BACKGROUND The dexmedetomidine(DEX)plus ropivacaine treatment enables a transversus abdominis plane block(TAPB)of the peripheral nerves in patients undergoing radical resection for colorectal cancer(CRC)that can provi...BACKGROUND The dexmedetomidine(DEX)plus ropivacaine treatment enables a transversus abdominis plane block(TAPB)of the peripheral nerves in patients undergoing radical resection for colorectal cancer(CRC)that can provide clinical data for improving the postoperative analgesic effect,reducing the risk of cognitive impairment,and decreasing the circulating levels of serum inflammatory factors and stress hormones.AIM To assess the impact of DEX plus ropivacaine-enabled TAPB on pain,postoperative cognitive dysfunction(POCD),and inflammatory/stress factors.METHODS Our patient cohort was randomly divided into control and observation groups(60/group).The observation group used a DEX plus ropivacaine-enabled TAPB,while the control group employed a ropivacaine-enabled TAPB.The pain score[Visual Analogy Scale(VAS),Montreal Cognitive Assessment(MoCA)],serum inflammatory factor level(C-reactive protein,interleukin-6 and tumor necrosis factor-α),serum stress hormone levels(cortisol and adrenaline)and postoperative adverse reactions were compared between the two groups.RESULTS The observation group VAS scores were lower than those of the control group(better analgesic effect,P<0.05).The MoCA and POCD scores decreased post-surgery in the observation group(P<0.05).In the elderly,the overall VAS and MoCA scores were significantly reduced compared with the young group.The C-reactive protein,interleukin-6,tumor necrosis factor-α,cortisol and adrenaline levels were lower in the observation group compared with the control group post-surgery(P<0.05).There was no significant difference in adverse reactions between the two groups post-surgery,but the incidence of adverse reactions in the observation group was still lower.DEX continuously inhibited p65-phosphorylation levels in the nuclear factorκB pathway at multiple time points,and its inhibitory effect became more significant over time.CONCLUSION DEX plus ropivacaine-enabled TAPB reduces POCD and inflammatory/stress hormone levels,and significantly improves the postoperative analgesic effect of patients undergoing radical resection for colorectal cancer.展开更多
BACKGROUND Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times.However,effective management of postoperative pain remains a significant challenge.Se...BACKGROUND Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times.However,effective management of postoperative pain remains a significant challenge.Several traditional methods,including opioid-based analgesia,are commonly used but are associated with side effects such as nausea,vomiting,sedation,and delayed recovery.In recent years,the erector spinae plane block(ESPB)has gained attention as an ultrasoundguided regional anesthesia technique offering promising results in various surgical procedures by reducing opioid requirements and enhancing patient comfort.AIM To evaluate the efficacy and safety of ESPB in comparison to conventional pain management strategies in patients undergoing laparoscopic nephrectomy.METHODS Following PRISMA guidelines,we searched PubMed,EMBASE,Web of Science,and the Cochrane Register for randomized controlled trials(RCTs)comparing ESPB with control for laparoscopic nephrectomy.The Cochrane Risk of Bias tool was employed for quality assessment.The primary outcome was total patient-controlled analgesia(PCA)consumption.Secondary outcomes included hospital discharge time and the incidence of postoperative nausea and vomiting.A random-effects meta-analysis was conducted to calculate pooled mean differences(MD)and odds ratios(OR)with 95%CIs.RESULTS Nine RCTs involving a total of 643 patients(ESPB group=320;control group=323)were included in the analysis.ESPB significantly reduced PCA opioid consumption compared to controls(MD:-14.24,95%CI:-20.66 to-7.83,P<0.0001).Subgroup analysis showed reduced PCA use with ESPB vs morphine(MD:-8.78,95%CI:-15.34 to-2.22,P=0.009),and a non-significant effect compared to other analgesics(MD:-48.26,95%CI:-143.60 to 47.09).No statistically significant differences were observed in discharge time or the incidence of nausea and vomiting.CONCLUSION ESPB demonstrates the potential of reducing PCA in laparoscopic nephrectomy patients;however,its impact on secondary outcomes remains inconclusive.Large-scale RCTs are needed to confirm ESPB's benefits and explore long-term effects.展开更多
Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic parave...Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic paravertebral block(PVB)after thoracoscopic surgery.Methods Ninety-two patients who underwent video-assisted thoracoscopic surgery(VATS)were randomly divided into group S(n=46)and group P(n=46).After anesthesia induction,the same anesthesiologist performed ultrasound-guided ESPB at T5 and T7 levels combined with SAPB at the level of the fifth rib in the midaxillary line in group S and ultrasound-guided PVB at T5 and T7 levels in group P.Patients in both groups were given 40 mL of 0.4%ropivacaine.Eighty-six patients completed the study(group S,n=44;group P,n=42).The morphine consumption,visual analogue scale(VAS)scores at rest and coughing,and frequency of remedial analgesia were recorded at 1,2,4,8,and 24 h postoperatively.Pulmonary function parameters were recorded at 1,4,and 24 h postoperatively,and the quality of recovery(QoR)-15 score at 24 h postoperatively.The adverse effects,duration of chest tube drainage and length of stay were also recorded.Results The morphine consumption at postoperative 4 and 8 h and the incidence of ipsilateral shoulder pain(ISP)were significantly lower in group S than in group P.The QoR-15 questionnaire score at postoperative 24 h was significantly lower in group P than in group S(P<0.05).The morphine consumption was lower at 24 h postoperatively in group S than in group P,with no significant difference found yet.The morphine consumption at other observed times,VAS scores,pulmonary function parameters,frequency of remedial analgesia,duration of chest tube drainage,length of stay,and incidence of other adverse events were comparable between group S and group P.Conclusion Ultrasound-guided ESPB combined with SAPB is non-inferior to PVB in terms of morphine consumption at postoperative 24 h and postoperative recovery.But,this approach can significantly reduce morphine consumption in the early postoperative period(0–8 h)after thoracoscopy with lower incidence of ISP.It is a simpler and safer operation.展开更多
Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-...Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-75 kg)scheduled for elective laparoscopic radical gastrectomy were enrolled in the current study.Sixty patients were randomly assigned to two groups by computer-generated randomization codes:an ultrasound-guided oblique subcostal transversus abdominis plane block(TAPB)group(group T,n=30)or an ultrasound-guided subcostal anterior QLB group(group Q,n=30).In both groups,bilateral ultrasound-guided oblique subcostal TAPB and subcostal anterior QLB were performed before general anesthesia with 0.25% ropivacaine 0.5 mL/kg.For postoperative management,all patients received patient-controlled intravenous analgesia(PCIA)with nalbuphine and sufentanil after surgery,maintaining visual analogue scale(VAS)scores<4 within 48 h.The intraoperative consumption of remifentanil,the requirement for sufentanil as a rescue analgesic,and the VAS scores at rest and coughing were recorded at 1,6,12,24 and 48 h after surgery.The recovery(extubation time after surgery,first ambulation time,first flatus time and length of postoperative hospital stay)and the adverse events(nausea and vomiting,skin pruritus,respiratory depression and nerve-block related complications)were observed and recorded.The primary outcome was the perioperative consumption of opioids.Results:Compared with group T,the intraoperative consumption of remifentanil,requirement for sufentanil and the frequency of PCIA were reduced in group Q.Meanwhile,VAS scores at all points of observation were significantly lower in group Q than in group T.Patients in group Q were also associated with shorter time to first out-of-bed activity and flatus,and shorter length of postoperative hospital stay than group T(P<0.05).There were no skin pruritus,respiratory depression or nerve-block related complications in both groups.Conclusion:Compared with ultrasound-guided oblique subcostal TAPB,ultrasound-guided subcostal anterior QLB provided greater opioid-sparing effect,lower visual analogue scores,and shorter postoperative hospital stay for laparoscopic radical gastrectomy.展开更多
BACKGROUND Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy.AIM To investigate and compare the anesthetic effects of intraven...BACKGROUND Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy.AIM To investigate and compare the anesthetic effects of intravenous general anesthesia combined with epidural anesthesia or ultrasound-guided bilateral transversus abdominal plane block(TAPB)in gastric cancer patients undergoing laparoscopic radical gastrectomy.METHODS The clinical data of 85 patients who underwent laparoscopic radical gastrectomy in our hospital from December 2020 to January 2023 were retrospectively collected and divided into a TAPB group(n=45)and epidural anesthesia group(n=40)according to the different anesthesia and analgesia programs used.The TAPB group received general anesthesia combined with TAPB,and the epidural anesthesia group received general anesthesia combined with epidural anesthesia.The pain status,cognitive status,intestinal barrier indicators,recovery quality,and incidence of complications were compared between the two groups.RESULTS Compared with the epidural anesthesia group,the TAPB group’s visual analog scale scores were significantly lower 6 h,12 h,24 h and 48 h after surgery(P<0.05).The incidence of postoperative cognitive dysfunction(POCD)in the TAPB group was significantly lower than that in the epidural anesthesia group,and the Mini-mental State Examination score 24 h after surgery was significantly higher in the TAPB group than the epidural anesthesia group(P<0.05).The levels of diamine oxidase and plasma D-lactate were significantly lower in the TAPB group than the epidural anesthesia group 24 h after surgery(P<0.05).The agitation score and the incidence of agitation during recovery were significantly lower in the TAPB group than epidural anesthesia group(P<0.05).The total incidence of postoperative complications in the TAPB group was 4.44%,significantly lower than the 20.00%in the epidural anesthesia group(P<0.05).CONCLUSION Compared with epidural anesthesia combined with general anesthesia,TAPB combined with general anesthesia had a good analgesic effect in laparoscopic radical gastrectomy and can further reduce the incidence of POCD and postoperative complications,improve the levels of intestinal barrier indicators,and improve postoperative recovery quality.展开更多
BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effect...BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect.However,the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear.AIM To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients.METHODS A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023.The patients were categorized into a control group(n=51),receiving remimazolam for general anesthesia,and an observation group(n=51),receiving TAPB combined with remimazolam for general anesthesia.A comparison was made between both groups in terms of hemodynamic parameters,stress markers,pain levels,recovery quality,analgesic effects,and adverse reactions during the perioperative period.RESULTS The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group(P<0.05).The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group(P<0.05).Five minutes after extubation,the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group(P<0.05).At 12 h,24 h,and 48 h following surgery,the visual analog scale scores of the observation group were considerably lower than those of the control group(P<0.05).The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group(P<0.05).The observation group exhibited considerably fewer effective pump presses,lower fentanyl dosages,and lower incidences of rescue analgesia within 24 h following surgery than the control group(P<0.05).CONCLUSION The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good,which is helpful to promote faster recovery after operation.展开更多
BACKGROUND Patients undergoing lumbar spine surgery usually suffer severe pain in the postoperative period.The erector spinae plane block(ESPB),first published in 2016,can anesthetize the ventral and dorsal rami of th...BACKGROUND Patients undergoing lumbar spine surgery usually suffer severe pain in the postoperative period.The erector spinae plane block(ESPB),first published in 2016,can anesthetize the ventral and dorsal rami of thoracic nerves and produce an extensive multi-dermatomal sensory block.AIM To assess whether bilateral ultrasound-guided ESPB at a lower thoracic level could improve pain control and quality of recovery in patients undergoing lumbar spine surgery.METHODS A total of 60 patients aged 18-80 years scheduled to undergo lumbar spine surgery with general anesthesia were randomly assigned to two groups:ESPB group(preoperative bilateral ultrasound-guided ESPB at T10 vertebral level)and control group(no preoperative ESPB).Both groups received standard general anesthesia.The main indicator was the duration to the first patient controlled intravenous analgesia(PCIA)bolus.RESULTS In the ESPB group,the duration to the first PCIA bolus was significantly longer than that in the control group(h)[8.0(4.5,17.0)vs 1.0(0.5,6),P<0.01],and resting and coughing numerical rating scale(NRS)scores at 48 h post operation were significantly lower than those in the control group(P<0.05).There was no significant difference between the two groups regarding resting and coughing NRS scores at 24 h post operation.Sufentanil consumption during the operation was significantly lower in the ESPB group than in the control group(P<0.01),while there was no significant difference between the two groups regarding morphine consumption at 24 or 48 h post operation.In the ESPB group,Modified Observer’s Assessment of Alertness/Sedation score within 20 min after extubation was higher and duration in the post-anesthesia care unit was shorter than those in the control group(P<0.01).CONCLUSION In patients undergoing lumbar spine surgery,ultrasound-guided ESPB at a lower thoracic level improves the analgesic effect,reduces opioid consumption,and improves postoperative recovery.展开更多
Laparoscopic surgery is the main treatment method for patients with gastrointestinal malignant tumors.Although laparoscopic surgery is minimally invasive,its tool stimulation and pneumoperitoneum pressure often cause ...Laparoscopic surgery is the main treatment method for patients with gastrointestinal malignant tumors.Although laparoscopic surgery is minimally invasive,its tool stimulation and pneumoperitoneum pressure often cause strong stress reactions in patients.On the other hand,gastrointestinal surgery can cause stronger pain in patients,compared to other surgeries.Transversus abdominis plane block(TAPB)can effectively inhibit the transmission of nerve impulses caused by surgical stimulation,alleviate patient pain,and thus alleviate stress reactions.Remazolam is an acting,safe,and effective sedative,which has little effect on hemodynamics and is suitable for most patients.TAPB combined with remazolam can reduce the dosage of total anesthetic drugs,reduce adverse reactions,reduce stress reactions,and facilitate the rapid postoperative recovery of patients.展开更多
BACKGROUND The serratus anterior muscle,located in the lateral aspect of the thorax,plays a crucial role in shoulder movement and stability.Thoracoscopic surgery,while minimally invasive,often results in significant p...BACKGROUND The serratus anterior muscle,located in the lateral aspect of the thorax,plays a crucial role in shoulder movement and stability.Thoracoscopic surgery,while minimally invasive,often results in significant postoperative pain,complicating patient recovery and potentially extending hospital stays.Traditional anesthesia methods may not adequately address this pain,leading to increased complications such as agitation due to inadequate pain management.AIM To evaluate the application value of ultrasound-guided serratus anterior plane block(SAPB)in patients undergoing thoracoscopic surgery,focusing on its effects on postoperative analgesia and rehabilitation.METHODS Eighty patients undergoing thoracoscopic surgery between August 2021 and December 2022 were randomly divided into two groups:An observation group receiving ultrasound-guided SAPB and a control group receiving standard care without SAPB.Both groups underwent general anesthesia and were monitored for blood pressure,heart rate(HR),oxygen saturation,and pulse.The primary outcomes measured included mean arterial pressure(MAP),HR,postoperative visual analogue scale(VAS)scores for pain,supplemental analgesic use,and incidence of agitation.RESULTS The observation group showed significantly lower cortisol and glucose concentrations at various time points post-operation compared to the control group,indicating reduced stress responses.Moreover,MAP and HR levels were lower in the observation group during and after surgery.VAS scores were significantly lower in the observation group at 1 h,4 h,6 h,and 12 h post-surgery,and the rates of analgesic supplementation and agitation were significantly reduced compared to the control group.CONCLUSION Ultrasound-guided SAPB significantly improves postoperative analgesia and reduces agitation in patients undergoing thoracoscopic surgery.This technique stabilizes perioperative vital signs,decreases the need for supplemental analgesics,and minimizes postoperative pain and stress responses,underscoring its high application value in enhancing patient recovery and rehabilitation post-thoracoscopy.展开更多
Objective:To explore the suitable dosage of dexmedetomidine preemptive analgesia combined with transverse abdominal muscle block for postoperative analgesia of colon cancer.Methods:From March 2018 to October 2019,120 ...Objective:To explore the suitable dosage of dexmedetomidine preemptive analgesia combined with transverse abdominal muscle block for postoperative analgesia of colon cancer.Methods:From March 2018 to October 2019,120 patients undergoing laparoscopic radical resection of colon cancer in our hospital were randomly divided into control group(group C,without dexmedetomidine),low-dose group(group L,0.5μg/kg),medium-dose group(group M,1μg/kg)and high-dose group(group M,0.5μg/kg)The Mean arterial pressure,MAP),Heart rate,HR)and visual analog scale(vas)pain were compared at 2 h(T0),4 h(T1),8 h(T2),12 h(T3),24 h(T4)and 48 h(T5)after operation The pain sensitive area of mechanical stimulation was measured at T4,T5 and 72 h(T6)after operation.The adverse reactions of patients after operation were compared.Results:Compared with C group,MAP and HR of L,M and H groups decreased in different degrees at each time point.MAP and HR of m and h groups were lower than those of l group at different time points(P<0.05).The VAS score and pain sensitive area of T4-T6 in l,m and h groups were significantly lower than those in c group(P<0.05),but there was no significant difference in Ramsay score among groups(p>0.05).The vas score and pain sensitive area of m and h groups were lower than those of l group(P<0.05).Incidence of postoperative adverse reactions in l,m and h groups was lower than that in c group(P<0.05).Conclusion:Dexmedetomidine at doses of 1μg/kg and 1.5μg/kg has a good analgesic effect without increasing the incidence of adverse reactions.It is recommended that 1μg/kg Dexmedetomidine be used as an auxiliary drug dose of ropivacaine during TAP block.At the same time,it is necessary to strengthen monitoring to avoid adverse reactions such as hypotension and bradycardia.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In this retrospective observational study, we evaluated patients who underwent elective lumbar stenosis surgery between February 1, 2019, and April 1, 2019. Patients who underwent surgery for lumbar spinal stenosis under general anesthesia alone were compared with those who underwent general anesthesia combined with erector spinae plane block.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Aims:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We aimed to retrospectively evaluate whether erector spinae plane block reduced opioid consumption following surgery for spinal stenosis.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective observational study</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We collected data on the pain scores, time for the first requirement for patient-controlled analgesia with tramadol, the cumulative patient-controlled analgesia dose, requirement for rescue analgesia, time to first stand up postoperatively and the incidence of postoperative nausea and vomiting.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Sixty patients were included in the study. The numerical rating scale</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s pain scores were significantly lower in the erector spinae plane group at 1, 2, 4, 6, 12 and 24 hours than in the general anesthesia group. The cumulative dose of patient-controlled analgesia with tramadol was higher in the general anesthesia group than in the ESP group [212.0 (6.6) mg, vs. 107.3 (36.9 mg), (p <0.001)]. The time to first stand up after surgery was significantly longer in the general anesthesia group (p = 0.011).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> ESP block appear to be an effective method to relieve pain after lumbar surgery.</span>展开更多
Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends ...Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends to the cervical level. Herein, we present a successful multilevel ESPB plus an interscalene block using liposomal bupivacaine in a 45-year-old female patient with metastatic sarcoma who presented for scapula and proximal humerus resection. The post-operative course was smooth, and the patient was discharged home on post-operative day 2 with minimal narcotic requirements.展开更多
Objective:To investigate whether continuous erector spinae plane block(ESPB)improves the quality of recovery(QoR)and decreases postoperative acute and chronic pain in patients undergoing minimally invasive cardiac sur...Objective:To investigate whether continuous erector spinae plane block(ESPB)improves the quality of recovery(QoR)and decreases postoperative acute and chronic pain in patients undergoing minimally invasive cardiac surgery.Methods:This was a single-center,double-blind,prospective,randomized,placebo-controlled trial.A total of 120 patients were randomized to groups at a 1:1 ratio.They received general anaesthesia and an ESP catheter(ropivacaine or normal saline)before surgery,and received patient-controlled intravenous analgesia with sufentanil and continuous ESPB with a pulse injection of 8 mL(ropivacaine or normal saline)per h after 20 mL of the experimental drug was administered at the end of surgery.The primary outcome was the 15-item quality of recovery scale(QoR-15)score at 24 h after surgery.The secondary outcomes included the severity of pain,sufentanil consumption,incidence of rescue analgesia,and proportion of patients with chronic pain.Results:The QoR-15 score was greater in the ESPB group than in the control group at 24 h after surgery[112(108–118)vs.109(101–114),P=0.023].ESPB was associated with a lower cough visual analogue scale(VAS)score(44 vs.47,P=0.001),resting VAS score(28 vs.35.5,P=0.003),sufentanil consumption(104.8µg vs.145.5µg,P=0.000),and incidence of rescue analgesia(20.0%vs.43.3%,P=0.006).Conclusion:Continuous ESPB mildly improved the QoR-15 score in patients undergoing minimally invasive cardiac surgery and reduced postoperative pain scores,opioid consumption,and the incidence of rescue analgesia.展开更多
Objective:This paper aims to analyze the analgesic effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with non-steroidal anti-inflammatory analgesic drug lornoxicam on abdominal surgery in pat...Objective:This paper aims to analyze the analgesic effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with non-steroidal anti-inflammatory analgesic drug lornoxicam on abdominal surgery in patients with a history of drug addiction.Methods:32 patients aged 18-60 who underwent lower abdominal surgery in the First People's Hospital of Liangshan Yi Autonomous Prefecture and Butuo County People's Hospital of Liangshan Yi Autonomous Prefecture from January 2022 to March 2023 were selected,the patients must have drug abuse history for more than 1 year,with a history of drug withdrawal and relapse.The patients were divided into observation group and control group by the envelope method,with 16 cases in the observation group and 16 cases in the control group.Two groups of patients underwent ultrasound-guided bilateral transversus abdominis plane block after the operation.The observation group was treated with dexmedetomidine hydrochloride 1μg/kg+0.25%ropivacaine hydrochloride 40ml,and the control group was treated with 40ml 0.9%sodium chloride injection,the two groups of patients returned to the ward after operation and given intravenous infusion of lornoxicam for relieving the pain.The visual analogue scale(VAS)score of postoperative pain,the times of rescue analgesia,the time of postoperative anal exhaust,the time of ambulation,nausea and vomiting,withdrawal symptoms,related adverse reactions,and hospitalization days were compared between the two groups.Results:The VAS score of postoperative pain in the observation group was significantly lower than that in the control group,P<0.05.Patients in the observation group used less postoperative rescue analgesics than those in the control group,P<0.05.For postoperative anal exhaust time,the difference between the two groups of patients was relatively small,and the time in the observation group was shorter,P>0.05.The time to get out of bed and the length of hospital stay were not significantly different between the control group and the observation group,P>0.05.The withdrawal symptoms of the patients in the observation group were better,P<0.05,nausea and vomiting,and other adverse reactions were lower in the control group,P<0.05.Conclusion:Ultrasound-guided transversus abdominis plane block combined with lornoxicam can be used to relieve pain in abdominal surgery for patients with drug addiction,which can effectively improve the therapeutic effect of patients and reduce the number of postoperative rescue analgesia.Thus,it has high clinical application value.展开更多
Since the original publication on the erector spinae plane (ESP) block in 2016, the technique of the ESP block has evolved significantly in the last few years. This review highlights recent developments in the techniq...Since the original publication on the erector spinae plane (ESP) block in 2016, the technique of the ESP block has evolved significantly in the last few years. This review highlights recent developments in the technique for administering the ESP block and proposes directions for future research. Continuous efforts are being aimed at improving understanding regarding the administration of the ESP block. Current reports suggest that the ESP block provides effective analgesia in thoracic and abdominal sites in patients of all ages. However, no cohort studies or randomized controlled trials were performed in 2016 and 2017. The ESP block is an effective analgesic tool in a wide range of sites. However. We are uncertain how effective the ESP block is compared to other types of regional anesthesia. Therefore, more research on ESP blocks is required.展开更多
Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in...Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.展开更多
Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analg...Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.展开更多
Background:There is no standard analgesic pathway after percutaneous nephrolithotomy.At our institution,an Enhanced Recovery After Surgery(ERAS)pathway was instated that included a preoperative erector spinae plane(ES...Background:There is no standard analgesic pathway after percutaneous nephrolithotomy.At our institution,an Enhanced Recovery After Surgery(ERAS)pathway was instated that included a preoperative erector spinae plane(ESP)block to improve pain control and minimize opioid usage in the postoperative setting.Materials and methods:At our institution,an ERAS pathway was created for patients undergoing percutaneous nephrolithotomy.This pathway involved a preoperative ESP block and the replacement of opioids with multimodal analgesia.Patient charts were retro-spectively reviewed and placed into 2 cohorts:one cohort participated in the ERAS pathway,whereas the other received traditional pain control.The primary outcome evaluated was postoperative morphine equivalents received.Secondary outcomes included nursing pain scores,opioid prescriptions for home,and quality of life.Descriptive statistics were performed by nonparametric Mann-Whitney U andχ2 tests for continuous and categorical variables,respectively.Results:Sixty patients were identified in the ERAS cohort versus 70 in the traditional pain control cohort.There was a statistically sig-nificant difference in average postoperative morphine equivalents received(17.0 vs.39.9,p<0.01)and average postoperative nursing pain score(2.4 vs.3.6,p<0.01).Fifty-three percent(32/60)of patients in the ERAS cohort received an opioid prescription for home compared with 80%(56/70)in the traditional cohort(p<0.01).There was no significant quality-of-life difference between the groups.No adverse patient events resulted from the block.Conclusions:An ERAS pathway including a preoperative ESP block and multimodal analgesia decreased morphine equivalents received and nursing pain scores.Future randomized prospective studies with the ERAS protocol can be considered.展开更多
Background:Pancreaticoduodenectomy(PD)is associated with severe postoperative pain.Optimized pain management can potentially elevate patients’postoperative quality of life.This study focused on comparing the analgesi...Background:Pancreaticoduodenectomy(PD)is associated with severe postoperative pain.Optimized pain management can potentially elevate patients’postoperative quality of life.This study focused on comparing the analgesic efficacy and subsequent functional recovery of three techniques,continuous local wound infiltration(LWI),four-quadrant transversus abdominis plane(4QTAP)block,and needle electrical twitch obtaining intramuscular stimulation(NETOIMS),in patients subjected to open PD.Methods:This is a prospective,single-blinded,randomized controlled study.Among a total of 80 eligible patients,72 were randomized into the LWI,4QTAP block,or NETOIMS groups for postoperative pain management.The primary outcome measured was the pain score,which was recorded on postoperative days(PODs)0,1,2,3,5,7,14,and 28.Additionally,consumption of morphine milligram equivalents(MMEs)and ibuprofen until POD 3 was analyzed.Functional recovery indicators,such as gait speed and peak cough flow(PCF),were assessed on the day before surgery(baseline),and on PODs 2,7,14,and 28.A one-way analysis of variance,with subsequent post-hoc Bonferroni analysis,was used to compare these main outcomes.Results:Out of the 72 patients,68(LWI,22;4QTAP,23;NETOIMS 23)were included in the final analysis.Compared to the LWI group,both the 4QTAP block and NETOIMS group demonstrated significantly lower pain scores from PODs 0 through 7(P<0.001 for POD 0-5;P=0.001 for POD 7,for both groups).The pain scores in the 4QTAP block and NETOIMS groups were comparable across all recorded time points.Up to POD 3,there was a significant reduction in both MMEs(P<0.001)and ibuprofen consumption(P=0.003)in these groups.Additionally,on POD 2,the 4QTAP block and NETOIMS groups exhibited superior PCF(P<0.001)and faster gait speed(P=0.008)compared to the LWI group.Conclusions:Compared to LWI,both 4QTAP block and NETOIMS were more effective in reducing postoperative pain,necessitated fewer analgesics,and facilitated improved functional recovery after PD.Trial Registration:Clinical Research Information Service of Korea Disease Control and Prevention Agency;cris.nih.go.kr;registration ID:KCT0005814.展开更多
BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated ...BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated the analgesic efficacy of unilateral continuous erector spinae block(ESB)compared to thoracic epidural analgesia(TEA)in terms of quality of pain relief and perioperative hemodynamic changes.AIM To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.METHODS This prospective,observational study was conducted at a tertiary care hospital of central India.Sixty-eight adult patients of either gender,posted for elective thoracic surgeries requiring one lung ventilation,were allocated to either TEA(n=34)or ESB(n=34)group,based on the attending anesthesiologist’s expertise.Continuous data were analyzed by independent t-tests,and categorical data byχ2 tests.RESULTS The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group.Resting numerical rating scale scores(0 hour,6 hours,and 72 hours post-extubation)were significantly higher in the ESB group compared to the TEA group[1.70±1.03 vs 1.05±0.77(P=0.004);1.64±0.98 vs 1.2±0.88(P=0.05);3.2±1.07 vs 2.61±0.92(P=0.013)].Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group.Additionally,block performance time was significantly longer in the ESB group(16.58±3.66 vs 13.84±2.88,P=0.001).CONCLUSION The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy,though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.展开更多
文摘BACKGROUND The dexmedetomidine(DEX)plus ropivacaine treatment enables a transversus abdominis plane block(TAPB)of the peripheral nerves in patients undergoing radical resection for colorectal cancer(CRC)that can provide clinical data for improving the postoperative analgesic effect,reducing the risk of cognitive impairment,and decreasing the circulating levels of serum inflammatory factors and stress hormones.AIM To assess the impact of DEX plus ropivacaine-enabled TAPB on pain,postoperative cognitive dysfunction(POCD),and inflammatory/stress factors.METHODS Our patient cohort was randomly divided into control and observation groups(60/group).The observation group used a DEX plus ropivacaine-enabled TAPB,while the control group employed a ropivacaine-enabled TAPB.The pain score[Visual Analogy Scale(VAS),Montreal Cognitive Assessment(MoCA)],serum inflammatory factor level(C-reactive protein,interleukin-6 and tumor necrosis factor-α),serum stress hormone levels(cortisol and adrenaline)and postoperative adverse reactions were compared between the two groups.RESULTS The observation group VAS scores were lower than those of the control group(better analgesic effect,P<0.05).The MoCA and POCD scores decreased post-surgery in the observation group(P<0.05).In the elderly,the overall VAS and MoCA scores were significantly reduced compared with the young group.The C-reactive protein,interleukin-6,tumor necrosis factor-α,cortisol and adrenaline levels were lower in the observation group compared with the control group post-surgery(P<0.05).There was no significant difference in adverse reactions between the two groups post-surgery,but the incidence of adverse reactions in the observation group was still lower.DEX continuously inhibited p65-phosphorylation levels in the nuclear factorκB pathway at multiple time points,and its inhibitory effect became more significant over time.CONCLUSION DEX plus ropivacaine-enabled TAPB reduces POCD and inflammatory/stress hormone levels,and significantly improves the postoperative analgesic effect of patients undergoing radical resection for colorectal cancer.
文摘BACKGROUND Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times.However,effective management of postoperative pain remains a significant challenge.Several traditional methods,including opioid-based analgesia,are commonly used but are associated with side effects such as nausea,vomiting,sedation,and delayed recovery.In recent years,the erector spinae plane block(ESPB)has gained attention as an ultrasoundguided regional anesthesia technique offering promising results in various surgical procedures by reducing opioid requirements and enhancing patient comfort.AIM To evaluate the efficacy and safety of ESPB in comparison to conventional pain management strategies in patients undergoing laparoscopic nephrectomy.METHODS Following PRISMA guidelines,we searched PubMed,EMBASE,Web of Science,and the Cochrane Register for randomized controlled trials(RCTs)comparing ESPB with control for laparoscopic nephrectomy.The Cochrane Risk of Bias tool was employed for quality assessment.The primary outcome was total patient-controlled analgesia(PCA)consumption.Secondary outcomes included hospital discharge time and the incidence of postoperative nausea and vomiting.A random-effects meta-analysis was conducted to calculate pooled mean differences(MD)and odds ratios(OR)with 95%CIs.RESULTS Nine RCTs involving a total of 643 patients(ESPB group=320;control group=323)were included in the analysis.ESPB significantly reduced PCA opioid consumption compared to controls(MD:-14.24,95%CI:-20.66 to-7.83,P<0.0001).Subgroup analysis showed reduced PCA use with ESPB vs morphine(MD:-8.78,95%CI:-15.34 to-2.22,P=0.009),and a non-significant effect compared to other analgesics(MD:-48.26,95%CI:-143.60 to 47.09).No statistically significant differences were observed in discharge time or the incidence of nausea and vomiting.CONCLUSION ESPB demonstrates the potential of reducing PCA in laparoscopic nephrectomy patients;however,its impact on secondary outcomes remains inconclusive.Large-scale RCTs are needed to confirm ESPB's benefits and explore long-term effects.
文摘Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic paravertebral block(PVB)after thoracoscopic surgery.Methods Ninety-two patients who underwent video-assisted thoracoscopic surgery(VATS)were randomly divided into group S(n=46)and group P(n=46).After anesthesia induction,the same anesthesiologist performed ultrasound-guided ESPB at T5 and T7 levels combined with SAPB at the level of the fifth rib in the midaxillary line in group S and ultrasound-guided PVB at T5 and T7 levels in group P.Patients in both groups were given 40 mL of 0.4%ropivacaine.Eighty-six patients completed the study(group S,n=44;group P,n=42).The morphine consumption,visual analogue scale(VAS)scores at rest and coughing,and frequency of remedial analgesia were recorded at 1,2,4,8,and 24 h postoperatively.Pulmonary function parameters were recorded at 1,4,and 24 h postoperatively,and the quality of recovery(QoR)-15 score at 24 h postoperatively.The adverse effects,duration of chest tube drainage and length of stay were also recorded.Results The morphine consumption at postoperative 4 and 8 h and the incidence of ipsilateral shoulder pain(ISP)were significantly lower in group S than in group P.The QoR-15 questionnaire score at postoperative 24 h was significantly lower in group P than in group S(P<0.05).The morphine consumption was lower at 24 h postoperatively in group S than in group P,with no significant difference found yet.The morphine consumption at other observed times,VAS scores,pulmonary function parameters,frequency of remedial analgesia,duration of chest tube drainage,length of stay,and incidence of other adverse events were comparable between group S and group P.Conclusion Ultrasound-guided ESPB combined with SAPB is non-inferior to PVB in terms of morphine consumption at postoperative 24 h and postoperative recovery.But,this approach can significantly reduce morphine consumption in the early postoperative period(0–8 h)after thoracoscopy with lower incidence of ISP.It is a simpler and safer operation.
基金supported by Young Scholar Research Grant of Chinese Anesthesiologist Association(No.21800009).
文摘Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-75 kg)scheduled for elective laparoscopic radical gastrectomy were enrolled in the current study.Sixty patients were randomly assigned to two groups by computer-generated randomization codes:an ultrasound-guided oblique subcostal transversus abdominis plane block(TAPB)group(group T,n=30)or an ultrasound-guided subcostal anterior QLB group(group Q,n=30).In both groups,bilateral ultrasound-guided oblique subcostal TAPB and subcostal anterior QLB were performed before general anesthesia with 0.25% ropivacaine 0.5 mL/kg.For postoperative management,all patients received patient-controlled intravenous analgesia(PCIA)with nalbuphine and sufentanil after surgery,maintaining visual analogue scale(VAS)scores<4 within 48 h.The intraoperative consumption of remifentanil,the requirement for sufentanil as a rescue analgesic,and the VAS scores at rest and coughing were recorded at 1,6,12,24 and 48 h after surgery.The recovery(extubation time after surgery,first ambulation time,first flatus time and length of postoperative hospital stay)and the adverse events(nausea and vomiting,skin pruritus,respiratory depression and nerve-block related complications)were observed and recorded.The primary outcome was the perioperative consumption of opioids.Results:Compared with group T,the intraoperative consumption of remifentanil,requirement for sufentanil and the frequency of PCIA were reduced in group Q.Meanwhile,VAS scores at all points of observation were significantly lower in group Q than in group T.Patients in group Q were also associated with shorter time to first out-of-bed activity and flatus,and shorter length of postoperative hospital stay than group T(P<0.05).There were no skin pruritus,respiratory depression or nerve-block related complications in both groups.Conclusion:Compared with ultrasound-guided oblique subcostal TAPB,ultrasound-guided subcostal anterior QLB provided greater opioid-sparing effect,lower visual analogue scores,and shorter postoperative hospital stay for laparoscopic radical gastrectomy.
文摘BACKGROUND Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy.AIM To investigate and compare the anesthetic effects of intravenous general anesthesia combined with epidural anesthesia or ultrasound-guided bilateral transversus abdominal plane block(TAPB)in gastric cancer patients undergoing laparoscopic radical gastrectomy.METHODS The clinical data of 85 patients who underwent laparoscopic radical gastrectomy in our hospital from December 2020 to January 2023 were retrospectively collected and divided into a TAPB group(n=45)and epidural anesthesia group(n=40)according to the different anesthesia and analgesia programs used.The TAPB group received general anesthesia combined with TAPB,and the epidural anesthesia group received general anesthesia combined with epidural anesthesia.The pain status,cognitive status,intestinal barrier indicators,recovery quality,and incidence of complications were compared between the two groups.RESULTS Compared with the epidural anesthesia group,the TAPB group’s visual analog scale scores were significantly lower 6 h,12 h,24 h and 48 h after surgery(P<0.05).The incidence of postoperative cognitive dysfunction(POCD)in the TAPB group was significantly lower than that in the epidural anesthesia group,and the Mini-mental State Examination score 24 h after surgery was significantly higher in the TAPB group than the epidural anesthesia group(P<0.05).The levels of diamine oxidase and plasma D-lactate were significantly lower in the TAPB group than the epidural anesthesia group 24 h after surgery(P<0.05).The agitation score and the incidence of agitation during recovery were significantly lower in the TAPB group than epidural anesthesia group(P<0.05).The total incidence of postoperative complications in the TAPB group was 4.44%,significantly lower than the 20.00%in the epidural anesthesia group(P<0.05).CONCLUSION Compared with epidural anesthesia combined with general anesthesia,TAPB combined with general anesthesia had a good analgesic effect in laparoscopic radical gastrectomy and can further reduce the incidence of POCD and postoperative complications,improve the levels of intestinal barrier indicators,and improve postoperative recovery quality.
文摘BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect.However,the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear.AIM To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients.METHODS A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023.The patients were categorized into a control group(n=51),receiving remimazolam for general anesthesia,and an observation group(n=51),receiving TAPB combined with remimazolam for general anesthesia.A comparison was made between both groups in terms of hemodynamic parameters,stress markers,pain levels,recovery quality,analgesic effects,and adverse reactions during the perioperative period.RESULTS The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group(P<0.05).The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group(P<0.05).Five minutes after extubation,the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group(P<0.05).At 12 h,24 h,and 48 h following surgery,the visual analog scale scores of the observation group were considerably lower than those of the control group(P<0.05).The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group(P<0.05).The observation group exhibited considerably fewer effective pump presses,lower fentanyl dosages,and lower incidences of rescue analgesia within 24 h following surgery than the control group(P<0.05).CONCLUSION The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good,which is helpful to promote faster recovery after operation.
文摘BACKGROUND Patients undergoing lumbar spine surgery usually suffer severe pain in the postoperative period.The erector spinae plane block(ESPB),first published in 2016,can anesthetize the ventral and dorsal rami of thoracic nerves and produce an extensive multi-dermatomal sensory block.AIM To assess whether bilateral ultrasound-guided ESPB at a lower thoracic level could improve pain control and quality of recovery in patients undergoing lumbar spine surgery.METHODS A total of 60 patients aged 18-80 years scheduled to undergo lumbar spine surgery with general anesthesia were randomly assigned to two groups:ESPB group(preoperative bilateral ultrasound-guided ESPB at T10 vertebral level)and control group(no preoperative ESPB).Both groups received standard general anesthesia.The main indicator was the duration to the first patient controlled intravenous analgesia(PCIA)bolus.RESULTS In the ESPB group,the duration to the first PCIA bolus was significantly longer than that in the control group(h)[8.0(4.5,17.0)vs 1.0(0.5,6),P<0.01],and resting and coughing numerical rating scale(NRS)scores at 48 h post operation were significantly lower than those in the control group(P<0.05).There was no significant difference between the two groups regarding resting and coughing NRS scores at 24 h post operation.Sufentanil consumption during the operation was significantly lower in the ESPB group than in the control group(P<0.01),while there was no significant difference between the two groups regarding morphine consumption at 24 or 48 h post operation.In the ESPB group,Modified Observer’s Assessment of Alertness/Sedation score within 20 min after extubation was higher and duration in the post-anesthesia care unit was shorter than those in the control group(P<0.01).CONCLUSION In patients undergoing lumbar spine surgery,ultrasound-guided ESPB at a lower thoracic level improves the analgesic effect,reduces opioid consumption,and improves postoperative recovery.
基金Supported by Health Commission of Hebei Province,China,No.20240074Scientific Research Project of Hebei Provincial Administration of Traditional Chinese Medicine,China,No.2024317.
文摘Laparoscopic surgery is the main treatment method for patients with gastrointestinal malignant tumors.Although laparoscopic surgery is minimally invasive,its tool stimulation and pneumoperitoneum pressure often cause strong stress reactions in patients.On the other hand,gastrointestinal surgery can cause stronger pain in patients,compared to other surgeries.Transversus abdominis plane block(TAPB)can effectively inhibit the transmission of nerve impulses caused by surgical stimulation,alleviate patient pain,and thus alleviate stress reactions.Remazolam is an acting,safe,and effective sedative,which has little effect on hemodynamics and is suitable for most patients.TAPB combined with remazolam can reduce the dosage of total anesthetic drugs,reduce adverse reactions,reduce stress reactions,and facilitate the rapid postoperative recovery of patients.
文摘BACKGROUND The serratus anterior muscle,located in the lateral aspect of the thorax,plays a crucial role in shoulder movement and stability.Thoracoscopic surgery,while minimally invasive,often results in significant postoperative pain,complicating patient recovery and potentially extending hospital stays.Traditional anesthesia methods may not adequately address this pain,leading to increased complications such as agitation due to inadequate pain management.AIM To evaluate the application value of ultrasound-guided serratus anterior plane block(SAPB)in patients undergoing thoracoscopic surgery,focusing on its effects on postoperative analgesia and rehabilitation.METHODS Eighty patients undergoing thoracoscopic surgery between August 2021 and December 2022 were randomly divided into two groups:An observation group receiving ultrasound-guided SAPB and a control group receiving standard care without SAPB.Both groups underwent general anesthesia and were monitored for blood pressure,heart rate(HR),oxygen saturation,and pulse.The primary outcomes measured included mean arterial pressure(MAP),HR,postoperative visual analogue scale(VAS)scores for pain,supplemental analgesic use,and incidence of agitation.RESULTS The observation group showed significantly lower cortisol and glucose concentrations at various time points post-operation compared to the control group,indicating reduced stress responses.Moreover,MAP and HR levels were lower in the observation group during and after surgery.VAS scores were significantly lower in the observation group at 1 h,4 h,6 h,and 12 h post-surgery,and the rates of analgesic supplementation and agitation were significantly reduced compared to the control group.CONCLUSION Ultrasound-guided SAPB significantly improves postoperative analgesia and reduces agitation in patients undergoing thoracoscopic surgery.This technique stabilizes perioperative vital signs,decreases the need for supplemental analgesics,and minimizes postoperative pain and stress responses,underscoring its high application value in enhancing patient recovery and rehabilitation post-thoracoscopy.
基金National Natural Science Foundation of China(No.81803951)Guangdong Medical Science and Technology Foundation Project(No.B2013409)。
文摘Objective:To explore the suitable dosage of dexmedetomidine preemptive analgesia combined with transverse abdominal muscle block for postoperative analgesia of colon cancer.Methods:From March 2018 to October 2019,120 patients undergoing laparoscopic radical resection of colon cancer in our hospital were randomly divided into control group(group C,without dexmedetomidine),low-dose group(group L,0.5μg/kg),medium-dose group(group M,1μg/kg)and high-dose group(group M,0.5μg/kg)The Mean arterial pressure,MAP),Heart rate,HR)and visual analog scale(vas)pain were compared at 2 h(T0),4 h(T1),8 h(T2),12 h(T3),24 h(T4)and 48 h(T5)after operation The pain sensitive area of mechanical stimulation was measured at T4,T5 and 72 h(T6)after operation.The adverse reactions of patients after operation were compared.Results:Compared with C group,MAP and HR of L,M and H groups decreased in different degrees at each time point.MAP and HR of m and h groups were lower than those of l group at different time points(P<0.05).The VAS score and pain sensitive area of T4-T6 in l,m and h groups were significantly lower than those in c group(P<0.05),but there was no significant difference in Ramsay score among groups(p>0.05).The vas score and pain sensitive area of m and h groups were lower than those of l group(P<0.05).Incidence of postoperative adverse reactions in l,m and h groups was lower than that in c group(P<0.05).Conclusion:Dexmedetomidine at doses of 1μg/kg and 1.5μg/kg has a good analgesic effect without increasing the incidence of adverse reactions.It is recommended that 1μg/kg Dexmedetomidine be used as an auxiliary drug dose of ropivacaine during TAP block.At the same time,it is necessary to strengthen monitoring to avoid adverse reactions such as hypotension and bradycardia.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In this retrospective observational study, we evaluated patients who underwent elective lumbar stenosis surgery between February 1, 2019, and April 1, 2019. Patients who underwent surgery for lumbar spinal stenosis under general anesthesia alone were compared with those who underwent general anesthesia combined with erector spinae plane block.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Aims:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We aimed to retrospectively evaluate whether erector spinae plane block reduced opioid consumption following surgery for spinal stenosis.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective observational study</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We collected data on the pain scores, time for the first requirement for patient-controlled analgesia with tramadol, the cumulative patient-controlled analgesia dose, requirement for rescue analgesia, time to first stand up postoperatively and the incidence of postoperative nausea and vomiting.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Sixty patients were included in the study. The numerical rating scale</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s pain scores were significantly lower in the erector spinae plane group at 1, 2, 4, 6, 12 and 24 hours than in the general anesthesia group. The cumulative dose of patient-controlled analgesia with tramadol was higher in the general anesthesia group than in the ESP group [212.0 (6.6) mg, vs. 107.3 (36.9 mg), (p <0.001)]. The time to first stand up after surgery was significantly longer in the general anesthesia group (p = 0.011).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> ESP block appear to be an effective method to relieve pain after lumbar surgery.</span>
文摘Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends to the cervical level. Herein, we present a successful multilevel ESPB plus an interscalene block using liposomal bupivacaine in a 45-year-old female patient with metastatic sarcoma who presented for scapula and proximal humerus resection. The post-operative course was smooth, and the patient was discharged home on post-operative day 2 with minimal narcotic requirements.
基金supported by grants from the Shanghai Municipal Health Commission(No.202140270)the Science and Technology Commission of Shanghai Municipality(No.21Y11901900)the Natural Science Foundation of Shanghai(No.22ZR1410900).
文摘Objective:To investigate whether continuous erector spinae plane block(ESPB)improves the quality of recovery(QoR)and decreases postoperative acute and chronic pain in patients undergoing minimally invasive cardiac surgery.Methods:This was a single-center,double-blind,prospective,randomized,placebo-controlled trial.A total of 120 patients were randomized to groups at a 1:1 ratio.They received general anaesthesia and an ESP catheter(ropivacaine or normal saline)before surgery,and received patient-controlled intravenous analgesia with sufentanil and continuous ESPB with a pulse injection of 8 mL(ropivacaine or normal saline)per h after 20 mL of the experimental drug was administered at the end of surgery.The primary outcome was the 15-item quality of recovery scale(QoR-15)score at 24 h after surgery.The secondary outcomes included the severity of pain,sufentanil consumption,incidence of rescue analgesia,and proportion of patients with chronic pain.Results:The QoR-15 score was greater in the ESPB group than in the control group at 24 h after surgery[112(108–118)vs.109(101–114),P=0.023].ESPB was associated with a lower cough visual analogue scale(VAS)score(44 vs.47,P=0.001),resting VAS score(28 vs.35.5,P=0.003),sufentanil consumption(104.8µg vs.145.5µg,P=0.000),and incidence of rescue analgesia(20.0%vs.43.3%,P=0.006).Conclusion:Continuous ESPB mildly improved the QoR-15 score in patients undergoing minimally invasive cardiac surgery and reduced postoperative pain scores,opioid consumption,and the incidence of rescue analgesia.
基金supported by Liangshan Science and Technology Program(Project number:22ZDYF0100).
文摘Objective:This paper aims to analyze the analgesic effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with non-steroidal anti-inflammatory analgesic drug lornoxicam on abdominal surgery in patients with a history of drug addiction.Methods:32 patients aged 18-60 who underwent lower abdominal surgery in the First People's Hospital of Liangshan Yi Autonomous Prefecture and Butuo County People's Hospital of Liangshan Yi Autonomous Prefecture from January 2022 to March 2023 were selected,the patients must have drug abuse history for more than 1 year,with a history of drug withdrawal and relapse.The patients were divided into observation group and control group by the envelope method,with 16 cases in the observation group and 16 cases in the control group.Two groups of patients underwent ultrasound-guided bilateral transversus abdominis plane block after the operation.The observation group was treated with dexmedetomidine hydrochloride 1μg/kg+0.25%ropivacaine hydrochloride 40ml,and the control group was treated with 40ml 0.9%sodium chloride injection,the two groups of patients returned to the ward after operation and given intravenous infusion of lornoxicam for relieving the pain.The visual analogue scale(VAS)score of postoperative pain,the times of rescue analgesia,the time of postoperative anal exhaust,the time of ambulation,nausea and vomiting,withdrawal symptoms,related adverse reactions,and hospitalization days were compared between the two groups.Results:The VAS score of postoperative pain in the observation group was significantly lower than that in the control group,P<0.05.Patients in the observation group used less postoperative rescue analgesics than those in the control group,P<0.05.For postoperative anal exhaust time,the difference between the two groups of patients was relatively small,and the time in the observation group was shorter,P>0.05.The time to get out of bed and the length of hospital stay were not significantly different between the control group and the observation group,P>0.05.The withdrawal symptoms of the patients in the observation group were better,P<0.05,nausea and vomiting,and other adverse reactions were lower in the control group,P<0.05.Conclusion:Ultrasound-guided transversus abdominis plane block combined with lornoxicam can be used to relieve pain in abdominal surgery for patients with drug addiction,which can effectively improve the therapeutic effect of patients and reduce the number of postoperative rescue analgesia.Thus,it has high clinical application value.
文摘Since the original publication on the erector spinae plane (ESP) block in 2016, the technique of the ESP block has evolved significantly in the last few years. This review highlights recent developments in the technique for administering the ESP block and proposes directions for future research. Continuous efforts are being aimed at improving understanding regarding the administration of the ESP block. Current reports suggest that the ESP block provides effective analgesia in thoracic and abdominal sites in patients of all ages. However, no cohort studies or randomized controlled trials were performed in 2016 and 2017. The ESP block is an effective analgesic tool in a wide range of sites. However. We are uncertain how effective the ESP block is compared to other types of regional anesthesia. Therefore, more research on ESP blocks is required.
文摘Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.
文摘Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.
文摘Background:There is no standard analgesic pathway after percutaneous nephrolithotomy.At our institution,an Enhanced Recovery After Surgery(ERAS)pathway was instated that included a preoperative erector spinae plane(ESP)block to improve pain control and minimize opioid usage in the postoperative setting.Materials and methods:At our institution,an ERAS pathway was created for patients undergoing percutaneous nephrolithotomy.This pathway involved a preoperative ESP block and the replacement of opioids with multimodal analgesia.Patient charts were retro-spectively reviewed and placed into 2 cohorts:one cohort participated in the ERAS pathway,whereas the other received traditional pain control.The primary outcome evaluated was postoperative morphine equivalents received.Secondary outcomes included nursing pain scores,opioid prescriptions for home,and quality of life.Descriptive statistics were performed by nonparametric Mann-Whitney U andχ2 tests for continuous and categorical variables,respectively.Results:Sixty patients were identified in the ERAS cohort versus 70 in the traditional pain control cohort.There was a statistically sig-nificant difference in average postoperative morphine equivalents received(17.0 vs.39.9,p<0.01)and average postoperative nursing pain score(2.4 vs.3.6,p<0.01).Fifty-three percent(32/60)of patients in the ERAS cohort received an opioid prescription for home compared with 80%(56/70)in the traditional cohort(p<0.01).There was no significant quality-of-life difference between the groups.No adverse patient events resulted from the block.Conclusions:An ERAS pathway including a preoperative ESP block and multimodal analgesia decreased morphine equivalents received and nursing pain scores.Future randomized prospective studies with the ERAS protocol can be considered.
文摘Background:Pancreaticoduodenectomy(PD)is associated with severe postoperative pain.Optimized pain management can potentially elevate patients’postoperative quality of life.This study focused on comparing the analgesic efficacy and subsequent functional recovery of three techniques,continuous local wound infiltration(LWI),four-quadrant transversus abdominis plane(4QTAP)block,and needle electrical twitch obtaining intramuscular stimulation(NETOIMS),in patients subjected to open PD.Methods:This is a prospective,single-blinded,randomized controlled study.Among a total of 80 eligible patients,72 were randomized into the LWI,4QTAP block,or NETOIMS groups for postoperative pain management.The primary outcome measured was the pain score,which was recorded on postoperative days(PODs)0,1,2,3,5,7,14,and 28.Additionally,consumption of morphine milligram equivalents(MMEs)and ibuprofen until POD 3 was analyzed.Functional recovery indicators,such as gait speed and peak cough flow(PCF),were assessed on the day before surgery(baseline),and on PODs 2,7,14,and 28.A one-way analysis of variance,with subsequent post-hoc Bonferroni analysis,was used to compare these main outcomes.Results:Out of the 72 patients,68(LWI,22;4QTAP,23;NETOIMS 23)were included in the final analysis.Compared to the LWI group,both the 4QTAP block and NETOIMS group demonstrated significantly lower pain scores from PODs 0 through 7(P<0.001 for POD 0-5;P=0.001 for POD 7,for both groups).The pain scores in the 4QTAP block and NETOIMS groups were comparable across all recorded time points.Up to POD 3,there was a significant reduction in both MMEs(P<0.001)and ibuprofen consumption(P=0.003)in these groups.Additionally,on POD 2,the 4QTAP block and NETOIMS groups exhibited superior PCF(P<0.001)and faster gait speed(P=0.008)compared to the LWI group.Conclusions:Compared to LWI,both 4QTAP block and NETOIMS were more effective in reducing postoperative pain,necessitated fewer analgesics,and facilitated improved functional recovery after PD.Trial Registration:Clinical Research Information Service of Korea Disease Control and Prevention Agency;cris.nih.go.kr;registration ID:KCT0005814.
文摘BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated the analgesic efficacy of unilateral continuous erector spinae block(ESB)compared to thoracic epidural analgesia(TEA)in terms of quality of pain relief and perioperative hemodynamic changes.AIM To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.METHODS This prospective,observational study was conducted at a tertiary care hospital of central India.Sixty-eight adult patients of either gender,posted for elective thoracic surgeries requiring one lung ventilation,were allocated to either TEA(n=34)or ESB(n=34)group,based on the attending anesthesiologist’s expertise.Continuous data were analyzed by independent t-tests,and categorical data byχ2 tests.RESULTS The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group.Resting numerical rating scale scores(0 hour,6 hours,and 72 hours post-extubation)were significantly higher in the ESB group compared to the TEA group[1.70±1.03 vs 1.05±0.77(P=0.004);1.64±0.98 vs 1.2±0.88(P=0.05);3.2±1.07 vs 2.61±0.92(P=0.013)].Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group.Additionally,block performance time was significantly longer in the ESB group(16.58±3.66 vs 13.84±2.88,P=0.001).CONCLUSION The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy,though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.
