Current Issue : April-June Volume : 2022 Issue Number : 2 Articles : 6 Articles
Introduction: Regional anaesthesia techniques have been used for perioperative analgesia for hip fractures. The supra-inguinal approach to fascia iliaca block (FIB) can potentially provide superior analgesia compared to femoral nerve block (FNB) by blocking the obturator and lateral femoral cutaneous nerves. We aimed to evaluate the analgesic effect of single shot FIB and FNB for surgical fixation of hip fractures. Methods: After obtaining ethics approval and written, informed consent, 30 patients undergoing surgical fixation of hip fractures were recruited and randomized into 2 groups. Patients received either a single shot FIB or FNB with 0.5% Ropivacaine 30 mls, and a subarachnoid block. Pain scores were assessed pre-operatively, post-block, in recovery and at 24 hours post-operatively. Time to first analgesic, oxynorm consumption, opioid related side effects and block related complications were assessed at 24 hours. Results: There were no statistically significant difference in post-block pain scores, median (IQR) of 0 (0 - 0) versus 0 (0 - 0) at rest and 3 (2 - 6) versus 5 (2 - 6) on positioning for spinal; and 24 hour pain scores were 0 (0 - 0) versus 0 (0 - 0) at rest and 4 (2 - 5) versus 5 (2 - 6) on movement for FIB and FNB groups respectively. 5 patients from each group required post-operative opioids, post-operative opioids requirement were similar. Conclusions: Though ultrasound guided supra-inguinal FIB was more consistent in blocking the lateral femoral cutaneous nerve then a femoral nerve block, this did not translate to any difference in terms of pain scores, opioid consumption and side effects....
Background: The association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia protocol seems to be an attractive approach for the management of acute postoperative pain. Our study aimed to evaluate the impact of psychoeducational intervention on acute postoperative pain in pulmonary nodule (PN) patients treated with thoracoscopic surgery. Methods: In this study, 76 PN patients treated with thoracoscopic surgery and intravenous patient-controlled analgesia (IV-PCA) plus psychoeducational evaluation and intervention were selected as the psychoeducational intervention group (PG). Another 76 PN patients receiving IV-PCA without psychoeducational intervention after thoracoscopic surgery, treated as the control group (CG), were identified from the hospital database and matched pairwise with PG patients according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients. Results: The most common psychological disorders were anxiety and interpersonal sensitivity, which were recorded from 82.9% (63/76) and 63.2% (48/76) of PG patients. The numerical rating scale (NRS) pain scores of the PG patients were significantly lower than those of the CG patients at 2 and 24 h after surgery (P < 0.001). Total opioid consumption for acute postoperative pain in the PG was 52.1 mg of morphine equivalent, which was significantly lower than that (67.8 mg) in the CG (P = 0.038). PG patients had a significantly lower incidence of rescue analgesia than CG patients (28.9% vs. 44.7%, P = 0.044). Nausea/vomiting was the most common side effect of opioid medications, recorded for 3 (3.9%) PG patients and 10 (13.2%) CG patients (P = 0.042). In addition, no significant difference was observed between PG and CG patients in terms of grade 2 or higher postoperative complications...................
Introduction: Epiphora is a common ophthalmologic complaint and referrals to oculoplastics and, in the presence of lower complete lacrimonasal duct obstruction, may lead to mild to severe complications, thus requiring surgery to create a new drainage path. The external dacryocystorhinostomy with silicon intubation is the surgical technique with better long-term outcomes and performed in the institutions where this study was conducted. Can be performed under either general or loco-regional anesthesia, or a combination of both. Methods: This article presents a revision of 218 consecutive cases from December 2016 to June 2021 in two specialized centers with the same standardized surgical and anesthetic technique. Results: 242 surgical prontuaries were selected, with 218 filling the inclusion criteria. 13% of the patients required additional anesthetic infusion before the beginning of the surgery; 2.7% of the patients required field anesthetic infusion during the surgery and 6.4% required supplementary sedation, thus meaning a positive outcome, as the number of patients with intraoperative complaints was low, and the overall comfort was high. During the follow up, no patient required pain medication after 24 hours. Discussion: This study points towards the feasibility of the described technique in an outpatient fashion, with low, mild and tolerable side effects associated....
Background: Opioids are currently prescribed for chronic non-cancer pain (CNCP), and some patients use opioids continuously for long-term treatment. Stakeholders’ awareness about long-term opioid therapy is essential for improving the safety and effectiveness of pain treatment. The purpose of this study is to explore the perspectives of pain specialists, patients, and family caregivers about long-term opioid use in CNCP management. Methods: This study was a qualitative study and adhered to the COREQ guidelines. Pain specialists (n = 12), patients (n = 14), and family members (n = 9) were recruited to the study by purposive sampling at the Pain Clinic of Ramathibodi Hospital. Semi-structured interviews were recorded, verbatim transcribed, conceptually coded, and analyzed using Atlas.ti 8.0. Results: All groups of participants described opioids as non-first-line drugs for pain management. Opioids should be prescribed only for severe pain, when non-opioid pharmacotherapy and non-pharmacological therapies are not effective. Patients reported that the benefits of opioids were for pain relief, while physicians and most family members highlighted that opioid use should improve functional outcomes. Physicians and family members expressed concerns about opioid-related side effects, harm, and adverse events, while patients did not. Patients confirmed that they would continue using opioids for pain management under supervision. However, physicians stated that they would taper off or discontinue opioid therapy if patients’ pain relief or functional improvement was not achieved. Both patients and family members were willing to consider non-pharmacological therapies if potential benefits existed. Patient education, doctor–patient/family relationships, and opioid prescription policies were proposed to enhance CNCP management. Conclusion: Long-term opioid therapy for CNCP may be beneficial in patients who have established realistic treatment goals (for both pain relief and functional improvement) with their physicians. Regular monitoring and evaluation of the risks and benefits, adverse events, and drug-related aberrant behaviors are necessary. Integrated multimodal multidisciplinary therapies and family member collaborations are also important for improving CNCP management....
Background: Radiofrequency catheter ablation (RFCA) as a safe and effective method has been widely used in ventricular tachycardia (VT) patients, and with which anesthesiologists frequently manage their perioperative care. The aim of this study was to investigate the effects of different anesthetic depths on perioperative RFCA and recurrence in patients who with intractable VT and could not tolerate an awake procedure. Methods: We reviewed electronic medical records of patients with VT who underwent RFCA by general anesthesia from January 2014 to March 2019. According to intraoperative VT induction, they were divided into two groups: noninducible group (group N) and inducible group (group I). We constructed several multivariable regression models, in which covariates included patient characteristics, comorbidities, protopathy and bispectral index (BIS) value. Results: One hundred one patients were analyzed. Twenty-nine patients (28.7%) experienced VT no induction, and 26 patients (25.7%) relapsed within 1 year. Compared with group I, the proportion of patients with arrhythmogenic right ventricular cardiomyopathy in group N were higher (P < 0.05), and the recurrence rate of VT was significantly higher (51.7% vs 15.3%) (P < 0.05). The BIS value in group N was significantly lower (P < 0.01), in addition, the BIS < 40 was associated with elevated odds of VT no induction compared with a BIS > 50 (odds ratio, 6.92; 95% confidence interval, 1.47–32.56; P = 0.01). VT no induction was an independent predictor of recurrence after RFCA (odds ratio, 5.01; 95% confidence interval, 1.88–13.83; P < 0.01). Conclusion: Lower BIS value during VT induction in RFCA operation was associated with high risk of VT no induction, which affects postoperative outcomes. We proposed that appropriate depth of anesthesia should be maintained during the process of VT induction....
Background: To investigate the role of transmuscular quadratus lumborum block (TMQLB) for postoperative pain control, patient satisfaction and recovery in laparoscopic adrenalectomy. Methods: Seventy-two patients aged between 18 and 70 years with an ASA I-II and scheduled for laparoscopic adrenalectomy were randomized to receive a single-shot TMQLB with 0.4 ml/kg 0.5 % ropivacaine or 0.4 ml/kg 0.9 % saline as placebo. The primary endpoint was pain on movement at 12 h after surgery evaluated by the numeric rating scale (NRS, 0–10). P-values < 0.05 was considered statistically significant. The secondary outcomes included pain at rest and pain on movement evaluated by the NRS, and postoperative recovery related parameters. Results: NRS on movement at 12 h after surgery was lower in the TMQLB group compared with the control (median 2 vs. 3, p = 0.024). Intraoperative fentanyl consumption was lower in the TMQLB group (247.08 ± 63.54 vs. 285.44 ± 74.70, p = 0.022). The rate of using postoperative rescue tramadol was also lower in the TMQLB group (5.6 vs. 27.8 %, p = 0.027). Similar incidences of nausea and vomiting were observed (11.1 vs. 25 %, p = 0.220). Patient satisfaction of pain service was better in the TMQLB group (83.3 vs. 25 %, p < 0.001) with shorter time to ambulation (16.5 vs. 21 h, p = 0.004) and flatus (18.5 vs. 23.5 h, p = 0.006). Conclusions: TMQLB showed better control of postoperative pain on movement for laparoscopic adrenalectomy with improved patients’ satisfaction of anesthesia, shorter time to ambulation and flatus....
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