Regional Anesthesia & Pain Medicine最新文献

{"title":"Comparison of postoperative analgesic effects of posterior quadratus lumborum block and intrathecal morphine in laparoscopic donor hepatectomy: in reply","authors":"R. Kang, Seungwon Lee, J. Ko","doi":"10.1136/rapm-2022-104036","DOIUrl":"https://doi.org/10.1136/rapm-2022-104036","url":null,"abstract":"We thank Cai et al for their comments on our study. We performed our study to evaluate the analgesic efficacy of quadratus lumborum block (QLB) or intrathecal morphine (ITM) as part of a multimodal analgesic regimen. In our institution, postoperative pain management in the surgical ward is usually conducted by the surgical team, and we agree that postoperative pain management needs to be refined, and thus, we regularly discuss with the surgical team to improve patient recovery. Most patients in both groups had moderate to high abdominal pain or discomfort at the time of postoperative care unit (PACU) admission, as shown in figure 3 of our study, which was also consistent with our previous studies. The high pain level may reflect significant visceral pain combined with somatic pain. In addition, some patients in both groups had moderate pain at 24 hours and 48 hours after surgery because the analgesic duration might have worn off at 12 hours after QLB and at 36 hours after ITM, respectively. Second, we agree that the predetermined noninferiority margin of 1 might be small, which was already mentioned in the limitation. In our study, the predetermined noninferiority margin was set based on our previous study and review article for noninferiority analysis. Since the mean resting pain score at 24 hours is relatively low in the ITM group, we hypothesised that the noninferiority margin should also have to be low to compare QLB as an alternative to ITM. However, we disagree that the median minimal clinically significant differences for pain scores should be 1.5 at rest, since this value is usually applicable for total hip or knee arthroplasty, and not for liver surgery, especially in living donors. This should be elucidated in future studies. I appreciate your interest in our research.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"20 1","pages":"781 - 782"},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85099534","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":"Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia","authors":"T. Ashken, J. Bowness, A. Macfarlane, L. Turbitt, B. Bellew, N. Bedforth, D. Burckett-St Laurent, A. Delbos, K. El-Boghdadly, N. Elkassabany, Jenny Ferry, B. Fox, J. French, C. Grant, Ashwani Gupta, R. Gupta, Y. Gürkan, N. Haslam, H. Higham, Rosemary Hogg, D. Johnston, R. Kearns, C. Lobo, S. McKinlay, E. Mariano, S. Memtsoudis, P. Merjavy, M. Narayanan, J. A. Noble, David Phillips, M. Rosenblatt, A. Sadler, M. Sebastian, E. Schwenk, Alasdair Taylor, A. Thottungal, L. Valdés-Vilches, T. Volk, S. West, M. Wolmarans, J. Womack, A. Pawa","doi":"10.1136/rapm-2022-103738","DOIUrl":"https://doi.org/10.1136/rapm-2022-103738","url":null,"abstract":"Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for “block view” (which visualizes the block site and is maintained for needle insertion/injection). A “strong recommendation” was made if ≥75% of participants rated any structure as “definitely include” in any round. A “weak recommendation” was made if >50% of participants rated it as “definitely include” or “probably include” for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a “strong recommendation” was made for 60 structures on orientation scanning and 44 on the block view. A “weak recommendation” was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"71 1","pages":"762 - 772"},"PeriodicalIF":0.0,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84166214","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":"Comparison of sitting and prone positions for real-time ultrasound-guided thoracic epidural catheter placement: a randomized controlled trial","authors":"S. Shin, Jong-Hyuk Lee, Hyun-Jung Kwon, In-Gyu Lee, Dongseok Kim, Hakmoo Cho, Doo-Hwan Kim, S. Jeong","doi":"10.1136/rapm-2022-103786","DOIUrl":"https://doi.org/10.1136/rapm-2022-103786","url":null,"abstract":"Introduction Real-time ultrasound-guided thoracic epidural catheter placement (US-TECP) has been recently introduced. Patient’s position is associated with the success of spine interventions; however, the effects of position on the outcome of the procedure remain unknown. We aimed to assess the clinical usefulness of patient positioning during real-time US-TECP. Methods Patients were randomly assigned to the prone position group (group P) and sitting position group (group S). The primary outcome was needling time during the procedure. The secondary outcomes were time to mark space, total number of needle passes, number of skin punctures, first-pass success, final success, crossover success, and visibility of ultrasound (US) views. Global Rating Scale (GRS) score, Patient Comfort Scale score, procedural pain intensity, patient satisfaction, and procedure-related complications were also determined. Results Sixty-four patients were included in this study. The needling time was significantly shorter in group P than in group S (36.5 (26.5–51.0) vs 59.5 (34.5–152.0) s, p<0.01). The numbers of needle passes and skin punctures were significantly lesser in group P than in group S. First-pass success was higher in group P than in group S. Group P had higher GRS compared with group S. The time to mark space, final success, US visibility score, Patient Comfort Scale score, procedural pain intensity, and patient satisfaction did not differ between the groups. One patient in group S developed a vasovagal reaction. Discussion This study shows that prone position may be preferred for real-time US-TECP, considering its better clinical usefulness. Trial registration number KCT0005757.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"15 1","pages":"738 - 743"},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80932054","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":"Reply to ‘assessing postoperative benefits of regional blocks: an issue should be noticed’","authors":"M. Carella, F. Beck, N. Piette, J. Lecoq, V. Bonhomme","doi":"10.1136/rapm-2022-104011","DOIUrl":"https://doi.org/10.1136/rapm-2022-104011","url":null,"abstract":"To the editor We are grateful to Xue et al for their interest in our recent clinical trial concerning the suprainguinal fascia iliaca compartment block (SFICB) and its role in the management of postoperative analgesia after posterolateralapproached total hip arthroplasties (PLTHA). 2 In our trial, we wanted to report how this peripheral nerve block (PNB) technique can be useful in reducing postoperative pain by improving functional performance after PLTHA. We thank Xue et al for giving us the opportunity to clarify and emphasise some methodological aspects of our study and we are pleased to respond to their accurate observation. First, in our trial, SFICB was used in the context of multimodal analgesia, including Cox2selective nonsteroidal antiinflammatory drugs (NSAIDs), acetaminophen and dexamethasone. The details of this scheme are given in Appendix 1 of our publication. As recommended by the recent PROcedure SPEcific postoperative pain managemenT (PROSPECT) guidelines, not only does the evidence support the use of these molecules but recommends that trials inherent to postoperative analgesia research include multimodal schemes consistent with current clinical practice, with at least acetaminophen/NSAID/dexamethasone administration. In addition to preoperative NSAID and intraoperative acetaminophen and dexamethasone, all patients included in the trial received 60 mg etoricoxib once daily and acetaminophen 1 g every 6 hours postoperatively, as a complement to the PatientControlled Analgesia device. We acknowledge that his may have not appeared clearly enough in the Methods section of our manuscript. We believe that further studies on postoperative analgesia and the impact of different PNB techniques on functional recovery after PLTHA are needed. In line with the comment of Xue et al, we do agree that further research should obviously include the new PNBs only in the context of a basic multimodal analgesia regimen consistent with the evidence reported in the most recent guidelines. 4 Michele Carella , Florian Beck , Nicolas Piette, JeanPierre Lecoq, Vincent L Bonhomme 1,3 Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium Inflammation and Enhanced Rehabilitation Laboratory (Regional Anesthesia and Analgesia), GIGAI3 Thematic Unit, GIGAResearch, Liege University, Liege, Belgium Anesthesia and Perioperative Neuroscience Laboratory, GIGAConsciousness Thematic Unit, GIGAResearch, Liege University, Liege, Belgium","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"37 1","pages":"780 - 781"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82996008","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":"Assessing postoperative benefits of regional blocks: an issue that should be noticed","authors":"F. Xue, N. He, Yi Cheng","doi":"10.1136/rapm-2022-103959","DOIUrl":"https://doi.org/10.1136/rapm-2022-103959","url":null,"abstract":"To the editor In a singleblind randomized controlled trial including 86 patients who underwent posterolateral approach total hip arthroplasty, Carella et al assessed the effects of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery and showed that the suprainguinal fascia iliaca compartment block provided opioid sparing, improved postoperative pain control and enhanced functional recovery. Other than the limitations described by authors in the discussion, however, this study used a singlemode postoperative analgesia strategy in the control patients, that is, patientcontrolled analgesia with morphine. In fact, current enhanced recovery after surgery (ERAS) protocols of total hip arthroplasty recommend the multimodal strategies of postoperative analgesia, in which other than nerve or fascial plane blocks, a package of basic analgesics, such as paracetamol, nonsteroidal antiinflammatory drugs (NSAIDs) or cyclooxygenase2 specific inhibitors, and dexamethasone, is also included. 3 Thus, we believe that different results about postoperative analgesic efficacy of the suprainguinal fascia iliaca compartment block would have been obtained, if a package of basic analgesics had been included in the postoperative analgesia strategy of control patients in this study.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"9 1","pages":"780 - 780"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81804186","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":"American Society of Regional Anesthesia and Pain Medicine contrast shortage position statement.","authors":"Lynn Kohan, Zachary Pellis, David Anthony Provenzano, Amy C S Pearson, Samer Narouze, Honorio T Benzon","doi":"10.1136/rapm-2022-103830","DOIUrl":"10.1136/rapm-2022-103830","url":null,"abstract":"<p><p>The medical field has been experiencing numerous drug shortages in recent years. The most recent shortage to impact the field of interventional pain medicine is that of iodinated contrast medium. Pain physicians must adapt to these changes while maintaining quality of care. This position statement offers guidance on adapting to the shortage.</p>","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"20 1","pages":"511-518"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74769251","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":"PECS II block: clarifications sought on nomenclature.","authors":"Raghuraman M Sethuraman, Vidhya Narayanan","doi":"10.1136/rapm-2022-103623","DOIUrl":"10.1136/rapm-2022-103623","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"103 1","pages":"450"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80324373","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":"Comparison of postoperative analgesic effects of posterior quadratus lumborum block and intrathecal morphine in laparoscopic donor hepatectomy: a prospective randomized non-inferiority clinical trial","authors":"Seungwon Lee, R. Kang, G. Kim, M. Gwak, G. Choi, J. M. Kim, J. Ko","doi":"10.1136/rapm-2022-103577","DOIUrl":"https://doi.org/10.1136/rapm-2022-103577","url":null,"abstract":"Background Posterior quadratus lumborum block (QLB) and intrathecal morphine are accepted analgesic strategies in laparoscopic liver resection, but their effects have not been compared after laparoscopic donor hepatectomy. This study was planned to perform this comparison. Methods Fifty-six donors were randomized to receive bilateral posterior (QLB2, 20 mL of 0.375% ropivacaine on each side, 150 mg total) or preoperative injection of 0.4 mg morphine sulfate intrathecally. Primary outcome was resting pain score at 24 hour postsurgery. Secondary outcomes included cumulative opioid consumption and recovery parameters. Serial plasma ropivacaine concentrations were measured in QLB group. Only the outcome assessor was properly blinded. Results Mean resting pain score at 24-hour postsurgery was 4.19±1.66 in QLB group (n=27) and 3.07±1.41 in intrathecal morphine group (n=27, p=0.04). Mean difference (QLB group-intrathecal morphine group) was 1.11 (95% CI 0.27 to 1.95), and the upper limit of CI was higher than prespecified non-inferiority margin (δ=1), indicating an inferior effect of QLB. Cumulative opioid consumption was significantly higher in QLB group at 24 hours and 48 hours postsurgery. QLB group exhibited lower incidence of postoperative pruritus at all time points, and there were no differences in other recovery outcomes. All measured ropivacaine concentrations were below the threshold for systemic toxicity (4.3 µg/mL). Conclusions Bilateral posterior QLB elicited higher resting pain scores at 24-hour after laparoscopic donor hepatectomy than intrathecal morphine and did not meet the definition of non-inferiority. Trial registration number KCT0005360.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"2011 1","pages":"527 - 533"},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87709551","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":"Cryoanalgesia for shoulder pain: a motor-sparing approach to rotator cuff disease","authors":"A. Stogicza, P. Peng","doi":"10.1136/rapm-2022-103670","DOIUrl":"https://doi.org/10.1136/rapm-2022-103670","url":null,"abstract":"Introduction Rotator cuff disease is a common cause of musculoskeletal pain and disability, and the management can be challenging. Joint denervation emerges as a new technique, but the literature on shoulder neural ablation procedure is largely limited to pulsed radiofrequency due to the concern of motor impairment. We described a novel motor-sparing approach of cryoablation for the management of shoulder pain based on the recent literature on the innervation of shoulder. Methods Four patients with a history of rotator cuff disease refractory to conservative therapy and not amenable to surgery underwent a ultrasound-guided cryoablation of the capsular branches of the shoulder joint after a positive diagnostic injection. The target articular branches were based on the anatomical landmarks described in recent publication. They were the acromial, superior and inferior branches of the suprascapular nerve, the anterior branch of the axillary nerve, the nerve to the subscapularis, which were all located around the superior, posterior and anterior glenoid. The lateral pectoral nerve articular branch was targeted at the coracoclavicular space. Results All four patients experienced at least 60% pain relief with improvement in function for 6–12 months following the procedure without any clinical evidence of motor impairment. No adverse effect was observed. Discussion Based on the current understanding of the glenohumeral joint articular branches and their relationship to the bony landmark, targeting the articular branches only was feasible and led to good outcomes. Further large prospective cohort study is needed.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"100 1","pages":"576 - 580"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76226088","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":"Role of social networks in regional anesthesia research: a case study of the erector spinae plane block.","authors":"Alessandro De Cassai, Margherita Iuzzolino, Federico Geraldini, Edward R Mariano","doi":"10.1136/rapm-2022-103808","DOIUrl":"10.1136/rapm-2022-103808","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79621027","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}