Minerva anestesiologica最新文献

{"title":"Analgesic effect of lateral femoral cutaneous nerve block added to the pericapsular nerve group (PENG) block in primary total hip arthroplasty: a randomized clinical trial.","authors":"Fabricio A Cardoso, Anneliese Fortuna-Costa, Luis V Garcia","doi":"10.23736/S0375-9393.24.18141-2","DOIUrl":"10.23736/S0375-9393.24.18141-2","url":null,"abstract":"<p><strong>Background: </strong>Adequate hip joint and surgical incision analgesia represent a challenge in the postoperative period of primary total hip arthroplasty (THA). This study aimed to evaluate whether the combination of the lateral femoral cutaneous nerve block (LFCN block) and the pericapsular nerve group block (PENG block) influences postoperative analgesia and rescue opioids, in primary THA surgeries.</p><p><strong>Methods: </strong>A trial was proposed with 74 patients for THA surgeries under spinal anesthesia, where 37 received PENG block (GPENG) and the other 37, PENG block and LFCN block (GPENG+LFC). The primary outcome was the presence and intensity of pain at rest and on movement, using the Numeric Rating Scale. The secondary main outcome was the total consumption of opioids. The follow-up was 48 h.</p><p><strong>Results: </strong>Significantly fewer patients reported pain in the GPENG+LFC compared to GPENG: at rest, at 4 h (17 [45.95%] vs. 28 [75.68%] respectively, P=0.088), 12 h (4 [10.81%] vs. 17 [45.95%] respectively, P=0.016), and 24 h (4 [10.81%] vs. 13 [35.14%] respectively, P=0.0252); on movement, at 4 h (17 [45.95%] vs. 30 [81.08%] respectively, P=0.0002), 12 h (4 [10.81%] vs. 19 [51.35%] respectively, P=0.0003), and 24 h (5 [13.51%] vs. 14 [37.84%] respectively, P=0.0166). Total opioid consumption was significantly lower in GPENG+LFC compared to GPENG up to 48 hours postoperatively (1200 mg of tramadol and 6 mg of nalbuphine vs. 2400 mg and 21 mg respectively, P=0.0188).</p><p><strong>Conclusions: </strong>The combination of the LFCN block and the PENG block, compared to the sole PENG block, results in better analgesia at rest and on movement up to 24 h and a reduction in the total consumption of opioids up to 48 h after THA.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"26-35"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified thoracoabdominal nerves block through perichondrial approach block for pediatric kidney transplantation.","authors":"Volkan Özen, Engin I Turan, Beyzanur Aydoğdu, Ayça S Şahin","doi":"10.23736/S0375-9393.24.18617-8","DOIUrl":"https://doi.org/10.23736/S0375-9393.24.18617-8","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quadro-iliac plane block for lumbar multi-level instrumentation surgery: far away from the surgical area.","authors":"Bahadir Ciftci, Ahmet Cetinkal, Selcuk Alver, Ali Ahiskalioglu","doi":"10.23736/S0375-9393.24.18680-4","DOIUrl":"https://doi.org/10.23736/S0375-9393.24.18680-4","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized clinical trial comparing different combination of peripheral nerve blocks for intraoperative analgesia in patients on antithrombotic drugs undergoing hip fracture surgery: pericapsular nerve group (PENG) block versus femoral and obturator nerve block.","authors":"Francesca Gargano, Sabrina Migliorelli, Giuseppe Pascarella, Fabio Costa, Alessandro Strumia, Alice Bellezze, Alessandro Ruggiero, Massimiliano Carassiti","doi":"10.23736/S0375-9393.24.18534-3","DOIUrl":"https://doi.org/10.23736/S0375-9393.24.18534-3","url":null,"abstract":"<p><strong>Background: </strong>Locoregional anesthesia is commonly used in orthopedic trauma surgery, particularly in elderly patients. We conducted a prospective, monocentric, randomized controlled trial to evaluate the anesthetic and analgesic efficacy of pericapsular nerve group (PENG) block in patients on antithrombotic drugs undergoing hip fracture surgery, comparing it with femoral and obturator nerve block (FNB+ONB).</p><p><strong>Methods: </strong>Forty patients were randomly allocated to receive a PENG block or FNB and ONB, both combined with wound infiltration (WI). The main outcome was pain, assessed using a Numeric Rating Scale (NRS) 30 minutes after the block, in Post Anesthesia Care Unit (PACU) and in the postoperative 6, 12 and 24 hours. Secondary outcomes included intra and postoperative analgesic requirement, need to increase the level of sedation and postoperative complications.</p><p><strong>Results: </strong>We observed, except for 12 hours post-surgery, higher NRS values for PENG group compared to FNB + ONB group, with a median (IQR) NRS of 3 (2-4) vs. 2 (1-3.25) 30 minutes after the block, 1.5 (0-3.25) vs. 0 (0-1.25) at PACU, 1.5 (0-2) vs. 1 (0-2.25) at 6 hours, 1.5 (0-2) vs. 2 (1-2) at 12 hours, and 2 (0-2) vs. 1.5 (0-2) at 24 hours. Despite this, no result was statistically significant; all P>0.05. No differences were observed as regards other secondary outcomes.</p><p><strong>Conclusions: </strong>Our results suggest that PENG block is not inferior to FNB + ONB as anesthetic and analgesic technique in patients on antithrombotic drugs undergoing hip fracture surgery.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New insights into the use of dexamethasone-dexmedetomidine as perineural adjuvants in peripheral nerve and fascial blocks: an up-to-date narrative review.","authors":"Francesco Marrone, Pierfrancesco Fusco, Eros Pilia, Laura B Colantonio, Carmine Pullano","doi":"10.23736/S0375-9393.24.18476-3","DOIUrl":"https://doi.org/10.23736/S0375-9393.24.18476-3","url":null,"abstract":"<p><p>The discovery of the mechanism of action of local anesthetics, involving the blocking of sodium ion channels is considered a milestone in anesthesia. Potentially lethal toxic effects occur in the case of intravascular injection of local anesthetic (LA) or in case of exceeding dosages, as a result of systemic reabsorption. Attempts to prevent these life-threatening events have been made by developing novel LA and by adding adjuvants. The aim of this up-to-date review was to provide the newest insights on the two adjuvants dexamethasone and dexmedetomidine for regional anesthesia. The addition of perineural dexamethasone-dexmedetomidine combination has shown a faster onset, longer duration of action and increased intensity of neuronal blockade of regional anesthesia compared to perineural single adjunct. This is consistent with clinical studies (trials, observational studies and reports) of a marked prolongation of the local anesthetic effect. Nevertheless, further studies are needed to ascertain the full potential of this technique and all possible associated risks.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Centralized monitored anesthesia care by nurse anesthetist for cataract and glaucoma surgery in a 1:3 ratio: a non-inferiority study.","authors":"Simon Clariot, Jean-Marie Moures, Lucia Lopes, Damien Gatinel, Eric Gabison, Georges Nicolaos, Laurence Salomon, Jean-Michel Devys","doi":"10.23736/S0375-9393.24.18455-6","DOIUrl":"https://doi.org/10.23736/S0375-9393.24.18455-6","url":null,"abstract":"<p><strong>Background: </strong>Minor Ophthalmic Procedures (MOP), especially cataract or glaucoma surgery, are considered low risk. However, in France, anesthesia must be monitored continuously and carried out by an anesthetist or a nurse anesthetist (NA). The aim was to assess whether an externalized monitored anesthesia care (MAC) would be non-inferior to an individual MAC inside the OR regarding the incidence of severe hypertension, bradycardia, hypoxemia, and surgeon satisfaction.</p><p><strong>Methods: </strong>We performed a monocentric randomized, non-inferiority trial. Adults undergoing MOP with topical or locoregional anesthesia were randomly assigned to externalized MAC (the NA monitored simultaneously up to 3 patients with a screen monitor repeating the inside monitor) or inside MAC. The primary endpoint was a composite of per-operative complications defined as a blood pressure >200 mmHg, pulse rate <45/min, pulse oximetry <85%, or surgeon satisfaction regarding patient security <3/10. Secondary endpoints included patient and surgeons' overall satisfaction, re-operation within 24 hours, and nurses' overall satisfaction.</p><p><strong>Results: </strong>A total of 900 patients were enrolled (450 in both groups). The externalized MAC was non-inferior to inside MAC as event occurred in 29 patients (6.4%) and 26 patients (5.8%), respectively (adjusted difference - 0.7%). Patient agitation assessed by the surgeon was lower with the inside MAC (adjusted mean difference -0.33; 95%CI -0.61 to -0.04).</p><p><strong>Conclusions: </strong>Among patients undergoing MOP with topical or locoregional anesthesia, an externalized MAC strategy with a 1:3 NA-to-patient ratio were non-inferior to an inside monitoring on the incidence of severe hypertension, bradycardia, hypoxemia and surgeon satisfaction regarding patient safety.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights of the December 2024 issue.","authors":"Franco Cavaliere","doi":"10.23736/S0375-9393.24.18777-9","DOIUrl":"10.23736/S0375-9393.24.18777-9","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":"90 12","pages":"1063-1064"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided bilateral erector spinae plane block in the management of postoperative analgesia in living liver donors: a randomized, prospective study.","authors":"Tumay Uludag Yanaral, Hande Gungor, Ayşe Ince, Erkan C Celik, Onur Yaprak, Yunus O Atalay, Bahadir Ciftci, Pelin Karaaslan","doi":"10.23736/S0375-9393.24.18085-6","DOIUrl":"10.23736/S0375-9393.24.18085-6","url":null,"abstract":"<p><strong>Background: </strong>Living donor hepatectomy is a procedure associated with notable postoperative pain, impacting patient recovery and satisfaction. Addressing this challenge, we aimed to examine the effect of ultrasound-guided bilateral erector spinae plane block (ESPB) in postoperative analgesia management of patients undergoing living donor hepatectomy for liver transplantation.</p><p><strong>Methods: </strong>A single-center prospective, randomized, controlled study was conducted on ASA I-II patients aged 18-65 who underwent elective living donor hepatectomy. Participants were randomized into ESPB (N.=20) and control (N.=21) groups. ESPB was performed under ultrasound guidance with 0.25% bupivacaine (20 mL bilaterally) at T7-T9 levels. The control group received no block. Postoperative analgesia included IV acetaminophen, opioids, alongside fentanyl patient-controlled analgesia. Pain intensity was assessed using Numeric Rating Scale (NRS) at various time intervals. Primary outcome was to compare postoperative opioid consumption levels and secondary outcomes were to evaluate postoperative pain scores, requirement of rescue analgesia, and opioid-related side effects.</p><p><strong>Results: </strong>Patients in ESBP group exhibited lower total fentanyl consumption (P=0.023) and lower meperidine use for rescue analgesia (P=0.001) compared to controls. While static pain scores showed no significant difference, Group ESPB reported lower dynamic pain scores in the immediate postoperative period (P=0.047). The incidence of nausea was lower in Group ESPB (6 vs. 17, P=0.002) with no observed complications.</p><p><strong>Conclusions: </strong>ESPB displayed promise in effectively managing post-living donor hepatectomy pain, resulting in decreased opioid consumption, improved pain relief, and reduced rescue analgesia requirements. This technique holds potential to enhance recovery and patient satisfaction following donor hepatectomy.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"1082-1089"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ropivacaine and magnesium sulfate in sciatic nerve block at the popliteal level: randomized double-blind study.","authors":"Riccardo Pulitanò, Marco Giudice, Francesca La Verde, Enrico Di Sabatino, Massimiliano Carassiti, Giuseppe Pascarella","doi":"10.23736/S0375-9393.24.18126-6","DOIUrl":"10.23736/S0375-9393.24.18126-6","url":null,"abstract":"<p><strong>Background: </strong>Following surgical procedures, over 80% of patients experience acute pain, with half of them expressing dissatisfaction with pain relief. The modern approach to surgical treatment and pain management increasingly relies on implementing multimodal analgesia, which includes the use of adjuvants in addition to long-acting local anesthetics (such as ropivacaine). This double-blind randomized study evaluated the analgesic effect of magnesium sulfate added to ropivacaine in the sciatic nerve block at the popliteal level for bunion correction surgery.</p><p><strong>Methods: </strong>In this double-blind study, fifty patients were enrolled and randomized in a 1:1 ratio to receive ropivacaine and MgSO<inf>4</inf> 200 mg or ropivacaine and physiological solution. The primary endpoint was the duration of sensory block.</p><p><strong>Results: </strong>A statistically significant difference was observed in the onset time for sensory block (9.2 minutes vs. 21.8 minutes, P<0.001) and its duration (18.2 hours vs. 13.9 hours, P<0.001) between the two groups. Between 12 and 24 hours postoperatively, the maximum NRS pain scores in the magnesium group were lower than those in the control group (IQR [range]) 2 (2-3.8 [0-6.5]) vs. 6.7 (5.6-7.9 [2.7-9.2], P<0.001). The need for additional opioids after 12-24 hours was significantly higher in patients in the physiological solution group compared to those in the magnesium group.</p><p><strong>Conclusions: </strong>Our results suggest that magnesium added to the local anesthetic extends sensory block duration, reduces postoperative pain, improves the quality of analgesia, decreases the need for additional opioids. Further studies are needed to confirm these preliminary findings.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"1090-1097"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-shot sacral erector spinae block: a cadaveric study of dye spreading.","authors":"Yunus O Atalay, Bahar Tekin, Gamze Ansen, Emine Uzunoglu, Elif K Koc, Bayram U Sakul, Haci A Alici","doi":"10.23736/S0375-9393.24.18383-6","DOIUrl":"10.23736/S0375-9393.24.18383-6","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"1163-1164"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}