BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecyst...BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecystectomy,combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA)in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included.The study populations in the RA and GA groups were of comparable age(P=0.41),gender(P=0.98)and body mass index(P=0.24).The conversion rate from RA to GA was 2.3%.RA was associated with significantly less postoperative pain at 4 h[mean difference(MD):-2.22,P<0.00001],8 h(MD:-1.53,P=0.0006),12 h(MD:-2.08,P<0.00001),and 24 h(MD:-0.90,P<0.00001)compared to GA.Moreover,it was associated with significantly lower rate of nausea and vomiting[risk ratio(RR):0.40,P<0.0001].However,RA significantly increased postoperative headaches(RR:4.69,P=0.03),and urinary retention(RR:2.73,P=0.03).The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes,with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA.However,its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.展开更多
Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Pati...Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.展开更多
Objective: To investigate the relationship between different sedation depth and the restlessness after using midazolam as an adjuvant during regional anesthesia. Methods : One hundred and fifty patients undergoing r...Objective: To investigate the relationship between different sedation depth and the restlessness after using midazolam as an adjuvant during regional anesthesia. Methods : One hundred and fifty patients undergoing regional anesthesia were randomly divided into three groups. In group A, the patients were sedated at the level of OAA/S IV with midazolam during regional anesthesia. In group B and C, the sedation depths were kept at the levels of Ⅲ and Ⅱrespectively. The changes of BP, HR and SpO2 were recorded before and after midazolam. The rate of restlessness was also evaluated. Results: Blood pressures decreased in certain degree at 5 and 10 min after midazolam compared with those before in all three groups. BP decreased over 20% of the baseline in 4 cases in group A, in 5 cases in group B, and in 5 cases in group C. There was no significant difference in BP dropping among three groups. Compared with group B and C SpO2 dropped significantly at 3 and 5 rain after midazolam in group C, in which SpO2 was less than 93% in 8 cases. The restlessness rate in group C was 22%, which was significantly higher than those in group A (2% ,P〈0.01) and group B(4% ,P〈0.05). Conclusion: The sedation depth is related to the rate of restlessness when midazolam is used as an adjuvant during regional anesthesia. It is suggested that the appropriate sedation depth for the patients under regional anesthesia is OAA/S Ⅲ.展开更多
Burn injuries and their treatments result in severe pain.Unlike traumatic injuries that are characterized by a discrete episode of pain followed by recovery,burn-injured patients endure pain for a prolonged period tha...Burn injuries and their treatments result in severe pain.Unlike traumatic injuries that are characterized by a discrete episode of pain followed by recovery,burn-injured patients endure pain for a prolonged period that lasts through wound closure(e.g.background pain,procedural pain,breakthrough pain,neuropathic pain and itch).Regional anesthesia,including peripheral nerve blocks and neuraxial/epidural anesthesia,offers significant benefits to a multimodal approach in pain treatment.A‘regional-first’approach to pain management can be incorporated into the workflow of burn centers through engaging regional anesthesiologists and pain medicine practitioners in the care of burn patients.A detailed understanding of peripheral nerve anatomy frames the burn clinician’s perspective when considering a peripheral nerve block/catheter.The infra/supraclavicular nerve block provides excellent coverage for the upper extremity,while the trunk can be covered with a variety of blocks including erector spinae plane and quadratus lumborum plane blocks.The lower extremity is targeted with fascia iliaca plane and sciatic nerve blocks for both donor and recipient sites.Burn centers that adopt regional anesthesia should be aware of potential complications and contraindications to prevent adverse events,including management of local anesthetic toxicity and epidural infections.Management of anticoagulation around regional anesthesia placement is crucial to prevent hematoma and nerve damage.Ultimately,regional anesthesia can facilitate a better patient experience and allow for early therapy and mobility goals that are hallmarks of burn care and rehabilitation.展开更多
Background:Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial.The stage of cancer at the time of diagnosis is a key factor that defines prognosis and is one of...Background:Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial.The stage of cancer at the time of diagnosis is a key factor that defines prognosis and is one of the most important sources of heterogeneity for the treatment effect.We sought to update existing systematic reviews and clarify the effect of regional anesthesia on cancer recurrence in late-stage cancer patients.Methods:Medline,Embase,and Cochrane Library were searched from inception to September 2020 to identify randomized controlled trials(RCTs)and cohort studies that assessed the effect of regional anesthesia on cancer recurrence and overall survival(OS)compared with general anesthesia.Late-stage cancer patients were primarily assessed according to the American Joint Committee on Cancer Cancer Staging Manual(eighth edition),and the combined hazard ratio(HR)from random-effects models was used to evaluate the effect of regional anesthesia.Results:A total of three RCTs and 34 cohort studies(including 64,691 patients)were identified through the literature search for inclusion in the analysis.The risk of bias was low in the RCTs and was moderate in the observational studies.The pooled HR for recurrence-free survival(RFS)or OS did not favor regional anesthesia when data from RCTs in patients with late-stage cancer were combined(RFS,HR=1.12,95%confidence interval[CI]:0.58-2.18,P=0.729,I2=76%;OS,HR=0.86,95%CI:0.63-1.18,P=0.345,I^(2)=48%).Findings from observational studies showed that regional anesthesia may help to prevent disease recurrence(HR=0.87,95%CI:0.78-0.96,P=0.008,I2=71%)and improve OS(HR=0.88,95%CI:0.79-0.98,P=0.022,I^(2)=79%).Conclusions:RCTs reveal that OS and RFS were similar between regional and general anesthesia in late-stage cancers.The selection of anesthetic methods should still be based on clinical evaluation,and changes to current practice need more support from large,well-powered,and well-designed studies.展开更多
BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distres...BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distress.This case report explores the application of a sphenopalatine ganglion(SPG)block as an alternative anal-gesic modality to mitigate the discomfort associated with AFNI.CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion.The patient’s medical history included prior surgery,chemotherapy,and radiation therapy,resulting in signi-ficant jaw impairment and limited neck mobility.Considering the anticipated air-way challenges,AFNI was planned.A SPG block was performed under real-time ultrasound guidance,providing effective analgesia during nasotracheal intuba-tion.CONCLUSION The SPG block represents a promising analgesic approach in AFNI,offering po-tential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.展开更多
<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performan...<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. <b>Methods:</b> 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. <b>Results:</b> 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). <b>Conclusions:</b> In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.展开更多
BACKGROUND Headache is a common complication of regional anesthesia.The treatment of post spinal anesthesia headache varies depending on the cause.Although meningitis is rare,it can cause significant harm to the patie...BACKGROUND Headache is a common complication of regional anesthesia.The treatment of post spinal anesthesia headache varies depending on the cause.Although meningitis is rare,it can cause significant harm to the patient.Post dural puncture headache and septic meningitis are the most commonly suspected causes of post spinal anesthesia headache;however,other causes should also be considered.CASE SUMMARY A 69-year-old woman was scheduled for varicose vein stripping surgery under spinal anesthesia.The procedure was performed aseptically,and surgery was completed without any complications.After 4 d,the patient visited the emergency room with complaints of headache,nausea,and anorexia.Clinical examination revealed that the patient was afebrile.Considering the history of spinal anesthesia,post dural puncture headache and septic meningitis was initially suspected,and the patient was treated with empirical antibiotics.Subsequently,varicella-zoster virus PCR test result was positive,and all other test results were negative.The patient was diagnosed with meningitis caused by varicella-zoster virus and was treated with acyclovir for 5 d.The headache improved,and the patient was discharged without any problems.CONCLUSION Viral meningitis due to virus reactivation may cause headache after regional anesthesia.Therefore,clinicians should consider multiple etiologies of headache.展开更多
Objective: To study the efficacy of ginger on the Nausea and Vomiting during and after Cesarean Section under Spinal Anesthesia. Study Design: Double blind randomized controlled trial. Setting: Department of Obstetric...Objective: To study the efficacy of ginger on the Nausea and Vomiting during and after Cesarean Section under Spinal Anesthesia. Study Design: Double blind randomized controlled trial. Setting: Department of Obstetrics and Gynecology, Ahvaz University, Razi Hospital. Material and Method: From January 2008 to April 2008, 70 pregnant women underwent for elective cesarean section under spinal anesthesia were randomized received coded drug one hour prior section with 30 ml water. The patients were at term, single pregnancy, uterine and abdominal incision transversal, and spinal anesthesia with lidocain 5%. Patients were matched in two groups by these factors: age, height, weight, BMI, cause of cesarean section, gestational age, hypotention during and after cesarean section, duration of operation and nausea and vomiting in pregnancy. All patients were assessed for severity of nausea by visual analog nausea score (VANS). Frequency of vomiting and need antiemetic drug were evaluated during and 0/5, 1, 2, 4, 6 hours after cesarean section. Results: The results demonstrated the statistically significant differences in severity of nausea and vomiting during cesarean section (p = 0/000). Severity of nausea (p = 0/000) and vomiting (0/046) after cesarean section also was lower in ginger group than placebo group. There were statistically significant differences between two groups for need antiemetic drug during (0/000) and after (0/003) cesarean section. This need was lower in ginger group than placebo group. Side effects caused by ginger were not detected. Conclusion: Ginger has efficacy in decrease severity of nausea and vomiting during and after cesarean section under spinal anesthesia.展开更多
BACKGROUND Regional anesthesia is a promising method in patients with post coronavirus disease 2019(COVID-19)pulmonary sequelae for preserving pulmonary function and preventing postoperative pulmonary complications,co...BACKGROUND Regional anesthesia is a promising method in patients with post coronavirus disease 2019(COVID-19)pulmonary sequelae for preserving pulmonary function and preventing postoperative pulmonary complications,compared with general anesthesia.CASE SUMMARY We provided surgical anesthesia and analgesia suitable for breast surgery by performing pectoral nerve block type II(PECS-II),parasternal,and intercostobrachial nerve blocks with intravenous dexmedetomidine administration in a 61-year-old female patient with severe pulmonary sequelae after COVID-19infection.CONCLUSION Sufficient analgesia for 7 h was provided via PECS-II,parasternal,and intercostobrachial blocks perioperatively.展开更多
The first way to identify the needle in relation to the peripheral nerve W. Halsted and R. Hall in 1884 performed the first regional blockade (using direct visualization). However, Vassily von Anrep was a few months e...The first way to identify the needle in relation to the peripheral nerve W. Halsted and R. Hall in 1884 performed the first regional blockade (using direct visualization). However, Vassily von Anrep was a few months earlier described the blockade of the peripheral nerve by anatomical landmarks. In 1912, the blockade of the brachial plexus was first performed using electrical stimulation, but this technique has been widely used only since 1962. The most popular way to identify the needle relative to the nerve at the moment remains US guidance. A promising direction may be optical coherence tomography. But this method is under development. In the last decade, a method for determining the pressure of a local anesthetic has been introduced into practice to determine the position of the needle relative to the nerve.展开更多
Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends ...Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends to the cervical level. Herein, we present a successful multilevel ESPB plus an interscalene block using liposomal bupivacaine in a 45-year-old female patient with metastatic sarcoma who presented for scapula and proximal humerus resection. The post-operative course was smooth, and the patient was discharged home on post-operative day 2 with minimal narcotic requirements.展开更多
<b>Background:</b> One common method of pain control for total shoulder arthroplasty is long-duration delivery of local anesthetic via interscalene brachial plexus block (ISB) with a continuous catheter. A...<b>Background:</b> One common method of pain control for total shoulder arthroplasty is long-duration delivery of local anesthetic via interscalene brachial plexus block (ISB) with a continuous catheter. Alternatively, liposomal bupivacaine has also been administered as an ISB as a means to prolong the analgesic effect. This study was completed to measure the non-inferiority of single-injection ISB with liposomal bupivacaine compared with ISB continuous catheter for total shoulder arthroplasty. <b>Methods:</b> We performed a retrospective chart review of patients who underwent total shoulder arthroplasty using either an ISB continuous catheter or a single injection ISB with liposomal bupivacaine for post operative analgesia. The primary goal of this study was to determine if single-injection with liposomal bupivacaine conferred non-inferior pain scores compared to the continuous catheter. Secondary outcomes evaluated oxygen saturation as a measure of hemidiaphragmatic paresis, post operative opioid requirements, and difference in cost. <b>Results:</b> We identified 333 patients for the study: 126 received continuous catheter and 207 received single-injection with liposomal bupivacaine. The median length of stay was 1 day. Pain scores for those treated with single-injection with liposomal bupivacaine were non-inferior to pain scores of those treated with the continuous catheter on post-op days 0, 1 and 2. Pain scores were lower for single-injection with liposomal bupivacaine patients on days 3 and 4, however they did not reach statistical significance. There was no significant difference in oxygen saturation between the two groups. Both groups had similar daily morphine milligram equivalent requirements. Liposomal bupivacaine ISB was also found to be less expensive. <b>Conclusion:</b> Single-injection ISB with liposomal bupivacaine provides non-inferior analgesia at a reduced cost compared with continuous catheter ISB for total shoulder arthroplasty.展开更多
There is evidence that local anesthetic-induced seizures may be mediated by NMDA receptors which activate production of nitric oxide(NO).The objective of this study was to determine the effects,if any,of inhibition of...There is evidence that local anesthetic-induced seizures may be mediated by NMDA receptors which activate production of nitric oxide(NO).The objective of this study was to determine the effects,if any,of inhibition of NO synthesis on the responses of the central nervous and cardiovascular systems to bupivacaine.Sprague Dawley rats were assigned to two groups.The lightly anesthetized (0.5% halothane,70% N2O) and paralyzed (doxacurium) animals were given a NO synthase inhibitor[L-NAME,2 mg/(kg.min);n=6 ] of saline(n=5) i.v.for 30 min.Then bupivacaine was administered i.v. [2mg/(kg. min)]to both groups of animals until asystole.Arterial blood samples for bupivacaine concentration analysis (by HPLC)were taken during the stabilization period and during local anesthetic infusion. Student's t-test was used to determine significant differences(P< 0. 05) between groups. Average doses of bupivacaine that produced arrhythmias and asystole were remarkably lower in L-NAME vs. saline treated rats[arrhythmias (5.1±2.0)vs.(15.8±3. 8)mg/kg; asystole (15. 9±3. 2)vs.(27. 8±6.1)mg/kg; both P<0.05 ].The doses producing seizures and isoelectric EEG,and the duration of seizures did not differ significantly between the 2 treatment groups.However, EEG epileptiform activity was less intense (lower amplitude,shorter duration ietal activity) in the L-NAME treated animals.Arterial plasma concentrations of bupivacaine 5 min after the start of bupivacaine infusion were significantly higher in the L-NAME group.[(22, 3 ±2. 9)vs. (12. 8±1.5)mg/L, P<0. 05 ].These results suggest that NO synthase inhibition by L-NAME enhances the cardiac toxicity of bupivacaine probably by a pharmacokinetic action and reduces the central nervous system toxicity of bupivacaine probably by a pharmacodynamic action.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In this retrospective observational study, we evaluated patients who underwent elective lumbar stenosis surgery between February 1, 2019, and April 1, 2019. Patients who underwent surgery for lumbar spinal stenosis under general anesthesia alone were compared with those who underwent general anesthesia combined with erector spinae plane block.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Aims:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We aimed to retrospectively evaluate whether erector spinae plane block reduced opioid consumption following surgery for spinal stenosis.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective observational study</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We collected data on the pain scores, time for the first requirement for patient-controlled analgesia with tramadol, the cumulative patient-controlled analgesia dose, requirement for rescue analgesia, time to first stand up postoperatively and the incidence of postoperative nausea and vomiting.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Sixty patients were included in the study. The numerical rating scale</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s pain scores were significantly lower in the erector spinae plane group at 1, 2, 4, 6, 12 and 24 hours than in the general anesthesia group. The cumulative dose of patient-controlled analgesia with tramadol was higher in the general anesthesia group than in the ESP group [212.0 (6.6) mg, vs. 107.3 (36.9 mg), (p <0.001)]. The time to first stand up after surgery was significantly longer in the general anesthesia group (p = 0.011).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> ESP block appear to be an effective method to relieve pain after lumbar surgery.</span>展开更多
Background and Purpose: Postoperative pain after knee arthroplasty (TKA) is reported as severe in up to 60% of patients. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies rem...Background and Purpose: Postoperative pain after knee arthroplasty (TKA) is reported as severe in up to 60% of patients. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies remain about the need of supplemental sciatic nerve blocks (SNB) for better analgesia. Our aim is to assess the effect of the association of a SNB to a CFNB to reduce postoperative pain after TKA. Methods: A prospective randomized, single blinded, controlled study, on 50 patients undergoing TKA. Control group received a CFNB before general anesthesia;in the intervention group a single shot SNB was added after the CFNB was done. After the end of surgery all patients started a continuous local anesthetic infusion through the femoral catheter in the PACU (post-anesthesia care unit). Pain scores were measured in the PACU and at 12 h and 24 h postoperative using a visual analog scale (VAS). Results: VAS pain scores (mm) were lower and statistically significant for the intervention group up to 12 h postoperative: PACU admission mean VAS = 59.4 vs 30.2, P = 0.001;at 12 h mean VASr = 26.1 vs 9.2, P = 0.006;at 24 h mean VASr = 30.1 vs 32.7, P = 0.723. Conclusions: The association of a single shot SNB with a CFNB significantly reduces postoperative pain scores after TKA up to 12 h. At 24 h there are no differences between groups.展开更多
Application of volatile anesthetics greatly alters modern medicine.There are obvious advantages of volatile anesthetics such as strong anesthetic potency,rapid onset and elimination through respiration system.Isoflura...Application of volatile anesthetics greatly alters modern medicine.There are obvious advantages of volatile anesthetics such as strong anesthetic potency,rapid onset and elimination through respiration system.Isoflurane is one of the most widely used volatile anesthetics in clinic.Emulsified isoflurane,the emulsion of isoflurane,is a novel intravenous general anesthetic.With the development of emulsified isoflurane in the past fifteen years,its utility has spread from intravenous general anesthesia to various fields including regional anesthesia,organ protection,as well as anesthetic pharmacological study.In this review,we will summarize literatures of emulsified isoflurane about its history,clinical application and future potential utility in the above mentioned fields.展开更多
文摘BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecystectomy,combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA)in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included.The study populations in the RA and GA groups were of comparable age(P=0.41),gender(P=0.98)and body mass index(P=0.24).The conversion rate from RA to GA was 2.3%.RA was associated with significantly less postoperative pain at 4 h[mean difference(MD):-2.22,P<0.00001],8 h(MD:-1.53,P=0.0006),12 h(MD:-2.08,P<0.00001),and 24 h(MD:-0.90,P<0.00001)compared to GA.Moreover,it was associated with significantly lower rate of nausea and vomiting[risk ratio(RR):0.40,P<0.0001].However,RA significantly increased postoperative headaches(RR:4.69,P=0.03),and urinary retention(RR:2.73,P=0.03).The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes,with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA.However,its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.
文摘Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.
文摘Objective: To investigate the relationship between different sedation depth and the restlessness after using midazolam as an adjuvant during regional anesthesia. Methods : One hundred and fifty patients undergoing regional anesthesia were randomly divided into three groups. In group A, the patients were sedated at the level of OAA/S IV with midazolam during regional anesthesia. In group B and C, the sedation depths were kept at the levels of Ⅲ and Ⅱrespectively. The changes of BP, HR and SpO2 were recorded before and after midazolam. The rate of restlessness was also evaluated. Results: Blood pressures decreased in certain degree at 5 and 10 min after midazolam compared with those before in all three groups. BP decreased over 20% of the baseline in 4 cases in group A, in 5 cases in group B, and in 5 cases in group C. There was no significant difference in BP dropping among three groups. Compared with group B and C SpO2 dropped significantly at 3 and 5 rain after midazolam in group C, in which SpO2 was less than 93% in 8 cases. The restlessness rate in group C was 22%, which was significantly higher than those in group A (2% ,P〈0.01) and group B(4% ,P〈0.05). Conclusion: The sedation depth is related to the rate of restlessness when midazolam is used as an adjuvant during regional anesthesia. It is suggested that the appropriate sedation depth for the patients under regional anesthesia is OAA/S Ⅲ.
文摘Burn injuries and their treatments result in severe pain.Unlike traumatic injuries that are characterized by a discrete episode of pain followed by recovery,burn-injured patients endure pain for a prolonged period that lasts through wound closure(e.g.background pain,procedural pain,breakthrough pain,neuropathic pain and itch).Regional anesthesia,including peripheral nerve blocks and neuraxial/epidural anesthesia,offers significant benefits to a multimodal approach in pain treatment.A‘regional-first’approach to pain management can be incorporated into the workflow of burn centers through engaging regional anesthesiologists and pain medicine practitioners in the care of burn patients.A detailed understanding of peripheral nerve anatomy frames the burn clinician’s perspective when considering a peripheral nerve block/catheter.The infra/supraclavicular nerve block provides excellent coverage for the upper extremity,while the trunk can be covered with a variety of blocks including erector spinae plane and quadratus lumborum plane blocks.The lower extremity is targeted with fascia iliaca plane and sciatic nerve blocks for both donor and recipient sites.Burn centers that adopt regional anesthesia should be aware of potential complications and contraindications to prevent adverse events,including management of local anesthetic toxicity and epidural infections.Management of anticoagulation around regional anesthesia placement is crucial to prevent hematoma and nerve damage.Ultimately,regional anesthesia can facilitate a better patient experience and allow for early therapy and mobility goals that are hallmarks of burn care and rehabilitation.
基金supported by a grant of Peking Union Medical College Hospital Research Grant for Young Scholar(No.pumch201912048)。
文摘Background:Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial.The stage of cancer at the time of diagnosis is a key factor that defines prognosis and is one of the most important sources of heterogeneity for the treatment effect.We sought to update existing systematic reviews and clarify the effect of regional anesthesia on cancer recurrence in late-stage cancer patients.Methods:Medline,Embase,and Cochrane Library were searched from inception to September 2020 to identify randomized controlled trials(RCTs)and cohort studies that assessed the effect of regional anesthesia on cancer recurrence and overall survival(OS)compared with general anesthesia.Late-stage cancer patients were primarily assessed according to the American Joint Committee on Cancer Cancer Staging Manual(eighth edition),and the combined hazard ratio(HR)from random-effects models was used to evaluate the effect of regional anesthesia.Results:A total of three RCTs and 34 cohort studies(including 64,691 patients)were identified through the literature search for inclusion in the analysis.The risk of bias was low in the RCTs and was moderate in the observational studies.The pooled HR for recurrence-free survival(RFS)or OS did not favor regional anesthesia when data from RCTs in patients with late-stage cancer were combined(RFS,HR=1.12,95%confidence interval[CI]:0.58-2.18,P=0.729,I2=76%;OS,HR=0.86,95%CI:0.63-1.18,P=0.345,I^(2)=48%).Findings from observational studies showed that regional anesthesia may help to prevent disease recurrence(HR=0.87,95%CI:0.78-0.96,P=0.008,I2=71%)and improve OS(HR=0.88,95%CI:0.79-0.98,P=0.022,I^(2)=79%).Conclusions:RCTs reveal that OS and RFS were similar between regional and general anesthesia in late-stage cancers.The selection of anesthetic methods should still be based on clinical evaluation,and changes to current practice need more support from large,well-powered,and well-designed studies.
文摘BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distress.This case report explores the application of a sphenopalatine ganglion(SPG)block as an alternative anal-gesic modality to mitigate the discomfort associated with AFNI.CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion.The patient’s medical history included prior surgery,chemotherapy,and radiation therapy,resulting in signi-ficant jaw impairment and limited neck mobility.Considering the anticipated air-way challenges,AFNI was planned.A SPG block was performed under real-time ultrasound guidance,providing effective analgesia during nasotracheal intuba-tion.CONCLUSION The SPG block represents a promising analgesic approach in AFNI,offering po-tential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.
文摘<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. <b>Methods:</b> 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. <b>Results:</b> 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). <b>Conclusions:</b> In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.
文摘BACKGROUND Headache is a common complication of regional anesthesia.The treatment of post spinal anesthesia headache varies depending on the cause.Although meningitis is rare,it can cause significant harm to the patient.Post dural puncture headache and septic meningitis are the most commonly suspected causes of post spinal anesthesia headache;however,other causes should also be considered.CASE SUMMARY A 69-year-old woman was scheduled for varicose vein stripping surgery under spinal anesthesia.The procedure was performed aseptically,and surgery was completed without any complications.After 4 d,the patient visited the emergency room with complaints of headache,nausea,and anorexia.Clinical examination revealed that the patient was afebrile.Considering the history of spinal anesthesia,post dural puncture headache and septic meningitis was initially suspected,and the patient was treated with empirical antibiotics.Subsequently,varicella-zoster virus PCR test result was positive,and all other test results were negative.The patient was diagnosed with meningitis caused by varicella-zoster virus and was treated with acyclovir for 5 d.The headache improved,and the patient was discharged without any problems.CONCLUSION Viral meningitis due to virus reactivation may cause headache after regional anesthesia.Therefore,clinicians should consider multiple etiologies of headache.
文摘Objective: To study the efficacy of ginger on the Nausea and Vomiting during and after Cesarean Section under Spinal Anesthesia. Study Design: Double blind randomized controlled trial. Setting: Department of Obstetrics and Gynecology, Ahvaz University, Razi Hospital. Material and Method: From January 2008 to April 2008, 70 pregnant women underwent for elective cesarean section under spinal anesthesia were randomized received coded drug one hour prior section with 30 ml water. The patients were at term, single pregnancy, uterine and abdominal incision transversal, and spinal anesthesia with lidocain 5%. Patients were matched in two groups by these factors: age, height, weight, BMI, cause of cesarean section, gestational age, hypotention during and after cesarean section, duration of operation and nausea and vomiting in pregnancy. All patients were assessed for severity of nausea by visual analog nausea score (VANS). Frequency of vomiting and need antiemetic drug were evaluated during and 0/5, 1, 2, 4, 6 hours after cesarean section. Results: The results demonstrated the statistically significant differences in severity of nausea and vomiting during cesarean section (p = 0/000). Severity of nausea (p = 0/000) and vomiting (0/046) after cesarean section also was lower in ginger group than placebo group. There were statistically significant differences between two groups for need antiemetic drug during (0/000) and after (0/003) cesarean section. This need was lower in ginger group than placebo group. Side effects caused by ginger were not detected. Conclusion: Ginger has efficacy in decrease severity of nausea and vomiting during and after cesarean section under spinal anesthesia.
文摘BACKGROUND Regional anesthesia is a promising method in patients with post coronavirus disease 2019(COVID-19)pulmonary sequelae for preserving pulmonary function and preventing postoperative pulmonary complications,compared with general anesthesia.CASE SUMMARY We provided surgical anesthesia and analgesia suitable for breast surgery by performing pectoral nerve block type II(PECS-II),parasternal,and intercostobrachial nerve blocks with intravenous dexmedetomidine administration in a 61-year-old female patient with severe pulmonary sequelae after COVID-19infection.CONCLUSION Sufficient analgesia for 7 h was provided via PECS-II,parasternal,and intercostobrachial blocks perioperatively.
文摘The first way to identify the needle in relation to the peripheral nerve W. Halsted and R. Hall in 1884 performed the first regional blockade (using direct visualization). However, Vassily von Anrep was a few months earlier described the blockade of the peripheral nerve by anatomical landmarks. In 1912, the blockade of the brachial plexus was first performed using electrical stimulation, but this technique has been widely used only since 1962. The most popular way to identify the needle relative to the nerve at the moment remains US guidance. A promising direction may be optical coherence tomography. But this method is under development. In the last decade, a method for determining the pressure of a local anesthetic has been introduced into practice to determine the position of the needle relative to the nerve.
文摘Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends to the cervical level. Herein, we present a successful multilevel ESPB plus an interscalene block using liposomal bupivacaine in a 45-year-old female patient with metastatic sarcoma who presented for scapula and proximal humerus resection. The post-operative course was smooth, and the patient was discharged home on post-operative day 2 with minimal narcotic requirements.
文摘<b>Background:</b> One common method of pain control for total shoulder arthroplasty is long-duration delivery of local anesthetic via interscalene brachial plexus block (ISB) with a continuous catheter. Alternatively, liposomal bupivacaine has also been administered as an ISB as a means to prolong the analgesic effect. This study was completed to measure the non-inferiority of single-injection ISB with liposomal bupivacaine compared with ISB continuous catheter for total shoulder arthroplasty. <b>Methods:</b> We performed a retrospective chart review of patients who underwent total shoulder arthroplasty using either an ISB continuous catheter or a single injection ISB with liposomal bupivacaine for post operative analgesia. The primary goal of this study was to determine if single-injection with liposomal bupivacaine conferred non-inferior pain scores compared to the continuous catheter. Secondary outcomes evaluated oxygen saturation as a measure of hemidiaphragmatic paresis, post operative opioid requirements, and difference in cost. <b>Results:</b> We identified 333 patients for the study: 126 received continuous catheter and 207 received single-injection with liposomal bupivacaine. The median length of stay was 1 day. Pain scores for those treated with single-injection with liposomal bupivacaine were non-inferior to pain scores of those treated with the continuous catheter on post-op days 0, 1 and 2. Pain scores were lower for single-injection with liposomal bupivacaine patients on days 3 and 4, however they did not reach statistical significance. There was no significant difference in oxygen saturation between the two groups. Both groups had similar daily morphine milligram equivalent requirements. Liposomal bupivacaine ISB was also found to be less expensive. <b>Conclusion:</b> Single-injection ISB with liposomal bupivacaine provides non-inferior analgesia at a reduced cost compared with continuous catheter ISB for total shoulder arthroplasty.
文摘There is evidence that local anesthetic-induced seizures may be mediated by NMDA receptors which activate production of nitric oxide(NO).The objective of this study was to determine the effects,if any,of inhibition of NO synthesis on the responses of the central nervous and cardiovascular systems to bupivacaine.Sprague Dawley rats were assigned to two groups.The lightly anesthetized (0.5% halothane,70% N2O) and paralyzed (doxacurium) animals were given a NO synthase inhibitor[L-NAME,2 mg/(kg.min);n=6 ] of saline(n=5) i.v.for 30 min.Then bupivacaine was administered i.v. [2mg/(kg. min)]to both groups of animals until asystole.Arterial blood samples for bupivacaine concentration analysis (by HPLC)were taken during the stabilization period and during local anesthetic infusion. Student's t-test was used to determine significant differences(P< 0. 05) between groups. Average doses of bupivacaine that produced arrhythmias and asystole were remarkably lower in L-NAME vs. saline treated rats[arrhythmias (5.1±2.0)vs.(15.8±3. 8)mg/kg; asystole (15. 9±3. 2)vs.(27. 8±6.1)mg/kg; both P<0.05 ].The doses producing seizures and isoelectric EEG,and the duration of seizures did not differ significantly between the 2 treatment groups.However, EEG epileptiform activity was less intense (lower amplitude,shorter duration ietal activity) in the L-NAME treated animals.Arterial plasma concentrations of bupivacaine 5 min after the start of bupivacaine infusion were significantly higher in the L-NAME group.[(22, 3 ±2. 9)vs. (12. 8±1.5)mg/L, P<0. 05 ].These results suggest that NO synthase inhibition by L-NAME enhances the cardiac toxicity of bupivacaine probably by a pharmacokinetic action and reduces the central nervous system toxicity of bupivacaine probably by a pharmacodynamic action.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In this retrospective observational study, we evaluated patients who underwent elective lumbar stenosis surgery between February 1, 2019, and April 1, 2019. Patients who underwent surgery for lumbar spinal stenosis under general anesthesia alone were compared with those who underwent general anesthesia combined with erector spinae plane block.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Aims:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We aimed to retrospectively evaluate whether erector spinae plane block reduced opioid consumption following surgery for spinal stenosis.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective observational study</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We collected data on the pain scores, time for the first requirement for patient-controlled analgesia with tramadol, the cumulative patient-controlled analgesia dose, requirement for rescue analgesia, time to first stand up postoperatively and the incidence of postoperative nausea and vomiting.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Sixty patients were included in the study. The numerical rating scale</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s pain scores were significantly lower in the erector spinae plane group at 1, 2, 4, 6, 12 and 24 hours than in the general anesthesia group. The cumulative dose of patient-controlled analgesia with tramadol was higher in the general anesthesia group than in the ESP group [212.0 (6.6) mg, vs. 107.3 (36.9 mg), (p <0.001)]. The time to first stand up after surgery was significantly longer in the general anesthesia group (p = 0.011).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> ESP block appear to be an effective method to relieve pain after lumbar surgery.</span>
文摘Background and Purpose: Postoperative pain after knee arthroplasty (TKA) is reported as severe in up to 60% of patients. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies remain about the need of supplemental sciatic nerve blocks (SNB) for better analgesia. Our aim is to assess the effect of the association of a SNB to a CFNB to reduce postoperative pain after TKA. Methods: A prospective randomized, single blinded, controlled study, on 50 patients undergoing TKA. Control group received a CFNB before general anesthesia;in the intervention group a single shot SNB was added after the CFNB was done. After the end of surgery all patients started a continuous local anesthetic infusion through the femoral catheter in the PACU (post-anesthesia care unit). Pain scores were measured in the PACU and at 12 h and 24 h postoperative using a visual analog scale (VAS). Results: VAS pain scores (mm) were lower and statistically significant for the intervention group up to 12 h postoperative: PACU admission mean VAS = 59.4 vs 30.2, P = 0.001;at 12 h mean VASr = 26.1 vs 9.2, P = 0.006;at 24 h mean VASr = 30.1 vs 32.7, P = 0.723. Conclusions: The association of a single shot SNB with a CFNB significantly reduces postoperative pain scores after TKA up to 12 h. At 24 h there are no differences between groups.
文摘Application of volatile anesthetics greatly alters modern medicine.There are obvious advantages of volatile anesthetics such as strong anesthetic potency,rapid onset and elimination through respiration system.Isoflurane is one of the most widely used volatile anesthetics in clinic.Emulsified isoflurane,the emulsion of isoflurane,is a novel intravenous general anesthetic.With the development of emulsified isoflurane in the past fifteen years,its utility has spread from intravenous general anesthesia to various fields including regional anesthesia,organ protection,as well as anesthetic pharmacological study.In this review,we will summarize literatures of emulsified isoflurane about its history,clinical application and future potential utility in the above mentioned fields.