ABSTRACT
Ascites is a rare sign of aortic valve disease. Here, we report two cases of refractory ascites that had resulted from aortic stenosis and insufficiency and consequently improved after aortic valve replacement. The first case was a 44-year-old female who had undergone aortic valve repair for aortic stenosis 15 years earlier. She complained of dyspnea and severe abdominal distension due to unimproved massive ascites despite medical therapy. She was diagnosed with aortic stenosis and insufficiency and functional tricuspid insufficiency as well as complete atrioventricular block. She underwent mechanical aortic valve replacement, tricuspid annuloplasty and DDD pacemaker implantation. The second case was a 61-year-old man with a history of alcoholic liver disease who had been hospitalized for massive ascites, progressing rapidly in spite of aggressive medical therapy. Echocardiography revealed severe aortic stenosis and insufficiency; thus, he underwent bioprosthetic aortic valve replacement. Both patients were completely free from ascites about 6 months after surgery.
Subject(s)
Analgesia/methods , Gastrectomy/adverse effects , Nerve Block/methods , Pain, Postoperative/prevention & control , Aged, 80 and over , Anesthesia, General , Anesthetics, Local/administration & dosage , Female , Humans , Intercostal Nerves/drug effects , Male , Pain, Postoperative/etiology , Stomach Neoplasms/surgery , Treatment OutcomeSubject(s)
Arthroplasty, Replacement, Hip/adverse effects , Femoral Nerve/drug effects , Fracture Fixation, Internal/adverse effects , Nerve Block/methods , Pain/prevention & control , Aged , Female , Femoral Neck Fractures/surgery , Femoral Nerve/diagnostic imaging , Humans , Levobupivacaine/administration & dosage , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/innervation , Pain/etiology , Skin/innervation , Thigh/innervation , Treatment Outcome , Ultrasonography, InterventionalSubject(s)
Drug Hypersensitivity/etiology , Intracranial Aneurysm/surgery , Nerve Block/methods , Neurosurgical Procedures/adverse effects , Pain, Postoperative/prevention & control , Adult , Analgesics, Opioid/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Female , Humans , Neurosurgical Procedures/instrumentation , Pain, Postoperative/etiology , Scalp/diagnostic imaging , Scalp/innervation , Spinal Nerves/diagnostic imaging , Spinal Nerves/drug effects , Treatment Outcome , Ultrasonography, InterventionalABSTRACT
STUDY DESIGN: A retrospective study. PURPOSE: The first research on the erector spinae plane (ESP) block was published in 2016. To our knowledge, no cohort studies or randomized controlled trials of the ESP block were performed in 2016 and 2017. OVERVIEW OF LITERATURE: This study retrospectively investigated the efficacy of the ESP block in pain management after lumbar spinal surgery. METHODS: Patients who underwent lumbar spinal surgery in 2017 were enrolled in the study. Those who underwent secondary surgery with local anesthesia other than the ESP block were excluded. The primary outcome was the Numerical Rating Scale (NRS) pain score at various time points until the morning of postoperative day 2. The secondary outcomes were the amount of intravenous fentanyl administered during the first 24 hours following the surgery and the number of patients with complaints of complications such as nausea and vomiting until the morning of postoperative day 2. RESULTS: The data of 41 patients undergoing lumbar spinal surgery were retrospectively analyzed. Of these, 23 received only general anesthesia (G group), whereas the other 18 patients received the ESP block in addition to general anesthesia (E group). The NRS pain scores and the amount of fentanyl administered were lower in the G group than in the E group at all measured time points (all data were less than p<0.05). There was no significant difference in the incidence of complications between the two groups (p=0.11). CONCLUSIONS: The ESP block provides effective postoperative analgesic effect for 24 hours in patients undergoing lumbar spinal surgery.
Subject(s)
Humans , Anesthesia, General , Anesthesia, Local , Cohort Studies , Fentanyl , Incidence , Nausea , Pain Management , Retrospective Studies , Spinal Nerves , VomitingSubject(s)
Endarterectomy, Carotid/adverse effects , Nerve Block/methods , Pain Management/methods , Pain, Postoperative/therapy , Aged , Anesthetics, Local/administration & dosage , Humans , Male , Pain, Postoperative/etiology , Paraspinal Muscles/innervation , Perioperative Care/methods , Treatment OutcomeSubject(s)
Nerve Block/methods , Pain Management/methods , Pain, Postoperative/therapy , Transcatheter Aortic Valve Replacement/adverse effects , Aged, 80 and over , Anesthesia, General , Anesthetics, Local/administration & dosage , Female , Humans , Pain, Postoperative/etiology , Paraspinal Muscles/diagnostic imaging , Paraspinal Muscles/innervation , Perioperative Period , Treatment Outcome , Ultrasonography, InterventionalSubject(s)
Abdominal Muscles/innervation , Lower Extremity , Muscle Weakness/epidemiology , Nerve Block/adverse effects , Postoperative Complications/epidemiology , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Humans , Incidence , Japan/epidemiology , Levobupivacaine/administration & dosage , Levobupivacaine/adverse effects , Muscle Weakness/etiology , Postoperative Complications/etiology , Retrospective StudiesSubject(s)
Anesthetics, Local/administration & dosage , Nerve Block/methods , Pain Management/methods , Pain, Postoperative/prevention & control , Surgical Procedures, Operative/adverse effects , Abdominal Cavity/surgery , Abdominal Muscles/innervation , Anesthesia, General , Bupivacaine/administration & dosage , Bupivacaine/analogs & derivatives , Female , Humans , Levobupivacaine , Male , Middle Aged , Pain, Postoperative/etiology , Perioperative PeriodSubject(s)
Anesthetics, Local/administration & dosage , Nerve Block/methods , Nociception/drug effects , Surgical Procedures, Operative/adverse effects , Abdominal Muscles/innervation , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Needles , Nerve Block/instrumentation , Pain/etiology , Pain/prevention & control , Pain Management/methods , Pain Measurement , Perioperative Care/methods , Ultrasonography, Interventional/methodsSubject(s)
Intervertebral Disc Displacement/surgery , Laminectomy/adverse effects , Laminoplasty/adverse effects , Nerve Block/methods , Pain Management/methods , Pain, Postoperative/drug therapy , Abdominal Muscles/innervation , Aged , Anesthesia, General , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Bupivacaine/analogs & derivatives , Humans , Levobupivacaine , Lumbar Vertebrae , Lumbosacral Plexus/drug effects , Male , Middle Aged , Perioperative Period , Ultrasonography, InterventionalSubject(s)
Anesthetics, Local/administration & dosage , Fear/psychology , Intercostal Nerves/drug effects , Orthopedic Procedures/adverse effects , Pain Management/methods , Pain/etiology , Abdominal Muscles/diagnostic imaging , Abdominal Muscles/innervation , Anesthesia, Epidural/psychology , Anesthesia, General/methods , Bupivacaine/administration & dosage , Bupivacaine/analogs & derivatives , Child , Female , Funnel Chest/surgery , Humans , Intercostal Muscles/diagnostic imaging , Intercostal Muscles/innervation , Levobupivacaine , Pain/psychology , Perioperative Period , Ultrasonography, InterventionalSubject(s)
Anesthetics, Local/administration & dosage , Cervical Plexus Block/methods , Laminoplasty/adverse effects , Pain, Postoperative/prevention & control , Aged , Aged, 80 and over , Anesthesia, General/methods , Anesthesia, Intravenous/methods , Anesthetics, Intravenous/administration & dosage , Bupivacaine/analogs & derivatives , Cervical Plexus/diagnostic imaging , Cervical Plexus/drug effects , Cervical Vertebrae , Female , Humans , Levobupivacaine , Male , Perioperative Period , Supine Position , Ultrasonography, InterventionalABSTRACT
STUDY DESIGN: This paper was a single center-based retrospective study with prospective data collection. PURPOSE: Compared with other surgeries, limited options are available for perioperative pain management in spinal surgery. Therefore, we aimed to identify new pain management in this study. OVERVIEW OF LITERATURE: The thoracolumbar interfascial plane (TLIP) block has been reported to provide effective regional analgesia in the lumbar region. This study investigated the efficacy of the TLIP block for pain management in lumbar laminoplasty. METHODS: We investigated patients who underwent lumbar laminoplasty for the treatment of lumbar spinal canal stenosis from April to October 2015. Patients with secondary surgery or surgery involving more than four intervertebral spaces were excluded. The primary outcome measure was the pain scale score within 48 hours after the surgery. The secondary outcomes were the number of additional analgesic drugs used and the number of patients complaining of complications, such as nausea and vomiting, within 24 hours after the surgery. RESULTS: We retrospectively assessed the data of 44 patients who underwent lumbar laminoplasty. Of these, 25 patients received only general anesthesia (G group), whereas 19 patients received the TLIP block along with general anesthesia (T group). Compared with the G group, the T group reported lower pain scores for pain at 1, 2, 4, and 24 hours postoperatively. Moreover, the number of patients who received the additional analgesic pentazocine was lower in the T group than in the G group. The two groups showed no significant differences in the incidence of complications. CONCLUSIONS: The TLIP block provides effective analgesia for 24 hours postoperatively in patients undergoing lumbar laminoplasty.