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1.
Reg Anesth Pain Med ; 48(1): 7-13, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36167477

RESUMO

BACKGROUND AND AIMS: An opioid-sparing postoperative analgesic regimen following laparoscopic hemicolectomy is optimal to promote minimal postoperative pain, early mobilization, and improved quality of recovery. Various regional anesthesia techniques have been tested to improve postoperative pain management after laparoscopic hemicolectomy. In this study, we aimed to assess the effect of administering a preoperative bilateral ultrasound-guided anterior quadratus lumborum nerve block on postoperative opioid consumption after laparoscopic colon cancer surgery. METHODS: In this randomized, controlled, double-blinded trial, 69 patients undergoing laparoscopic hemicolectomy due to colon cancer were randomized to receive an anterior quadratus lumborum block with ropivacaine 0.375% 30 mL on each side or isotonic saline (placebo). The primary outcome measure was total opioid consumption during the first 24 hours postsurgery. The secondary outcome measures were pain scores, accumulated opioid consumption in 6-hour intervals, nausea and vomiting, ability of postoperative ambulation, time to first opioid, orthostatic hypotension or intolerance, postoperative Quality of Recovery-15 scores, surgical complications, length of hospital stay, and adverse events. RESULTS: The total opioid consumption in the first 24 hours postsurgery was not significantly reduced in the ropivacaine group compared with the saline group (mean 129 mg (SD 88.4) vs mean 127.2 mg (SD 89.9), p=0.93). In addition, no secondary outcome measures showed any statistically significant intergroup differences. CONCLUSION: The administration of a preoperative bilateral anterior quadratus lumborum nerve block as part of a multimodal analgesic regimen for laparoscopic hemicolectomy did not significantly reduce opioid consumption 24 hours postsurgery. Trial registration number NCT03570541.


Assuntos
Neoplasias do Colo , Laparoscopia , Bloqueio Nervoso , Humanos , Analgésicos Opioides , Ropivacaina/uso terapêutico , Anestésicos Locais , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Colectomia/efeitos adversos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Método Duplo-Cego , Analgésicos/uso terapêutico , Neoplasias do Colo/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/tratamento farmacológico
2.
Reg Anesth Pain Med ; 48(1): 47-48, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36261263
3.
Phys Med Rehabil Clin N Am ; 34(1): 291-309, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36410889

RESUMO

Peripheral nerve blocks (PNB) can lessen procedural pain and eliminate the known detrimental effects of our local anesthetics on our orthobiologic target tissues. Local nerve damage and local anesthetic systemic toxicity are risks of PNBs that can be minimized with meticulous injection technique and an understanding of why these complications can occur. Herein, several PNB techniques are described in an effort to enhance procedural safety, efficacy, and comfort.


Assuntos
Anestesia por Condução , Bloqueio Nervoso , Doenças do Sistema Nervoso Periférico , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Anestesia por Condução/métodos , Anestésicos Locais , Nervos Periféricos
4.
Reg Anesth Pain Med ; 48(1): 22-28, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36241348

RESUMO

BACKGROUND: The retrodural space of Okada is a potential space posterior to the ligamentum flavum that allows communication with the bilateral facet joints. However, the actual anatomy of this space has not been clearly visualized to date. We sought to investigate the characteristics of patients showing contrast spreading to the facet joint space during epidural injection and to clarify the anatomical structures of the retrodural space and adjacent ligamentous tissues in cadaveric specimens. METHODS: Fluoroscopic images of patients who underwent fluoroscopy-guided lumbar interlaminar epidural injection were assessed for contrast flow to the facet joints. Patient demographics, preprocedural imaging study findings, and epidural approaches were analyzed. The anatomical study included the sectional dissection, micro-CT imaging, and histological evaluation of lumbar spine specimens from 16 embalmed cadavers. RESULTS: Fluoroscopic images of 605 epidural injections were analyzed. Among them, 36 with inadvertent spread into the facet joints (5.9%) were identified. Multivariate analysis revealed that facet joint pathologies were significantly associated with inadvertent spread into the facet joints (OR 4.382; 95% CI 1.160 to 16.558; p=0.029). Micro-CT and histological findings consistently showed a retrodural space between the ligamentum flavum and interspinous ligament. Various anatomical communication routes in the posterior ligamentous complex leading to this space were observed in specimens with degenerative and pathological changes. CONCLUSION: Degenerative and pathological facet joint changes were associated with a higher incidence of spread into the retrodural space during epidural injection. Our findings confirm anatomical evidence for a false loss of resistance before the needle enters the epidural space.


Assuntos
Ligamento Amarelo , Articulação Zigapofisária , Humanos , Espaço Epidural/diagnóstico por imagem , Fluoroscopia , Injeções Epidurais , Ligamento Amarelo/diagnóstico por imagem , Manejo da Dor , Bloqueio Nervoso
6.
Reg Anesth Pain Med ; 48(1): 14-21, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36137734

RESUMO

INTRODUCTION: Hip fractures are a common frailty injury affecting a vulnerable geriatric population. It is debated if anesthetic and analgesic techniques are associated with altered risk for outcomes in hip fracture patients. This study aimed to determine the association of anesthesia and regional analgesia with all cause 12-month mortality and even longer-term mortality after hip fracture surgery in Australia and New Zealand. METHODS: Data from the Australian and New Zealand Hip Fracture Registry collected from 2016 to 2018, with a minimum follow-up of 12 months, were reviewed. Anesthesia type and use of regional nerve blocks were investigated. The primary outcome was all cause 12-month mortality. RESULTS: 12-month mortality was 30.6% (n=5410) in a total of 17,635 patients. There was no difference in 12-month mortality between patients who received spinal or general anesthesia (p=0.238). The administration of a combination of general and spinal anesthesia for surgery to repair the fracture was an independent predictor of higher 12-month mortality (unadjusted complete case HR=1.17 (95% CI 1.04 to 1.31); p<0.001). Nerve blocks performed in both the emergency department (ED) and the operating theater (OT) were associated with reduced long-term mortality (median follow-up 21 months) with an unimputed unadjusted HR=0.86 (95% CI 0.77 to 0.96; p=0.043). CONCLUSION: There was no difference in the association of 12-month mortality between general and spinal anesthesia in patients undergoing hip fracture surgery. However, there was an association with a higher risk of 12-month mortality in patients who received both general and spinal anesthesia for the same surgery. Patients who received a regional nerve block in both the ED and the OT had a lower association of 12-month and longer-term mortality risk. The reasons for these findings remain unknown and should be the subject of further research investigation.


Assuntos
Analgesia , Anestesia por Condução , Fraturas do Quadril , Idoso , Humanos , Anestesia por Condução/efeitos adversos , Anestesia por Condução/métodos , Austrália/epidemiologia , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/cirurgia , Nova Zelândia/epidemiologia , Sistema de Registros , Bloqueio Nervoso
7.
Rev. esp. anestesiol. reanim ; 69(10): 617-624, dic. 2022. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-VR-13

RESUMO

Objetivos: Lograr la analgesia perioperatoria adecuada puede ser difícil en los pacientes sometidos a cirugías de mama, debido a la compleja inervación de la mama y la axila. El objetivo del estudio es investigar la eficacia de bloqueo del plano del músculo erector de la columna (ESPB) en comparación con las técnicas anestésicas regionales convencionales (bloqueo paravertebral torácico [TPVB] y bloqueo del nervio pectoral [PECS] ecoguiado). Métodos: Se incluyó en el estudio a 80 mujeres programadas para mastectomía radical modificada (MRM) electiva, con puntuación ASAI-II, y edades comprendidas entre 18 y 60años. Se aleatorizó a las pacientes en cuatro grupos: TPVB, PECS, ESPB y grupo control. Todas las pacientes de los grupos de bloqueo recibieron 25ml de bupivacaína al 0,25% mediante guía ecográfica. El grupo control recibió únicamente opiáceos para el manejo del dolor perioperatorio. Se observó a las pacientes durante 48horas en el postoperatorio para medir la duración de la analgesia (resultado primario). Resultados: ESPB reflejó una menor duración de la analgesia en comparación con el bloqueo PECS, sin diferencia estadísticamente significativa en comparación con el grupo TPVB. El consumo de morfina se incrementó en ESPB en comparación con el grupo PECS, con una diferencia insignificante en comparación con el grupo TPVB. Se produjo una diferencia no significativa entre los grupos en términos de hemodinámica y complicaciones, reportándose un caso de neumotórax en el grupo TPVB. Conclusión: PECS y ESPB representan una buena alternativa a TPVB para analgesia post-mastectomía, reflejando el bloqueo PECS un efecto analgésico superior en cuanto a consumo de opiáceos, duración de la analgesia y puntuación EVA.(AU)


Objectives: Achieving adequate perioperative analgesia can be challenging in patients undergoing breast surgeries due to the complex nerve supply of the breast and axilla. The study aims to investigate the efficacy of ESPB in comparison to conventional regional anesthesia techniques (TPVB and PECS). Methods: Eighty female patients who were scheduled for elective MRM, with ASA scoreI-II, and aged between 18 and 60years, were included in the study. Patients were randomized into four groups: the TPVB, PECS, ESPB, and the control group. All patients in either block groups received 25ml bupivacaine 0.25% with ultrasound guidance. The control group received only opioids for perioperative pain management. The patients were observed for 48hours after surgery for the duration of analgesia (primary outcome) Results: ESPB has a shorter duration of analgesia than PECS block with no significant statistical difference compared with group TPVB. Morphine consumption is increased in ESPB compared to the PECS group, with an insignificant difference compared to group TPVB. There was an insignificant difference between the groups concerning hemodynamics and complications, with one pneumothorax case reported in the TPVB group. Conclusion: PECS and ESPB represent a good alternative to TPVB for post-mastectomy analgesia with a superior analgesic effect of PECS block regarding opioid consumption, duration of the analgesia, and VAS score.(AU)


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Nervos Torácicos , Neoplasias da Mama/cirurgia , Analgesia , Dor Pós-Operatória , Bloqueio Nervoso , Mastectomia , Anestesiologia , Reanimação Cardiopulmonar , Ginecologia
8.
Ann Plast Surg ; 89(6): 656-659, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416694

RESUMO

ABSTRACT: The analgesic efficacy of bilateral low thoracic erector spinae blocks for combined major breast and abdominal surgery has not been reported. The aim of this case series was to assess the feasibility and efficacy of T8 thoracic preincisional erector spinae blocks in patients undergoing total radical mastectomies with axillary lymph node dissections in addition to reconstruction with abdominal deep inferior epigastric flaps. The aim was to supply dermatomal coverage to provide analgesia for T2-L1 that formed the basis for an opioid-sparing multimodal technique in the context of our early recovery after breast surgery with deep inferior epigastric flap program.


Assuntos
Neoplasias da Mama , Bloqueio Nervoso , Retalho Perfurante , Humanos , Feminino , Mastectomia Simples , Mastectomia , Neoplasias da Mama/cirurgia , Estudos de Viabilidade , Mastectomia Radical , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção
9.
Sci Rep ; 12(1): 20606, 2022 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-36446941

RESUMO

Thoracic epidural analgesia (TEA) and transversus abdominis plane (TAP) block are used for pain control after abdominal surgery. Although there have been several meta-analyses comparing these two techniques, the conclusion was limited by a small number of studies and heterogeneity among studies. Our meta-analysis used the Medline, EMBASE, and Cochrane central library databases from their inception through September 2022. Randomized controlled trials (RCTs) comparing TEA and TAP block were included. The pre-specified primary outcome was the pain score at rest at 12 h postoperatively. Twenty-two RCTs involving 1975 patients were included. Pooled analyses showed the pain score at rest at 12 h postoperatively was significantly different between groups favoring TEA group (Mean difference [MD] 0.58, 95% confidence interval CI - 0.01, 1.15, P = 0.04, I2 = 94%). TEA group significantly reduced the pain score at 48 h at rest (MD 0.59, 95% CI 0.15, 1.03, P = 0.009, I2 = 86%) and at 48 h at movement (MD 0.53, 95% CI 0.07, 0.99, P = 0.03, I2 = 76%). However, there was no significant difference at other time points. Time to ambulation was shorter in TAP block but the incidence of hypotension at 24 h and 72 h was significantly lower in TAP block compared to TEA. Trial sequential analysis showed that the required information size has not yet been reached. Our meta-analysis demonstrated there was no significant or clinically meaningful difference in the postoperative pain scores between TEA and TAP block group. Given the insufficient information size revealed by TSA, the high risk of bias of our included studies, and the significant heterogeneity of our meta-analysis results, our results should be interpreted carefully but it is not likely that the addition of further studies could prove any clinically meaningful difference in pain score between these two techniques.


Assuntos
Analgesia Epidural , Anestesia Epidural , Bloqueio Nervoso , Humanos , Analgesia Controlada pelo Paciente , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia
10.
J Nanobiotechnology ; 20(1): 498, 2022 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-36424657

RESUMO

BACKGROUND: The lack of a satisfactory strategy for postoperative pain management significantly impairs the quality of life for many patients. However, existing nanoplatforms cannot provide a longer duration of nerve blockage with intensity-adjustable characteristics under imaging guidance for clinical applications. RESULTS: To overcome this challenge, we proposed a biocompatible nanoplatform that enables high-definition ultrasound imaging-guided, intensity-adjustable, and long-lasting analgesia in a postoperative pain management model in awake mice. The nanoplatform was constructed by incorporating perfluoropentane and levobupivacaine with red blood cell membranes decorated liposomes. The fabricated nanoplatform can achieve gas-producing and can finely escape from immune surveillance in vivo to maximize the anesthetic effect. The analgesia effect was assessed from both motor reactions and pain-related histological markers. The findings demonstrated that the duration of intensity-adjustable analgesia in our platform is more than 20 times longer than free levobupivacaine injection with pain relief for around 3 days straight. Moreover, the pain relief was strengthened by repeatable ultrasound irradiation to effectively manage postoperative pain in an intensity-adjustable manner. No apparent systemic and local tissue injury was detected under different treatments. CONCLUSION: Our results suggest that nanoplatform can provide an effective strategy for ultrasound imaging-guided intensity-adjustable pain management with prolonged analgesia duration and show considerable transformation prospects.


Assuntos
Nanopartículas , Bloqueio Nervoso , Camundongos , Animais , Manejo da Dor/métodos , Levobupivacaína , Qualidade de Vida , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Ultrassonografia/métodos
12.
Acta Clin Croat ; 61(1): 3-10, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36398073

RESUMO

Transversus abdominis plane (TAP) block is used to provide analgesia after lower abdominal surgery operations. TAP block has been shown to reduce postoperative pain scores and side effects of opioids after cesarean section. Generally, TAP block was introduced after cesarean section. It is assumed that delivery affects sonographic characteristics of the abdominal wall. For this reason, ultrasonographic measurement of the anatomy of the region defined for TAP block was performed before and after cesarean section. It was aimed to determine the estimated TAP block distance in the population undergoing cesarean section. Fifty patients who underwent cesarean section in the operating room were included in the study. The inclusion criteria were ASA score I-II, age 18-45 years, gestational age ≥32 weeks, and cesarean section performed by Pfannenstiel incision. Data on patient age, weight, height, body mass index, gravidity, parity, gestational age (weeks), concomitant disease and allergy were recorded. According to the results obtained in the study, ultrasound should be performed if TAP block is accessible. Before cesarean section, the external oblique muscle and internal oblique muscle are closer to surface than after cesarean section since the TAP distance after pregnancy will be deeper. Systematic data on ultrasonographic anatomy of the abdominal wall in pregnant women have not yet been published. The obstetric anesthesiologist should be aware of these changes when planning a TAP block in the context of cesarean section. There is a need for larger prospective studies.


Assuntos
Cesárea , Bloqueio Nervoso , Humanos , Feminino , Gravidez , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Lactente , Cesárea/métodos , Estudos Prospectivos , Músculos Abdominais/diagnóstico por imagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/etiologia
13.
West J Emerg Med ; 23(6): 878-885, 2022 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-36409943

RESUMO

INTRODUCTION: Regional anesthesia (RA) has become a prominent component of multimodal pain management in emergency medicine (EM), and its use has increased rapidly in recent decades. Nevertheless, there is a paucity of data on how RA practice has evolved in the specialty. In this study we sought to investigate how RA has been implemented in EM by analyzing trends of published articles and to describe the characteristics of the published research. METHODS: We retrieved RA-related publications from the SciVerse Scopus database from inception to January 13, 2022, focusing on studies associated with the use of RA in EM. The primary outcome was an analysis of trend based on the number of annual publications. Other outcomes included reports of technique diversity by year, trends in the use of individual techniques, and characteristics of published articles. We used linear regression analysis to analyze trends. RESULTS: In total, 133 eligible publications were included. We found that overall 23 techniques have been described and results published in the EM literature. Articles related to RA increased from one article in 1982 to 18 in 2021, and the rate of publication has increased more rapidly since 2016. Reports of lower extremity blocks (60.90%) were published most frequently in ranked-first aggregated citations. The use of thoracic nerve blocks, such as the erector spinae plane block, has increased exponentially in the past three years. The United States (41.35%) has published the most RA-related articles. Regional anesthesia administered by emergency physicians (52.63%) comprised the leading field in published articles related to RA. Most publications discussed single-shot (88.72%) and ultrasound-guided methods (55.64%). CONCLUSION: This study highlights that the number of published articles related to regional anesthesia in EM has increased. Although RA research has primarily focused on lower extremity blocks, clinical researchers continue to broaden the field of study to encompass a wide spectrum of techniques and indications.


Assuntos
Anestesia por Condução , Medicina de Emergência , Bloqueio Nervoso , Humanos , Estados Unidos , Bibliometria , Manejo da Dor
14.
RMD Open ; 8(2)2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36418088

RESUMO

OBJECTIVE: Adhesive capsulitis is a common painful shoulder condition. Treatment for the condition remains unsatisfactory. Suprascapular nerve block (SSNB) shows promise as a treatment option for adhesive capsulitis but there are no randomised controlled trials that examine its effect on pain or duration of the condition. The objective of this study was to examine the efficacy of SSNB for the management of adhesive capsulitis. METHODS: A randomised double-blind placebo-controlled trial of SSNB and standard therapy versus placebo and standard therapy was performed. In total, 54 patients were enrolled in the study. 27 patients received a glenohumeral joint (GHJ) injection and physiotherapy plus a 3-month SSNB, and 27 patients received a GHJ injection and physiotherapy plus a 3-month placebo injection. Patients were followed to resolution of their symptoms as measured by a combination of range of movement, pain scores, Shoulder Pain and Disability Index (SPADI) scores and perceived recovery scores. The primary outcome measure was time to resolution of symptoms. RESULTS: Participants who received the SSNB reduced the duration of their symptoms of adhesive capsulitis by an average of 6 months (mean time to resolution 5.4 (95% CI 4.4 to 6.3) months vs 11.2 (95% CI 9.3 to 13) months) in the placebo group. They also had reduced pain scores, improved range of movement and lower SPADI scores compared with the placebo group across all time points. CONCLUSION: SSNB reduced the duration of adhesive capsulitis and resulted in improved pain and disability experience for patients. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ANCTRN 12615001378516).


Assuntos
Bursite , Bloqueio Nervoso , Humanos , Resultado do Tratamento , Austrália , Bursite/terapia , Bursite/etiologia , Dor de Ombro/terapia , Dor de Ombro/tratamento farmacológico , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos
15.
Nan Fang Yi Ke Da Xue Xue Bao ; 42(10): 1526-1531, 2022 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-36329587

RESUMO

OBJECTIVE: To explore the effect of thoracic paravertebral anesthesia (TPVB) on prognosis of patients undergoing resection of lung cancer. METHODS: This study was conducted among the patients undergoing surgical resection of primary lung cancer under general anesthesia or TPVB combined with general anesthesia (TPVB+GA) between January, 2017 and May, 2018.The patients were enrolled in TPVB+GA group and GA group (control group) using a propensity score matching (PSM) method at the ratio of 1:2 based on their baseline characteristics.The clinical parameters, 5-year overall survival (OS), progression-free survival (PFS) and intraoperative dosage of opioids were compared between the two groups to assess the impact of TPVB on prognosis of the patients. RESULTS: Forty-seven patients were enrolled in TPVB+GA group and 94 in the control group.Kaplan-Meier survival analysis showed a significantly prolonged PFS in the patients with TPVB+GA (log-rank P=0.034), with an odds ratio (OR) of 0.45(95%CI: 0.33-0.89).Consistently, univariate and multivariate Cox regression analyses identified TPVB as an independent protective prognostic factor for patients with lung cancer resection (P=0.002, OR=0.33, 95%CI: 0.16-0.66).Cox regression analyses indicated that a lower intraoperative dose of remifentanil was significantly correlated with a longer PFS of the patients following lung cancer resection (P=0.017, OR=0.47, 95%CI: 0.25-0.87).Chi-square test confirmed that TPVB, but not general anesthesia, significantly reduced intraoperative dose of remifentanil, indicating a possible synergistic effect of TPVB with opioids to affect the survival of the patients. CONCLUSION: TPVB can prolong the survival time and improve the prognosis of the patients undergoing surgical resection of lung cancer.


Assuntos
Neoplasias Pulmonares , Bloqueio Nervoso , Humanos , Remifentanil , Dor Pós-Operatória , Bloqueio Nervoso/métodos , Analgésicos Opioides , Prognóstico , Neoplasias Pulmonares/cirurgia
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