesia was induced with intravenous propofol and maintained with isoflurane. Variables included duration to perform nerve blocks, intraoperative rescue analgesia, recovery score, postoperative pain scores (modified University of Melbourne, Colorado State University and visual analog pain scales), postoperative rescue analgesia-sedation and complications observed. Two-tailed Student t test, Mann-Whitney test, repeated measures analysis of variance, Friedman test and Fisher exact test were used for comparison. Significance was p < 0.05. RESULTS: Time to perform nerve blocks was [median (range)] 4.3 (2.6-6.1) minutes after aseptic skin preparation. Total fentanyl requirements were 14.2 ± 9 µg kg-1 and 25.4 ± 10 µg kg-1 (p = 0.02) and incidence of hypotension (mean arterial pressure < 60 mmHg) was 40% and 80% (p = 0.16) for groups RA and CON, respectively. Six of eight group CON dogs required more intensive treatment for hypotension than group RA dogs. Recovery scores were 1 (1-4) and 2.5 (1-4) for groups RA and CON, respectively (p = 0.04). RA dogs were less likely to require fentanyl rescue analgesia during the postoperative period (p = 0.04). CONCLUSION AND CLINICAL RELEVANCE: As part of a multimodal analgesia regimen, ultrasound-guided lumbar plexus and sciatic nerve blocks provided greater analgesia and improved recovery quality in dogs during TPLO surgery.


Assuntos
Anestésicos Locais/uso terapêutico , Cães/fisiologia , Bloqueio Nervoso/veterinária , Osteotomia/veterinária , Dor Pós-Operatória/veterinária , Ropivacaina/uso terapêutico , Joelho de Quadrúpedes/cirurgia , Anestésicos Locais/administração & dosagem , Animais , Cães/cirurgia , Feminino , Plexo Lombossacral , Masculino , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ropivacaina/administração & dosagem , Nervo Isquiático , Método Simples-Cego , Ultrassonografia de Intervenção/veterinária
6.
Anaesthesia ; 74(11): 1397-1405, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31465115

RESUMO

We performed a randomised, blinded, controlled study with adult patients scheduled for primary total knee arthroplasty under spinal anaesthesia. The aim was to investigate the analgesic effects of adductor canal block using catheter-based repeated boluses, either through a new suture-method catheter or a standard perineural catheter, compared with a single-injection technique. All patients received an adductor canal block after surgery with an initial bolus of 20 ml ropivacaine 0.75%, followed by 20 ml of ropivacaine 0.2% every 8 h in the standard and suture-method catheter groups, and sham boluses for the single-injection group. The primary outcome measure was total opioid consumption (intravenous morphine equivalents) from the end of surgery until 12:00 on postoperative day 2. Secondary outcomes were pain, muscle strength and ambulation. We randomly assigned (1:1:1) and analysed 153 patients. Total opioid consumption was median (IQR [range]) 24 (11-37 [0-148]) mg in the suture-method group, 38 (17-51 [0-123]) mg in the standard catheter group and 37 (14-57 [0-158]) mg in the single-injection group (p = 0.049). Differences were not statistically significant after Bonferroni correction (α = 0.05/3). There were no differences between groups on postoperative day 1. On postoperative day 2, there were no differences between catheter groups, but muscle strength and ambulation were improved compared with the single-injection group. We conclude that providing repeated boluses via a catheter did not decrease opioid consumption or pain compared with a single injection, but improved muscle strength and ambulation on postoperative day 2. The two types of catheters were similar.


Assuntos
Anestésicos Locais/farmacologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/farmacologia , Idoso , Analgesia/métodos , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho , Cateteres , Feminino , Humanos , Injeções , Masculino , Ropivacaina/administração & dosagem , Método Simples-Cego , Suturas , Resultado do Tratamento
7.
Rev Assoc Med Bras (1992) ; 65(7): 982-987, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389509

RESUMO

OBJECTIVE: A clinical, placebo-controlled, randomized, double-blind trial with two parallel groups. OBJECTIVE: to evaluate the efficacy of ropivacaine injection in each belly of the anterior and middle scalene muscles, guided by ultrasonography, in the treatment of Nonspecific Thoracic Outlet Syndrome (TOS) compared to cutaneous pressure. METHODS: 38 patients, 19 in the control group (skin pressure in each belly of the anterior and middle scalene muscles) and 19 in the intervention group (ropivacaine). Subjects with a diagnosis of Nonspecific Thoracic Outlet Syndrome, pain in upper limbs and/or neck, with no radiculopathy or neurological involvement of the limb affected due to compressive or encephalic root causes were included. The primary endpoint was functionality, evaluated by the Disabilities of the Arm, Shoulder, and Hand - DASH scale validated for use in Brasil. The time of the evaluations were T0 = before the intervention; T1 = immediately after; T2 = 1 week; T3 = 4 weeks; T4 = 12 weeks; for T1, the DASH scale was not applied. RESULTS: Concerning the DASH scale, it is possible to affirm with statistical significance (p> 0.05) that the intervention group presented an improvement of functionality at four weeks, which was maintained by the 12th week. CONCLUSION: In practical terms, we concluded that a 0.375% injection of ropivacaine at doses of 2.5 ml in each belly of the anterior and middle scalene muscles, guided by ultrasonography, in the treatment of Nonspecific Thoracic Outlet Syndrome helps to improve function.


Assuntos
Anestésicos Locais/administração & dosagem , Injeções Intramusculares/métodos , Músculos do Pescoço/efeitos dos fármacos , Ropivacaina/administração & dosagem , Síndrome do Desfiladeiro Torácico/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Método Duplo-Cego , Feminino , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(29): e16262, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335674

RESUMO

RATIONALE: The thoracic epidural block and thoracic paravertebral block are widely used techniques for multimodal analgesia after thoracic surgery. However, they have several adverse effects, and are not technically easy. Recently, the erector spinae plane block (ESPB), an injected local anesthetic deep to the erector spinae muscle, is a relatively simple and safe technique. PATIENT CONCERNS: Three patients were scheduled for video assisted thoracoscopic lobectomy with mediastinal lymph node dissection. All the patients denied any past medical history to be noted. DIAGNOSES: They were diagnosed with primary adenocarcinoma requiring lobectomy of lung. INTERVENTIONS: The continuous ESPB was performed at the level of the T5 transverse process. The patient was received the multimodal analgesia consisted of oral celecoxib 200 mg twice daily, intravenous patient-controlled analgesia (Fentanyl 700 mcg, ketorolac 180 mg, total volume 100 ml), and local anesthetic (0.375% ropivacaine 30 ml with epinephrine 1:200000) injection via indwelling catheter every 12 hours for 5 days. Additionally, we injected a mixture of ropivacaine and contrast through the indwelling catheter for verifying effect of ESPB and performed Computed tomography 30 minutes later. OUTCOMES: The pain score was maintained below 3 points for postoperative 5 days, and no additional rescue analgesics were administered during this period. In the computed tomography, the contrast spread laterally from T2-T12 deep to the erector spinae muscle. On coronal view, the contrast spread to the costotransverse ligament connecting the rib and the transverse process. In the 3D reconstruction, the contrast spread from T6-T10 to the costotransverse foramen. LESSONS: Our contrast imaging data provides valuable information about mechanism of ESPB from a living patient, and our report shows that ESPB can be a good option as a multimodal analgesia after lung lobectomy.


Assuntos
Adenocarcinoma de Pulmão , Adjuvantes Anestésicos , Neoplasias Pulmonares , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Músculos Paraespinais/fisiopatologia , Pneumonectomia , Ropivacaina/administração & dosagem , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/classificação , Idoso , Analgesia Controlada pelo Paciente/métodos , Anestésicos Locais/administração & dosagem , Terapia Combinada/métodos , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Toracoscopia/efeitos adversos , Toracoscopia/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
9.
Medicine (Baltimore) ; 98(27): e16334, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277184

RESUMO

BACKGROUND: Lumbar spine hyperosteogeny and ligament calcification are common in the elderly and anesthesia puncture through the conventional approach is difficult in this age group, and repeated puncture can increase the risk of spinal hematoma and nerve injury. This study aimed to observe the feasibility and safety of single spinal anesthesia administered with 25G needle through the lateral crypt for lower-extremity fracture surgery in elderly patients. METHODS: The subjects were 60 elderly patients in our hospital (aged 65-80 years; ASA grades I and II) scheduled for lower-extremity fracture surgery (procedure was predicted to last within 2 h) under single spinal anesthesia by different approaches through L3-4. They were randomly divided into 2 groups: in the first group, 25G needle was used in a vertical approach (group C, n=30); in the second, 25G needle was passed through the inner edge of the small joints of L3-4 to the lateral crypt (group L, n=30). After successful completion of the puncture procedure, 2.5 mL of 0.5% hyperbaric ropivacaine was used for spinal anesthesia. We then recorded the puncture times, sensory block level, and adverse reactions (e.g., headache, lumbago, and lower limb pain). RESULTS: No significant differences in onset time, sensory block level and adverse reaction were noted between the 2 groups. The puncture success rate in group L was not significantly higher and the number of attempts per puncture was not significantly less than that in group C (93.3% vs 70%) (P = .063). Nerve-root irritation was more frequent in group L than in group C but with no significant difference (P > .05). CONCLUSION: Single spinal anesthesia through the lateral crypt approach is safe and effective for lower-extremity fracture surgery in elderly patients. Thus, this approach is a feasible alternative when the conventional approach fails.


Assuntos
Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Artroplastia de Quadril , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Ropivacaina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Raquianestesia/instrumentação , Estudos de Viabilidade , Feminino , Hemiartroplastia , Humanos , Vértebras Lombares , Masculino , Agulhas
10.
Int J Surg ; 69: 132-138, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150800

RESUMO

BACKGROUND: Pain due to coughing after thoracoscopic surgery remains a clinical problem, and its relief by intrapleural analgesia has not been extensively studied. This study attempts to determine the suitable volume of 0.75% ropivacaine needed for intrapleural analgesia after thoracoscopic surgery. METHODS: A double-blind, randomized, controlled trial was performed. Forty-five patients were randomly divided into three groups: R20, R15, and R10 (n = 15); 20 ml, 15 ml, or 10 ml of 0.75% ropivacaine was injected into the pleural cavity of each patient in the 3 groups, respectively, when the pain score from postoperative coughing was ≥4. The primary outcome was pain score upon coughing (C-NRS), and the secondary outcomes were pain score at rest (R-NRS), morphine consumption, time of onset, and duration of intrapleural analgesia. RESULTS: All patients in the R20 and R15 groups reported effective pain relief after intrapleural injection when postoperative coughing occurred. However, only 7 patients in the R10 group reported effective relief of pain. Compared with the patients in the R10 group, patients in the R20 and R15 groups had lower C-NRS scores, less morphine consumption at 8 h and 24 h, a shorter time to pain relief, and a longer duration of analgesia. There was no significant difference of R-NRS among the three groups. CONCLUSION: Intrapleural analgesia with 0.75% ropivacaine at a volume of 15 ml or 20 ml effectively relieved pain due to coughing after thoracoscopic surgery. TRIAL REGISTRATION: ChiCTR1800017515.


Assuntos
Anestésicos Locais/administração & dosagem , Tosse/fisiopatologia , Manejo da Dor/métodos , Ropivacaina/administração & dosagem , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleura
11.
A A Pract ; 12(11): 401-402, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31162168

RESUMO

A 20-year-old man submitted to surgical insertion of a lumboperitoneal drain as a treatment for intracranial hypertension, secondary to venous sinus thrombosis, developed severe headache accompanied by nausea, vomiting, and diplopia 24 hours postoperative. Cerebral spinal fluid low-pressure headache was diagnosed. A transnasal sphenopalatine ganglion block with ropivacaine was performed without complications. Pain relief was immediate, complete, and sustained for about 24 hours; a second block was performed effectively with pain control, and the patient was discharged. Sphenopalatine ganglion block may be a safe and efficient treatment for the cerebral spinal fluid hypotension headache secondary to lumboperitoneal shunt.


Assuntos
Cefaleia/terapia , Ropivacaina/administração & dosagem , Bloqueio do Gânglio Esfenopalatino/métodos , Derivação Ventriculoperitoneal/efeitos adversos , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/cirurgia , Masculino , Resultado do Tratamento , Adulto Jovem
12.
Int J Surg ; 68: 35-39, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31185312

RESUMO

BACKGROUND: Paravertebral block (PVB) as a sole anesthetic technique is difficult even in experienced hands. Hence, this study was undertaken to study the safety and efficacy of PVB and to compare with subarachnoid block (SAB) for inguinal hernia repair surgery (IHRS) in elderly male patients. MATERIALS AND METHODS: Sixty-five male patients aged 65 to 89 scheduled for IHRS were allocated randomly by computer-generated randomisation sequence into two groups. They underwent PVB (Group PVB: 33 patients were injected with 10 ml ropivacaine 0.5% at each level from T12 to L1) or SAB (Group SAB: 32 patients were injected with 15 mg ropivacaine 0.5% at L3-L4 level). Primary outcomes were hemodynamic changes and duration of postoperative analgesia. Secondary outcomes were dosage of remedial analgesics, time to perform the block, side effects and satisfaction of patients. RESULTS: The hemodynamics in the Group PVB were more stable than those in the Group SAB during surgery (P < 0.05). The duration of post-operative analgesia was significantly longer in the Group PVB (P < 0.001). The total dose of fentanyl was smaller in the Group PVB in the first 24 h (P < 0.001). The time to perform the block was significantly longer in the Group PVB (P < 0.001). There was a significant difference in the visual analogue scales (VAS) scores between the two groups at 4 h, 6 h, 8 h and 10 h (P < 0.05) but not at 2 h, 12 h and 24 h (P > 0.05). The VAS scores were lowest at 2 h for both the 2 groups, highest at 12 h for Group PVB and at 8 h for Group SAB respectively. The Group PVB had fewer adverse effects (P < 0.05) and higher satisfaction of patients (P < 0.05). CONCLUSION: Ultrasound-guided PVB can ensure the anesthetic effects of unilateral-opened IHRS in elderly male patients. It has a small impact on hemodynamics, a longer postoperative analgesia time and less complications.


Assuntos
Raquianestesia/métodos , Anestésicos/administração & dosagem , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Bloqueio Nervoso/métodos , Ropivacaina/administração & dosagem , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Herniorrafia/efeitos adversos , Humanos , Injeções , Masculino , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Coluna Vertebral/inervação , Espaço Subaracnóideo , Resultado do Tratamento
13.
Vet Anaesth Analg ; 46(5): 682-688, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31204254

RESUMO

OBJECTIVE: To determine the anesthesia cost from ultrasound-guided lumbar plexus and sciatic nerve blocks confirmed with electrostimulation for unilateral tibial plateau leveling osteotomy (TPLO) surgery in dogs. STUDY DESIGN: Prospective, randomized, blinded clinical trial. ANIMALS: A group of 20 dogs weighing 33.9 ± 6.0 kg (mean ± standard deviation). METHODS: All dogs were administered hydromorphone and atropine, propofol for induction of anesthesia and isoflurane for maintenance. Hydromorphone and carprofen were administered for recovery. The dogs were randomly assigned to one of two groups, lumbar plexus and sciatic nerve blocks with ropivacaine [regional anesthesia (RA)] or sham blocks with saline [control (CON)]. Fentanyl was administered for rescue analgesia intraoperatively and postoperatively. The cost to manage anesthesia was divided into fixed and variable costs using the micro-costing method. The variable costs were compared using Student's t test or Mann-Whitney U test. RESULTS: The fixed anesthesia costs were equal between groups at US$354.00 per case. The variable anesthesia cost range was US$27.90-100.10 for RA and US$21.00-180.50 for CON. Overall, cost per dog in CON was from -US$6.9 to US$80.4 compared with RA. For 160 TPLO cases per year, hospital cost when RA is performed decreased the cost by $12,864 per year up to increased cost by $1104 per year, depending on the requirements for systemic drugs and incidence/severity of anesthesia complications. The estimated fee charge per case for service necessary to reimburse the cost of a new ultrasound (US$25,000.00) and nerve locator (US$925.00) over their life span of 6 and 10 years, respectively, is US$26.62. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasound-guided lumbar plexus and sciatic nerve blocks with electrostimulation confirmation can increase the anesthesia cost through use of specific equipment. However, in most cases, the anesthesia cost decreased as a result of decreased costs for pain management and treatment of complications.


Assuntos
Cães/fisiologia , Terapia por Estimulação Elétrica/veterinária , Bloqueio Nervoso/veterinária , Osteotomia/veterinária , Dor Pós-Operatória/veterinária , Joelho de Quadrúpedes/cirurgia , Ultrassonografia de Intervenção/veterinária , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Animais , Colorado , Terapia Combinada/economia , Terapia Combinada/veterinária , Análise Custo-Benefício , Cães/cirurgia , Terapia por Estimulação Elétrica/economia , Feminino , Plexo Lombossacral , Masculino , Bloqueio Nervoso/economia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ropivacaina/administração & dosagem , Ropivacaina/uso terapêutico , Nervo Isquiático , Método Simples-Cego , Ultrassonografia de Intervenção/economia
14.
Medicine (Baltimore) ; 98(18): e15330, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045772

RESUMO

RATIONALE: Although intrathecal opioid infusion has been used for decades for the treatment of severe pain, myoclonus as one of the complications of this therapeutic modality is now beginning to be recognized more. PATIENTS CONCERNS: Here, we report three patients who developed myoclonus after dose adjustment in intrathecal drug delivery system for the treatment of refractory cancer pain. DIAGNOSIS: Spinal myoclonus is a sudden, brief, shock-like muscle contractions originating from the central nervous system. In our cases, it occurred after opioid administration via intrathecal delivery system with no abnormality found in laboratory or imaging examinations. INTERVENTIONS: Spinal myoclonus can be treated effectively by reducing the dose or infusion rate as described in case 1, or changing from an intrathecal to systemic administration in case 2, or correcting infusion and bolus parameters mistakes in case 3. OUTCOMES: All patients recovered quickly after stopping or decreasing the intrathecal drug infusion. LESSONS: Prevention is more important than treatment as for spinal myoclonus. Pain management teams should be aware of this distressing complication. Dose of intrathecal drugs should not exceed the recommended maximal daily doses by guidelines and patient education is important for successful intrathecal analgesic therapy.


Assuntos
Morfina/efeitos adversos , Mioclonia/induzido quimicamente , Neoplasias/tratamento farmacológico , Ropivacaina/efeitos adversos , Doenças da Coluna Vertebral/induzido quimicamente , Conscientização , Dor do Câncer/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Feminino , Humanos , Injeções Espinhais/métodos , Pessoa de Meia-Idade , Morfina/administração & dosagem , Mioclonia/prevenção & controle , Metástase Neoplásica , Neoplasias/complicações , Manejo da Dor/métodos , Dor Intratável/tratamento farmacológico , Ropivacaina/administração & dosagem , Doenças da Coluna Vertebral/fisiopatologia , Doenças da Coluna Vertebral/prevenção & controle
15.
Medicine (Baltimore) ; 98(18): e15385, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045789

RESUMO

BACKGROUND: Thoracotomy is one of the most painful surgeries; therefore, video-assisted thoracoscopic surgery (VATS) was developed to reduce the surgical stress of thoracotomy. Although VATS results in reduced postoperative pain compared with thoracotomy, it is still painful. Serratus plane block (SPB) is a novel technique that provides lateral chest wall analgesia by blocking the lateral branch of the intercostal nerve. METHODS: We conducted a prospective study in 50 patients, aged 20 to 75 years, undergoing three-port VATS lobectomy. Group G (n = 25) received conventional general anesthesia and Group S (n = 25) received SPB before induction of general anesthesia. In Group S, 20 ml of 0.375% ropivacaine was injected between the serratus anterior and latissimus dorsi muscles. During surgery, anesthesia was maintained by adjusting the propofol dose to maintain a bispectral index of 40 to 60 and the remifentanil dose to maintain blood pressure and heart rate within 70 to 130% of baseline. RESULTS: Intraoperative remifentanil consumption was significantly lower in Group S compared to that in Group G (519.9 µg vs 1047.7 µg, P < .001). Moreover, emergence time was significantly shorter in Group S compared to Group G (10.8 minutes vs 14.9 minutes, P = .01). However, there were no significant differences in systolic blood pressure and heart rate (HR) between the groups at each time point. The doses of rescue drugs for the control of blood pressure and HR were not significantly different between the 2 groups. CONCLUSIONS: Ultrasound-guided SPB could be a safe and effective regional anesthesia technique for VATS.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Pneumonectomia/métodos , Ropivacaina/administração & dosagem , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Período de Recuperação da Anestesia , Músculos do Dorso , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Ultrassonografia de Intervenção , Adulto Jovem
16.
J Int Med Res ; 47(6): 2562-2570, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079512

RESUMO

OBJECTIVE: This study was designed to evaluate the neurotoxicity of dexmedetomidine combined with ropivacaine for continuous femoral nerve block in rabbits. METHODS: Thirty New Zealand rabbits were randomly divided into 5 groups of 6 rabbits each and received a continuous femoral nerve block with saline; 0.25% ropivacaine; or 1, 2, or 3 µg/mL of dexmedetomidine added to 0.25% ropivacaine (Groups A-E, respectively). Sensory and motor function was assessed after the nerve block. The rabbits were anesthetized and killed after 48 hours of a continuous femoral nerve block, and the femoral nerves were removed for light and electron microscopy analyses. RESULTS: The behavior scores were highest in Group A at 2 and 6 hours after injection. The scores were higher in Groups B and C than in Groups D and E at these same time points. All groups showed normal pathological tissues in the femoral nerves under optical microscopy. Under electron microscopy, histological abnormalities were observed only in Group E; none of the other groups exhibited pathological abnormalities. Quantitative analysis of the myelin sheath area revealed no significant difference in the axonal area, total area of the myelin sheath, or ratio of the total axonal area to the total area of the myelin sheath in all groups. CONCLUSION: The lowest doses of dexmedetomidine (1 and 2 µg/mL) combined with 0.25% ropivacaine for continuous femoral nerve block resulted in no neurotoxic lesions, but the higher dose (3 µg/mL) resulted in neurotoxic lesions in this rabbit experimental model.


Assuntos
Analgésicos não Entorpecentes/efeitos adversos , Anestésicos Locais/efeitos adversos , Dexmedetomidina/efeitos adversos , Nervo Femoral/efeitos dos fármacos , Bloqueio Nervoso/métodos , Síndromes Neurotóxicas/patologia , Ropivacaina/efeitos adversos , Analgésicos não Entorpecentes/administração & dosagem , Anestésicos Locais/administração & dosagem , Animais , Dexmedetomidina/administração & dosagem , Relação Dose-Resposta a Droga , Síndromes Neurotóxicas/etiologia , Coelhos , Ropivacaina/administração & dosagem
17.
Rev Bras Anestesiol ; 69(3): 272-278, 2019.
Artigo em Português | MEDLINE | ID: mdl-31080007

RESUMO

BACKGROUND AND OBJECTIVES: Inadequate pain relief after anterior cruciate ligament reconstruction affects mobility leading to development of adhesions, weakened ligament insertion and muscle atrophy. Adductor canal block for postoperative analgesia preserves quadriceps strength. The present study was conducted to compare pain free period in patients undergoing arthroscopic anterior cruciate ligament reconstruction, receiving ultrasound-guided adductor canal block with ropivacaine alone and ropivacaine with clonidine. METHODS: A prospective randomized double blinded study was conducted including sixty-three adult, ASA class I, II patients undergoing anterior cruciate ligament reconstruction. They were randomized into three groups: Group S - control group received adductor canal block with 30mL saline, Group R - ropivacaine group received adductor canal block with 30mL of 0.375% ropivacaine and Group RC - clonidine group received adductor canal block with 30mL of 0.375% ropivacaine with clonidine 1µg.kg-1. The primary aim was to compare the pain free period in patients receiving adductor canal block with ropivacaine alone or ropivacine with clonidine. The secondary outcomes were pain score at rest and movement, total analgesic requirement, sedation score and postoperative nausea and vomiting. RESULTS: The mean pain free periods were 20min, 384.76min and 558.09min for Group S, Group R and Group RC, respectively and this difference was statistically significant (p < 0.001). There was no significant difference between Group R and Group RC in terms of pain scores at rest and movement and total analgesic requirement. CONCLUSION: Addition of clonidine to ropivacaine in USG guided adductor canal block led to significant prolongation of pain free period though pain score at rest and movement, and rescue analgesic requirement, did not differ.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia/métodos , Clonidina/administração & dosagem , Bloqueio Nervoso/métodos , Ropivacaina/administração & dosagem , Adulto , Analgésicos/administração & dosagem , Anestésicos Locais/administração & dosagem , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ultrassonografia de Intervenção/métodos , Adulto Jovem
18.
Neuroradiology ; 61(8): 881-889, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31101947

RESUMO

PURPOSE: To analyze the causes of pain, imaging characteristics, and therapeutic effect of spinal injection in patients with extreme low back pain or sciatica. METHODS: We analyzed 381 consecutive patients with extreme low back pain or sciatica visiting our spinal intervention center between January and December 2017. Clinical and imaging characteristics were analyzed. The treatment response, defined as a numerical pain rating scale decrease of ≥ 30%, was measured. Fisher's exact test was performed to identify the association between the injection response and subsequent lumbar surgery rate. RESULTS: The most frequent cause of pain was spinal stenosis, followed by herniated intervertebral disc, facet osteoarthritis, and osteoporotic compression fracture. A herniated intervertebral disc was the most common disorder in patients < 50 years of age, while spinal stenosis was the most common in patients ≥ 50 years of age. Women comprised 66.4% of the study population. The majority of lumbar pathologies occurred below L3/4. Spinal injection was found to be effective in 44.2% of cases. Those who responded to the injection showed a significantly lower rate of lumbar surgery within 6 months (P = 0.004). CONCLUSIONS: Those with extreme low back pain or sciatica had clinical and imaging characteristics similar to those with typical low back pain referred for spinal injection. Spinal injection could be an effective method of pain control for patients with extreme low back pain or sciatica.


Assuntos
Injeções Espinhais , Dor Lombar/diagnóstico por imagem , Vértebras Lombares , Imagem por Ressonância Magnética , Ciática/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Dexametasona/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Ropivacaina/administração & dosagem , Ciática/tratamento farmacológico , Ciática/etiologia , Doenças da Coluna Vertebral/complicações
20.
World Neurosurg ; 128: e1126-e1130, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31121375

RESUMO

BACKGROUND: Protocols for effective postoperative pain control in patients undergoing spinal surgery are not standardized. In our study, we compared the effects of hemostatic absorbable gelatin sponge impregnated with ropivacaine versus normal saline when applied to the transverse process of the operated vertebrae on the postoperative pain following instrumentation spine surgery. METHODS: A prospective double-blind randomized study was conducted on 30 patients undergoing spine surgery. At the end of surgery, the hemostatic gelatin sponge was applied by the surgeon on the transverse process of the operated vertebra containing either ropivacaine 0.5% or normal saline NaCl 0.9. Pain was assessed using the visual analog scale (VAS) every 4 hours for 48 hours postoperatively in the 2 groups (ropivacaine vs. normal saline). The total amount of postoperative opioid use was also recorded. RESULTS: The VAS score was significantly lower in patients receiving hemostatic gelatin sponge impregnated with local anesthetics as compared with patients receiving gelatin sponge impregnated with normal saline 48 hours postoperatively; the mean total dose of meperidine given in the first 48 hours postoperatively was significantly lower (53.5 ± 51.0 mg) in patients receiving gelatin sponge impregnated with local anesthetics as compared with patients receiving hemostatic gelatin sponge impregnated with normal saline (140.5 ± 102 mg). CONCLUSIONS: Use of intraoperative hemostatic gelatin sponge impregnated with ropivacaine applied on the transverse process of the operated vertebrae intraoperatively resulted in decreasing the postoperative pain in patients undergoing lumbar instrumentation surgery as manifested by the decrease in the VAS score and the total dose of opioids.


Assuntos
Anestésicos Locais/administração & dosagem , Esponja de Gelatina Absorvível/uso terapêutico , Hemostáticos/uso terapêutico , Vértebras Lombares/cirurgia , Dor Pós-Operatória/prevenção & controle , Ropivacaina/administração & dosagem , Idoso , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Período Intraoperatório , Vértebras Lombares/efeitos dos fármacos , Masculino , Meperidina/uso terapêutico , Pessoa de Meia-Idade , Solução Salina/administração & dosagem , Fusão Vertebral , Resultado do Tratamento
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