Local and Regional Anesthesia最新文献

{"title":"Current Status and Global Trend of Rebound Pain After Regional Anesthesia: A Bibliometric Analysis.","authors":"Rui Zhou, Wencai Jiang, Qingyuan Miao, Xinyang Li, Lize Xiong","doi":"10.2147/LRA.S455347","DOIUrl":"10.2147/LRA.S455347","url":null,"abstract":"<p><strong>Purpose: </strong>Rebound pain after regional anesthesia, a common phenomenon when the analgesic effect wears off, has been recognized in the last a few years. The aim of this study is to analyze the status and tendency of this area in a macroscopic perspective.</p><p><strong>Methods: </strong>Bibliometric analysis is the primary methodology of this study. Literature retrieval was conducted in Web of Science (WoS) Core Collection. WoS, Excel, VOSviewer and CiteSpace were employed to do the analyses and visualization. Parameters were analyzed, such as publications, citations, journals, and keywords, etc.</p><p><strong>Results: </strong>In total, 70 articles in the past 10 years were identified eligible. Most articles (14 pieces) were published in 2021, followed by 2022 and 2023 with 13 articles. Researchers come from 134 institutions and 20 countries. Huang Jung-Taek, Hallym College, and USA are the most productive author, institution and country, respectively. The articles were mainly published on the top journals of anesthesiology, orthopedics and surgery. The topic of these articles is primarily about the clinical issues of rebound pain. Peripheral nerve block, brachial plexus block and femoral nerve block are the activist keywords in the area, while perioperative management, fracture surgery and outcome may become hotpots in the next years.</p><p><strong>Conclusion: </strong>Our results show that the study of rebound pain after regional anesthesia starts relatively late and is in upward tendency, future studies can focus on the perioperative management and outcomes of fracture patients, and the definition and mechanism of rebound pain after regional anesthesia.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"67-77"},"PeriodicalIF":2.9,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916785","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":"Knowledge, Attitudes and Practices Regarding Use of Local Anaesthetics Among Non-Anaesthesia Healthcare Professionals at Mulago National Referral Hospital.","authors":"Intisar Ahmed Abdi, John Mark Kasumba, Agnes Wabule, Mary T Nabukenya, Joseph Kayongo, Bernadette Kyoheirwe, Abdirizak Abdullahi Sheikdon, Kamaludin D Osman","doi":"10.2147/LRA.S428661","DOIUrl":"10.2147/LRA.S428661","url":null,"abstract":"<p><strong>Introduction: </strong>Local anaesthetics (LA) are commonly used in dental and surgical emergency wards by both anaesthesia professionals and non-anaesthesia professionals. Anecdotal evidence shows that non-anaesthesia health-care professionals do not monitor vital signs during the use of local anaesthesia, and there are no standard hospital guidelines on the use of LA and management of LA toxicity by non-anaesthesia professionals.</p><p><strong>Purpose: </strong>This study sought to assess the knowledge, attitudes and practices regarding local anaesthetic use among non-anaesthesia health-care professionals at Mulago National Referral Hospital.</p><p><strong>Patients and methods: </strong>This was a cross-sectional study that utilized a quantitative research approach. The sample size of the study was 43 non-anaesthesia healthcare professionals from the casualty and surgical outpatient wards and Mulago dental ward. Data was collected using a questionnaire and analyzed using STATA 15.</p><p><strong>Results: </strong>Overall, 66.67% of the Specialist, 76.47% of the senior house officers, 100% of medical officers, and 80% of the clinical orthopedic house officers had unsatisfactory levels of knowledge in Mulago casualty and surgical outpatient wards. 20% of the specialist and 16.67% of the senior house officers had unsatisfactory levels of knowledge in Mulago dental ward. 87.5% of the non-anaesthesia health-care professionals do not give a test dose on a routine basis in Mulago casualty and surgical outpatient wards. A total of 63.64% of the non-anaesthesia healthcare professionals in Mulago dental ward do not sterilize the site of injection.</p><p><strong>Conclusion: </strong>Non-anaesthesia health-care professionals had unsatisfactory levels of knowledge, somewhat good practices, and negative attitudes toward LA use.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"29-37"},"PeriodicalIF":2.9,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140110566","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":"Combined Supra-Inguinal Fascia Iliaca, Sciatic Nerve, and Posterior Femoral Cutaneous Nerve Blocks in Austere Settings for Hemodynamically Unstable Patients with Vascular Injuries from Weapon Wounds: A Case Series.","authors":"Majaliwa Shabani, Seydina Alioune Beye, Abdoulaye Traore, Xavier Raingeval, Daouda Coulibaly, Sophie Crespo","doi":"10.2147/LRA.S452367","DOIUrl":"10.2147/LRA.S452367","url":null,"abstract":"<p><strong>Purpose: </strong>The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique-sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks -in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments.</p><p><strong>Patients and methods: </strong>Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1% lidocaine and 0.5% levobupivacaine.</p><p><strong>Results: </strong>The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) were performed without complications in all patients. Three of the patients received light sedation prior to the initiation of the block procedure. All surgeries were completed successfully without the need for additional analgesics or conversion to general anesthesia.</p><p><strong>Conclusion: </strong>The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) appears to be a safe anesthetic option for unstable or high-risk patients requiring lower limb surgery. Further research with a larger cohort is necessary to validate our findings and to potentially standardize this approach.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"19-27"},"PeriodicalIF":2.9,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10916515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049820","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":"Successful Use of Ultrasound Guided Quadratus Lumborum Block Without General Anesthesia for Open Appendectomy in a Patient with Heart Failure with Reduced Ejection Fraction- A Case Report and Literature Review.","authors":"Muhammad Jaffar Khan, Yasir Eltayeb, Arunabha Karmakar, Rohma Malik, Tarig Elsafi","doi":"10.2147/LRA.S438176","DOIUrl":"10.2147/LRA.S438176","url":null,"abstract":"<p><strong>Background: </strong>Patients diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) are at high risk of perioperative cardiovascular complications. While it is important to focus on optimizing their cardiac function, it is also crucial to address and optimize any other modifiable risk factors that could potentially impact postoperative outcome. This also includes careful consideration of anesthetic techniques to suit the patient and facilitate the surgery. However, there is a scarcity of evidence regarding the safety of specific anesthetic approaches for heart failure patients.</p><p><strong>Case presentation: </strong>We describe the case of an adult patient in mid-50s, with a history of ischemic dilated cardiomyopathy with reduced Ejection Fraction (about 25%) who presented with acute gangrenous appendicitis and was scheduled for an open appendectomy. It was deemed to be a high-risk patient for general and spinal anesthesia. With the guidance of a multidisciplinary team, surgery was successfully performed using a quadratus lumborum block with standard monitoring. The patient was comfortable and hemodynamically stable throughout the procedure. The postoperative course was uneventful.</p><p><strong>Conclusion: </strong>Quadratus Lumborum Block for open appendectomy can be a beneficial alternative anesthesia technique in high-risk patients that significantly lowers perioperative cardiovascular risk, maintains hemodynamics, enhances satisfaction, and shortens hospital stay.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"9-17"},"PeriodicalIF":2.9,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10899805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139990536","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":"A Novel Ultrasound-Guided \"Three in One\" Approach Plus Interfascial Plane Blocks for the Treatment of Cervicogenic Headache.","authors":"Danxu Ma, Abulaihaiti Maimaitimin, Yun Wang","doi":"10.2147/LRA.S446667","DOIUrl":"10.2147/LRA.S446667","url":null,"abstract":"<p><strong>Objective: </strong>Cervicogenic headache (CEH) is a condition resulting from upper cervical spine dysfunction and associated structural and soft tissue abnormalities, significantly impacting patients' quality of life. To acquire better therapeutic results, we presented a novel ultrasound-guided \"three in one\" approach plus interfascial plane (IFP) blocks for the treatment of CEH. This approach allows for the modulation of C2 dorsal root ganglion (DRG), third occipital nerve (TON), and C3 medial branch with one-point puncture. Additionally, it allows for IFP blocks between the upper neck and occipital muscles within the same scanning plane.</p><p><strong>Patients and methods: </strong>We evaluated patients diagnosed with CEH from July 2021 to December 2022 in our pain clinic. We included those who did not respond to conservative treatment and single occipital nerve block, therefore received nerve block or pulsed radiofrequency (PRF) using the \"Three in One\" approach plus IFP blocks. The accuracy of the ultrasound-guided C2 DRG puncture procedures was confirmed through fluoroscopy with C-arm and the sensory testing of PRF. The therapeutic effect of these interventions was assessed using the numerical rating scale (NRS) scores during telephone follow-ups at 1, 3, and 6 months.</p><p><strong>Results: </strong>Utilizing the \"Three in One\" approach, a total of 5 patients diagnosed with CEH underwent nerve block plus IFP blocks, while 2 patients underwent PRF plus IFP blocks. Employing ultrasound-guided C2 DRG puncture procedures, the needle tip's correct placement was confirmed through both fluoroscopy and sensory testing of PRF. Notably, none of the cases experienced any complications associated with the approach. Subsequent follow-up assessments revealed an improvement in the NRS scores for CEH in all patients.</p><p><strong>Conclusion: </strong>The ultrasound-guided \"Three in One\" approach plus IFP blocks may be a potential effective method for the treatment of CEH.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697785","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":"Analgesic Effects of Different Local Infiltration Anesthesia Techniques Combined with Femoral Nerve Block in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Clinical Trial","authors":"Yong-Kang Gui, Rui-Fei Xiao, Ya-Ru Luo, Yang Liu, Xin Da, Sizhu Zhu, De-Wen Shi, Xu-Dong Hu, Guang-Hong Xu","doi":"10.2147/lra.s436767","DOIUrl":"https://doi.org/10.2147/lra.s436767","url":null,"abstract":"","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"269 ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139022159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Missing Postoperative Longitudinal Pain Data on Study Results Investigating Analgesia from Transversus Abdominis Plane Block on Postoperative Day One Following Abdominal Surgery: A Single-Center Retrospective Chart Review.","authors":"James Harvey Jones","doi":"10.2147/LRA.S439429","DOIUrl":"10.2147/LRA.S439429","url":null,"abstract":"<p><strong>Background: </strong>The aims of this study are to analyze the association between the number of recorded pain scores and baseline pain following surgery, analgesia technique, and patient demographics, as well as the substitution of missing data with the results from mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.</p><p><strong>Methods: </strong>This retrospective chart review was approved by the Institutional Review Board (IRB). The following data were collected: patient demographics (age, gender, body mass index (BMI), race, and ethnicity); surgery type and date; analgesia with or without transversus abdominis plane (TAP) block; as well as the time, date, and value for all postoperative pain scores on the first postoperative day (POD). The following null hypotheses were tested: (1) the number of pain recordings will be independent of TAP block analgesia, baseline pain on POD 1, and patient demographics; and (2) there will be no significant differences in pain scores with and without TAP block analgesia following complete case analysis, mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.</p><p><strong>Results: </strong>This study analyzed 486 patients including 2562 recorded pain scores. An increase in age by one year is, on average, associated with a 0.04 (95% confidence interval (CI) -0.060 to -0.025) decrease in the number of pain scores recorded (p < 0.001). Black race is associated with 0.763 less pain scores, on average (95% CI -1.49 to -0.039) and this value is statistically significant (p = 0.039). All datasets with substituted values for missing data yield lower pain scores for patients who did not receive TAP block. Significant differences in recorded pain scores are only noted for scores recorded between 0400 and 0759 and 1600-1959 in mixed models.</p><p><strong>Conclusion: </strong>Discrepancies in pain score recordings among patients are associated with age and black race. When these discrepancies are addressed with statistical methods, clinically significant differences are appreciated.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"16 ","pages":"173-182"},"PeriodicalIF":2.9,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10695121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138487918","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":"Quadratus Lumborum Block as a Cornerstone for Neonatal Intestinal Surgery Enhanced Recovery (ERAS): A Case Series.","authors":"Cassandra Hoffmann,&nbsp;Angela Snow,&nbsp;Celine Chedid,&nbsp;Carol Abi Shadid,&nbsp;Eiichi A Miyasaka","doi":"10.2147/LRA.S403567","DOIUrl":"10.2147/LRA.S403567","url":null,"abstract":"<p><strong>Purpose: </strong>Neonates present unique challenges for pediatric surgical teams. To optimize outcomes, it is imperative to standardize perioperative care by using early extubation and multimodal analgesic techniques. The quadratus lumborum (QL) block provides longer duration and superior pain relief than other single-injection abdominal fascial plane techniques. The purpose of this case series was to report our initial experience with QL blocks in neonatal patients treated with intestinal ERAS.</p><p><strong>Patients and methods: </strong>Ten neonates requiring intestinal surgery at a single tertiary care center who received QL blocks between December 2019 and April 2022 for enhanced recovery were studied. Bilateral QL blocks were performed with 0.5 mL/kg of 0.25% ropivacaine per side with an adjuvant of 1 mcg/kg of dexmedetomidine.</p><p><strong>Results: </strong>Gestational age at birth ranged from 32.2 to 41 weeks. The median age, weight, and American Society of Anesthesiologists (ASA) score at the time of surgery was 5 days [range 7.5 hours, 60 days], 2.84 kg [range 1.5, 4.5], and 3, respectively. Bilateral QL blocks were performed without complications in all patients. Two patients were outside the neonatal range from birth to surgery, but were under 42 weeks gestational age when corrected for prematurity. All patients were extubated with well-controlled pain, and no patient required reintubation within the first 24 hours. Postoperatively, median cumulative morphine equivalents were 0.16 mg/kg [range 0, 0.79] and six patients received scheduled acetaminophen. Morphine (0.1 mg/kg) was administered to patients with a modified neonatal infant pain scale (NIPS) score greater than or equal to 4, and pain was reassessed 1 hour after administration (Appendix).</p><p><strong>Conclusion: </strong>When developing intestinal ERAS protocols, Bilateral QL blocks may be considered for postoperative analgesia in the neonatal population. Further prospective studies are required to validate this approach in neonates.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"16 ","pages":"165-171"},"PeriodicalIF":2.9,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/98/d9/lra-16-165.PMC10576531.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236664","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":"Effect of 2% Topical Lidocaine Gel on Discomfort from Electrical Stimulation During Nerve Conduction Studies- A Prospective Double-Blind Placebo-Controlled Study.","authors":"Kefah Al-Hayk,&nbsp;Mahmoud M Smadi,&nbsp;Lina M Elsalem,&nbsp;Ahmed Yassin,&nbsp;Suha Aqaileh,&nbsp;Deema H Obiedat,&nbsp;Ahmad Kefah Al-Hayk,&nbsp;Majdi Al Qawasmeh,&nbsp;Raid Kofahi,&nbsp;Khalid El-Salem","doi":"10.2147/LRA.S426076","DOIUrl":"https://doi.org/10.2147/LRA.S426076","url":null,"abstract":"<p><strong>Purpose: </strong>Procedure discomfort can limit electrodiagnostic studies. Reducing discomfort can maximize the benefits of these diagnostic tools. This study targeted the discomfort associated with nerve conduction studies (NCS).</p><p><strong>Patients and methods: </strong>This was a prospective randomized double-blind placebo-controlled study comparing the effect of topical lidocaine gel (2%) versus analgesic-free lubricant gel (K-Y gel) on pain perception during NCS. Sequential patients (n=130) referred for routine NCS participated in the study. We applied 1 mL of lidocaine gel to one palm, and 1 mL of K-Y gel to the other as a control. After 20-45 min of application, graded increments of electrical stimulation intensity were delivered to record the median and ulnar mixed palmar nerve responses. Patients were then asked to score the degree of pain felt from electrical stimulation over each palm using the Wong-Baker Faces Pain Scale (WBFPS) and the Numeric Rating Scale (NRS), independent of baseline pain.</p><p><strong>Results: </strong>Mean WBFPS and NRS scores for lidocaine-treated palms were significantly lower than those for controls using parametric paired <i>t</i>-test (3.79 vs 4.37 and 3.35 vs 3.78 respectively, all p-values<0.05). Subgroup analysis showed a significant decrease in mean scores in females, patients aged ≤50 years, patients without a history of previous NCS, and patients without comorbidities (all p-values<0.05). Median scores using nonparametric Wilcoxon ranked test also showed statistically significant differences (all p-values<0.05).</p><p><strong>Conclusion: </strong>The results indicate that topical lidocaine 2% gel reduces discomfort associated with NCS. However, despite the statistical significance, clear clinical significance may be lacking. Clinical implementation may be considered for the subgroups that showed the greatest benefit. Further studies that incorporate more efficient drug delivery methods may yield better results.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"16 ","pages":"153-163"},"PeriodicalIF":2.9,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/1e/lra-16-153.PMC10543085.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41134770","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":"Systemic Ropivacaine Concentrations Following Local Infiltration Analgesia and Femoral Nerve Block in Older Patients Undergoing Total Knee Arthroplasty.","authors":"Sigita Kazune,&nbsp;Inga Nurka,&nbsp;Matiss Zolmanis,&nbsp;Arturs Paulausks,&nbsp;Dace Bandere","doi":"10.2147/LRA.S425353","DOIUrl":"https://doi.org/10.2147/LRA.S425353","url":null,"abstract":"<p><strong>Purpose: </strong>The study examined the pharmacokinetic profile of fixed formulation mixtures comprising 225 mg of ropivacaine for local infiltration analgesia with or without epinephrine, and femoral nerve block in older patients presenting for orthopedic surgery and explored potential influences of block type, age, and body weight on this profile.</p><p><strong>Patients and methods: </strong>Twenty four patients scheduled for total knee arthroplasty were randomly assigned to three groups: femoral nerve block, local infiltration analgesia with epinephrine and local infiltration analgesia without epinephrine. Blood samples were collected at 10, 30, 60, and 120 min following the block and total plasma concentrations of ropivacaine were quantified by high performance liquid chromatography.</p><p><strong>Results: </strong>The mean individual peak total plasma concentrations of ropivacaine in local infiltration analgesia with and without epinephrine, and femoral nerve block group were 0.334, 0.490 and 0.545 μg mL^-1 (p = 0.16). Local infiltration with epinephrine group had significantly lower plasma ropivacaine concentrations at 30, 60 and 120 minutes. The plasma ropivacaine concentrations exceeded 2.2 μg mL^-1 in one patient. Age, but not body weight, had a moderate correlation with peak plasma ropivacaine concentration (r = 0.37, p = 0.08).</p><p><strong>Conclusion: </strong>Administration of a fixed 225 mg dose of ropivacaine for local infiltration analgesia with epinephrine and femoral nerve block results in plasma ropivacaine concentrations below the toxicity threshold, indicating their safety. The use of local infiltration analgesia with epinephrine provides a greater safety margin, as local infiltration analgesia without epinephrine may lead to ropivacaine concentrations associated with symptoms of local anesthetic toxicity.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"16 ","pages":"143-151"},"PeriodicalIF":2.9,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/a2/lra-16-143.PMC10508276.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41122036","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}