Local and Regional Anesthesia最新文献

{"title":"Retrospective Comparison of Extrafascial versus Intrafascial Interscalene Brachial Plexus Block with Reduced Volume: Impact on Hemidiaphragmatic Paralysis and Hemodynamic Effects in Shoulder Surgery Patients.","authors":"Antonio Coviello, Giorgio Ranieri, Filomena Coppola, Rossella Damonte, Dario Cirillo, Andrea Uriel De Siena, Fabrizio Fattorini, Paolo Scimia, Gaetano Castellano, Federico Rucci, Giuseppe Servillo","doi":"10.2147/LRA.S529154","DOIUrl":"10.2147/LRA.S529154","url":null,"abstract":"<p><strong>Background and aim: </strong>Interscalene Brachial Plexus Block (ISBPB) is commonly used for shoulder surgery anesthesia to reduce opioid use and general anesthesia complications. However, it may cause diaphragmatic paresis due to phrenic nerve involvement. This study compares the incidence of hemidiaphragmatic paralysis and the frequency of side effects-including hemodynamic changes and postoperative complications-between the Extrafascial (ExF) and Intrafascial (InF) approaches for ISBPB using reduced anesthetic volume. The aim is to assess whether the ExF approach may be preferable in patients with reduced cardiopulmonary reserve (eg, COPD or heart failure).</p><p><strong>Methods: </strong>A retrospective study was conducted at Federico II University in Naples, Italy, including 61 patients undergoing shoulder surgery from January 2024 to October 2024. About 33 patients received ExF while 28 received InF ISBPB, all with Ropivacaine 0.5% (10 mL), Mepivacaine 2% (5 mL), and Dexamethasone (4 mg). The primary outcome was the incidence of hemidiaphragmatic paralysis, evaluated via ultrasound pre and 30 minutes after the block by assessing diaphragm excursion, thickness, and thickening fraction. Secondary outcomes included intraoperative hemodynamic changes and postoperative complications: pain (NRS), analgesic/antiemetic requests, PONV, pruritus, shivering, anxiety, and discomfort.</p><p><strong>Results: </strong>The TF significantly decreased after the block in both groups (p < 0.001), with no intergroup. Diaphragm paralysis occurred in 28 patients in each group (p = 0.093), without clinical respiratory effects. The InF group had more hypotension episodes (100% vs 30.3%, p = 0.002), and significantly lower mean and systolic blood pressure values at 1 and 2 hours after-block. No cases of anxiety, pruritus, shivering, or discomfort were observed. NRS was higher in the InF group at 6 hours but lower at 12 and 24 hours. Analgesic/antiemetic needs were similar; PONV was more frequent in the ExF.</p><p><strong>Conclusion: </strong>Both approaches resulted in similar rates of hemidiaphragmatic paralysis. However, ExF was associated with fewer hemodynamic effects, suggesting potential benefit in high-risk cardiopulmonary patients.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"87-102"},"PeriodicalIF":1.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on Analgesia in Patients with Nerve Blocks: A Pilot Survey of Perioperative Nurses.","authors":"James Harvey Jones, Stuart Alan Grant","doi":"10.2147/LRA.S538162","DOIUrl":"10.2147/LRA.S538162","url":null,"abstract":"<p><strong>Background: </strong>The influence of nerve blocks on treatment bias, a form of implicit bias where patient characteristics lead to inequal treatment, remains unexplored.</p><p><strong>Methods: </strong>This was a pilot study that utilized a survey to collect data from nurses at a single academic medical center. The following information was collected from the respondents: age (years); gender (male, female, other); nursing experience (years); specialization (surgery, medicine, emergency, perioperative, other); prior formal training on pain management in patients with or without nerve blocks; and how frequently they encounter patients with nerve blocks. Hypothetical clinical scenarios were presented to investigate pain medication dosing strategies that were rated with a 3-point Likert scale (more, equal, or less medication). Impacts of various patient conditions (alcohol abuse, anxiety, depression, marijuana use, nerve block, opioid abuse, and substance abuse) on pain medication and opioid dosing strategies were further investigated with a 5-point Likert scale (ranging from strongly disagree to strongly agree).</p><p><strong>Results: </strong>Overall, the survey had a 32.59% response rate. Treatment bias towards patients with nerve blocks was evident in 21.43% (9/42) and 11/30 (36.67%) of respondents for pain medications and opioids, respectively.</p><p><strong>Conclusion: </strong>This pilot study suggests that patients with nerve blocks may be treated differently than those without blocks, regardless of their reported pain. However, given the study's exploratory design, these findings should be interpreted as hypothesis-generating.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"77-86"},"PeriodicalIF":1.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diagonal Vector (DIVE) Approach for Lumbar Plexus Block - A Comparison with Chayen's Technique.","authors":"Christian Dumps, Stefanie Nothofer, Manfred Weiss, Wolfgang Hoelz, Rainer J Litz, Robert Bocher, Felicitas Kies, Richard Funk, Axel Rüdiger Heller, Philipp Simon","doi":"10.2147/LRA.S527808","DOIUrl":"10.2147/LRA.S527808","url":null,"abstract":"<p><strong>Purpose: </strong>Substantial understanding of anatomic landmarks remains mandatory for regional anesthesia procedures of the lower limbs, even in times of ultrasound-guided techniques. Theoretically, applying a diagonal vector (DIVE) from the posterior superior iliac spine towards the spinous process of lumbar vertebra 3 leads to a higher error tolerance and closer nerve approximation when compared to Chayen's approach. The purpose of this study was to compare both techniques regarding clinical applicability, accuracy and risk profile.</p><p><strong>Patients and methods: </strong>Lumbar plexus block was performed bilaterally according to Chayen's technique and the DIVE method in embalmed bodies donated to science. The posterior medial half of the psoas major muscle was predefined as the puncture target area. Essential anatomical landmarks were labelled, photographed and a computer-aided analysis of the images was conducted. Both approaches were compared regarding the puncture success rate, spatial nerve approximation and complications such as vessel or kidney punctures.</p><p><strong>Results: </strong>Both techniques were applied bilaterally on 34 embalmed bodies (50% male, mean age ± standard deviation 82 ± 8 years, height 167 ± 10cm) and led to similar success rates of a psoas muscle hit (Chayen vs DIVE 86.3% vs 82.8%). DIVE punctures were more often localized in the medial third of the psoas (p<0.001), whereas the risk for vessel or kidney punctures was similar (p=0.473; p=0.367, respectively).</p><p><strong>Conclusion: </strong>Punctures according to the DIVE method resulted in a higher puncture accuracy compared to Chayen's technique with comparable practicability and risk profile. When using the DIVE Block, a window for a successful puncture can be expected between a quarter and a third of the PSIS- L3SP distance.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"67-76"},"PeriodicalIF":1.9,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could Wound Instillation Provide an Efficient Analgesia Comparable to That Provided by PECS-II Block for Modified Radical Mastectomy Using Ketamine-Bupivacaine Combination? A Pilot Study.","authors":"Ahmad M Abd El-Rahman, Saif Eldeen Gamal Khalaf, Mohamed H Bakri","doi":"10.2147/LRA.S515752","DOIUrl":"10.2147/LRA.S515752","url":null,"abstract":"<p><strong>Background and aim: </strong>In the light of the abundance of various analgesic methods available for analgesia following modified radical mastectomy (MRM) (pharmacological or interventional), we aimed to try a very simple technique using a drug combination (ketamine-bupivacaine) through wound instillation and to compare it to the reputable PECS-II block using the same drug combination. We hypothesized that, with this drug combination, local instillation may achieve a comparable, long lasting, analgesia for almost 48 hours, with less costly, and simple method.</p><p><strong>Patients and methods: </strong>Sixty women scheduled to undergo MRM participated in this study. Patients were randomized to have either; ultrasound-guided, modified PECS block (PECS group), or instillation of analgesics into the surgical wound (local instillation group). In both groups, we used 1 mg/kg ketamine HCL plus 0.25% bupivacaine HCL in a 30 mL volume. Total consumption of rescue morphine, time to 1^st analgesic request, numerical rating scale (NRS), hemodynamic effects were recorded over 48 hours postoperatively. In addition, the time required to perform either technique and possible side effects were recorded.</p><p><strong>Results: </strong>Total consumption of rescue morphine, first analgesic request, pain scores, showed no statistically significant differences in both groups; the local instillation procedure required a statistically significant shorter time to perform than the PECS procedure. None of the groups showed significant differences in the incidence of adverse effects.</p><p><strong>Conclusion: </strong>Local wound instillation provided a comparable analgesia to PECS-II block following modified radical mastectomy. Ketamine-bupivacaine combination prolonged analgesia for almost 2 days.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"57-66"},"PeriodicalIF":1.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Entry Selective Trunk Block (S-SeTB): An Innovative Approach to Complete Upper Extremity Anesthesia in Weapon-Wounded Patients in Low-Resource Settings.","authors":"Majaliwa Shabani, Sophie Crespo, Xavier Raingeval","doi":"10.2147/LRA.S524347","DOIUrl":"10.2147/LRA.S524347","url":null,"abstract":"<p><strong>Background: </strong>Regional anesthesia for upper extremity surgery in weapon-wounded patients is challenging, particularly in low-resource settings. Existing techniques often require multiple needle entries and ultrasound probe repositioning, increasing complexity and risk. There is a need for a simpler, effective technique providing complete anesthesia from the shoulder to the hand.</p><p><strong>Methods: </strong>We developed a novel ultrasound-guided regional anesthesia technique-the Single-entry Selective Trunk Block (S-SeTB)-which targets the superior trunk (ST), middle trunk (MT), and C8 ventral ramus (C8VR) with local anesthetic diffusion to the inferior trunk (IT). The procedure uses one skin entry point to deliver three injections and is combined with a superficial cervical plexus (SCP) block using the same entry and ultrasound plane. Over 600 procedures were performed in field hospitals operated by the International Committee of the Red Cross, with observations documented.</p><p><strong>Results: </strong>The S-SeTB consistently achieved full anesthesia of the upper extremity, including the shoulder and clavicle, without the need for conversion to general anesthesia. The technique was well tolerated and effective in complex trauma cases. No major complications were reported. Compared to conventional selective trunk blocks or hybrid brachial plexus approaches, the S-SeTB required lower anesthetic volumes (20-25 mL) and demonstrated reduced procedural complexity and risks (eg, pneumothorax, vascular puncture).</p><p><strong>Conclusion: </strong>The S-SeTB, combined with SCP and intercostobrachial nerve blocks, offers a reliable, resource-efficient, and safer alternative to traditional brachial plexus block techniques. It is particularly well-suited for austere environments where anesthesia resources and safety margins are limited. Further prospective studies are ongoing to evaluate block dynamics and confirm efficacy.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"45-55"},"PeriodicalIF":1.9,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Hematoma Following Ultrasound-Guided Rectus Sheath Block.","authors":"Toshie Shiraishi","doi":"10.2147/LRA.S511201","DOIUrl":"10.2147/LRA.S511201","url":null,"abstract":"<p><strong>Purpose: </strong>Rectus sheath block is a commonly used nerve block to reduce pain from abdominal surgery. Although hematoma complications due to vascular injury during nerve block is rare, it remains an important consideration, particularly in cases requiring the use of antithrombogenic agents. In rectus sheath block, anesthesiologists are aware that major vessels subject to needle puncture injury during the procedure include the inferior epigastric artery (IEA) and inferior epigastric vein (IEV). However, increasing use of ultrasound-guided block has resulted in a decrease in significant bleeding risk, including in patients taking antithrombogenic agents. We recently experienced a large subcutaneous hematoma (430 mL) after rectus sheath block. In this case report, we describe the clinical course of the hematoma and discuss its cause and the possible vessels involved, including the IEA and IEV, and branches such as the superior epigastric arteries and veins.</p><p><strong>Case presentation: </strong>A 40-year-old female underwent bilateral ultrasound-guided rectus sheath block and transversus abdominis block following laparoscopic cholecystectomy. After the operation, a large, painful hematoma was identified with a volume estimated at 430 mL. Investigation of the bleeding site by CT scan showed that the hematoma was subcutaneous and in an area with multiple venous and arterial branches. Identification of the responsible vessel appeared difficult; however, on discussion with the radiologist, bleeding from a cutaneous (or deeper) vessel from the block or surgical (trocar or needle) injury was included in the different diagnosis. The superficial epigastric artery was considered the most probable source because it was the closest to the hematoma.</p><p><strong>Conclusion: </strong>Although the IEA and IEV are the major candidates for vascular injury in rectus sheath block, clinicians should recognize that the SEA can also be injured during rectus sheath block procedures.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"39-44"},"PeriodicalIF":1.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perineural Dexamethasone is More Efficient Than Perineural Dexmedetomidine in Prolonging Popliteal Sciatic and Saphenous Nerve Blocks: A Single-Center, Prospective, Double-Blinded, Randomized Controlled Trial.","authors":"Guiyu Lei, Lili Wu, Yue Yin, Shu Zhang, Guyan Wang","doi":"10.2147/LRA.S515510","DOIUrl":"https://doi.org/10.2147/LRA.S515510","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to assess and compare the effectiveness of perineural dexamethasone (DEX) and perineural dexmedetomidine (DEM) as adjuvant in popliteal sciatic and saphenous nerve blocks, focusing on the duration of analgesia and side effects following major foot and ankle surgeries.</p><p><strong>Patients and methods: </strong>Ninety patients scheduled for major foot and ankle surgeries under general anesthesia, who received popliteal sciatic and saphenous nerve blocks, were randomly assigned to one of three groups: (1) control group receiving 0.375% ropivacaine; (2) DEX group receiving 0.375% ropivacaine combined with 10 mg perineural dexamethasone; (3) DEM group receiving 0.375% ropivacaine combined with 0.75 μg/kg perineural dexmedetomidine. The primary outcome measured was the duration of analgesia, defined as the time from the administration of the nerve block to the onset of the first pain sensation in the surgical area. Secondary outcomes included opioid consumption within the first 48 hours post-surgery and the incidence of side effects such as hypotension and bradycardia. (Clinical trial registration number: ChiCTR2100048127).</p><p><strong>Results: </strong>The time until the first perception of pain was significantly extended in the DEX group (28.0 (3.3) hours) compared to the DEM group (24.1 (1.3) hours) and the control group (17.5 (3.5) hours, P<0.001). Additionally, opioid consumption within the first 24 hours was markedly reduced in both the DEX and DEM groups compared to the control group (P<0.001). However, opioid usage between 0 to 48 hours post-surgery showed no significant differences among the three groups. The DEM group experienced a higher incidence of hypotension and bradycardia compared to both the DEX and control group (P<0.001).</p><p><strong>Conclusion: </strong>Both 10 mg dexamethasone and 0.75 µg/kg dexmedetomidine effectively prolonged analgesia in patients undergoing major foot and ankle surgery with a popliteal sciatic and saphenous nerve block. However, dexamethasone (10 mg) provided a significantly longer duration of analgesia compared to dexmedetomidine (0.75 µg/kg).</p><p><strong>Trial registration: </strong>Chictr.org.cn identifier: ChiCTR2100048127.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"27-38"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Combining Lidocaine and Ropivacaine on the Duration of Analgesia and Anesthesia of an Infraclavicular Brachial Plexus Block.","authors":"Mathias T Steensbæk, Jens L Temberg, Sina Yousef, Sanja Pisljagic, Christian Steen-Hansen, Anders K Nørskov, Kai H W Lange, Christian Rothe, Lars H Lundstrøm","doi":"10.2147/LRA.S505536","DOIUrl":"https://doi.org/10.2147/LRA.S505536","url":null,"abstract":"<p><strong>Background: </strong>Combining local anesthetics for peripheral nerve blocks may change block characteristics, resulting in altered onset and block duration. We aimed to investigate the block characteristics of an infraclavicular brachial plexus block regarding block duration, pain after block cessation, and patient satisfaction by using a combination of lidocaine-epinephrine and ropivacaine.</p><p><strong>Methods: </strong>In this retrospective cohort study, 103 patients undergoing ambulatory hand or wrist surgery received an infraclavicular brachial plexus block with either a combination of ropivacaine 5 mg/mL combined with lidocaine 20 mg/mL and epinephrine 5 µg/mL (COMBI group) or only ropivacaine 5 mg/mL (ROPI group). The primary outcome was \"Total block duration\". Secondary outcomes were \"Time until block begins to subside\", \"Pain after complete block cessation (Numerical Rating Scale 0-10)\", and \"Patient experience of nerve block\". All outcomes were patient-reported. Multivariable regression analyses were used to adjust for predefined potential confounders.</p><p><strong>Results: </strong>\"Total block duration\" (mean ± SD) was 655±215 minutes in the COMBI group and 961±195 in the ROPI group; mean difference of 309 minutes; <i>P</i><0.001. \"Time until block begins to subside\" was 396±120 minutes in the COMBI group and 642±214 minutes in the ROPI group; <i>P</i><0.001. The median \"Pain after block cessation\" on a Numeric rank scale (NRS) was 5.0 (IQR 3.0-8.0) in the COMBI group and 6.0 (IQR 4.0-7.0) in the ROPI group; <i>P</i>=0.80. In the COMBI group, 60% were satisfied with block quality versus 38% in the ROPI group; <i>P</i>=0.042. Multivariable adjusted analyses confirmed the results regarding block duration and pain after block cessation but not satisfaction.</p><p><strong>Conclusion: </strong>Combining lidocaine-epinephrine and ropivacaine reduced the duration of analgesia by approximately 5 hours. Pain after block cessation was moderately high in both groups.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"17-25"},"PeriodicalIF":1.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative \"Three-in-One\" Method for Intervention of Lower Limb Neuropathic Pain: Retrospective Case Series Study.","authors":"Jinyu Lai, Yan Lai, Yijun Wu, Yong Xiang, Fengqin Zhang","doi":"10.2147/LRA.S511488","DOIUrl":"10.2147/LRA.S511488","url":null,"abstract":"<p><strong>Purpose: </strong>Minimally invasive intervention therapy anterior cutaneous branch of the femoral nerve for refractory neuropathic pain in the inner thigh area typically requires punctures at multiple sites to target the three nerves of the obturator nerve cutaneous branch, anterior cutaneous branch of the femoral nerve, and infrapatellar branch of the saphenous nerve. Clinical practice has demonstrated that the innovative \"three-in-one\" technique allows for simultaneous targeting of the three cutaneous nerves from a single entry point, effectively treating inner thigh pain. Moreover, this approach can also be used for local anaesthesia in shallow surgical procedures in the inner thigh area. We hope to promote this puncture technique among pain physicians.</p><p><strong>Patients and methods: </strong>Clinical data of 8 patients with localized pain in the inner thigh from the Pain Department of Taihe Hospital, Shiyan City, Hubei Medical College, from April 2023 to September 2024 were collected. All the patients experienced pain in the cutaneous branch of the obturator nerve, the anterior branch of medial femoral cutaneous nerve, and the infrapatellar branch of the saphenous nerve. The \"three-in-one\" approach was used for nerve block and radiofrequency puncture.</p><p><strong>Results: </strong>After the \"three-in-one\" approach, the 8 patients showed varying degrees of improvement in their Numeric Rating Scale (NRS) scores. The patients were satisfied with the treatment method and efficacy, and no complications, such as nerve damage, occurred during the operation.</p><p><strong>Conclusion: </strong>The \"three-in-one\" approach is a potentially effective method for treating pain in the inner lower limb area, significantly reducing the damage caused by multiple puncture and providing ideas for more minimally invasive treatment of other areas; this approach meets expectations for more minimally invasive treatment.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"9-15"},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Intravenous Chloroprocaine in Gastrointestinal Endoscopy: A Randomized Controlled Trial.","authors":"Peng Zhang, Jin Zhang, Ying Zhao, Jun Chen, Shaolin Wang","doi":"10.2147/LRA.S505804","DOIUrl":"10.2147/LRA.S505804","url":null,"abstract":"<p><strong>Background: </strong>While propofol is a commonly utilized medication for sedation during gastrointestinal endoscopy, it is associated with adverse effects such as hypotension and injection pain. This trial was conducted to test the hypothesis that chloroprocaine can reduce the requirement for propofol and alleviate injection pain during gastrointestinal endoscopy.</p><p><strong>Methods: </strong>Sixty patients undergoing gastrointestinal endoscopy were enrolled and randomly divided into study group (Group CP) and control group (Group C). Patients in Group CP received intravenous chloroprocaine 2 mg/kg, followed by continuous infusion at 6 mg·kg^-1·h^-1 until the end of examination. Patients in Group C received the same volume of saline. Subsequently, all patients were intravenously administered sufentanil at a dose of 0.05 μg/kg. Thirty seconds later, propofol was uniformly infused intravenously at a rate of 60 mL/min using an infusion pump. The primary outcome was the consumption of propofol. Secondary outcomes included the incidence of hypoxemia, hypotension, bradycardia, injection pain, and coughing/body movement during examination. The recovery time, PACU stay time, postoperative pain score, and endoscopists' satisfaction score were also recorded.</p><p><strong>Results: </strong>Group CP demonstrated a significantly lower total requirement for propofol compared to Group C, with means of (119±14) mg and (148±18) mg respectively, P<0.001. This trend was also observed for both the first and supplemental doses. There were no significant differences between the two groups regarding intraoperative adverse events. The incidence of injection pain in Group CP was lower than that in Group C (P=0.007). The recovery time [(4.7±1.4) vs (6.6±1.3), P<0.001], PACU stay time [(13.0±2.9) vs (16.7±3.0), P<0.001] and postoperative pain score [(1.9±0.7) vs (2.5±0.7), P=0.002] in Group CP were lower than those in Group C.</p><p><strong>Conclusion: </strong>Intravenous chloroprocaine reduces the requirement for propofol, alleviates propofol injection pain, and improves recovery in patients undergoing gastrointestinal endoscopy.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"1-8"},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}