The primary objective of this study was to compare the analgesic efficacy of combined suprascapular and axillary nerve block (SSAX) with interscalene block (ISB) after arthroscopic shoulder surgery. ...Our hypothesis was that ultrasound-guided SSAX would provide postoperative analgesia equivalent to ISB.
Sixty adult patients undergoing arthroscopic shoulder surgery received either SSAX or ISB prior to general anesthesia, in a randomized fashion. Pain scores, satisfaction, and adverse effects were recorded in the recovery room, 6 hours, 24 hours, and 7 days after surgery.
Combined suprascapular and axillary nerve block provided nonequivalent analgesia when compared with ISB at different time points postoperatively, except on postoperative day 7. Interscalene block had better mean static pain score in the recovery room (ISB 1.80 95% confidence interval CI, 1.10-2.50 vs SSAX 5.45 95% CI, 4.40-6.49; P < 0.001). At 24 hours, SSAX had better mean static pain score (ISB 6.35 95% CI, 5.16-7.54 vs SSAX 3.92 95% CI, 2.52-5.31; P = 0.01) with similar satisfaction between the groups.
Combined suprascapular and axillary nerve block provides nonequivalent analgesia compared with ISB after arthroscopic shoulder surgery. While SSAX provides better quality pain relief at rest and fewer adverse effects at 24 hours, ISB provides better analgesia in the immediate postoperative period. For arthroscopic shoulder surgery, SSAX can be a clinically acceptable analgesic option with different analgesic profile compared with ISB.
BACKGROUND:Bilateral paravertebral block (PVB) is a suitable alternative to thoracic epidural analgesia (TEA) for abdominal surgeries. This randomized clinical trial aims to determine if PVB is ...noninferior to TEA in terms of analgesia after midline laparotomy.
METHODS:Seventy American Society of Anesthesiologists (ASA) class I–III patients undergoing a laparotomy through a midline incision were randomized to receive either TEA (TEA group) or continuous bilateral PVB (PVB group) as a part of a multimodal analgesia regimen in an open-label design. Noninferiority was to be concluded if the mean between-group difference in pain on movement at the 24 postoperative hours was within a margin of 2 points on a 0–10 numerical rating scale (NRS). Pain score at rest and on movement, analgesic consumption, hemodynamics, and adverse events during the first 72 postoperative hours were the secondary outcome measures assessed for superiority. Postblock and steady-state plasma concentrations of ropivacaine and pattern of dye spread were also recorded in the PVB group.
RESULTS:The primary outcome of pain scores on movement at 24 postoperative hours was noninferior in PVB group in comparison to TEA group (mean difference 95% confidence interval {CI}, 0.43 −0.72–1.58). The pain scores at rest and on movement at other time points of assessment were within clinically acceptable limits in both groups with no significant differences between the groups over time. Arterial plasma ropivacaine levels were within safe limits, while steady-state venous level was higher than an acceptable threshold in 9 of 34 cases.
CONCLUSIONS:As a component of multimodal analgesia, bilateral PVB provides noninferior analgesia compared to TEA for midline laparotomy.
Life cycle assessments of the “carbon footprints” of anaesthetic equipment, medications, and procedures,23 global endorsement of sustainable anaesthesia practice,4 and expanding literature on the ...atmospheric effects of inhalational anaesthetics5678 show the problem; however, strong evidence for specific solutions is relatively sparse and novel compared with other aspects of healthcare.4910
The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and ...their health implications remain controversial or unclear.
In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement.
Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes.
Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.
Regional analgesic techniques such as paravertebral blocks (PVBs) have been popularized for analgesia following video-assisted thoracoscopic surgery (VATS). In this single center retrospective ...propensity matched cohort of subjects, we investigate the impact of paravertebral blocks on the analgesic and non-analgesic outcomes.
Institutional database was queried to identify all patients undergoing VATS between January 2013 and July 2019 and these patients were divided into those who received paravertebral blocks in combination with general anesthesia (GA) PVB group and those who received GA without paravertebral blocks GA group. Propensity score matching based on common patient confounders were used to identify patients in each group. Primary outcomes of the study were average pain scores and opioid consumption in the first 24 hours. Secondary analgesic outcomes included pain scores and opioid requirements at other timepoints over the first 48 hours. Non analgesic outcomes were obtained from STS General Thoracic Surgery Database and included length of hospital stay, need for ICU admission, composite outcome of any complication during the hospital course and 30-day mortality. Exploratory analyses were conducted to investigate the impact of PVB on analgesia following different types of surgery and as to whether any other covariates had a greater influence on the included patient centered outcomes.
After propensity score matching, a total of 520 patients (260 per group) were selected for the study out of 1095 patients. The opioid consumption in terms of oral morphine milligram equivalent (MME) Median (IQR) for the first 24 hours was significantly lower with the use of PVB PVB group- 78.5 (96.75); GA group-127.0 (111.5); p<0.001 while the average pain scores in the first 24 hours did not differ significantly PVB group-4.71 (2.28); GA group-4.85 (2.30); p = 0.70. The length of hospital stay, opioid requirements at other timepoints, need for ICU admission in the immediate post-operative period and the composite outcome-'any complication' (35% vs 48%) were significantly lower with the use of PVB. Subgroup analysis showed a longer duration of benefit following major lung surgeries compared to others.
Paravertebral blocks reduced the length of stay and opioid consumption up to 48 hours after VATS without significantly impacting pain scores.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Currently, there is little understanding of the role of echogenic needles and beam steering at moderate angles of needle insertion. The ultrasound images of the echogenic and nonechogenic needles ...inserted into pork at 40°, 50°, and 60° were scored by anesthesiologists on a scale of 0–10. The effect of different levels of beam steer was also explored. At 40°, steep beam steering improves visualization of both nonechogenic and echogenic needles to an equal, satisfactory level. At 50° and 60°, visualization of nonechogenic needles is poor, whereas visibility of an echogenic needle was adequate and may be improved with steep beam steering.
The onset of neurologic complications after regional anesthesia is a complex process and may result from an interaction of host, agent, and environmental risk factors. The purpose of this systematic ...review was examine the qualitative evidence relating to various risk factors implicated in neurologic dysfunction after peripheral nerve block (PNB). The MEDLINE, OVID, and EMBASE databases were primary sources for literature. Cochrane, LILACS, DARE, IndMed, ERIC, NHS, and HTA via Centre for Reviews and Dissemination (CRD; York University) databases were searched for additional unique results. Randomized controlled studies, case–control studies, cohort studies, retrospective reviews, and case reports/case series reporting neurologic outcomes after PNB were included. Relevant, good-quality systematic reviews were also eligible. Human and animal studies evaluating factors important for neurologic outcomes were assessed separately. Information on study design, outcomes, and quality was extracted and reviewed independently by the 2 review authors. An overall rating of the quality of evidence was assigned using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Relevant full-text articles were separated based on type (prospective, retrospective, and nonhuman studies). Strengths of association were defined as high, moderate, inconclusive, or inadequate based on study quality and direction of association. The evidence from 77 human studies was reviewed to assess various host, agent, and environmental factors that have been implicated as possible risks. Most of the available evidence regarding the injurious effects of the 3 cardinal agents of mechanical insult, pressure, and neurotoxicity was extracted from animal studies (42 studies). Among the risk factors investigated in humans, block type had a strong association with neurologic outcome. Intraneural injection, which seems to occur commonly with PNBs, showed an inconsistent direction of association. Measures meant to increase precision and ostensibly reduce the occurrence of complications such as currently available guidance techniques showed little effect on the incidence of neurologic complications. Recovery from neurologic injury appears to be worse in patients with pre-existing risk factors. Categorization and definition of neurologic complication varied among studies, making synthesis of evidence difficult. Also, a significant portion of the evidence surrounding neurologic injury associated with PNB comes from animal or laboratory studies, the results of which are difficult to translate to clinical scenarios. Of the human studies, few had an a priori design to test associations between a specific risk factor exposure and resultant neurologic sequelae. A few risk factor associations were identified in human studies, but overall quality of evidence was low. Much of the evidence for risk factors comes from animal models and case reports. The final neurologic outcome seems to represent the complex interaction of the host, agent, and the environment.
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