RESUMEN
BACKGROUND: Local anesthetics are used in various sites and mechanisms to maximize perioperative analgesia and reduce opioid use and side effects. Pain management in the bariatric setting is challenging and the efficacy of local anesthetics intraoperatively is under current evaluation. OBJECTIVES: To determine the safety and efficacy of a new intra-abdominal anesthetic technique performed during laparoscopic bariatric operations: visceral block. METHODS: During this prospective randomized double-blinded pilot study, 16 patients undergoing bariatric surgery were treated with the injection of ropivacaine to the anterior esophagogastric junction fat, and 15 were injected with saline as control. RESULTS: The procedure was shown to be safe, and no adverse events nor side effects were encountered. A non-statistically significant trend toward the use of a non-opioid analgesia was documented during the first postoperative hours. CONCLUSIONS: Visceral block is a safe and feasible intraoperative procedure. A trend toward its efficacy warrants future larger scale studies.
Asunto(s)
Anestésicos Locales , Cirugía Bariátrica , Laparoscopía , Dolor Postoperatorio , Ropivacaína , Humanos , Método Doble Ciego , Cirugía Bariátrica/métodos , Cirugía Bariátrica/efectos adversos , Proyectos Piloto , Femenino , Masculino , Anestésicos Locales/administración & dosificación , Ropivacaína/administración & dosificación , Adulto , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Dolor Postoperatorio/tratamiento farmacológico , Estudios Prospectivos , Laparoscopía/métodos , Bloqueo Nervioso/métodos , Resultado del Tratamiento , Obesidad Mórbida/cirugíaRESUMEN
BACKGROUND: As a frequent disease, prostatic hyperplasia could be treated by transurethral resection of prostate (TURP). However, postoperative pain may affect the prognosis of patients to some extent, so exploring reasonable anaesthetic drugs is an important measure to reduce the recovery period of anaesthesia. This study used the combination of ropivacaine and nalbuphine for intraoperative anaesthesia in patients undergoing TURP to investigate its effect on pain during anaesthesia recovery. METHODS: A retrospective study was conducted on the clinical data of 205 patients with prostatic hyperplasia who underwent TURP in our hospital from June 2020 to December 2022. All patients experienced epidural anaesthesia, and 110 patients who used ropivacaine combined with nalbuphine were included in the study group, whereas 95 patients who used ropivacaine and lidocaine were classified as the control group. The Visual Analogue Scale was used to evaluate the pain conditions of patients. The levels of pain mediators, such as substance P (SP), bradykinin (BK) and histamine (HIS), the stress levels, including cortisol (Cort), adrenocorticotropic hormone (ACTH) and norepinephrine (NE), and the incidence of adverse reactions were compared between the two groups. RESULTS: At T0 (postoperative 30 min), T1 (postoperative 60 min), T2 (postoperative 2 h) and T3 (postoperative 4 h), the study group had significantly lower pain scores (p < 0.01), levels of SP, BK and HIS (p < 0.001), and levels of Cort, ACTH and NE (p < 0.05) than the control group. No statistical difference was observed in the incidences of adverse reactions between the two groups (p > 0.05). CONCLUSIONS: The combination of ropivacaine and nalbuphine has a notable analgesic effect during anaesthesia recovery in patients undergoing TURP. It inhibits the secretion of pain and physical stress indicators and relieves postoperative pain to a large extent.
Asunto(s)
Anestésicos Locales , Nalbufina , Dolor Postoperatorio , Hiperplasia Prostática , Ropivacaína , Resección Transuretral de la Próstata , Humanos , Masculino , Ropivacaína/administración & dosificación , Resección Transuretral de la Próstata/efectos adversos , Hiperplasia Prostática/cirugía , Nalbufina/administración & dosificación , Nalbufina/uso terapéutico , Estudios Retrospectivos , Anciano , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Anestésicos Locales/administración & dosificación , Persona de Mediana Edad , Quimioterapia Combinada , Dimensión del DolorRESUMEN
Labor epidural analgesia (LEA) is associated with increased maternal body temperature; however, the responsible mechanism is unknown. Recent studies suggest that changes in EA affect the incidence of fever and that epidural sufentanil supplementation enhances analgesia and reduces the amount of local anesthetic. The aim of this study was to evaluate the effect of different concentrations of sufentanil combined with ropivacaine on intrapartum fever during delivery. We performed a retrospective study comparing maternal fever rates in patients receiving labor analgesia between December 2018 and January 2019. Each patient receiving different concentrations of sufentanil in their EA received either proposal H (0.08% ropivacaineâ +â 0.4 µg/mL sufentanil) or proposal L (0.08% ropivacaineâ +â 0.2 µg/mL sufentanil), with the same nulliparous status. The primary outcome of this study was the incidence of intrapartum maternal fever, which was defined as any temperatureâ ≥â 38°C during labor using Fisher exact test. Secondary outcome measures included visual analog scale (VAS) pain scores, birth events, and neonatal outcomes. We observed a perinatal fever incidence rate of 11.7% in the group receiving proposal L, while the incidence rate was 19.8% in the group receiving proposal H (Pâ =â .001). Five hours after administration, the average body temperature of the puerpera decreased significantly in the proposal L group compared with proposal H group. In addition, treatment with 0.2 µg/mL sufentanil provided satisfactory pain relief during labor, shortened the first stage of labor and total labor time, reduced oxytocin use, and had no significant adverse effects on neonatal outcomes. EA may increase the risk of intrapartum epidural-associated fever. Compared with the 0.4 µg/mL sufentanil group, the 0.2 µg/mL sufentanil group can provide better analgesia and improve maternal fever. These retrospective results highlighted the importance of prospective and mechanistic studies of maternal fever associated with intraspinal analgesia.
Asunto(s)
Analgesia Epidural , Anestésicos Locales , Fiebre , Ropivacaína , Sufentanilo , Humanos , Sufentanilo/administración & dosificación , Sufentanilo/efectos adversos , Sufentanilo/uso terapéutico , Femenino , Ropivacaína/administración & dosificación , Ropivacaína/uso terapéutico , Embarazo , Estudios Retrospectivos , Adulto , Fiebre/epidemiología , Fiebre/prevención & control , Analgesia Epidural/métodos , Analgesia Epidural/efectos adversos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Analgesia Obstétrica/métodos , Analgesia Obstétrica/efectos adversos , Trabajo de Parto/efectos de los fármacos , Dimensión del Dolor , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , IncidenciaRESUMEN
BACKGROUND: Previous studies have suggested that perioperative anesthesia could have direct impacts on cancer cell biology. The present study investigated the effects of ropivacaine administration on lung adenocarcinoma cells. METHODS: Ropivacaine was administered to A549 cells at concentrations of 0.1, 1, and 6 mM for 2 h. Angiotensin-converting enzyme 2 (ACE2) small interfering RNA (siRNA) transfection was performed 6 h prior to ropivacaine administration. Cell proliferation and migration were assessed with cell counting kit 8 (CCK-8) and a wound healing assay at 0 and 24 h after anesthesia exposure. PCR arrays were performed, followed by PCR validation. RESULTS: Ropivacaine administration inhibited A549 cell proliferation and migration in a concentration-dependent manner, with ACE2 upregulation and HIF1α (hypoxia-inducible factor 1α) downregulation. The anticancer effect of ropivacaine was canceled out via ACE2 siRNA transfection. PCR arrays showed specific gene change patterns in the ropivacaine and respective ACE2-knockdown groups. EGFR (epidermal growth factor receptor), BAX (Bcl-2-associated X protein) and BCL2 (B-cell/CLL lymphoma 2) were suppressed with ropivacaine administration; these effects were reversed via ACE2 siRNA induction. CONCLUSION: Ropivacaine administration inhibited A549 cell biology in conjunction with ACE2 upregulation via the inhibition of the Wnt1 (wingless/Integrated 1) pathway.
Asunto(s)
Adenocarcinoma del Pulmón , Enzima Convertidora de Angiotensina 2 , Movimiento Celular , Proliferación Celular , Regulación Neoplásica de la Expresión Génica , Neoplasias Pulmonares , Ropivacaína , Humanos , Ropivacaína/farmacología , Proliferación Celular/efectos de los fármacos , Enzima Convertidora de Angiotensina 2/metabolismo , Enzima Convertidora de Angiotensina 2/genética , Movimiento Celular/efectos de los fármacos , Células A549 , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/tratamiento farmacológico , Adenocarcinoma del Pulmón/patología , Adenocarcinoma del Pulmón/metabolismo , Adenocarcinoma del Pulmón/genética , Adenocarcinoma del Pulmón/tratamiento farmacológico , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Proteína Wnt1/metabolismo , Proteína Wnt1/genética , Regulación hacia Arriba/efectos de los fármacos , Vía de Señalización Wnt/efectos de los fármacosRESUMEN
INTRODUCTION: Total knee arthroplasty (TKA) is accompanied by severe postoperative pain, which is reported to be an important cause of chronic pain. Ultrasound-guided adductor canal block (ACB) combined with infiltration between the popliteal artery and posterior capsular of the knee (IPACK) has been proven to have a better effect on relieving acute pain after TKA. However, whether it has a significant effect on the incidence of chronic pain after TKA has not been reported. This trial was designed to investigate the effect of ultrasound-guided ACB combined with IPACK on the incidence and intensity of chronic pain after TKA. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, 100 subjects scheduled for TKA were randomly (1:1) divided into two groups: the ropivacaine group and the placebo group. Patients in each group received ultrasound-guided ACB + IPACK procedures with 0.25% ropivacaine or equal volume normal saline. All patients received multimodal analgesia. Pain intensity was assessed using the Numerical Rating Scale (NRS). The primary outcome was the incidence of chronic pain at 3 months after TKA by telephone follow-up. In addition, pain intensity in early resting and mobilized states, chronic pain intensity, the time to first rescue analgesia; opioid consumption; CRP and IL-6 after the operation; length of postoperative hospital stay; and cost of hospitalization and postoperative complications; as well as the function of the knee in the early stage after the operation, were recorded. RESULTS: Ninety-one participants were included in the final analysis. At 3 months, the incidence of chronic pain was 30.4% in the ropivacaine group, significantly lower than 51.1% in the placebo group. Compared with the placebo group, the ACB + IPACK with ropivacaine group had significantly lower pain scores at 4 hours, 8 hours, 16 hours, and 24 hours after the operation; increased the knee range of motion at 8 hours and 24 hours after the operation; and a significantly decreased incidence of chronic pain at 3 months after the operation. During the follow-up period, there were no nerve block-related complications in either group. CONCLUSION: In the context of multimodal analgesia protocols, ACB combined with IPACK before surgery decreases the incidence and intensity of chronic pain 3 months after TKA compared with placebo injection. In addition, it reduces the NRS scores, whether at rest or during mobilization, and improves knee function within 24 hours after TKA. TRIAL REGISTRATION: This trial was registered in the China Clinical Trial Center (registration number ChiCTR2200065300) on November 1, 2022.
Asunto(s)
Anestésicos Locales , Artroplastia de Reemplazo de Rodilla , Dolor Crónico , Bloqueo Nervioso , Dolor Postoperatorio , Arteria Poplítea , Ropivacaína , Ultrasonografía Intervencional , Humanos , Método Doble Ciego , Masculino , Femenino , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Bloqueo Nervioso/métodos , Estudios Prospectivos , Anciano , Ropivacaína/administración & dosificación , Ultrasonografía Intervencional/métodos , Anestésicos Locales/administración & dosificación , Persona de Mediana Edad , Dolor Crónico/prevención & control , Dolor Crónico/etiología , Dolor Crónico/tratamiento farmacológicoRESUMEN
OBJECTIVE: This randomized controlled and double-blind study aimed to investigate whether the analgesic effect of the adductor canal block (ACB) combined with the genicular nerve block (GNB) after total knee arthroplasty is noninferior to that of the adductor canal block combined with local infiltration analgesia (LIA). METHODS: A total of 102 patients undergoing total knee arthroplasty under general anesthesia were included and randomly divided into: ACB + GNB and ACB + LIA groups; the ACB + LIA group received 80 mL of 0.2% ropivacaine with adrenaline 10 µg/mL for LIA, whereas the ACB + GNB group received 4 mL of 0.2% ropivacaine for the blockade of five peri-knee nerves. The primary outcome was the median difference in the visual analog scale scores at rest at 24 h between the two groups. Secondary outcomes involved the median differences in the pain scores at other time points. Other outcomes included the cumulative dosage of opioids calculated in morphine equivalents in the first 24 h and indicators related to knee joint functional recovery. RESULTS: In total, 36 and 38 patients were included in the ACB + GNB and ACB + LIA groups, respectively. We found that the median difference (95% confidence internal) in postoperative rest pain at 24 h (noninferiority criteria, â³ = 1) was - 0.5 (- 1 to 0, p = 0.002). The median difference in cumulative opioid consumption was 1 mg (- 1 to 3, p = 0.019), meeting the noninferiority criteria, â³ = 7.7 mg. CONCLUSIONS: ACB combined with GNB provides noninferior analgesia compared to ACB with LIA on the first day after total knee arthroplasty while significantly reducing local anesthetic use. TRIAL REGISTRATION: Name of the Registry: Chinese Clinical Trial Registry; Trial Registration Number: ChiCTR2300074274; Date of Registration. August 2, 2023.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Bloqueo Nervioso , Dolor Postoperatorio , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Bloqueo Nervioso/métodos , Masculino , Femenino , Método Doble Ciego , Anciano , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Analgesia/métodos , Ropivacaína/administración & dosificación , Anestésicos Locales/administración & dosificación , Dimensión del Dolor/métodos , Resultado del Tratamiento , Manejo del Dolor/métodosRESUMEN
Background: In order to improve perioperative pain and reduce the adverse outcome of severe pain in elderly hip fractures, anterior iliopsoas muscle space block (AIMSB) can be used clinically to reduce pain. The aim of the study is to investigate the 50% effective concentration (EC50) of ropivacaine for ultrasound-guided anterior iliopsoas space block in elderly with hip fracture. Methods: A total of 27 patients were enrolled with aged ≥65 years, American society of Anesthesiologists (ASA) physical status classification II-III and undergoing Total Hip Arthroplasty (THA). We measured the EC50 using Dixon's up-and-down method. Ultrasound-guided AIMSB was performed preoperatively with an initial concentration of 0.2% in the first patient. After a successful or unsuccessful postoperative analgesia, the concentration of local anesthetic was decreased or increased 0.05%, respectively in the next patient. The successful block effect was defined as no sensation to pinprick in the area with femoral nerve, obturator nerve, and lateral femoral cutaneous nerve in 30 min. Meanwhile, the EC50 of ropivacaine was determined by using linear model, linear-logarithmic model, probit regression model, and centered isotonic regression. Results: A total of 12 patients (48%) had a successful block. All patients with a successful block had a postoperative visual analog scale score of <4 in the 12 h. The estimated EC50 values in linear model, linear-logarithmic model, probit regression model, and centered isotonic regression (a nonparametric method) were 0.268%, 0.259%, 0.277%, and 0.289%. The residual standard error of linear model was the smallest (0.1245). Conclusion: The EC50 of ropivacaine in anterior iliopsoas space block under ultrasound guidance is 0.259-0.289%.
Asunto(s)
Anestésicos Locales , Fracturas de Cadera , Bloqueo Nervioso , Dolor Postoperatorio , Músculos Psoas , Ropivacaína , Ultrasonografía Intervencional , Humanos , Ropivacaína/administración & dosificación , Anciano , Anestésicos Locales/administración & dosificación , Masculino , Femenino , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Ultrasonografía Intervencional/métodos , Músculos Psoas/inervación , Músculos Psoas/diagnóstico por imagen , Fracturas de Cadera/cirugía , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Relación Dosis-Respuesta a DrogaRESUMEN
BACKGROUND: It was reported that either shorter programmed intermittent epidural bolus (PIEB) intervals or high-speed bolus can produce more extensive epidural spread. We hypothesized that a combination of shortened time interval and increased speed of epidural bolus might further improve analgesic effect and therefore reduce the hourly volume for epidural labour analgesia. METHODS: This double-blind dose-finding study used a biased coin up-and-down sequential allocation method to determine the 90% effective bolus volume of ropivacaine combined with sufentanil while using the push pump at a rate of 400 mL/hr and interval of 30 min to provide effective analgesia without breakthrough pain. We used 0.1% ropivacaine with 0.4 µg/mL sufentanil, with bolus volumes ranging from 3 to 6 mL. The first patient was assigned a volume of 3 mL, and the remaining volumes were assigned according to the biased coin-up-and-down method. RESULTS: The estimated 90% effective volume (EV90) of ropivacaine combined with sufentanil for epidural labour analgesia at a time interval of 30 min was 4.88 mL (95% confidence interval 4.83-5.38). CONCLUSIONS: The optimum bolus volume of ropivacaine with sufentanil while using push pump at a time interval of 30 min is approximately 5 mL. It could probably further reduce the hourly bolus volume for epidural labour analgesia.
Asunto(s)
Amidas , Analgesia Epidural , Analgesia Obstétrica , Anestésicos Locales , Ropivacaína , Sufentanilo , Humanos , Ropivacaína/administración & dosificación , Sufentanilo/administración & dosificación , Método Doble Ciego , Femenino , Analgesia Epidural/métodos , Embarazo , Adulto , Anestésicos Locales/administración & dosificación , Analgesia Obstétrica/métodos , Amidas/administración & dosificación , Analgésicos Opioides/administración & dosificación , Relación Dosis-Respuesta a Droga , Factores de Tiempo , Adulto JovenRESUMEN
Regional analgesia based on the local anesthetic ropivacaine plays a crucial role in postoperative pain management and recovery; however, the short duration of analgesia limits its clinical potential. Various drug delivery systems such as microparticles and lipid carriers have been used to prolong the analgesic effect, yet most of them are prone to abrupt release from the site of administration or have poor analgesic effects of less than 48 h, which fail to meet the needs of postoperative analgesia. In this study, a low-molecular-weight gelator sodium deoxycholate-based hydrogel loaded with ropivacaine (DC-ROP gel) was designed for long-acting analgesia. The noncovalent interaction between ropivacaine and sodium deoxycholate helps to improve the stability and sustained release performance of the gel. This internal drug-binding hydrogel also avoids experiencing the burst release effect commonly seen in polymer hydrogels previously reported for the slow release of local anesthetics. DC-ROP gel exhibited the dual advantages of self-healing after compression and long-term controlled release. In mice with inflammatory pain, DC-ROP gel achieved peripheral nerve block for more than 1 week after a single injection. Histological and blood biochemical analyses confirmed that the DC-ROP gel did not produce systemic toxicity, and cytotoxicity experiments demonstrated that the DC-ROP gel resulted in low irritation. These results suggest that DC-ROP gel provides a promising strategy for local anesthetics in long-term postoperative pain management, broadening the potential of bile salt-based low-molecular-weight hydrogels for drug delivery.
Asunto(s)
Anestésicos Locales , Ácido Desoxicólico , Hidrogeles , Ropivacaína , Ropivacaína/química , Ropivacaína/farmacología , Hidrogeles/química , Hidrogeles/farmacología , Animales , Ácido Desoxicólico/química , Ratones , Anestésicos Locales/química , Anestésicos Locales/administración & dosificación , Anestésicos Locales/farmacología , Analgesia/métodos , Masculino , Peso MolecularRESUMEN
INTRODUCTION: Selective posterior rhizotomy (SPR) is a preferred procedure for relieving spastic children with cerebral palsy, but it is associated with severe pain and significant emergence agitation (EA). The thoracolumbar interfascial plane (TLIP) block provides an effective blockade to the dorsal branch of the spinal nerve. We hypothesise that the TLIP block may be an effective tool to alleviate EA and postoperative pain scores in children with cerebral palsy undergoing SPR. METHODS AND ANALYSIS: This study is a single-centre, randomised, parallel-controlled trial being conducted in Beijing, China. A total of 50 paediatric patients with cerebral palsy scheduled for SPR are randomised in a 1:1 ratio to receive bilateral TLIP block with 0.2% ropivacaine 0.5 mL/kg or control. Patients in the TLIP group receive general anaesthesia combined with TLIP block, while patients in the control group receive only general anaesthesia, without a TLIP block. The primary outcome is the Paediatric Anaesthesia Emergence Delirium Score. The secondary outcomes are the incidence of EA, the Wong-Baker Faces Pain-rating Scale, the perioperative haemodynamics, the intraoperative remifentanil and propofol dosage, the extubation time and recovery time, and adverse reactions. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine on 21 September 2023 (2023DZMEC-379-02). Written informed consent is obtained from the legal guardian of each patient. The results of this study will be published in peer-reviewed international journals. TRIAL REGISTRATION NUMBER: ChiCTR2300076397.
Asunto(s)
Anestesia General , Parálisis Cerebral , Delirio del Despertar , Bloqueo Nervioso , Dolor Postoperatorio , Rizotomía , Ultrasonografía Intervencional , Humanos , Parálisis Cerebral/complicaciones , Parálisis Cerebral/cirugía , Anestesia General/métodos , Bloqueo Nervioso/métodos , Niño , Rizotomía/métodos , Ultrasonografía Intervencional/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Masculino , Ropivacaína/administración & dosificación , Ropivacaína/uso terapéutico , Femenino , Preescolar , Ensayos Clínicos Controlados Aleatorios como Asunto , Anestésicos Locales/administración & dosificación , China , AdolescenteRESUMEN
INTRODUCTION: Transversus abdominis plane (TAP) blocks are commonly performed for postoperative analgesia in elective cesarean section. Ropivacaine is the most commonly used local anesthetic for TAP blocks. Currently, the concentration of ropivacaine for TAP blocks is various, and increasing number of randomized controlled trials (RCTs) have compared the effects of different concentration of ropivacaine for TAP blocks in cesarean section. This protocol of a systematic review and meta-analysis aims to identify the optimal concentration of ropivacaine for TAP blocks in elective cesarean section. METHODS AND ANALYSIS: Databases including PubMed, Web of science, the Cochrane library, and EMBASE will be searched from their inception to May 1, 2024. RCTs that investigated the analgesia of different concentrations of ropivacaine for TAP blocks in elective cesarean section will be identified. The analgesia duration will be the primary outcome. Secondary outcomes will include the analgesics consumption over postoperative 24 hours, postoperative pain scores at rest and movement, and the incidence of adverse effects. RevMan 5.4 software will used for statistical analysis. The evidence quality of synthesized results will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. ETHICS AND DISSEMINATION: Ethical approval is not applicable. The results of this study will be published on completion. TRIAL REGISTRATION: PROSPERO registration number: CRD42024496907.
Asunto(s)
Músculos Abdominales , Anestésicos Locales , Cesárea , Metaanálisis como Asunto , Bloqueo Nervioso , Dolor Postoperatorio , Ropivacaína , Revisiones Sistemáticas como Asunto , Ropivacaína/administración & dosificación , Humanos , Cesárea/métodos , Bloqueo Nervioso/métodos , Músculos Abdominales/inervación , Músculos Abdominales/efectos de los fármacos , Anestésicos Locales/administración & dosificación , Femenino , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Embarazo , Procedimientos Quirúrgicos Electivos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Background and Objectives: Surgical wound analgesia has been analyzed in many studies, but few have focused on its relationship with inflammatory markers. As such, we aimed to determine the influence of analgesic surgical wound infiltration in open colorectal surgery on the seric levels of pro- and anti-inflammatory markers and the associated efficacy in postoperative pain control. Materials and Methods: Forty patients who underwent open colorectal surgery were prospectively randomized: group 0, epidural analgesia; group 1, intravenous analgesia (control), group 2, preincision and prelaparoraphy infiltration; and, group 3, prelaparoraphy infiltration. Wound infiltration was performed with ropivacaine. We analyzed the levels of IL-6 and IL-10 cytokines before and 6 h after surgery and their correlation with pain scores. Results: The postoperative Il-6 levels were significantly lower in group 0 than in the control (p = 0.041). The postoperative Il-10 levels were significantly higher in group 3 (p = 0.029) than in the control. Six hours after the operation, the pain scores were significantly lower in all groups than in the control (p = 0.005, p = 0.022, and p = 0.017 for groups 0, 2, and 3, respectively). Pain scores were significantly correlated with Il-10 levels in group 2 (p = 0.047); in group 3, IL-10 levels directly correlated with those of Il-6 (p = 0.026). Conclusions: The analgetic effect of preincisional and prelaparoraphy analgetic infiltration was efficient. The analgetic infiltration of the surgical wound prior to closure stimulates both the inflammatory activator and regulator interleukins.
Asunto(s)
Dolor Postoperatorio , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Proyectos Piloto , Anciano , Interleucina-10/sangre , Interleucina-10/análisis , Ropivacaína/uso terapéutico , Ropivacaína/administración & dosificación , Estudios Prospectivos , Citocinas/sangre , Interleucina-6/sangre , Interleucina-6/análisis , Cirugía Colorrectal/métodos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Dimensión del Dolor/métodos , Adulto , Herida Quirúrgica/tratamiento farmacológico , Herida Quirúrgica/complicaciones , Analgésicos/uso terapéutico , Analgesia Epidural/métodosRESUMEN
OBJECTIVE: In this study, we evaluated the efficacy and safety of 1 µg/kg dexmedetomidine as an adjuvant treatment to ropivacaine in children undergoing upper limb surgeries under ultrasound-guided axillary brachial plexus blocks and general anesthesia. METHODS: We enrolled 90 children (aged 1-8 years; ASA I-II) undergoing closed reduction and internal fixation for upper extremity fractures at the Xiamen Children's Hospital and randomly assigned them to one of two groups: L (injection with 0.25% ropivacaine) or D (injection with 0.25% ropivacaine containing 1 µg/kg dexmedetomidine) using the random number table method. The main outcome indicators recorded were the facial expression, leg activity, position, crying, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores of children after surgery and the duration of block and analgesia maintenance. The secondary outcome indicators were vital sign data at the time of ultrasound probe placement (T1), at the time of block completion (T2), prior to the beginning of surgery (T3), 5 min after the beginning of surgery (T4), and at the end of surgery (T5), as well as the time of postoperative recovery, the number of cases of remedial analgesia, and complications. RESULTS: There was no statistical difference between the two groups in terms of general data, block completion time, postoperative recovery time, and complications (P > 0.05). Compared to the L group, the D group had significantly lower FLACC scores at 6 h after surgery, as well as significantly lower systolic blood pressure, diastolic blood pressure, and heart rate values at T4 and T5, and significantly longer duration of postoperative analgesia maintenance (all P < 0.05). CONCLUSION: Dexmedetomidine (1 µg/kg) as a local anesthetic adjuvant to ropivacaine can alleviate pain at 6 h postoperatively, prolong analgesia maintenance, and reduce intraoperative blood pressure and heart rate in pediatric patients undergoing closed reduction and internal fixation for upper extremity fractures, with no obvious complications or delayed recovery. CLINICAL REGISTRY NUMBER: Registration website: www.chictr.org.cn, Registration number: ChiCTR2200065163, Registration date: October, 30, 2022.
Asunto(s)
Bloqueo del Plexo Braquial , Dexmedetomidina , Ropivacaína , Humanos , Dexmedetomidina/administración & dosificación , Ropivacaína/administración & dosificación , Bloqueo del Plexo Braquial/métodos , Masculino , Femenino , Preescolar , Niño , Lactante , Anestésicos Locales/administración & dosificación , Ultrasonografía Intervencional/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Plexo Braquial/diagnóstico por imagen , Plexo Braquial/efectos de los fármacosRESUMEN
BACKGROUND: Improved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head. OBJECTIVE: This study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section. STUDY DESIGN: In this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function. RESULTS: Median (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2-4] vs 3 [2-4], respectively; P=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (P<.001), as well as shortened the time to first flatus (P=.03) and first drinking (P<.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0-19.0] hours vs 15.3 [13.3-17.0] hours, estimated median difference, 1.5; 95% CI, 1-2; P<.001). CONCLUSION: As a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.
Asunto(s)
Cesárea , Bloqueo Nervioso , Dolor Postoperatorio , Humanos , Femenino , Cesárea/métodos , Cesárea/efectos adversos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Dolor Postoperatorio/diagnóstico , Embarazo , Adulto , Bloqueo Nervioso/métodos , Estudios Prospectivos , Analgesia por Acupuntura/métodos , Dimensión del Dolor/métodos , Anestésicos Locales/administración & dosificación , Analgesia Controlada por el Paciente/métodos , Músculos Abdominales , Ropivacaína/administración & dosificación , Resultado del TratamientoRESUMEN
BACKGROUND: Inter-scalene block (ISB) is associated with an inevitable risk of hemi-diaphragmatic paresis (HDP). To reduce the risk of HDP, an upper trunk block (UTB) has been proposed at the brachial plexus division level. OBJECTIVE: We hypothesised that UTB would be associated with a lower incidence of HDP than ISB while providing sufficient analgesia following arthroscopic shoulder surgery. DESIGN: Randomised controlled trial. SETTING: A tertiary teaching hospital. PATIENTS: Seventy patients aged 20 to 80âyears undergoing arthroscopic rotator cuff repair. INTERVENTION: Ultrasound-guided ISB or UTB was performed with 5âml 0.75% ropivacaine. MAIN OUTCOME MEASURES: The primary outcome was the incidence of complete HDP, assessed by diaphragm excursion using ultrasound, defined as a decrease to 25% or less of baseline or occurrence of paradoxical movement. Postoperative pulmonary function change, pain scores, opioid consumption and pain-related outcomes were the secondary outcomes. RESULTS: The UTB group had a significantly lower incidence of complete HDP than the ISB group [5.9% (2/34) vs. 41.7% (15/36); absolute difference, 35.8%; 95% confidence interval (CI), 17.8 to 53.7%; P â<â0.001]. The postblockade decline in pulmonary function was more pronounced in the ISB group than that in the UTB group. The pain score at 1âh postoperatively was not significantly different between the groups (ISB vs. UTB group: median 0 vs. 1; median difference, -1; 95% CI, -2 to 0.5). No significant difference was observed in any other secondary outcomes. CONCLUSION: UTB was associated with a lower incidence of HDP compared with ISB while providing excellent analgesia in arthroscopic shoulder surgery. TRIAL REGISTRATION: Clinical Trial Registry of Korea ( https://cris.nih.go.kr ) identifier: KCT0007002. IRB NUMBER: Chungnam National University Hospital Institutional Review Board No. 2021-12-069.
Asunto(s)
Artroscopía , Dolor Postoperatorio , Parálisis Respiratoria , Humanos , Artroscopía/efectos adversos , Artroscopía/métodos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Dolor Postoperatorio/diagnóstico , Parálisis Respiratoria/prevención & control , Parálisis Respiratoria/etiología , Anciano de 80 o más Años , Ultrasonografía Intervencional , Diafragma/inervación , Diafragma/diagnóstico por imagen , Bloqueo del Plexo Braquial/métodos , Anestésicos Locales/administración & dosificación , Adulto Joven , Bloqueo Nervioso/métodos , Resultado del Tratamiento , Ropivacaína/administración & dosificación , Hombro/cirugíaRESUMEN
The study aimed to compare the quality of perioperative analgesia, the motor block duration, and the effects on main cardiovascular parameters of dexmedetomidine (1 µg/kg/nerve block) or magnesium sulphate (2 mg/kg/nerve block) as adjuvants to 0.3% ropivacaine for sciatic and saphenous nerves block in dogs undergoing tibial plateau leveling osteotomy (TPLO). Dogs randomly received perineural dexmedetomidine-ropivacaine (D group), magnesium sulphate-ropivacaine (M group), or ropivacaine (C group). Fentanyl was administered in case of intraoperative nociception. Postoperative pain was assessed using the Short Form-Glasgow Composite Measure Pain Scale (SF-GCMPS) and VAS scale. The duration of motor blockade and intra- and postoperative cardiovascular parameters were also recorded. Group M required significantly more fentanyl than D group (p = 0.04). Group M had a significantly higher SF-GCMPS score than group C at 4 (p = 0.002) and 5 h after extubation (p = 0.01), and a significantly higher VAS score than group D at 3 h after extubation (p = 0.03), and at 4 h if compared to group C (p = 0.009). No significant differences regarding the duration of motor blockade were detected between groups (p = 0.07). The heart rate was significantly lower in group D than in M and C groups intraoperatively and during the first 1.5 h post extubation. The addition of dexmedetomidine or magnesium sulphate as adjuvants to perineural ropivacaine did not improve the quality of perioperative analgesia and did not prolong the motor blockade in dogs undergoing sciatic and saphenous nerves block for TPLO surgery.
Asunto(s)
Dexmedetomidina , Sulfato de Magnesio , Bloqueo Nervioso , Osteotomía , Dolor Postoperatorio , Ropivacaína , Animales , Perros , Dexmedetomidina/administración & dosificación , Dexmedetomidina/farmacología , Ropivacaína/administración & dosificación , Ropivacaína/farmacología , Sulfato de Magnesio/farmacología , Sulfato de Magnesio/administración & dosificación , Osteotomía/veterinaria , Dolor Postoperatorio/veterinaria , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Masculino , Femenino , Bloqueo Nervioso/veterinaria , Anestésicos Locales/administración & dosificación , Anestésicos Locales/farmacología , Tibia/cirugíaRESUMEN
BACKGROUND: The efficacy and reliability of erector spinae plane block (ESPB) in posterior open lumbar spine surgery has been demonstrated; however, few randomized controlled trials of lumbar ESPB (L-ESPB) in lumbar unilateral bi-portal endoscopic (UBE) surgery have been reported. METHODS: A total of 120 patients, aged 18 to 65 (who underwent elective lumbar UBE surgery under general anesthesia and exhibited an American Society of Anesthesiologists physical status of I to III) were randomly assigned in a 1:1 ratio to the ESPB group and the Control group. Ultrasound(US)-guided unilateral single-shot 0.25% ropivacaine L-ESPB was performed in the ESPB group, but not in the control group. Postoperative analgesic strategy for all patients: patient controlled intravenous analgesia (PCIA, diluted and dosed with fentanyl alone) was initiated immediately after surgery combined with oral compound codeine phosphate and ibuprofen sustained release tablets (1 tablet containing ibuprofen 200 mg and codeine 13 mg, 1 tablet/q12h) commenced 6 h postoperatively. We collected and compared patient-centred correlates intraoperatively and 48 h postoperatively. The primary outcomes were intraoperative and postoperative opioid consumption and postoperative quality of recovery-15 (QoR-15) scores. RESULTS: Compared to the control group (n = 56), the ESPB group (n = 58) significantly reduced intraoperative remifentanil consumption (estimated median difference - 280 mcg, 95% confidence interval [CI] - 360 to - 200, p < 0.001, power = 100%); significantly reduced fentanyl consumption at 24 h postoperatively (estimated median difference - 80mcg, 95%[CI] - 128 to - 32, p = 0.001, power = 90%); and significantly enhanced the QoR-15 score at 24 h postoperatively (estimated median difference 11, 95%[CI] 8 to 14, p < 0.001, power = 100%). Compared to the control group, the ESPB group enhanced the resting numeric rating scale (NRS) score up to 8 h postoperatively, and the active movement NRS score up to 4 h postoperatively. The incidence of postoperative nausea and vomiting (PONV) (p = 0.015, power = 70%), abdominal distension (p = 0.024, power = 64%), and muscular calf vein thrombosis (MCVT) (p = 0.033, power = 58%) was lower in the ESPB group than in the control group. Moreover, the occurrence of L-ESPB related adverse reactions was not found herein. CONCLUSION: US-guided L-ESPB reduces intraoperative and 24 h postoperative opioid consumption and improves patients' QoR-15 scores at 24 h postoperatively. L-ESPB can be safely and effectively utilized in lumbar UBE surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2200061908 , date of registration: 10/07/2022. Registry URL.
Asunto(s)
Analgesia Controlada por el Paciente , Analgésicos Opioides , Vértebras Lumbares , Bloqueo Nervioso , Dolor Postoperatorio , Ropivacaína , Humanos , Masculino , Dolor Postoperatorio/prevención & control , Femenino , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Adulto , Estudios Prospectivos , Analgésicos Opioides/administración & dosificación , Vértebras Lumbares/cirugía , Analgesia Controlada por el Paciente/métodos , Ropivacaína/administración & dosificación , Endoscopía/métodos , Anestésicos Locales/administración & dosificación , Ultrasonografía Intervencional/métodos , Anciano , Adulto Joven , Adolescente , Ibuprofeno/administración & dosificación , Músculos ParaespinalesRESUMEN
BACKGROUND: This study investigated the optimal concentration of ropivacaine epidural anesthesia for clinical use in percutaneous transforaminal endoscopic discectomy (PTED) by comparing the effects of different concentrations. METHODS: Seventy patients scheduled for their first PTED procedure were enrolled in this randomized controlled trial. Patients were randomized to receive ropivacaine at varying concentrations (0.3% or 0.4%). Primary outcome measures included the numeric rating scale (NRS) and hip extension level (HEL). Secondary outcome measures included intraoperative fentanyl dosage and postoperative complications. RESULTS: One patient withdrew due to severe postoperative complications. The remaining 69 patients were allocated to the 0.3% (n = 34) and 0.4% (n = 35) groups, respectively. Baseline characteristics showed no significant differences between the two groups (P > 0.05). The NRS score was significantly lower in the 0.4% group than in the 0.3% group (P < 0.01), whereas the HEL score was significantly higher (P < 0.001). The average fentanyl dose in the 0.4% group was significantly lower than that in the 0.3% group (P < 0.01). Postoperative complications occurred in five and two patients in the 0.3% and 0.4% groups, respectively. CONCLUSION: Although 0.4% ropivacaine (20 mL) impacts muscle strength, it does not impede PTED surgery. Given its effective analgesic properties and few postoperative complications, 0.4% ropivacaine can be considered a preferred dose for PTED. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trials Registry (Registration number: ChiCTR2200060364; Registration Date: 29/5/2022) and on chictr.org.cn ( https://www.chictr.org.cn/showproj.html?proj=171002 ).
Asunto(s)
Anestesia Epidural , Anestésicos Locales , Ropivacaína , Humanos , Ropivacaína/administración & dosificación , Femenino , Masculino , Adulto , Persona de Mediana Edad , Anestésicos Locales/administración & dosificación , Anestesia Epidural/métodos , Discectomía Percutánea/métodos , Fentanilo/administración & dosificación , Endoscopía/métodos , Relación Dosis-Respuesta a Droga , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológicoRESUMEN
OBJECTIVE: To describe an ultrasound-guided approach to the sciatic nerve and the distribution of nerve staining using two injectate volumes of dye in barred owls. STUDY DESIGN: Descriptive, randomized, assessor-blinded, cadaveric study. ANIMALS: Twelve barred owl cadavers. METHODS: The sciatic nerve was visualized with a 13-6 MHz linear ultrasound probe placed on the medial aspect of the proximal femur in barred owl cadavers. A needle was inserted at the proximal caudal thigh, and cranially advanced in-plane until the tip was immediately adjacent and ventral to the sciatic nerve. Eleven owls were injected bilaterally with a 1:1 solution of 1% methylene blue and 0.5% ropivacaine, with high-volume (HV; 0.4 mL kg-1) and low-volume (LV; 0.2 mL kg-1) treatments. Nerve staining ≥ 1 cm circumferentially was determined by dissection 15 minutes post-injection. The coelom was then opened to inspect for aberrant dye spread. In one barred owl cadaver, a 1:1 solution of 1% methylene blue and 74% ioversol contrast was injected, and computed tomography was performed immediately before and 15 minutes after injection for evaluation of injectate spread. RESULTS: The HV treatment (0.4 mL kg-1) resulted in successful nerve staining in 100% of injections, whereas the LV treatment (0.2 mL kg-1) resulted in successful nerve staining in 91% of injections. There was no leakage of injectate into undesired locations (e.g. coelomic cavity) in any cadaver. CONCLUSIONS AND CLINICAL RELEVANCE: In barred owls, the sciatic nerve can be visualized with ultrasound and injecting a ropivacaine/dye solution under ultrasound guidance successfully stained the sciatic nerve in the majority of cases. This technique holds potential for providing analgesia distal to the stifle joint; however, further investigations are necessary to evaluate its practical application in a clinical setting.
Asunto(s)
Cadáver , Bloqueo Nervioso , Ropivacaína , Nervio Ciático , Estrigiformes , Ultrasonografía Intervencional , Animales , Nervio Ciático/efectos de los fármacos , Bloqueo Nervioso/veterinaria , Bloqueo Nervioso/métodos , Ultrasonografía Intervencional/veterinaria , Ultrasonografía Intervencional/métodos , Ropivacaína/administración & dosificación , Azul de Metileno/administración & dosificación , Anestésicos Locales/administración & dosificación , Masculino , FemeninoRESUMEN
STUDY OBJECTIVE: We conducted this double-blinded randomized controlled trial to examine whether the combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane (TAP) block could improve analgesia efficacy and duration for gastric cancer patients. DESIGN: Randomized controlled trial. SETTING: The preoperative area, operating room, postanesthesia recovery room and bed ward. PATIENTS: A total of 312 adult patients (104 per group) with gastric cancer were included. INTERVENTIONS: Patients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 µg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 µg·kg-1 dexmedetomidine [C]). MEASUREMENTS: The primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events. MAIN RESULTS: The incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; P = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; P = 0.04). CONCLUSIONS: The combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery. TRIAL REGISTRATION NUMBER: ChiCTR2000037981.