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Background: Successful brachial plexus blockade produces sympathetic blockade, resulting in increased skin temperature in the blocked segments. This study aimed to evaluate the accuracy of infrared thermography in predicting failed segmental supraclavicular brachial plexus block. Methods: This prospective observational study included adult patients undergoing upper-limb surgery under supraclavicular brachial plexus block. Sensation was evaluated at the dermatomal distribution of the ulnar, median, and radial nerves. Block failure was defined as absence of complete sensory loss 30 min after block completion. Skin temperature was evaluated by infrared thermography at the dermatomal supply of the ulnar, median, and radial nerves at baseline, 5, 10, 15, and 20 min after block completion. The temperature change from the baseline measurement was calculated for each time point. Outcomes were the ability of temperature change at each site to predict failed block of the corresponding nerve using area under receiver-operating characteristic curve (AUC) analysis. Results: Eighty patients were available for the final analysis. The AUC (95% confidence interval [CI]) for the ability of temperature change at 5 min to predict failed ulnar, median, and radial nerve block was 0.79 (0.68-0.87), 0.77 (0.67-0.86), and 0.79 (0.69-0.88). The AUC (95% CI) increased progressively and reached its maximum values at 15 min (ulnar nerve 0.98 [0.92-1.00], median nerve 0.97 [0.90-0.99], radial nerve 0.96 [0.89-0.99]) with negative predictive value of 100%. Conclusion: Infrared thermography of different skin segments provides an accurate tool for predicting failed supraclavicular brachial plexus block. Increased skin temperature at each segment can exclude block failure in the corresponding nerve with 100% accuracy.
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Background and Aims: Infants exposed to major surgery are at risk of injuries to the immature brain because of reduced arterial oxygen saturation. This study compared the effect of volume-controlled ventilation (VCV) versus pressure-controlled ventilation (PCV) on cerebral oxygenation in neonates subjected to repair of tracheoesophageal fistula (TEF) under video-assisted thoracoscopic surgery (VATS). Methods: This randomised controlled study included 30 full-term neonates scheduled for VATS for managing TEF under general anaesthesia. They were randomised to either VC group (n = 15), who received VCV, or PC group (n = 15), who received PCV. Cerebral oxygenation (rScO2) was monitored throughout the surgery with documentation of episodes of cerebral desaturation. Peripheral oxygen saturation, partial pressure of carbon dioxide (PaCO2), and end-tidal carbon dioxide were recorded at baseline, after induction of anaesthesia, and every 30 min till the end of the surgery. Results: rScO2 was significantly higher in the PC group than the VC group at baseline and was significantly higher in the VC group after 15 min (P = 0.041). Later, it was comparable in both the groups up to 60 min after starting the surgery. Cerebral desaturation was significantly more common in the PC group (80%) compared to VC group (33.3%) (P = 0.010). PC group required higher fraction of inspired oxygen and positive end-expiratory pressure to prevent cerebral desaturation. PaCO2 was significantly higher in the PC group than the VC group at 30 and 60 min (P = 0.005 and 0.029). Conclusion: VCV is safer than PCV for cerebral oxygenation during VATS in neonates.
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Purpose: The study aimed to evaluate the analgesic efficiency of dexmedetomidine (DEX) when added to levobupivacaine in continuous ultrasound-guided serratus anterior plane block (SAPB) performed at the end of major thoracic surgery. Methods: This randomized, double-blind trial included 50 adults undergoing thoracic surgery. Continuous SAPB was performed at the end of surgery. Patients were randomized into two groups. Group L (n=25) received levobupivacaine only while Group DL (n=25) received a mixture of levobupivacaine and DEX. All patients received intravenous (IV) paracetamol every 8 hrs. Morphine IV was given according to VAS score of pain as a 5 mg loading dose. The primary outcome measure was postoperative pain intensity. Secondary outcome measures were postoperative morphine consumption and adverse effects. Results: Analgesia was satisfactory in the two groups up to 24 hrs. VAS score was significantly lower in group DL compared to group L between 6 and 24 hrs postoperatively. Total morphine consumption was significantly lower in group DL compared to group L (p<0.001). Up to 12 hrs postoperatively, sedation score was significantly lower in group DL compared to group L. Afterwards, all patients were fully alert. All values of mean arterial pressure and heart rate were within the clinically accepted ranges. There were no recorded cases of hypotension or bradycardia in the whole studied group. Conclusions: Continuous SAPB with levobupivacaine plus DEX seems to be a promising analgesic alternative following thoracotomy. Combined with IV paracetamol, this approach provided adequate analgesia and proper sedation. Trial registration: ISRCTN registry; study ID: ISRCTN35517318.
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PURPOSE: The study aimed at the evaluation of the impact of intravenous (IV) dexamethasone on efficacy and duration of analgesia of paravertebral block (PVB) in patients undergoing modified radical mastectomy (MRM). PATIENTS AND METHODS: This randomized, double-blind controlled trial included 50 patients with breast cancer scheduled for unilateral MRM. Ultrasound-guided PVB was performed in out-of-plane technique. The technique was repeated at each segment from C7 to T6. The participants were randomly allocated to one of two groups. Group BD (n=25) received IV 8 mg dexamethasone diluted with 8 mL of normal saline to reach 10 mL solution, while Group B received IV 10 mL normal saline. Top-up local infiltration analgesia into the surgical field was performed by the surgeon if needed using lidocaine 1% intraoperatively. Propofol infusion of 50-100 µg/kg/min was maintained throughout the surgery. The time to administration of the first postoperative analgesic dose, pain intensity as visual analog scale (VAS) score, number of patients who required rescue morphine analgesia, total morphine consumption, postoperative nausea and vomiting (PONV) impact scale, and the overall satisfaction of patients with pain management were measured. RESULTS: Fifty patients were randomized and analyzed. The time to first rescue analgesic dose was significantly longer in Group DB (P<0.001). The VAS scores were significantly lower in Group DB compared to Group B up to 12 hours postoperatively. Morphine consumption was lower in Group DB compared to Group B. PONV Impact Scale score was significantly higher in Group B. CONCLUSION: Systemic dexamethasone increased the efficacy and duration of the single-shot multilevel PVB in breast cancer surgery. TRIAL REGISTRATION: ISRCTN registry, study ID: ISRCTN15920148.
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OBJECTIVE: The aim of this study is to investigate the effect of transdermal fentanyl (TDF) as an adjuvant to paravertebral block (PVB) for pain control after breast cancer surgery. PATIENTS AND METHODS: This randomized, double-blind trial included fifty females with breast cancer scheduled for surgery. They were randomly allocated into one of two equal groups. The TDF group used transdermal fentanyl patches (TFPs) 25 µg/h applied 10 h preoperative then PVB with 20 mL of bupivacaine 0.25% was done before induction of general anesthesia. The PVB group used placebo patches in addition to PVB the same way as TDF group. Postoperative pain was assessed with a visual analog scale (VAS) score up to 48 h. Intravenous morphine 0.1 mg/kg was given when the VAS is ≥ 3 or on patient request. The primary outcome measures were the time to first request for analgesia and the total analgesic consumption in the first 48 h. RESULTS: Relative to the VAS score reading was 30 min. After the end of surgery, VAS score decreased significantly in the two groups up to 48 postoperative hours and was significantly lower in TDF group up to 24 h. The time to first request of additional analgesia was significantly longer, and total dose of morphine consumption was significantly lower in TDF group (P < 0.001, and P = 0.039, respectively). CONCLUSION: TFPs releasing 25 µg/h is a safe and effective adjuvant to PVB after breast cancer surgery. It provides adequate analgesia with reduction of opioid consumption and minimal adverse effects.
