RESUMEN
PURPOSE: Charcot-Marie-Tooth (CMT) disease is an inherited neurologic disorder characterized by progressive peripheral neuropathies. The use of peripheral nerve blocks (PNB) in patients with CMT disease has been controversial because of concerns about exacerbating existing neurologic impairments and the "double hit" hypothesis. We aimed to assess the use of PNB in pediatric patients with CMT disease undergoing orthopedic surgery to address the limited data available in the literature on this topic. METHODS: In this retrospective cohort study, we included all pediatric patients with CMT disease scheduled for orthopedic surgery receiving PNB at our centre. All of the patients had preoperative neurologic exams and received one or more ultrasound-guided regional anesthesia techniques. Data extracted included details of anesthesia technique, surgical procedure, opioid consumption, and pain scores during the first three postoperative days. We also reviewed any complications such as neurologic deficits and local anesthetic toxicity. We used descriptive statistics to summarize the findings. RESULTS: We included 25 patients, 14 of whom (56%) presented with pre-existing neurologic deficits, primarily in the lower extremities. Postoperative assessments revealed no new neurologic impairments in 24/25 (96%) patients, with only one patient experiencing a nerve injury possibly related to the surgical procedure. Opioid consumption was low in the postanesthesia care unit and on the day of surgery. No additional complications were noted in the first 72 hr after surgery. CONCLUSION: Despite concerns, PNB showed favourable outcomes in a pediatric cohort with CMT disease, with low opioid consumption and pain scores and minimal complications during follow-up. These findings match previous reports of adult patients with CMT disease and suggest that the benefits of PNB may outweigh the perceived risks in pediatric patients with CMT disease.
RéSUMé: OBJECTIF: La maladie de Charcot-Marie-Tooth (CMT) est une maladie neurologique héréditaire caractérisée par des neuropathies périphériques progressives. L'utilisation de blocs nerveux périphériques (BNP) chez la patientèle atteinte de CMT est controversée en raison des inquiétudes concernant l'exacerbation des déficiences neurologiques existantes et de l'hypothèse d'une « double insulte ¼. Notre objectif était d'évaluer l'utilisation de BNP chez les patient·es pédiatriques atteint·es de CMT bénéficiant d'une chirurgie orthopédique afin de pallier les données limitées disponibles dans la littérature à ce sujet. MéTHODE: Dans cette étude de cohorte rétrospective, nous avons inclus tou·tes les patient·es pédiatriques atteint·es de CMT devant bénéficier d'une chirurgie orthopédique et recevant un BNP dans notre centre. Tou·tes ont bénéficié d'examens neurologiques préopératoires et ont reçu une ou plusieurs techniques d'anesthésie régionale échoguidées. Les données extraites comprenaient des détails sur la technique d'anesthésie, l'intervention chirurgicale, la consommation d'opioïdes et les scores de douleur au cours des trois premiers jours postopératoires. Nous avons également examiné toutes les complications telles que les déficits neurologiques et la toxicité des anesthésiques locaux. Nous avons utilisé des statistiques descriptives pour résumer les résultats. RéSULTATS: Nous avons inclus 25 patient·es, dont 14 (56 %) présentaient des déficits neurologiques préexistants, principalement dans les membres inférieurs. Les évaluations postopératoires n'ont révélé aucune nouvelle déficience neurologique chez 24 patient·es sur 25 (96 %), une seule personne ayant subi une lésion nerveuse possiblement liée à l'intervention chirurgicale. La consommation d'opioïdes était faible en salle de réveil et le jour de l'opération. Aucune complication supplémentaire n'a été notée dans les 72 premières heures après la chirurgie. CONCLUSION: Malgré les inquiétudes, le BNP a montré des résultats favorables dans une cohorte pédiatrique atteinte de CMT, avec une faible consommation d'opioïdes et des scores de douleur et des complications minimes pendant le suivi. Ces résultats correspondent à des comptes rendus antérieurs de patient·es adultes atteint·es de CMT et suggèrent que les avantages des BNP pourraient l'emporter sur les risques perçus chez la patientèle pédiatrique atteinte de CMT.
Asunto(s)
Enfermedad de Charcot-Marie-Tooth , Bloqueo Nervioso , Humanos , Estudios Retrospectivos , Niño , Bloqueo Nervioso/métodos , Femenino , Masculino , Adolescente , Estudios de Cohortes , Ultrasonografía Intervencional/métodos , Dolor Postoperatorio , Preescolar , Procedimientos Ortopédicos/métodos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Nervios Periféricos , Anestésicos Locales/administración & dosificaciónRESUMEN
Background: Chronic pelvic pain remains challenging for physicians to manage due to central and peripheral sensitization and multiple pain generators including the bladder, pelvic floor, and pudendal nerve. Pain management providers have used nerve blocks for years for diagnosis and treatment. We developed a desensitization algorithm that provides a stepwise approach to improve patients pain scores. Methods: This is a prospective observational cohort study of 182 women aged 15-90 years old with chronic pelvic pain using an algorithm from 2016 to 2018. Treatment started with an Anesthetic Challenge Test of the bladder to guide us through a protocol of intravesical therapy and/or pudendal nerve blocks as a second step. Results: ACT POSITIVE patients, who received intravesical therapy: 84% had a Visual Analog Score pain improvement of at least 50%, 64% improved at least 80% (41% pain-free). Those desiring additional relief that received further Pudendal Blocks: 83% had final improvement of at least 50% (67% pain-free). ACT NEGATIVE patients received Pudendal Blocks with 80% of subjects achieving at least 50% relief, 65% improved at least 80% (35% pain-free). All final groups showed a statistically significance of P < .05% when compared to their initial pain scores. Conclusion: Management of women with chronic pelvic pain would ideally start with treating a specific diagnosis which, in most cases, is difficult to establish since the majority have more than one pain generator. Our algorithm simplified the approach and reduced the severity of pain scores prior to any further necessary surgical interventions.
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Algoritmos , Dolor Crónico , Bloqueo Nervioso , Dimensión del Dolor , Dolor Pélvico , Humanos , Femenino , Dolor Pélvico/terapia , Adulto , Persona de Mediana Edad , Estudios Prospectivos , Dolor Crónico/terapia , Anciano , Adulto Joven , Adolescente , Anciano de 80 o más Años , Bloqueo Nervioso/métodos , Manejo del Dolor/métodos , Fenotipo , Nervio PudendoRESUMEN
OBJECTIVE: To assess the clinical scenarios in which nerve blocks are employed in the context of burning mouth syndrome (BMS). STUDY DESIGN: This scoping review followed the PRISMA-ScR. A protocol was generated on Open Science Framework. Electronic searches were performed in the following databases: PubMed, Scopus, EMBASE, Web of Science, LILACS, and Cochrane, in addition to the grey literature and citations from Grémeau-Richard et al. (2010). RESULTS: Nerve blocks were used for treatment purposes in all cases. The mandibular nerve and the stellate ganglion were both blocked in 50% studies, while the maxillary nerve and lingual nerve were blocked in 25% study each. The anesthetics used were lidocaine (50%) and bupivacaine (50%). Relief was generally reported after immediate block, and at a mean follow-up of 4.5 weeks, there was considerable improvement compared to the initial conditions when the mandibular and/or maxillary nerve were targeted. CONCLUSIONS: The use of nerve blocks has been employed in the treatment of patients with refractory BMS. Clinical studies with standardized methodology are necessary to validate and understand the potential role of mandibular and maxillary nerve block in this setting.
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Anestésicos Locales , Síndrome de Boca Ardiente , Bloqueo Nervioso , Humanos , Síndrome de Boca Ardiente/terapia , Bloqueo Nervioso/métodos , Anestésicos Locales/administración & dosificación , Anestesia Local/métodos , Lidocaína/administración & dosificaciónRESUMEN
BACKGROUND: Laparoscopic cholecystectomy is known for its minimally invasive nature, but postoperative pain management remains challenging. Despite the enhanced recovery after surgery (ERAS) protocol, regional analgesic techniques like modified perichondral approach to thoracoabdominal nerve block (M-TAPA) show promise. Our retrospective study evaluates M-TAPA's efficacy in postoperative pain control for laparoscopic cholecystectomy in a middle-income country. METHODS: This was a retrospective case-control study of laparoscopic cholecystectomy patients at Hospital General de Mexico in which patients were allocated to the M-TAPA or control group. The data included demographic information, intraoperative variables, and postoperative pain scores. M-TAPA blocks were administered presurgery. OUTCOMES: opioid consumption, pain intensity, adverse effects, and time to rescue analgesia. Analysis of variance (ANOVA) compared total opioid consumption between groups, while Student's t test compared pain intensity and time until the first request for rescue analgesia. RESULTS: Among the 56 patients, those in the M-TAPA group had longer surgical and anesthetic times (p < 0.001), higher ASA 3 scores (25% vs. 3.12%, p = 0.010), and reduced opioid consumption (p < 0.001). The M-TAPA group exhibited lower postoperative pain scores (p < 0.001), a lower need for rescue analgesia (p = 0.010), and a lower incidence of nausea/vomiting (p = 0.010). CONCLUSION: Bilateral M-TAPA offers effective postoperative pain control after laparoscopic cholecystectomy, especially in middle-income countries, by reducing opioid use and enhancing recovery.
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Colecistectomía Laparoscópica , Bloqueo Nervioso , Dolor Postoperatorio , Humanos , Colecistectomía Laparoscópica/métodos , Masculino , Estudios Retrospectivos , Femenino , Bloqueo Nervioso/métodos , Dolor Postoperatorio/tratamiento farmacológico , Persona de Mediana Edad , Adulto , Estudios de Casos y Controles , México , Analgésicos Opioides/uso terapéutico , Analgésicos Opioides/administración & dosificación , Manejo del Dolor/métodosRESUMEN
OBJECTIVES: This study examined the impact of premedication with ibuprofen and ibuprofen-arginine and the influence of preoperative pain and anxiety on inferior alveolar nerve block (IANB) efficacy in cases of symptomatic irreversible pulpitis. MATERIALS AND METHODS: The study involved 150 SIP patients who were randomly assigned to receive ibuprofen (600 mg), ibuprofen-arginine (1,155 mg), or a placebo 30 min before IANB. Preoperative anxiety and pain levels were assessed using the Modified Dental Anxiety Scale and the Heft-Parker visual scale. IANB efficacy was determined by the absence of or mild pain during the procedure. Statistical analysis included chi-square, z-tests, Analysis of Variance, and Student's t tests. RESULTS: The ibuprofen and ibuprofen-arginine groups exhibited significantly higher IANB success rates (62% and 78%, respectively) compared to the placebo group (34%). However, no significant difference was observed between the ibuprofen and ibuprofen-arginine groups. Patients with successful IANB in the ibuprofen and ibuprofen-arginine groups displayed lower median anxiety scores (8) than those with failed blocks (15) and lower mean preoperative pain scores (118.3). CONCLUSION: In cases of symptomatic irreversible pulpitis the preemptive medication with ibuprofen-arginine effectively increased the efficacy of the inferior alveolar nerve block The inferior alveolar nerve block efficacy was influenced by preoperative anxiety levels and the intensity of pain. CLINICAL RELEVANCE: This research underscores the potential benefits of oral premedication with ibuprofen and ibuprofen-arginine in improving anesthesia outcomes in cases of symptomatic irreversible pulpitis.
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Arginina , Ibuprofeno , Nervio Mandibular , Bloqueo Nervioso , Dimensión del Dolor , Pulpitis , Humanos , Pulpitis/cirugía , Ibuprofeno/uso terapéutico , Ibuprofeno/administración & dosificación , Método Doble Ciego , Masculino , Bloqueo Nervioso/métodos , Femenino , Arginina/uso terapéutico , Arginina/administración & dosificación , Adulto , Anestesia Dental/métodos , Resultado del Tratamiento , Persona de Mediana Edad , Combinación de MedicamentosRESUMEN
Postoperative pain after cardiac surgery plays an important role in the patient's recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade.
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Fibrilación Atrial , Tubos Torácicos , Criocirugía , Dolor Postoperatorio , Humanos , Fibrilación Atrial/cirugía , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Criocirugía/métodos , Criocirugía/instrumentación , Bloqueo Nervioso/métodos , Procedimientos Quirúrgicos Cardíacos/métodos , Nervios Intercostales , Resultado del Tratamiento , CatéteresRESUMEN
OBJECTIVE: The aim of this study is to evaluate the effect of erector spinae plane block (ESPB) as a rescue therapy in the recovery room. MATERIALS AND METHODS: This single-center historical cohort study included patients who received either ESPB or intravenous meperidine for pain management in the recovery room. Patients' numeric rating scale (NRS) scores and opoid consumptions were evaluated. RESULTS: One hundred and eight patients were included in the statistical analysis. Sixty-two (57%) patients received ESPB postoperatively (pESPB) and 46 (43%) patients were managed with IV meperidine boluses only (IV). The cumulative meperidine doses administered were 0 (0-40) and 30 (10-80) mg for the pESPB and IV groups, respectively (p < 0.001). NRS scores of group pESPB were significantly lower than those of Group IV on T30 and T60. CONCLUSION: ESPB reduces the frequency of opioid administration and the amount of opioids administered in the early post-operative period. When post-operative rescue therapy is required, it should be considered before opioids.
OBJETIVO: Evaluar el efecto del bloqueo del plano erector espinal (ESPB) como terapia de rescate en la sala de recuperación. MÉTODO: Este estudio de cohortes histórico de un solo centro incluyó a pacientes que recibieron ESPB o meperidina intravenosa para el tratamiento del dolor en la sala de recuperación. Se evaluaron las puntuaciones de la escala de calificación numérica (NRS) de los pacientes y los consumos de opiáceos. RESULTADOS: En el análisis estadístico se incluyeron 108 pacientes. Recibieron ESPB 62 (57%) pacientes y los otros 46 (43%) fueron manejados solo con bolos de meperidina intravenosa. Las dosis acumuladas de meperidina administradas fueron 0 (0-40) y 30 (10-80) mg para los grupos de ESPB y de meperidina sola, respectivamente (p < 0.001). Las puntuaciones de dolor del grupo ESPB fueron significativamente más bajas que las del grupo de meperidina sola en T30 y T60. CONCLUSIONES: El ESPB reduce la frecuencia de administración de opiáceos y la cantidad de estos administrada en el posoperatorio temprano. Cuando se requiera terapia de rescate posoperatoria, se debe considerar antes que los opiáceos.
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Analgésicos Opioides , Meperidina , Bloqueo Nervioso , Dolor Postoperatorio , Músculos Paraespinales , Humanos , Masculino , Femenino , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Bloqueo Nervioso/métodos , Músculos Paraespinales/inervación , Adulto , Meperidina/administración & dosificación , Meperidina/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Estudios de Cohortes , Dimensión del Dolor , Anciano , Colecistectomía , Anestésicos Locales/administración & dosificación , Estudios RetrospectivosRESUMEN
INTRODUCTION: Transversus abdominis plane (TAP) block is a widely used anesthetic technique of the abdominal wall, where ultrasound guidance is considered the gold standard. In this study, we aimed to compare the effectiveness of laparoscopic-assisted TAP (LTAP) block with ultrasound-assisted TAP (UTAP) block for post-operative pain, nausea, vomiting, duration of the block, and bowel function. MATERIALS AND METHODS: This study included 60 patients who were randomly assigned to two groups to undergo either the LTAP or UTAP block technique after laparoscopic cholecystectomy. The time taken for administering the block, post-operative nausea and vomiting, post-operative pain, respiratory rate, bowel movements, and analgesia requirements were reported. RESULTS: The time taken for the LTAP block was shorter (p < 0.001). Post-operative mean tramadol consumption, paracetamol consumption, and analgesic requirement were comparable between the two groups (p = 0.76, p = 0.513, and p = 0.26, respectively). The visual analog scale at 6, 24, and 48 h was statistically not significant (p = 0.632, p = 0.802, and p = 0.173, respectively). Nausea with vomiting and the necessity of an antiemetic medication was lower in the UTAP group (p = 0.004 and p = 0.009, respectively). CONCLUSION: The LTAP block is an easy and fast technique to perform in patients as an alternative method where ultrasound guidance or an anesthesiologist is not available.
ANTECEDENTES: El bloqueo del plano transverso del abdomen (TAP) es una técnica anestésica de la pared abdominal ampliamente utilizada, en la cual la guía ecográfica se considera el método de referencia. OBJETIVO: Comparar la efectividad del bloqueo TAP asistido por laparoscopia (LTAP) con el bloqueo TAP asistido por ultrasonido (UTAP) para el dolor posoperatorio, las náuseas y los vómitos, y la función intestinal. MÉTODO: El estudio incluyó 60 pacientes que fueron asignados aleatoriamente a dos grupos para someterse a la técnica de bloqueo LTAP o UTAP después de una colecistectomía laparoscópica. Se informaron el tiempo de administración del bloqueo, las náuseas y los vómitos posoperatorios, el dolor posoperatorio, la frecuencia respiratoria, las evacuaciones y los requerimientos de analgesia. RESULTADOS: El tiempo de bloqueo LTAP fue menor (p < 0.001). El consumo medio de tramadol, el consumo de paracetamol y el requerimiento de analgésicos posoperatorios fueron comparables entre los dos grupos (p = 0.76, p = 0.513 y p = 0.26, respectivamente). El dolor en la escala analógica visual a las 6, 24 y 48 horas no fue estadísticamente significativo (p = 0.632, p = 0.802 y p = 0.173, respectivamente). CONCLUSIONES: El bloqueo PATL es una técnica fácil y rápida de realizar en pacientes como método alternativo cuando no se dispone de guía ecográfica o anestesióloga.
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Colecistectomía Laparoscópica , Bloqueo Nervioso , Dolor Postoperatorio , Náusea y Vómito Posoperatorios , Ultrasonografía Intervencional , Humanos , Colecistectomía Laparoscópica/métodos , Femenino , Masculino , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Persona de Mediana Edad , Ultrasonografía Intervencional/métodos , Bloqueo Nervioso/métodos , Adulto , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/prevención & control , Náusea y Vómito Posoperatorios/etiología , Músculos Abdominales/inervación , Músculos Abdominales/diagnóstico por imagen , Estudios ProspectivosRESUMEN
Selection of anesthetic technique for thigh amputation is complicated by patients' comorbid conditions. The sacral erector spinae plane block (ESPB) is an emerging technique with potential as a primary anesthetic for thigh amputation. We detail a case involving a 79-year-old undergoing thigh amputation, where sacral ESPB proved insufficient, prompting a shift to spinal anesthesia. This instance underscores the necessity for further investigation into the reliability of the sacral ESPB for lower limb surgeries. Until such evidence is established, caution is advised in relying solely on the sacral ESPB for thigh amputations, and consideration of alternative techniques is recommended.
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Anestésicos , Bloqueo Nervioso , Humanos , Anciano , Muslo/cirugía , Reproducibilidad de los Resultados , Amputación QuirúrgicaRESUMEN
OBJECTIVE: A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy. METHODS: Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores. RESULTS: The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05). CONCLUSION: Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.
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Anestésicos Locales , Colecistectomía Laparoscópica , Bloqueo Nervioso , Dimensión del Dolor , Dolor Postoperatorio , Tramadol , Humanos , Colecistectomía Laparoscópica/métodos , Masculino , Femenino , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Adulto , Persona de Mediana Edad , Tramadol/administración & dosificación , Tramadol/uso terapéutico , Anestésicos Locales/administración & dosificación , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Resultado del Tratamiento , Ultrasonografía Intervencional/métodosRESUMEN
SUMMARY: The application effect of transversus abdominis plane block (TAPB) combined with thoracic paravertebral block (TPVB) or erector spinae plane block (ESP) under ultrasound guidance in endoscopic radical resection of esophageal cancer under general anesthesia was studied. From March 2021 to February 2022, patients who underwent endoscopic radical resection of esophageal cancer in our hospital were selected as the research object, and 90 patients were selected as the samples. Patients were divided into groupA and group B according to the difference of blocking schemes. Group A received ESP and Group B received TPVB. The dosage of sufentanil, nerve block time, awakening time and extubation time of the two groups were counted. The postoperative pain, sedation effect, sleep satisfaction and analgesia satisfaction of the two groups were compared, and the complications of the two groups were observed. The nerve block time and extubation time in group A were shorter than those in group B (P0.05). At T2, T3 and T4, the visual analogue scale (VAS) scores of group A at rest and cough were significantly lower than those of group B (P0.05). The satisfaction of sleep and analgesia in group A was higher than that in group B (P0.05). The analgesic effect of ultrasound-guided TAPB combined with ESP is better than that of ultrasound-guided TAPB combined with TPVB, and it can shorten the time of nerve block and extubation, which is worth popularizing.
Se estudió el efecto de la aplicación del bloqueo del plano transverso del abdomen (TAPB) combinado con el bloqueo paravertebral torácico (TPVB) o el bloqueo del plano del erector de la columna (ESP) bajo guía ecográfica en la resección radical endoscópica del cáncer de esófago bajo anestesia general. Desde marzo de 2021 hasta febrero de 2022, en nuestro hospital, se seleccionaron como objeto de investigación pacientes sometidos a resección radical endoscópica de cáncer de esófago, y como muestra se seleccionaron 90 pacientes. Los pacientes se dividieron en el grupo A y el grupo B según la diferencia de esquemas de bloqueo. El grupo A recibió ESP y el grupo B recibió TPVB. Se contaron la dosis de sufentanilo, el tiempo de bloqueo nervioso, el tiempo de despertar y el tiempo de extubación de los dos grupos. Se compararon el dolor posoperatorio, el efecto de la sedación, la satisfacción del sueño y la satisfacción de la analgesia de los dos grupos y se observaron las complicaciones de los dos grupos. El tiempo de bloqueo nervioso y el tiempo de extubación en el grupo A fueron más cortos que los del grupo B (P0,05). En T2, T3 y T4, las puntuaciones de la escala visual analógica (EVA) del grupo A en repo- so y tos fueron significativamente más bajas que las del grupo B (P 0,05). La satisfacción del sueño y la analgesia en el grupo A fue mayor que en el grupo B (P0,05). El efecto analgésico de la TAPB guiada por ecografía combinada con ESP es mejor que el de la TAPB guiada por ecografía combinada con TPVB, y puede acortar el tiempo de bloqueo nervioso y extubación, lo que vale la pena popularizar.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Vértebras Torácicas/efectos de los fármacos , Esofagectomía/métodos , Músculos Abdominales/efectos de los fármacos , Endoscopía/métodos , Músculos Paraespinales/efectos de los fármacos , Bloqueo Nervioso/métodos , Ultrasonografía , Analgésicos Opioides/administración & dosificaciónRESUMEN
OBJECTIVE: Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases. METHODS: The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively. RESULTS: The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups. CONCLUSION: Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.
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Colecistectomía Laparoscópica , Bloqueo Nervioso , Dimensión del Dolor , Dolor Postoperatorio , Tramadol , Humanos , Colecistectomía Laparoscópica/métodos , Persona de Mediana Edad , Adulto , Bloqueo Nervioso/métodos , Masculino , Femenino , Dolor Postoperatorio/prevención & control , Anciano , Adulto Joven , Adolescente , Tramadol/administración & dosificación , Analgésicos Opioides/administración & dosificación , Resultado del Tratamiento , Músculos Paraespinales/inervación , Analgesia Controlada por el Paciente/métodos , Factores de TiempoRESUMEN
OBJECTIVE: To assess the anesthetic efficacy of articaine with the needle-free/Comfort-in™ method compared to the conventional needle method. To assess pain during anesthesia application, onset of anesthesia and patient`s self-reported quality of life-related to oral health after the dental emergency appointment. MATERIALS AND METHODS: This parallel, randomized clinical trial was conducted by a single operator/dentist in the state of Maranhao, northeast of Brazil. Included participants were adult dental patients with one molar (maxillary) or premolar (maxillary or mandibular) tooth diagnosed with symptomatic irreversible pulpitis. The primary outcome was the anesthetic efficacy, measured using a combination of electrical and cold pulp tests (cold + EPT) and the Numerical Rating Scale (NRS). Secondary outcomes were pain during anesthesia application, onset of anesthesia, and patient`s quality-of-life (measured with the OHIP-14). RESULTS: 62 patients were randomized in the anesthesia needle-free group and Comfort-in group (34.26 ± 10.786 × 33.29 ± 8.399 years old, respectively). The group of patients in the Comfort-in group had 71.0% success. Patients from the Comfort-in group reported statistically lower pain during the anesthesia application than patients from the conventional group (2.13 ± 2.172 × 6.03 ± 3.146 NRS scores, respectively) as well as immediately after the anesthetic procedure. Patients self-reported negative impact in quality of life was similar between groups before (p > 0.05) and after (p > 0.05) the dental emergency. CONCLUSIONS: Comfort-in™ had similar efficacy to the conventional needle method. CLINICAL RELEVANCE: This trial showed that it is possible to anesthetize patients with tooth pulpits without using needles to provide comfort mainly to anxious patients.
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Anestesia Dental , Bloqueo Nervioso , Pulpitis , Adulto , Humanos , Adulto Joven , Carticaína , Pulpitis/cirugía , Anestésicos Locales , Calidad de Vida , Bloqueo Nervioso/métodos , Anestesia Dental/métodos , Dolor , Método Doble Ciego , Nervio Mandibular , LidocaínaRESUMEN
OBJECTIVE: This study aimed to systematically evaluate the efficacy and safety of Endoscopic Ultrasonography (EUS) for the treatment of pancreatic cancer. METHODS: The PubMed, Embase, Web of Science, and Google Scholar databases were searched from the inception of the databases to June 2022. RevMan 5.3.0 software was utilized for data analysis. In total, 13 self-descriptive studies, which enrolled 382 patients, were finally included. RESULTS: It was revealed that EUS for the treatment of pancreatic cancer exhibited a lower incidence of adverse reactions (Relative Risk Ration [RR = 0.23], 95 % Confidence interval [95 % CI 0.23-0.23]), a higher success rate (RR = 0.90, 95 % CI 0.90-0.90), and a low failure rate (RR = 0.06, 95 % CI 0.06-0.06). Moreover, EUS-guided Celiac Plexus Neurolysis (EUS-CPN) not only significantly relieved pancreatic cancer patients' pain (RR = 0.83, 95 % CI 0.83-0.83), but also significantly eliminated pain in some patients (RR = 0.09, 95 % CI 0.09-0.09). The effects of EUS on pancreatic cancer treatment were satisfactory, and few adverse reactions were found. CONCLUSION: Owing to the restricted sample size in this meta-analysis, primarily consisting of descriptive studies, it was imperative to conduct more rigorously designed, multi-center, long-term follow-up, larger sample, and Randomized Controlled Trials (RCTs) to validate the findings.
Asunto(s)
Bloqueo Nervioso , Neoplasias Pancreáticas , Humanos , Endosonografía/efectos adversos , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/terapia , Dolor Abdominal/etiologíaRESUMEN
Objective: The objective of the study is to investigate the effect of pericapsular nerve group (PENG) block in early analgesia in elderly patients with hip fracture. Methods: A total of 44 elderly patients with hip fracture admitted to our hospital from August 2021 to December 2022 were selected and divided into 2 groups according to different analgesia programs. Results: At T1~T4, the resting and active visual analog scale (VAS) scores in group P were lower than group F (p < 0.05). The resting and active VAS scores at T5 in both groups were no visible differences (p > 0.05). After 30 min of block, systolic blood pressure, diastolic blood pressure, and heart rate were decreased in both groups (p < 0.05), but no obvious difference was found in the two groups (p > 0.05). Before surgery, Pittsburgh Sleep Quality Index (PSQI) and mini-mental state scale (MMSE) scores in both groups were reduced, and PSQI score in group P was lower than that in group F and MMSE score was higher than group F (p < 0.05). Conclusion: PENG technology is safe and effective in the early analgesia of elderly hip fractures. It can effectively block physiological stress response caused by acute trauma, improve pre-operative sleep quality, and reduce the incidence of cognitive dysfunction.
Objetivo: Investigar el efecto del bloqueo del grupo del nervio pericapsular en analgesia temprana en pacientes ancianos con fractura de cadera. Método: Se seleccionaron 44 pacientes ancianos con fractura de cadera ingresados en nuestro hospital entre agosto de 2021 y diciembre de 2022, divididos en dos grupos según diferentes programas de analgesia. Resultados: En T1~T4, los valores de la escala visual análoga (EVA) en reposo y con actividad en el grupo P fueron menores que en el grupo F (p < 0.05). Los puntajes de la EVA en reposo y en actividad en T5 en ambos grupos no mostraron diferencias visibles (p > 0.05). Después de 30 minutos de bloqueo, la presión arterial sistólica y diastólica, y la frecuencia cardiaca, disminuyeron en ambos grupos (p < 0.05), pero no se encontró una diferencia obvia entre ellos (p > 0.05). Antes de la cirugía, las puntuaciones del Pittsburgh Sleep Quality Index (PSQI) y de la Mini-Mental State Scale (MMSE) en ambos grupos eran reducidas, y la puntuación del PSQI en el grupo P fue menor que en el grupo F, y la puntuación del MMSE fue mayor que en el grupo F (p < 0.05). Conclusiones: La técnica de bloqueo del grupo del nervio pericapsular es segura y efectiva en la analgesia temprana de fracturas de cadera en ancianos. Puede bloquear eficazmente la respuesta al estrés fisiológico causado por un trauma agudo, mejorar la calidad del sueño preoperatorio y reducir la incidencia de disfunción cognitiva.
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Fracturas de Cadera , Bloqueo Nervioso , Humanos , Fracturas de Cadera/cirugía , Bloqueo Nervioso/métodos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Dimensión del Dolor , Analgesia/métodos , Manejo del Dolor/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Presión Sanguínea/efectos de los fármacosRESUMEN
A local anaesthetic block performed in cranial and mandibular foramina contributes towards analgesia and the reduction of systemic anaesthesia in procedures in the oral cavity. However, anatomical differences between in wild animals may require adaptations to the anaesthetic and surgical manoeuvres of the head used in domestic animals. With that in mind, we aimed to describe the topography and morphometry of the infraorbital and mandibular foramina in Bradypus variegatus, to support perineural anaesthetic approaches in the cranio-mandibular region of this species. We demonstrated that in B. variegatus there is no significant variability in the morphometric data, allowing access to the studied foramina to occur in a similar way in adult individuals. Finally, we understand that the techniques for the infraorbital and mandibular foramen needed to be adapted due to the anatomical singularities of the species, which culminated in new reference points for more assertive needle positioning.
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Anestésicos , Bloqueo Nervioso , Perezosos , Humanos , Animales , Cráneo , Bloqueo Nervioso/veterinaria , BocaRESUMEN
OBJECTIVE: To compare the effectiveness of administering inferior alveolar nerve blocks (IANB) for the first time with or without a previous practical lesson using a simple manufactured simulator. METHODS: This was a study designed to compare students' first administration of IANB anesthesia during 2022, with or without a previous practical lesson. Students were randomized into two groups. The experimental group attended both theoretical lessons and a practical lesson with a simulator device, while the control group attended only theoretical lessons. The theoretical lesson included usual contents such as anatomy, physiology, technical maneuvers for administering anesthesia, tips, and complications, and the practical lesson consisted of the administration of anesthesia using a simple manufactured simulator. After students applied their first IANB, its efficacy, and their answers to a questionnaire on a 5-point Likert scale were recorded. Statistical analysis consisted of the Chi-square test (p < 0.05). RESULTS: The study recorded 60 anonymous surveys. The main difference observed was in instrument handing (p < 0.05), and there was a tendency in the ease of recognition of the anatomical marks used for the technique-pterygomandibular raphe and coronoid notch of the mandible (p = 0.08 and 0.11, respectively). No difference in success was observed (p > 0.05). Self-confidence and personal feelings did not differ statistically. All students agreed strongly or partially that training with the simulator model was helpful. CONCLUSION: Students who used simple manufactured simulators achieved better outcomes for instrument handling, and possibly for identification of anatomical landmarks, than those who received only theoretical lessons.
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Anestesia Dental , Educación en Odontología , Nervio Mandibular , Bloqueo Nervioso , Bloqueo Nervioso/métodos , Humanos , Educación en Odontología/métodos , Anestesia Dental/métodos , Estudiantes de Odontología/psicología , Entrenamiento Simulado/métodos , Anestesiología/educación , Modelos AnatómicosRESUMEN
AIM: The anaesthetic success rate of an inferior alveolar nerve block (IANB) in mandibular molars with irreversible symptomatic pulpitis can be low, and postoperative pain control in teeth with this diagnosis can be challenging. This study aimed to evaluate the influence of preemptive use of dexamethasone and oral potassium diclofenac on the success of IANB. The influence of these drugs on the intensity of postoperative pain was assessed as a secondary outcome. METHODOLOGY: Eighty-four patients with mandibular molars diagnosed with irreversible symptomatic pulpitis recorded preoperative pain intensity using a cold thermal test and a modified Numerical Rating Scale (mNRS). Sixty minutes before the anaesthetic procedure, patients were randomly assigned to one of three groups based on the medication they received: dexamethasone (4 mg), diclofenac potassium (50 mg), or placebo. All patients received IANB with 4% articaine (1:200 000 epinephrine), and 15 min later, they were evaluated for pain intensity using the cold thermal test. Anaesthetic success was analysed. The pain intensity was then recorded, and endodontic treatment and provisional restoration of the tooth were executed in a single session. Patients were monitored for 6, 12, 24, 48 and 72 h using the mNRS to assess the intensity of postoperative pain. RESULTS: There was a statistically significant increase in anaesthetic success when 4 mg dexamethasone (39.3%) or 50 mg diclofenac potassium (21.4%) was used compared to the placebo group (3.6%) (p < .001), with no significant difference between the two drugs. Regarding postoperative pain, dexamethasone was superior to placebo at 6 h (p < .001), with diclofenac having an intermediate behaviour, not differing between dexamethasone and placebo (p > .05). There was no significant difference amongst the groups at 12 h (p > .05). At 24, 48 and 72 h, the effectiveness of dexamethasone and diclofenac were comparable, and both were superior to placebo (p < .001). CONCLUSION: The use of dexamethasone or diclofenac potassium was favourable in terms of increasing the success rate of inferior alveolar nerve block in cases of mandibular molars with irreversible symptomatic pulpitis and decreased the occurrence of postoperative pain when compared to the use of a placebo.
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Anestesia Dental , Anestésicos , Bloqueo Nervioso , Pulpitis , Humanos , Anestesia Dental/métodos , Anestésicos/farmacología , Anestésicos Locales , Antiinflamatorios/farmacología , Dexametasona/farmacología , Diclofenaco/farmacología , Método Doble Ciego , Lidocaína , Nervio Mandibular , Diente Molar/cirugía , Bloqueo Nervioso/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Pulpitis/cirugíaRESUMEN
BACKGROUND: Pain management plays an essential role in postoperative recovery after lung surgeries. The Erector Spinae Plane Block (ESPB) is a widely used regional anaesthesia technique; however, few clinical trials have compared this block to active control in thoracic surgeries. This study evaluated the non-inferiority of the analgesia provided by ESPB when compared to paravertebral block (PVB) in lung surgeries. METHODS: Randomised, active-controlled, blinded for patients and assessors, non-inferiority trial. Patients who underwent unilateral lung surgeries were divided into two groups according to the regional anaesthesia technique-continuous ESPB or PVB at the T5 level. The primary outcome was to assess pain using a numerical rating scale (NRS) with a test of the interaction of three measures over 24 h postoperatively. An NRS score ≥ 7 was considered analgesia failure, and the prespecified non-inferiority margin was 10%. RESULTS: In the interim analysis that terminated this study, 120 participants were enrolled. ESPB patients reported higher mean NRS general values over 24 h, 4.6 ± 3.2 in the ESPB group versus 3.9 ± 2.9 in the PVB group, with a difference of -0.67 (-15.2%) and 95%CI: -1.29 to -0.05 (p = .02), demonstrating not non-inferiority. In addition, the ESPB group presented higher NRS failure of analgesia over 24 h (p < .01) and required more postoperative opioids (p = .01 over 24 h). There was no difference in patient satisfaction between groups. CONCLUSION: This trial demonstrated that a continuous erector spinae plane block was not non-inferior to a continuous paravertebral block for analgesia after lung surgery but resulted in higher levels of postoperative pain and opioid consumption.