Effect Of Nerve Block Research Articles

Infraorbital nerve block for pain management in pediatric cleft lip surgery in resource-limited areas of Indonesia: A case series

Introduction and importanceCleft lip and palate (CLP) are congenital anomalies of the craniofacial region, commonly found in low- and middle-income countries, including Indonesia. Surgical correction of clefts typically begins at around three months of age to support infant growth. An infraorbital nerve block is an option for regional anesthesia in CLP surgery. This case series aims to determine the effectiveness of infraorbital nerve block in pain management for pediatric CLP surgery. Case presentationThis case series includes five patients who fulfilled the Millard criteria for CLP surgery. All patients received general anesthesia followed by an infraorbital nerve block with 0.2 % ropivacaine in the infraorbital foramen area using the intraoral approach. Data were collected preoperatively, intraoperatively, and postoperatively. DiscussionThe combination of general anesthesia and infraorbital nerve block resulted in stable hemodynamics, low delirium scores, low pain intensity, and adequate oral intake postoperatively. ConclusionInfraorbital nerve block with ropivacaine provides intraoperative hemodynamic stability, decreased delirium, and effective postoperative pain management in pediatric patients undergoing CLP surgery.

Analgesic Effect of Caudal and Abdominal Nerve Blocks among Children Undergoing Inguinal Surgeries: An Original Research.

Pediatric inguinal surgeries sometimes cause considerable post-operative pain that requires effective analgesics. Caudal and abdominal nerve blocks may help this population with pain. It is uncertain how successful they are compared. A randomized controlled trial included 70 pediatric inguinal surgery patients. An abdominal (ANB) or caudal nerve block (CNB) was randomly assigned to participants in addition to usual analgesic treatment. Post-operative pain was measured at various times using a standardized scale. The initial rescue analgesia time and dose were recorded. Statistics were used to compare CNB and ANB results. The CNB and ANB groups were demographically similar. At every time point, the two groups' analgesic usage and post-operative pain were similar. No serious adverse events occurred in either group. CNB and ANB provide equivalent analgesia for pediatric inguinal surgeries. Both approaches alleviate pain well and have similar post-operative effects. Individual nerve block approaches must be chosen based on patient features and clinical considerations. More research is needed to determine each procedure's long-term safety and results.

Comparison of Analgesic Effects of Continuous Femoral Nerve Block, Femoral Triangle Block, and Adductor Block After Total Knee Arthroplasty: A Randomized Clinical Trial.

This study aimed to compare the analgesic effects of continuous femoral nerve block (FNB), femoral triangle block (FTB), and adductor canal block (ACB) following total knee arthroplasty (TKA). The goal was to identify the most effective nerve block technique among these. Patients undergoing TKA were randomly assigned to 1 of 3 groups: FNB, FTB, or ACB. Nerve blocks were administered preoperatively, with catheters placed for patient-controlled nerve analgesia (PCNA). The primary end point was the Numeric Rating Scale (NRS) score at movement at 24 hours postsurgery. Secondary end points included NRS scores at rest and movement, quadriceps strength, Timed Up and Go (TUG) test performance, range of motion, effective PCNA utilization, and opioid consumption at various postsurgery time points. Of the 94 valid data sets analyzed (FNB: 31, FTB: 31, ACB: 32), significant differences were observed in the primary end point (H=7.003, P =0.03). Post hoc analysis with Bonferroni correction showed that the FNB group had a significantly lower median pain score (3 [2 to 4]) compared with the ACB group (4 [3 to 5], Bonferroni-adjusted P =0.03). Regarding secondary end points, both the FNB and FTB groups had significantly lower NRS scores than the ACB group at various time points after surgery. Quadriceps strength and TUG completion were better in the FTB and ACB groups. There were no statistically significant differences among the groups for the other end points. Continuous FTB provides postoperative analgesia comparable to FNB but with the advantage of significantly less impact on quadriceps muscle strength, a benefit not seen with FNB. Both FTB and ACB are effective in preserving quadriceps strength postoperatively.

Effects of Ultrasound-Guided Thoracic Paravertebral Nerve Block Combined with Perineural or IV Dexmedetomidine on Acute and Chronic Pain After Thoracoscopic Resection of Lung Lesions: A Double-Blind Randomized Trial.

Thoracic paravertebral block (TPVB) analgesia can be prolonged by local anesthetic adjuvants such as dexmedetomidine. This study aimed to evaluate the two administration routes of dexmedetomidine on acute pain and chronic neuropathic pain (NeuP) prevention compared with no dexmedetomidine. A total of 216 patients were randomized to receive TPVB using 0.4% ropivacaine alone (R Group), with perineural dexmedetomidine 0.5 μg·kg-1 (RD0.5 Group) or 1.0 μg·kg-1 (RD1.0 Group), or intravenous (IV) dexmedetomidine 0.5 μg·kg-1·h-1 (RDiv Group). The primary outcome was the incidence of chronic NeuP, defined as a Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain score > 12 points at 3-month after surgery. (1) For the primary outcome, RD0.5 Group and RD1.0 Group demonstrated a decreased incidence of chronic NeuP at 3-month after surgery; (2) Compared with R Group, RDiv Group, RD0.5 Group, and RD1.0 Group can reduce VAS scores at rest and movement and Prince-Henry Pain scores at 12 and 24-h after surgery, the consumption of oral morphine equivalent (OME) and improve QOD-15 at POD1; (3) Compared with RDiv Group, RD0.5 Group and RD1.0 Group can reduce VAS scores at rest and movement and Prince-Henry Pain scores at 12 and 24-h after surgery, the consumption of postoperative OME and improve QOD-15 at POD1; (4) Compared with RD0.5 Group, RD1.0 Group effectively reduced VAS scores at rest at 12 and 24-h after surgery, VAS scores in movement and Prince-Henry Pain scores at 12-h after surgery. However, RD1.0 Group showed an increased incidence of drowsiness. Perineural or IV dexmedetomidine are similarly effective in reducing acute pain, but only perineural dexmedetomidine reduced chronic NeuP. Moreover, considering postoperative complications such as drowsiness, perineural dexmedetomidine (0.5 μg·kg-1) may be a more appropriate choice. Chinese Clinical Trial Registry (ChiCTR2200058982).

The effect of greater occipital nerve block on amplification of somatic symptoms and anxiety and depression levels in chronic migraine.

It is known that chronic migraine (CM) is often accompanied by anxiety, depression, and psychosomatic complaints. We designed this study with the assumption that greater occipital nerve (GON) block treatment could potentially improve not only pain symptoms but also psychosomatic complaints. This study aimed to evaluate the changes in the visual analog scale (VAS), somatosensory amplification scale (SSAS), beck depression ınventory (BDI), and beck anxiety ınventory (BAI) with GON block treatment in patients with CM. This study was conducted retrospectively on 164 patients with CM between December 2018 and January 2023. Patients underwent six sessions of GON block treatment at weeks 0, 1, 2, 3, 5, and 7. VAS, SSAS, BAI, and BDI scores; number of attacks per month (NAM); attack pain duration (APD); and monthly use of analgesics (UA) were compared before the start and at week 8 of GON block treatment. The mean age of the subjects was 38 ± 9years. Statistical analysis revealed that VAS, SSAS, BAI, and BDI scores; NAM; APD; and monthly UA were statistically significantly lower following GON block treatment than before GON block treatment (p < 0.001 each). GON block treatment was effective for pain and somatic complaints (amplification of physical symptoms), anxiety, and depressive symptoms accompanying CM in patients with CM.

Effect of Preoperative Bilateral Ultrasound-Guided Quadratus Lumborum Nerve Block on Quality of Recovery After Minimally Invasive Hysterectomy in an Enhanced Recovery After Surgery (ERAS) Setting

Study ObjectiveTo assess the effect of preoperative bilateral ultrasound-guided quadratus lumborum nerve block (QLB) on quality of recovery after minimally invasive hysterectomy, in an Enhanced Recovery After Surgery (ERAS) setting. DesignRandomized, controlled, double-blinded trial (Canadian Task Force level I) SettingUniversity affiliated tertiary medical center PatientsAll women undergoing an elective robotic or laparoscopic hysterectomy. Women with chronic pain, chronic anticoagulation, and body mass index (BMI) > 50 kg/m2 were excluded. InterventionPatients were randomized with a 1:1 allocation, to one of the following two arms, and stratified based on robotic versus laparoscopic approach.1. QLB: QLB (Bupivacaine) + Sham local trocar sites infiltration (normal saline). 2. Local Infiltration: Sham QLB (normal saline) + local infiltration (Bupivacaine) Measurements and Main ResultsThe primary outcome was defined as the quality of recovery score based on the validated questionnaire (QOR-40), completed 24-hours postoperatively. Secondary outcomes included: dynamic pain scores, accumulated opioid consumption up to 24-hours, post-operative nausea and vomiting, surgical complications, length of hospital stay, time to first pain medication administration in the post-anesthesia care unit (PACU) and adverse events. 76 women were included in the study. Demographic characteristics were similar in both groups. Median age was 44 (IQR 39-50) years, 47% of the participants were African American and mean BMI was 32.8 (SD 8.1) kg/m2. The mean QOR-40 score was 179.1 (+/- 10.3SD) in the QLB and 175.6 (+/- 9.7SD) for the local anesthesia group (p=0.072). All secondary outcomes were comparable between groups. ConclusionsQLBs do not significantly improve quality of recovery after elective robotic or laparoscopic hysterectomy compared to local anesthetic port site infiltration.

Efficacy of Unilateral External Oblique Intercostal Fascial Plane Block Versus Subcostal TAP Block in Laparoscopic Cholecystectomy: Randomized, Prospective Study.

This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery. After ethics committee approval, ASA I-II patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25mg pethidine as a rescue analgesic to patients with VAS ≥4. Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (P > .05). It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.

Comparison of the effects of sciatic nerve block combined with continuted femoral nerve block or continuted adductor canal block on pain and motor function after total knee arthroplasty

To compare the effect of sciatic nerve block (SNB) combined with continuted femoral nerve block (FNB) or continuted adductor canal block (ACB) on pain and motor function after total knee arthroplasty (TKA). A total of 60 patients with TKA-treated osteoarthritis of the knee who met the selection criteria were enrolled between November 2020 and February 2021 and randomised allocated into the study group (SNB combined with continuted ACB) and the control group (SNB combined with continuted FNB), with 30 cases in each group. There was no significant difference in gender, age, body mass, height, body mass index, preoperative Hospital for Special Surgery (HSS) score, femoral tibial angle, and medial proximal tibial angle between the two groups ( P>0.05). The operation time, the initial time to the ground, the initial walking distance, and the postoperative hospital stay were recorded. At 2, 4, 6, 12, 24, and 48 hours after operation, the numerical rating scale (NRS) score was used to evaluate the rest pain around the knee joint, the quadriceps femoris muscle strength was evaluated by the freehand muscle strength method, and the knee flexion and extension angles were measured. There was no significant difference in the operation time and initial walking distance between the two groups ( P>0.05); the initial time to the ground and postoperative hospital stay of the study group were significantly shorter than those of the control group ( P<0.05). Except for the 48-hour postoperative NRS score of the study group, which was significantly lower than that of the control group ( P<0.05), there was no significant difference in the NRS scores between the two groups at the remaining time points ( P>0.05). The quadriceps femoris muscle strength from 4 to 24 hours postoperatively and the knee extension angle from 2 to 6 hours postoperatively of the study group were significantly better than those of the control group ( P<0.05); the differences in the quadriceps femoris muscle strength and knee extension and flexion angles between the two groups at the remaining time points were not significant ( P>0.05). SNB combined with either continuted ACB or continuted FNB can effectively relieve pain in patients after TKA, and compared with combined continuted FNB, combined continuted ACB has less effect on quadriceps femoris muscle strength, and patients have better recovery of knee flexion and extension mobility.

Nerve Block Guided by Anatomic Landmarks Only Reduces Pain in Botulinum Toxin Type A Treatment for Glabellar and Forehead Wrinkles.

Botulinum toxin type A is widely used to treat glabellar and forehead wrinkles, but the pain caused by multiple injections often deters patients from receiving long-term treatment. Despite several methods used to alleviate this pain, consistency and effectiveness remain a challenge. Therefore, this study aimed to evaluate the effectiveness and safety of nerve block guided by anatomic landmarks only in reducing pain associated with botulinum toxin type A injections. Between 2018 and 2022, the study enrolled 90 patients divided into 3 groups: the nerve block group (n = 30), the lidocaine cream group (n = 30), and the control group (n = 30). In the nerve block group, a landmarks-based technique was used to perform the nerve block. The study collected general information and comorbidities, and recorded pain at each point and time spent on preparation and treatment for each patient's forehead and glabellar area on each side. Patient-reported outcomes and complications were followed up at 2, 4, and 12 weeks after the injections. The nerve block group had significantly lower total pain scores in all regions compared to the lidocaine cream and control groups (P < 0.01). There were no significant differences in patient-reported outcomes between the groups at any follow-up point. Additionally, the complication rates related to injection were low and comparable among the 3 groups. Nerve block guided by anatomic landmarks only is a safe, effective, and consistent approach to reduce pain during botulinum toxin type A treatment for glabellar and forehead lines. This technique may offer advantages over other methods used to alleviate the pain associated with these injections.

Duloxetine Combined with Nerve Block for Cervical Headache with Anxiety Depression

Objective: To investigate the effect of duloxetine and nerve block in cervical headache with anxiety depression. Methods: 60 patients with cervical headache, anxiety and depression in the pain department of our hospital were randomly divided into control group and treatment group, with 30 patients in each group. The control group was treated with a cervical nerve block, and the treatment group was treated with a cervical nerve block in combination with duloxetine. Before and after treatment, both groups used the visual analog rating scale (Visual Analogue Scale, VAS) and sleep quality (Quality of Sleep, QS) to evaluate the improvement of pain degree and anxiety and depression, evaluate the clinical treatment effect and observe adverse effects. Results: VAS, scores and QS were lower than before treatment (P&lt;0.05), and VAS and QS were significantly lower than the control group (P&lt;0.05). Neither group had any serious adverse effects. Conclusion: Duloxetine combined with nerve block can effectively treat cervical headache combined with anxiety and depression. The combined treatment has better effect than single therapy, safe and effective, and is worthy of clinical promotion and application.

The Effect of Pectoral Nerve Blocks on Opioid Use and Postoperative Pain in Masculinizing Mastectomy: A Randomized Controlled Trial.

The Effect of Pectoral Nerve Blocks on Opioid Use and Postoperative Pain in Masculinizing Mastectomy: A Randomized Controlled Trial.

Effectiveness and complication of low-dose trigeminal nerve block with alcohol in idiopathic trigeminal neuralgia

Background: Trigeminal nerve block with alcohol was introduced long ago as a treatment method for trigeminal neuralgia. However, very little information is available in the literature regarding trigeminal nerve block with alcohol, and therefore, we evaluated the efficacy and related complications of an alcohol block of the trigeminal nerve for the treatment of indiopathic trigeminal neuralgia.Subjects and methods: Longitudinal and retrospective study in 38 idiopathic trigeminal neuralgia patients with low-dose trigeminal nerve block with alcohol from January 2019 to July 2022. Results: 38 patients were analyzed who received absolute alcohol injections in the management of trigeminal neuralgia (TN) from January 2019 to July 2022. There are 30 cases were injected with 0,3 ml of absolute alcohol and 8 cases with a greater 0,3 ml dose. The visual analogue scale (VAS) was used for pain improved with moderate level (18 cases) and severe level (12 cases) before, 24 patients had marked improvement of pain with mild level or free from pain. 30 patients (100%) who initially became free from pain experienced a recurrence of pain at least 1 year. Using the Barrow Neurologic Institude pain scale (BNI-PS), after 2 weeks there were only 2 patients (6,7%) experienced recurrent pain with BNI-PS IV, 2 patients (6,7%) with BNI-PS IV after 12 months and 5 patient (17,2%) with BNI-PS IV, 1 patient with BNI-PS V (3,4%) after more than 12 months. No serious complications were reported. Facial numbness was reported in 16 cases (53,3%) with 0,3 ml of absolute alcohol and 8 cases (87,5%) with a greater 0,3 ml dose. Other complications included: keratitis in 4 cases (13,3%) with 0,3 ml of absolute alcohol and 1 cases (25%) with a greater 0,3 ml dose, masseter muscle weakness in 7 cases (23,3,%) with 0,3 ml of absolute alcohol and 2 cases (25,5%) with a greater 0,3 ml dose.

Ultrasound Guided Maxillary Nerve Block for Perioperative Pain Management for Patients Undergoing Endoscopic Sinus Surgery: Randomized Control Trial

Background: Proper perioperative pain management remains a cornerstone of well-conducted functional endoscopic sinus surgery (FESS). In such a context, proper pain management entails the adequate provision of prolonged postoperative analgesia, the avoidance of overusing opioids, and consequently limiting their unwanted side effects. Objectives: We aimed to evaluate the effect of bilateral ultrasound-guided suprazygomatic maxillary nerve block (MNB) on postoperative pain in patients undergoing FESS. Methods: Patients eligible for FESS were randomized into two groups: the MNB group (n = 30), who underwent bilateral ultrasound-guided suprazygomatic maxillary nerve block after induction of anesthesia, and a control group (n = 30), who received multimodal analgesia, including opioids. Postoperatively, patients were observed for 48 hours. Pain scores were evaluated upon arrival to the sPACU and at 2, 6, 12, 24, 36, and 48 hours postoperatively, particularly at the time of removal of the hemostatic agent after 36 hours postoperatively. Total rescue analgesia, postoperative complications (including nausea and vomiting [PONV], hypotension, bradycardia, headache), and patient satisfaction were also diligently recorded. Results: Sixty patients who were candidates and underwent FESS surgery were enrolled randomly in both groups. The NRS pain score in the MNB group was significantly lower than that of the control group (P &lt; 0.001), especially the NRS during the removal of the hemostatic agent at T10 was significantly lower in the MNB group (P &lt; 0.001). However, at the 24 - hour point post-surgery, there were no significant differences between both groups (P = 0.568). Total rescue analgesia required was significantly lower in the MNB group compared with the control group (P &lt; 0.001) throughout the first 48 hours postoperatively. The percentage of patients with no postoperative complications (nausea, vomiting, and headache) was higher in the MNB group (76.7 %) compared with the control group (40 %). Patient satisfaction was statistically significantly higher in the MNB group (P &lt; 0.001). Conclusions: Bilateral ultrasound-guided suprazygomatic MNB appeared to be safe and advantageous, as its use was associated with a decrease in total analgesic consumption, a reduction in postoperative morbidities such as pain, nausea, and vomiting, and greater patient satisfaction.

Comparative evaluation of intraligamentary injection and traditional inferior alveolar nerve block in endodontic management of mandibular molar with symptomatic irreversible pulpitis: A randomized double-blinded clinical trial

Background: Intraligamentary anesthesia (ILA) injection using a single-tooth anesthesia (STA) system has been used as a supplementary technique for pulpal anesthesia in cases of irreversible pulpitis. Aims and Objective: The current clinical trial was undertaken to assess and compare the effectiveness of the conventional inferior alveolar nerve block (IANB) and the ILA technique utilizing the STA system for endodontic management of mandibular molars presenting symptomatic irreversible pulpitis. Materials and Methods: Patients diagnosed with symptomatic irreversible pulpitis inmandibular molar were allocated into two groups: Group I IANB (n=30) and Group II- STA system (n=30). The onset of anesthesia was evaluated using the electric pulp test, whereas for pain perception the Heft-Parker Visual Analog Scale score was recorded before, during, and after anesthesia. Post-anesthetic pain was recorded at 3 h, 24 h, and 1 week. The collected data was evaluated for effectiveness pain perception, and acceptability of the anesthetic technique, using appropriate statistical tests. Results: The mean time of onset for the Group II STA system (2.93±1.80) was significantly higher (P=0.0001) than Group I IANB (1.40±0.86). Pain at the site of injection was insignificant (P&gt;0.05) between both groups. The severity of pain during the root canal procedure was significantly different (P&lt;0.0001) in both cohorts. For both groups, the patient’s acceptance of the anesthetic procedure was statistically insignificant (P=0.21). Conclusions: The STA system reported similar effectiveness in terms of effectiveness, pain perception, and acceptability of anesthetic technique when compared to IANB. Hence, the primary anesthetic treatment for conducting endodontic procedures on molars with symptomatic irreversible pulpitis appears to be the utilization of the ILA-employing STA system.

Comparative evaluation of two methods of prolonged femoral nerve block using an elastomeric pump after knee arthroplasty: a prospective randomized controlled study

BACKGROUND: The number of knee arthroplasty (KA) surgeries is increasing annually. These surgeries are associated with severe pain. The optimal method of choice in perioperative analgesia in these patients remains controversial. The use of regional analgesia, including prolonged analgesia, allows for high pain relief and increased patient satisfaction. Modern elastomeric pumps (EP) provide prolonged conduction analgesia, which significantly expands the possibilities of perioperative pain relief. OBJECTIVE: To evaluate the effectiveness of prolonged femoral nerve block using EP with and without bolus after KA. MATERIALS AND METHODS: This prospective randomized study included 75 patients who were divided into two clinical groups: group 1 (n=36), patients who received prolonged regional analgesia using EP with controlled injection without bolus, and group 2 (n=39), patients who received prolonged regional analgesia using EP with bolus. In the postoperative period, the level of pain at rest and during movement was assessed after 6, 12, 24, and 48 hours as well as the need for opioid analgesics, consumption of local anesthetic for various options of continued regional analgesia, quadriceps femoris muscle function, and distance traveled by patients after surgery in the first 2 days. RESULTS: No significant differences were noted in pain level at rest and during movement in the observation period between the groups (p=0.213). No additional prescription of opioid analgesics was required. Local anesthetic consumption was lower in group 2 (group 1.384±33.4 ml; group 2.237±25.1 ml; p=0.031). Patients in group 2 had greater activity in knee extension and, thus, greater distance traveled after surgery. CONCLUSION: The use of EP with a bolus has been demonstrated to provide adequate levels of analgesia and better functional recovery in patients with bolus after KA than in patients without bolus. This technique is recommended as a component of enhanced recovery program after surgery.

Comparisons in analgesic effects between ultrasound-guided erector spinae plane block and surgical intercostal nerve block after video-assisted thoracoscopic surgery: A randomized controlled trial

Study objectiveThis study aimed to compare the analgesic effects of anesthesiologist-administrated erector spinae plane block (ESPB) and surgeon-administrated intercostal nerve block (ICNB) following video-assisted thoracoscopic surgery (VATS). DesignRandomized, controlled, double-blinded study. SettingOperating room, postoperative recovery room and ward in two centers. PatientsOne hundred patients, ASA I-III and scheduled for elective VATS. InterventionsThe anesthesiologist-administrated ESPB under ultrasound guidance or surgeon-administrated ICNB under video-assisted thoracoscopy was randomly provided during VATS. Regular oral non-opioid analgesic combined with intravenous rescue morphine were prescribed for multimodal analgesia after surgery. MeasurementsThe primary outcomes were the pain score and morphine consumption during 48 h after surgery. Postoperative pain intensity were assessed using the 10-cm visual analogue scale at 1 h, 24 h, and 48 h after surgery. Morphine consumption at these time points was compared between the two study groups. Furthermore, oral weak opioid rescue analgesic was also provided at 24 h after surgery. Postoperative quality of recovery at 24 h was also assessed using the QoR-15 questionnaire, along with duration of chest tube drainage and hospital stay were compared as secondary outcomes. Main resultsPatients in the two study groups had comparable baseline characteristics, and surgical types were also similar. Postoperative VAS changes at 1 h, 24 h, and 48 h after surgery were also comparable between the two study groups. Both groups had low median scores (<4.0) at all time points (all p > 0.05). Patients in the ESPB group required statistically non-significant higher 48-h morphine consumption [3 (0–6) vs. 0 (0–6) mg in the ESPB group and ICNB group respectively; p = 0.135] and lower numbers of oral rescue analgesic (0.4 ± 1.2 vs. 1.0 ± 1.8 in the ESPB group and ICNB group respectively; p = 0.059). Additionally, patients in the two study groups had similar QoR15 scores and lengths of hospital stay. ConclusionsBoth anesthesiologist-administered ultrasound-guided ESPB and surgeon-administered VATS ICNB were effective analgesic techniques for patients undergoing VATS for tumor resection.

Ultrasound-Guided Occipital Nerve Block in the Management of Refractory Headache and Its Outcomes: A Prospective Study

Abstract Purpose Headache severely impacts health and lifestyle, causing distress and leading to accommodative changes in affected individuals. Treatment options available for refractory headache range from a conservative approach to advanced forms. The purpose of our study was to evaluate the effectiveness of ultrasound-guided occipital nerve block (ONB) in the management of refractory headaches using visual analog scale (VAS) score and Barrow Neurological Institute Pain Intensity Score (BNIPIS). Methods A study sample of 30 eligible patients with refractory headaches including occipital neuralgia, migraine, tension headache, cluster headache, and vascular headaches aged between 18 and 65 years were included in our study. VAS and BNIPIS were noted for each patient before and after the procedure. ONB was given around the target nerve under aseptic precaution. Two milliliters of 0.5% bupivacaine was used as an injection solution for all patients. Results The mean VAS score in acute pain at pre-treatment and post-treatment after 24 hours and 3 months was found as 7.53, 1.53, and 3.20, whereas in chronic pain the score was 8.13, 3.07, and 5.87, respectively. Pre-treatment pain levels in acute and chronic subjects in BNIPIS IV and V category shifted to category I and II after 24 hours (postinjection) that later were recorded II and III, respectively, after 3 months. Conclusion Standard treatment guidelines are given by the international headache association for the management of headaches. The use of ONB is well advocated and practiced for a long time. In our study, we found that the use of greater occipital nerve block reduced pain levels affecting VAS and BNIPIS, which was more effective in acute cases than in chronic cases.

Effect of Ropivacaine Intercostal Nerve Block Combined with Patient Controlled Intravenous Analgesia on Postoperative Analgesia after Breast Augmentation.

To observe the effect of ropivacaine intercostal nerve block combined with PCIA as early postoperative analgesia following breast augmentation surgery with prosthesis (axillary approach) METHODS: A total of 80 women with breast augmentation surgery were selected in the plastic surgery department of Chongqing Huamei Plastic Surgery Hospital from December 2021 to May 2022. They were equally randomized into control group and observation group, with 40 cases in each one. Before placing the prosthesis, the control group was given 0.9% normal saline for intercostal nerve block; the observation group was given 0.75% ropivacaine +1‰ adrenaline for intercostal nerve block. Patient controlled intravenous analgesia (PCIA) was used after operation. Observation indexes the visual analog scale (VAS) of resting and motor state at 4h, 24h, 48h and 72h after operation and the adverse reactions. The VAS scores of patients at rest and exercise and adverse reactions in the observation group were lower than those in the control group (P<0.05). Ropivacaine intercostal nerve block combined with PCIA can effectively alleviate the pain after breast augmentation with pectoralis major prosthesis through axillary incision, help patients more comfortably through the perioperative period, accelerate postoperative recovery, reduce the dosage of systemic opioids and effectively reduce side effects. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Targeted local anesthesia: a novel slow-release Fe3O4-lidocaine-PLGA microsphere endowed with a magnetic targeting function.

Lidocaine microspheres can prolong the analgesic time to 24-48h, which still cannot meet the need of postoperative analgesia lasting more than 3 days. Therefore, we added Fe3O4 to the lidocaine microspheres and used an applied magnetic field to attract Fe3O4 to fix the microspheres around the target nerves, reducing the diffusion of magnetic lidocaine microspheres to the surrounding tissues and prolonging the analgesic time. Fe3O4-lidocaine-PLGA microspheres were prepared by the complex-emulsion volatilization method to characterize and study the release properties in vitro. The neural anchoring properties and in vivo morphology of the drug were obtained by magnetic resonance imaging. The nerve blocking effect and analgesic effect of magnetic lidocaine microspheres were evaluated by animal experiments. The mean diameter of magnetically responsive lidocaine microspheres: 9.04±3.23μm. The encapsulation and drug loading of the microspheres were 46.18±3.26% and 6.02±1.87%, respectively. Magnetic resonance imaging showed good imaging of Fe3O4-Lidocain-PLGA microspheres, a drug-carrying model that slowed down the diffusion of the microspheres in the presence of an applied magnetic field. Animal experiments demonstrated that this preparation had a significantly prolonged nerve block, analgesic effect, and a nerve anchoring function. Magnetically responsive lidocaine microspheres can prolong analgesia by slowly releasing lidocaine, which can be immobilized around the nerve by a magnetic field on the body surface, avoiding premature diffusion of the microspheres to surrounding tissues and improving drug targeting.

Effectiveness of Peripheral Nerve Block in Terms of Search for a Standardized Treatment Protocol in Diabetic Foot Patients Using Anticoagulants: A Double-Center Study.

Lower-extremity amputation for a diabetic foot is mainly performed under general or central neuraxial anesthesia. Ultrasound-guided peripheral nerve block (PNB) can be a good alternative, especially for patients who require continuous anticoagulation treatment and patients with additional comorbidities. We evaluated bleeding due to PNB application in patients with diabetic foot receiving antiplatelet or anticoagulant therapy. Perioperative morbidity and mortality and the need for intensive care hospitalization were analyzed. This study included 105 patients with diabetic foot or debridement who underwent distal foot amputation or debridement between February and October 2020. Popliteal nerve block (17 mL of 5% bupivacaine and 3 mL of saline) and saphenous nerve block (5 mL of 2% lidocaine) were applied to the patients. Postoperative pain scores (at 4, 8, 12, and 24 hours) and complications due to PNB were evaluated. Intensive care admission and 1-month mortality were recorded. The most common diseases accompanying diabetes were hypertension and peripheral artery disease. No complications due to PNB were observed. Mean ± SD postoperative first analgesic need was determined to be 14.1 ± 4.1 hours. Except for one patient, this group was followed up without the need for postoperative intensive care. In 16 patients, bleeding occurred as leakage from the surgical area, and it was stopped with repeated pressure dressing. Mean ± SD patient satisfaction score was 8.36 ± 1.59. Perioperative mortality was not observed. Ultrasound-guided PNB can be an effective and safe anesthetic technique for diabetic patients undergoing distal foot amputation, especially those receiving antiplatelet or anticoagulant therapy and considered high risk.