ABSTRACT
Abstract Background: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. Methods: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. Results: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0%; 13.8 ± 1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards Visual Analog Scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, Visual Analog Scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). Conclusion: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.
Resumo Introdução: A neurólise do plexo celíaco guiada por tomografia computadorizada tornou-se uma técnica quase segura para aliviar a dor abdominal maligna. Comparamos a técnica de agulha única mudando o posicionamento do paciente e a técnica de agulha dupla usando a abordagem anterocrural posterior. Métodos: No grupo designado para neurólise celíaca com agulha dupla (n = 17), a técnica de abordagem anterocrural posterior foi utilizada com duas agulhas para injetar 12,5 mL de fenol a 10% de cada lado em decúbito ventral. No grupo designado para neurólise celíaca com agulha única (n = 17), a abordagem anterocrural posterior foi utilizada com uma única agulha para injetar 25 mL de fenol a 10% do lado esquerdo com o paciente em decúbito lateral esquerdo e posteriormente virado para o lado direito. Os parâmetros de monitorização foram a taxa de falha dos bloqueios e a duração do posicionamento dos pacientes, o tempo da técnica, os escores da escala visual analógica, as complicações (hipotensão, diarreia, vômitos, hemorragia, dano neurológico e infecção) e a analgesia de resgate. Resultados: A taxa de falha dos bloqueios e a duração do posicionamento dos pacientes aumentaram significativamente na neurólise celíaca com o uso de agulha dupla vs. agulha única (30,8% vs. 0%,13,8 ± 1,2 vs. 8,9 ± 1; p = 0,046, p ≤ 0,001, respectivamente). Além disso, o tempo da técnica foi significativamente maior na neurólise celíaca com agulha dupla que na neurólise celíaca com agulha única (24,5 ± 5,1 vs. 15,4 ± 1,8; p ≤ 0,001). Não houve diferença significativa em relação aos escores da escala visual analógica: neurólise celíaca com agulha dupla = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) e neurolise celíaca com agulha única = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) após um dia,uma semana, um e três meses, respectivamente. No entanto, os escores da escala visual analógica para cada grupo foram significativamente menores comparados aos valores basais (p ≤ 0,001). Não houve diferença estatisticamente significativa quanto à analgesia de resgate e complicações (p > 0,05). Conclusão: A neurólise celíaca com o uso de agulha única e a alteração do posicionamento do paciente apresenta uma taxa menor de falha do bloqueio, menos tempo de procedimento e menor duração do posicionamento do paciente que o uso de duas agulhas para neurólise celíaca em malignidade abdominal.
Subject(s)
Humans , Male , Female , Aged , Abdominal Pain/therapy , Cancer Pain/therapy , Abdominal Neoplasms/complications , Nerve Block/methods , Tomography, X-Ray Computed , Abdominal Pain/etiology , Celiac Plexus/diagnostic imaging , Prospective Studies , Phenol/administration & dosage , Middle Aged , NeedlesABSTRACT
BACKGROUND: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. METHODS: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. RESULTS: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0.13.8±1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards visual analogue scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, visual analogue scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). CONCLUSION: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.
Subject(s)
Abdominal Neoplasms/complications , Abdominal Pain/therapy , Cancer Pain/therapy , Nerve Block/methods , Abdominal Pain/etiology , Aged , Celiac Plexus/diagnostic imaging , Female , Humans , Male , Middle Aged , Needles , Phenol/administration & dosage , Prospective Studies , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The thyroid gland surgery is a common and painful procedure demanding analgesia. Many regional techniques are applied for anterior neck surgeries mostly assigned in relation to the involved cervical fascia. Dexmedetomidine (Precedex) is a selective alpha 2 adrenoceptor agonist which prolongs the sensory blockade duration of local anesthetics. Our study hypothesis is that ultrasound (US)-guided bilateral superficial cervical plexus block (BSCPB) may provide longer analgesia when adding dexmedetomidine to bupivacaine-epinephrine. PURPOSE: The aim of this study is to evaluate the analgesic efficacy and possible side effects of US-guided BSCPB and the effect of dexmedetomidine addition to bupivacaine-epinephrine in patients undergoing thyroid surgery. METHODS: This prospective, double-blind, randomized study was performed on 42 patients randomized into two equal groups each of 21; bupivacaine Group B and dexmedetomidine Group D. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Total pethidine consumption in 24 h is the primary outcome. The visual analog scale, timing of the first opioid request, and hemodynamics are the secondary outcomes. RESULTS: In Group D, there was a longer time to the first request of opioid postoperatively, a lower total pethidine consumption and pain score postoperatively, and lower fentanyl requirements intraoperatively. CONCLUSIONS: Sonographic-guided bilateral SCPB using a combination of bupivacaine, dexmedetomidine, and epinephrine was superior to bupivacaine for prolonged analgesia with less intra- and postoperative opioid consumption and lower side effect profile during thyroid surgery.
ABSTRACT
BACKGROUND: Scalp defects can be reconstructed either with skin graft, local flaps, free flaps, or tissue expansion. Tissue expanders have been proved to be fruitful in the pediatric population. Scalp expansion has proved to be useful in the reconstruction of posttraumatic and postburn alopecic defects. Selective nerve block can be added for attenuation of sympathetic stimulation and decrease surgical stress in cranial surgeries. In this study, a comparison was done between using selective nerve block and without selective nerve block in both stages of tissue expansion procedure. PATIENTS AND METHODS: This study included 32 different children who underwent tissue expansions in the management of postburn alopecia. Pediatric patients presented with postburn alopecia of the scalp with mature scar were included in this work. RESULTS: Postoperative analgesics were less in children who had received scalp block, whereas it was shorter in patients who did not receive any scalp block. Meperidine consumption was much more less in patients who received selective scalp nerve block. Pain score was markedly decreased in children who had received selective scalp nerve block in the immediate postoperative period. Children who received scalp block showed marked attenuation in the surgical stress responses with minimal changes in heart rate and mean arterial blood pressure after skin incision. CONCLUSIONS: Scalp nerve block is considered an excellent choice for postoperative pain control with less need for opioid analgesia.
Subject(s)
Alopecia/surgery , Burns/surgery , Dermatologic Surgical Procedures , Nerve Block/methods , Pain, Postoperative/prevention & control , Scalp/surgery , Tissue Expansion , Alopecia/etiology , Burns/complications , Child , Female , Follow-Up Studies , Humans , Male , Prospective Studies , Scalp/innervation , Treatment OutcomeABSTRACT
BACKGROUND: Thoracic paravertebral block (TPVB) is a high-quality analgesic technique used for many types of surgery, trauma, and chronic pain. AIM: The aim of this study is to assess safety and efficacy of adding dexmedetomidine to levobupivacaine in TPVB for postoperative analgesia after unilateral laparoscopic thoracic sympathectomy. PATIENTS AND METHODS: Sixty adult patients of the American Society of Anesthesiologists physical status classes I and II, aged 20-45 years, of either sex, submitted for unilateral laparoscopic thoracic sympathectomy under general anesthesia at Mansoura University Hospital. Patients were classified into two groups such as levobupivacaine (GL): patients received isobaric 0.5% levobupivacaine 1 mg/kg in 20-ml volume for TPVB and levobupivacaine-dexmedetomidine (GLD): patients received isobaric 0.5% levobupivacaine 1 mg/kg and 10-µg dexmedetomidine in 20 ml volume for TPVB. STATISTICAL ANALYSIS: Data were first tested for normality by Kolmogorov-Smirnov test. Normally distributed continuous data were analyzed using unpaired Student's t-test. Nonnormally distributed continuous and ordinal data were analyzed using Mann-Whitney U-test. Categorical data were analyzed by Chi-square test or Fisher's exact test as appropriate. RESULTS: A faster onset and longer duration of sensory blockade was significantly higher in group GLD with mean ± standard deviation (SD) (8.57 ± 7.22 min and 11.98 ± 1.42 h) than in group GL (15.21 ± 4.35 min and 9.75 ± 3.29 h). Sensory block regression time was significantly longer in group GLD with mean ± SD (10.8 ± 2.31 h) compared to group GL (8.82 ± 1.71 h). Furthermore, a significant reduction in visual analog scale occurred in group GLD compared with the GL group up to 24 h postoperatively (P < 0.05). No significant difference in Ramsay Sedation Scale (RSS) between both groups. The number of patients asked for postoperative analgesia was significantly fewer in group GLD compared with group GL (14 compared to 21)*. The time (hours) of first request for analgesia was significantly longer in group GLD compared with GL group (7.8 ± 3.22 compared to 9.7 ± 2.51*). The total postoperative fentanyl requirements in 24 h (in micrograms) was significantly less in GLD group compared to GL group (320 ± 110 compared to 190 ± 120*). CONCLUSION: The addition of dexmedetomidine as adjuvant to levobupivacaine in TPVB for elective unilateral laparoscopic thoracic sympathectomy can markedly improve the postoperative analgesia with lower pain scores and a marked reduction of the postoperative analgesic requirements and low side effect profile.
ABSTRACT
BACKGROUND: Local anesthetic infiltration for medical thoracoscopy has an analgesic properties for short duration. Single injection thoracic paravertebral block (PVB) provides limited analgesia. PURPOSE: Comparison between thoracic PVB performed at two or three levels with local infiltration for anesthetic adequacy in adult medical thoracoscopy as a primary outcome and postthoracoscopic analgesia and pulmonary function as secondary outcomes for adult medical thoracoscopy. PATIENTS AND METHODS: Prospective randomized control study included 63 adult patients with exudative pleural effusion randomly divided into three groups of 21 patients: 3-level PVB, 2-level PVB group, and local infiltration group. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Pain visual analog scale and spirometry were used for comparison as anesthetic adequacy in adult medical thoracoscopy as a primary outcome besides prolonged analgesia and improved pulmonary function as secondary outcomes. RESULTS: The anesthetic adequacy was 95.3% in 3-level PVB group, 81% in 2-level PVB group, and 71.5% in local infiltration group. The mean sensory level was 1 ± 0.8 and 1 ± 0.6 segment above and 0.8 ± 0.6 and 0.7 ± 0.7 segment below the injected level in 3-level PVB group and 2-level PVB, respectively. VAS was statistically significant higher in local infiltration compared to the other two groups immediately postthoracoscopic and 1 h after. Two-hour postthoracoscopy, significant increase in forced vital capacity values in the three groups compared to their basal values whereas forced expiratory volume at 1 s (FEV1) only in both PVB groups. CONCLUSION: Unilateral 3-level TPVB was superior to 2-level TPVB and LA infiltration for anesthetic adequacy for patients undergoing medical thoracoscopy. Moreover, US-guided TPVB was followed by higher FEV1 values and lower pain scores during the next 12 h postthoracoscopy in comparison to local infiltration, so 3-level TPVB is an effective and relatively safe anesthetic technique for adult patients undergoing medical thoracoscopy which may replace local anesthesia.
