scholarly journals Thoracic Paravertebral Nerve Block with Ropivacaine and Adjuvant Dexmedetomidine Produced Longer Analgesia in Patients Undergoing Video-Assisted Thoracoscopic Lobectomy: A Randomized Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jun Zha ◽  
Shiliang Ji ◽  
Chen Wang ◽  
Zhe Yang ◽  
Shigang Qiao ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Nerve Block ◽  
Single Point ◽  
Anesthesia Induction ◽  
Patient Controlled Analgesia ◽  
Video Assisted ◽  
Thoracoscopic Lobectomy ◽  
Significant Difference ◽  
American Society ◽  
The Times

Purpose. This study evaluated the postoperative analgesic effect of ultrasound-guided single-point thoracic paravertebral nerve block (TPVB) combined with dexmedetomidine (DEX) in patients undergoing video-assisted thoracoscopic lobectomy. Methods. Sixty adult patients of the American Society of Anesthesiologists (ASA) I–III were randomly assigned into three groups (n = 20 each). G group: patients received routine general anesthesia; PR group: patients received 0.5% ropivacaine; and PRD group: patients received 0.5% ropivacaine with 1 μg/kg DEX. TPVB was performed in the T5 space before surgery, and then, general anesthesia induction and video-assisted thoracoscopic lobectomy were performed. Analgesics were administered through the patient-controlled analgesia (PCA) device intravenously. The background infusion of each PCA device was set to administer 0.02 μg/kg/h sufentanil, with a lockout time of 15 min, and a total allowable volume is 100 ml. Results. Compared to PR and G groups, the total sufentanil consumption after operation, the times of analgesic pump pressing, the pain score, and the incidence of postoperative nausea or vomiting in the PRD group were significantly reduced ( p < 0.05 ). Also, the duration of first time of usage of the patient-controlled analgesia (PCA) was longer. The heart rate (HR) and mean arterial pressure (MAP) during operation were lower in the PRD group as compared with the other two groups in most of the time. However, hypotension and arrhythmia occurred in three groups with no statistically significant difference. Conclusions. A small volume of TPVB with ropivacaine and DEX by single injection produced longer analgesia in patients undergoing video-assisted thoracoscopic lobectomy, reduced postoperative opioids consumption, and the incidence of side effects.

Intercostal Nerve Blockade with Exparel® Results in Lower Opioid Usage during the First 24 Hours after Video-Assisted Thorascopic Surgery

2018 ◽  
Vol 84 (9) ◽  
pp. 1433-1438 ◽  
Author(s):  
Thomas M. Kelley ◽  
Daniel W. Bailey ◽  
Preston Sparks ◽  
Robert Rice ◽  
Erin Caddell ◽  
...  
Keyword(s):  
Nerve Block ◽  
Intercostal Nerve ◽  
Inclusion Criteria ◽  
Intercostal Nerve Block ◽  
Nerve Blocks ◽  
Video Assisted ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Morphine Equivalent

Liposomal bupivacaine (LipoB) provides prolonged local anesthetic effects and has seen usage in several fields of surgery. We review our experience using LipoB intraoperatively for intercostal nerve blocks after video-assisted throacoscopic surgery (VATS). A retrospective, single-center review was conducted for patients undergoing VATS from August 2012 to December 2014. Patients those who received LipoB as an intercostal nerve block were compared with patients who received blocks with standard bupivacaine. Opiate amounts used within the first six hours and then subsequent 18,48, and 72 hours were converted into morphine equivalents for comparison. Forty-seven patients met inclusion criteria: 21 receiving LipoB intercostal nerve block and 26 controls. Groups were similar for age, diabetes, hypertension, chronic kidney disease, body mass index and American Society of Anesthesiologists scores. The LipoB group had a larger portion of males (P < 0.02). Postoperatively, morphine equivalent usage was significantly less in the LipoB group compared with the standard bupivacaine within the first six hours after surgery (15.62 vs 52.41, P = 0.001) and in the subsequent 18 hours (28.98 vs 65.17, P = 0.01). After the first 24 hours there was not a significant difference in opiate usage between the two groups. There was no difference in length of stay between the two groups. In our study group of VATS patients, an intercostal nerve block with LipoB significantly reduced the usage of postoperative opioids in the first 24 hours only when compared with standard bupivacaine.

scholarly journals Effects of COX 1-2 Inhibitors on Prevention of Rocuronium Injection Pain: Controlled, Randomised, Double Blind Study

2021 ◽  
Author(s):  
Mehmet Sahap ◽  
Handan Gulec ◽  
Esra ozayar ◽  
Ozlem zdemir ◽  
Merve Kacan ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Control Group ◽  
Anesthesia Induction ◽  
Movement Response ◽  
Rocuronium Bromide ◽  
Cox Inhibitors ◽  
Significant Difference ◽  
Group 2 ◽  
Withdrawal Response ◽  
Group 1

Purpose : Rocuronium bromide is a painful agent while general anesthesia induction. The aim of the study is to investigate the effects of cox inhibitors as a resque agent against the rocuronium pain Methodology : Sixty patients enrolled for the general anesthesia enrolled in this study. Patients were allocated into two groups (Group 1: Dexkethoprofen group, Group 2: Control group) .Pain was evaluated by during rocuronium injection, patients were scored by a scale showed below. 0;No movement response to injection 1;Mild movement response to injection 2;Hand withdrawal response to injection 3;Arm withdrawal response to injection We also evaluated the pain with 2 questions when the patient was in the recovery room.Question 1.What was the last feeling before you fall into sleep? and question 2. Did you feel any pain on your hand during medication injection for anesthesia? Results:There were differences between the groups in terms of total pain score for example in group 1 there were 16 (53%) patients who did not make any movement during rocuronium injection while there were 22 (73%) patients in group 2.There was significant difference in injection rocuronium bromide pain between group 1: dexkethoprofen group, Group 2: control group in terms of the answer to the second question.Patients felt less pain than the control group. Conclusion:The effect of cox inhibitors on rocuronium pain was seen in our study but check is also effective in reducing pain in vascular width.

scholarly journals Evaluation of the Efficacy of Low-Dose Naloxone for the Prevention of Acute Remifentanil-Induced Hyperalgesia in Patients Undergoing General Anesthesia for Laparotomy

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Jalil Makarem ◽  
Hossein Majedi ◽  
Fateme Bahmaee ◽  
Seyed Mohammad Mireskandari ◽  
Fatemeh Amraei ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Low Dose ◽  
Major Complication ◽  
Concomitant Administration ◽  
Remifentanil Infusion ◽  
Morphine Dose ◽  
Post Surgery ◽  
Significant Difference ◽  
Opioid Administration ◽  
American Society

Background: Hyperalgesia is a major complication of continuous or intermittent opioid administration. The evidence suggests that concomitant administration of low-dose naloxone could prevent the development of acute opioid-induced hyperalgesia, with no effect on pain control. Objectives: The current study aimed to assess the effects of intraoperative low-dose naloxone, adding to remifentanil infusion on preventing acute postoperative hyperalgesia in patients undergoing general anesthesia for laparotomy. Methods: In this randomized clinical trial, patients undergoing general anesthesia for laparotomic hysterectomy in a tertiary referral teaching hospital from February to December 2019 were randomly assigned to one of three groups of remifentanil-naloxone (remifentanil 0.3 μg/ kg/min with low-dose naloxone 0.25μg/kg /h prepared in 50 mL of normal saline), remifentanil (0.3 μg/kg/min), and control (receiving 50 mL saline infusion), intraoperatively. Patients and researchers were blinded to the type of intervention. The severity of hyperalgesia, as the main outcome, was evaluated by the static Tactile test. The severity of pain was assessed by visual analogous scale 0.5, 2, 6, 12, and 24 hours after surgery. Results: In total, 75 patients were evaluated. The results showed no difference concerning the independent variables (age, body mass index, hypertension, surgery duration, anesthesia duration, and American Society of Anesthesiologists (ASA) class) between the three groups. Heart rate was significantly different in all study time points between the three groups (P < 0.001), but mean arterial pressure and systolic and diastolic blood pressure showed no significant difference (P > 0.05) throughout the study. Assessment of hyperalgesia using the tactile test revealed a higher incidence of hyperalgesia in the remifentanil group in 0.5, 2, 6, 12, and 24 hours after surgery compared to the other two groups, which was statistically significant between the groups at 0.5, 2, and 6 hours after surgery (P < 0.05). Shivering incidence, Morphine dose in 24 hours post-surgery, morphine dose in the recovery room, and VAS for pain were significantly different during the study between the three groups (P < 0.05). Conclusions: This study demonstrated the efficacy of intraoperative low-dose naloxone (0.25 μg/kg/h) added to remifentanil infusion on reducing the frequency and severity of acute postoperative hyperalgesia in patients undergoing general anesthesia for laparotomy hysterectomy.

Comparing outcomes after peripheral nerve block versus general anesthesia for lower extremity amputation: a nationwide exploratory retrospective cohort study in Japan

2020 ◽  
Vol 45 (6) ◽  
pp. 399-404 ◽  
Author(s):  
Hiroaki Abe ◽  
Masahiko Sumitani ◽  
Hiroki Matsui ◽  
Shotaro Aso ◽  
Reo Inoue ◽  
...  
Keyword(s):  
Propensity Score ◽  
Lower Extremity ◽  
Peripheral Nerve ◽  
General Anesthesia ◽  
Nerve Block ◽  
Postoperative Delirium ◽  
Peripheral Nerve Block ◽  
Lower Extremity Amputation ◽  
Significant Difference ◽  
Extremity Amputation

Background and objectivesThe health benefits of peripheral nerve block (PNB) on postoperative complications after lower extremity amputation (LEA) compared with general anesthesia (GA) remains controversial. We performed a retrospective propensity score-matched cohort analysis to compare major outcomes after LEA with PNB versus GA.Materials and methodsWe used a nationwide inpatient database in Japan to compare patient outcomes after LEA with PNB versus GA from 2010 to 2016. Our primary outcome was 30-day mortality after LEA. The incidence of composite morbidity from life-threatening complications and of delirium within 30 days after LEA were secondary outcomes. We conducted propensity score-matched analyses of patients who underwent below knee or foot amputation using 36 covariates. Logistic regression analyses fitted with generalized estimating equations were performed to calculate ORs and their 95% CIs.ResultsOf 11 796 patients, 747 received PNB and 11 049 received GA. After one-to-four propensity score matching, 747 patients were included in the PNB group and 2988 in the GA group. The adjusted ORs for postoperative mortality, composite morbidity and delirium within 30 days after LEA were 1.11 (95% CI 0.75 to 1.64), 1.15 (95% CI 0.85 t o1.56) and 0.75 (95% CI 0.57 to 0.98), respectively, for the PNB group with reference to the GA group.ConclusionsThere was no significant difference between groups in 30-day mortality or composite morbidity. The PNB group showed a significantly lower risk of postoperative delirium than the GA group. Our findings suggest that PNB may have advantages over GA in preventing postoperative delirium among patients undergoing LEA.

Comparison of Intra and Post-operative Sedation efficacy of Dexmedetomidine-Midazolam and Dexmedetomidine-Propofol for Major Abdominal Surgery

2021 ◽  
Vol 22 ◽  
Author(s):  
Yuanyuan Gao ◽  
Fei Yan
Keyword(s):  
Clinical Trial ◽  
Abdominal Surgery ◽  
Oxygen Saturation ◽  
General Anesthesia ◽  
Arterial Oxygen Saturation ◽  
Carbon Dioxide Tension ◽  
Major Abdominal Surgery ◽  
Arterial Oxygen ◽  
Anesthesia Induction ◽  
Significant Difference

Background: The effectiveness and side effects of dexmedetomidine (DEX) in combination with midazolam and propofol have not been comparatively studied in a single clinical trial as sedative agents to general anesthesia before. Objective: The objective of this study is to compare intra and post-operative sedation between DEX-Midazolam and DEX-Propofol in patients who underwent major abdominal surgery on the duration of general anesthesia, hemodynamic and sedation effect. Method: This prospective, randomized, double-blinded clinical trial included 50 patients who were 20 to 60 years of age and admitted for major abdominal surgery. The patients were randomly assigned by a computer-generated random numbers table to sedation with DEX plus midazolam (DM group) (n=25) or DEX plus propofol (DP group) (n=25). In the DM group, patients received a bolus dose of 0.1 mg/kg of midazolam and immediately initiated the intravenous (i.v.) infusion of DEX 1 µg/kg over a 10 min and 0.5 µg/kg/hr by continuous i.v. infusion within operation period. In the DP group, patients received pre-anesthetic i.v. DEX 1 µg/kg over 15 min before anesthesia induction and 0.2-1 µg/kg/hr by continuous i.v. infusion during the operative period. After preoxygenation for at least 2 min, during the surgery, patients received propofol infusion dose of 250 μg/kg/min for 15 min then a basal infusion dose of 50 μg/kg/min. The bispectral index (BIS) value, as well as mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2), percutaneous arterial oxygen saturation (SpO2) and end-tidal carbon dioxide tension (ETCO2) were recorded before anesthesia (T0), during anesthesia (at 15-min intervals throughout the surgical procedure), by a blinded observer. Evidence of apnea, hypotension, hypertension and hypoxemia were recorded during surgery. Results: The hemodynamic changes, including HR, MAP, BIS, VT, SaO2, and RR had a downward tendency with time, but no significant difference was observed between the groups (P>0.05). However, the two groups showed no significant differences in ETCO2 and SPO2 values in any of the assessed interval (P>0.05). In this study, the two groups showed no significant differences in the incidence of nausea, vomiting, coughing, apnea, hypotension, hypertension, bradycardia and hypoxemia (P>0.05). Respiratory depression and Conclusion: Our study showed no significant differences between the groups in hemodynamic and respiratory changes in each of the time intervals. There were also no significant differences between the two groups in the incidence of complication intra and post-operative. Further investigations are required to specify the optimum doses of using drugs which provide safety in cardiovascular and respiratory system without adverse disturbance during surgery.

scholarly journals A comparison of the outcomes of dexmedetomidine and remifentanil with sufentanil-based general anesthesia in pediatric patients for the transthoracic device closure of ventricular septal defects

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ling-Shan Yu ◽  
Wen-Peng Xie ◽  
Jian-Feng Liu ◽  
Jing Wang ◽  
Hua Cao ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Pediatric Patients ◽  
Length Of Hospital Stay ◽  
Clinical Information ◽  
Skin Incision ◽  
Anesthesia Induction ◽  
Ventricular Septal Defects ◽  
Device Closure ◽  
Septal Defects ◽  
Significant Difference

Abstract Objective To compare the safety and efficacy of dexmedetomidine and remifentanil with sufentanil-based general anesthesia for the transthoracic device closure of ventricular septal defects (VSDs) in pediatric patients. Methods A retrospective analysis was performed on 60 children undergoing the transthoracic device closure of VSDs from January 2019 to June 2020. The patients were divided into two groups based on different anesthesia strategies, including 30 cases in group R (dexmedetomidine- and remifentanil-based general anesthesia) and 30 cases in group S (sufentanil-based general anesthesia). Results There was no significant difference in preoperative clinical information, hemodynamics before induction and after extubation, postoperative pain scores, or length of hospital stay between the two groups. However, the hemodynamic data of group R were significantly lower than those of group S at the time points of anesthesia induction, skin incision, thoracotomy, incision closure, and extubation. The amount of intravenous patient-controlled analgesia (PCA), the duration of mechanical ventilation, and the length of the intensive care unit (ICU) stay in group R were significantly less than those in group S. Conclusion Dexmedetomidine combined with remifentanil-based general anesthesia for the transthoracic device closure of VSDs in pediatric patients is safe and effective.

Sign in / Sign up

Export Citation Format

Share Document