Efficacy Of Regional Anesthesia Research Articles

Efficacy of regional anesthesia in episcleral surgery: a randomized controlled double-blind clinical study

BACKGROUND: Surgical interventions for severe fundus diseases associated with diabetes mellitus, proliferative processes against the background of retinal detachment, and acute inflammatory diseases require the development of multimodal algorithms to provide sufficient analgesic and anti-inflammatory effects.
 AIM: To evaluate the efficacy of combined pterygopalatine blockade (PPB) and retrobulbar blockade (RBB) in patients with episcleral retinal detachment surgery.
 MATERIALS AND METHODS: The study included 100 patients who underwent episcleral surgery for retinal detachment. All patients were randomized into two groups: group 1 (retrobulbar blockade, n=50) and group 2 (pterygopalatine blockade in combination with retrobulbar blockade, n=50). The level of akinesia, volume of local anesthetic, consumption of analgesics, pain, and postoperative nausea and vomiting (PONV) were evaluated.
 RESULTS: In group 2, only 12% of the patients were prescribed promedol 2% intraoperatively, which is significantly lower than that in group 1 (p=0.463). In group 2, the pain level 8 h after surgery according to the verbal sensation scale was 0.80.63. In group 1, the average pain score was 1.691.8 (p=0.558). PONV was observed in 4% of the patients in group 1. In group 2, no PONV occurred (p=0.563).
 CONCLUSION: The combination of PPB and RBB allows for controlling not only pain sensitivity but also vegetative, motor, and neuroendocrine manifestations associated with pain both in the intraoperative and early postoperative periods.

31 Regional Anesthesia for Reducing Postoperative Opioid Use in Split Thickness Skin Grafting

IntroductionSplit thickness skin grafting is ubiquitous in the management of acute burns and burn reconstruction. Patients describe the resulting partial-thickness donor site wound as one of the most painful aspects of burn care. Managing donor site pain is challenging and frequently involves potent opioid regimens. Rapid reepithelization of the donor site makes long-acting local and regional anesthesia an attractive option for reducing opioid use. This study aims to determine the efficacy of graft donor site regional anesthesia at reducing postoperative opioid consumption in burn patients.MethodsA retrospective review of burn patients undergoing split-thickness skin grafting at our institution was performed. Patient demographics, burn mechanism, and percent burned total body surface area were collected. The type of regional anesthesia, when it was performed, and the anesthetic agents used were also determined. Milligram morphine equivalents (MME) were calculated for three 24-hour periods postoperatively to quantify opioid usage. The total MME in 72h postoperatively was also determined and used to calculate per day MME requirements. Mean, and peak pain scores in the first 24h postoperatively were collected. Univariate and multivariate analyses were performed to determine the efficacy of regional anesthesia.ResultsTwenty-five patients were identified, 14 who received donor site regional anesthesia and 11 who did not. The two groups did not differ significantly in age, gender, race, BMI, or burn mechanism. The regional anesthesia group had a significantly lower percent burned TBSA (5.3 vs. 21.6, p < 0.001). Still, donor site dimensions did not differ significantly between groups (363 cm2 vs. 411 cm2, p = 0.247). The use of regional anesthesia was associated with significantly lower MME requirements in the first 24h postoperatively (22.5 vs. 84.9, p = 0.023), lower total requirements after 72h (47.3 vs. 147.8, p = 0.016), and lower per day requirements (17.6 vs., 51, p = 0.014). The regional anesthesia group was discharged on average one week sooner (5.1 days vs. 12.4 days, p = 0.031). Multivariate analysis demonstrated the use of regional anesthesia independently predicted decreasing MME requirements in the first 24h after surgery, decreasing MME requirements in total, and decreasing per day MME requirements. No patients experienced anesthesia-related complications.ConclusionsIn a cohort of burn patients undergoing split-thickness skin grafting, the use of regional anesthesia was highly effective at reducing opioid requirements in the immediate postoperative period. We believe regional anesthetic blockades should be considered to provide long-lasting donor site analgesia. More investigation is warranted into ideal anesthetic agents, the maximum donor site dimensions, and the extent of cost savings.

Erector spine plane block as a universal, safe and effective component of multimodal anesthesia

The rapid development of evidence-based medicine in Ukraine and in the the world clearly demonstrates the effectiveness of multimodal anesthesia in the perioperative period. In addition to oral and intravenous nonsteroidal anti-inflammatory drugs, the use of regional methods of anesthesia plays a special role. The safety, efficacy of regional anesthesia and the reduction of intra- and postoperative complications are no longer in doubt. There is no anatomical area that cannot be anesthetized without the use of peripheral or central nerve blocks. However, the issue of which block as well as its anatomical basis should be used to minimize the risk for patients has to date been debatable and relevant. The aim: to review and analyze modern sources of information in the field of anesthesiology, intensive care, and regional anesthesia; to determine the place of the ESP block among other fascial blocks and demonstrate the world experience and features of applying ESP block in different pathologies and in different surgical interventions. The main and continuing priority in the daily work of an anesthesiologist is patient safety and the principle – “Do no harm”. A huge range of regional anesthesia methods are popular among anesthesiologists and intensivists. However, it is still unclear which one of these is as safe as it is effective. Conclusions. ESP block is a universal, effective and relatively simple method of regional anesthesia, which effectively improves patient outcomes and reduces the number of intra- and postoperative complications.

Efficacy of regional anesthesia using ankle block in ankle and foot surgeries: a systematic review.

Ankle blocks are commonly used as surgical anesthetics and for postoperative analgesia during foot surgeries. It is chiefly an infiltration block which utilizes a localized anesthetic approach for providing surgical anaesthesia for a variety of foot procedures. Thus, in this systematic review, we focus primarily on the use, effectiveness, success and failures of regional ankle blocks in outpatient surgeries and hereby compare them with other anesthetic techniques and agents commonly used. Literature search was carried out using PubMed, Medline, Embase, Scopus and Cochrane Library for the studies existing till April 2021. Search was conducted by two independent reviewers separately keeping in view the structured format of the review. Data were thoroughly read and were extracted manually into a structured data extraction form. After going through the databases, 252 relevant articles were identified as per the search strategy. Among those 99 duplicate records were taken away. Among the remaining one hundred fifty-three records, one hundred thirty-eight records were excluded majorly going through their titles and abstracts. Next matching our inclusion criteria and going through the full texts, fifteen studies were excluded. Lastly, after excluding the reviews and case studies we included relevant 11 studies that compared the efficacy of ankle block in outpatient foot and ankle surgery in the present analysis. Seven studies used anatomic landmark guided (ALG) approach, three studies used ultrasound guided (USG) approach, while one study included both approaches. The results showed a significantly lower VAS score postoperatively at 24 hrs. It was observed that in general, immediately after surgery the VAS pain scores are low due to the continued analgesic effect provided by the ankle block. 0.25%-0.5% bupivacaine was the most common single long-acting local anesthetics used. Patient satisfaction ranged from 66%-95.8%. Major complications included block failure and consequent requirement of general anesthesia and few cases of transient nerve injuries. Therefore, this systematic review supports the fact that ankle block has advantages like excellent success rates with minimal side effects, high levels of patient satisfaction and decreased hospital expenses. Thus, it proves to be a safe and highly effective means of regional anesthesia for the majority of foot and ankle surgeries in outpatient settings.

Novel nerve imaging and regional anesthesia, bio-impedance and the future.

Ultrasound technology has transformed the practice of regional anaesthesia. Anaesthesiologists routinely use real-time images to guide needle and local anaesthetic placement adjacent to nerves. It is widely accepted that the era of ultrasonography has improved peripheral nerve block success rates and lessened the dose of local anaesthetic required to achieve success. Contemporary reports of harm in relation to nerve injury or local anaesthetic systemic toxicity are reassuring. The safety and efficacy of regional anaesthesia have thus been enhanced. Ultrasound guidance is, however, not a panacea. Ultrasound guidance requires the development of complex psychomotor skills. Harm may still occur where the needle or local anaesthetic is misplaced, resulting in nerve injury, vascular injury or local anaesthetic systemic toxicity. Advances in both imaging and needle technology may further enhance the safety and efficacy of ultrasound-guided regional anaesthesia. This review will focus on peer review literature to characterise the clinical challenges and explore the potential solutions.

Strategies to Optimize the Efficacy of Regional Anesthesia

The mode of delivery of epidural solutions has progressed from clinician-delivered boluses, to automated continuous epidural infusions and the addition of patient-controlled epidural analgesia (PCEA), and now to programmed intermittent epidural boluses (PIEBs) in addition to PCEA. Currently, there is promising evidence for the use of combination PIEB and PCEA to minimize additional bolus requirements and reduce the amount of local anesthetic consumed, as well as improved patient satisfaction. There are few data regarding this mode of delivery in peripheral nerve catheters. The existing data in the peripheral nerve catheters do not show a clear advantage for the use of the programmed intermittent bolus (PIB) method. More studies are needed in various peripheral nerve/fascia plane blocks to answer this question. Studies looking at the median effective dose in 50% of patients of local anesthetics for labor epidurals (minimum local anesthetic concentration [MLAC]) have allowed the comparison of the relative potency of different local anesthetics. Even though the absolute numbers are not useful, we know that ropivacaine is only 60% as potent as bupivacaine for its analgesic potency and development of motor block, so it provides no advantage over bupivacaine for the labor epidural setting. MLAC studies have also allowed the study of adjuvants and their effect on labor analgesia. Fentanyl, epinephrine, and clonidine have been studied, showing significant local anesthetic–sparing effects. The risks and benefits of each adjuvant should be weighed for each patient, but fentanyl and epinephrine have an excellent benefit-to-risk ratio.

Sciatic lateral popliteal block with clonidine alone or clonidine plus 0.2% ropivacaine: effect on the intra-and postoperative analgesia for lower extremity surgery in children: a randomized prospective controlled study

BackgroundThe effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. Most of the studies in adults have demonstrated the positive effects of clonidine on intra- and postoperative analgesia when used as an adjunctive agent or in some cases as a single to regional techniques. In the pediatric population, there are only few trials involving clonidine as an adjunct to regional anesthesia, and the analgesic benefits are not definite in this group of patients. The evidence concerning perineural administration of clonidine is so far inconclusive in children, as different types and volume of local anesthetic agents have been used in these studies. Moreover, the efficacy of regional anesthesia is largely affected by the operator's technique, accuracy and severity of operation.MethodsThe use of clonidine alone or combined with 0.2% ropivacaine for effective analgesia after mild to moderate painful foot surgery was assessed in 66 children, after combined sciatic lateral popliteal block (SLPB) plus femoral block. The patients were randomly assigned into three groups to receive placebo, clonidine, and clonidine plus ropivacaine. Time to first analgesic request in the groups was analyzed by using Kaplan-Meier and the log-rank test (mean time, median time, 95% CI).ResultsIn our study, clonidine administered alone in the SLPB seems promising, maintaining intraoperatively the hemodynamic parameters SAP, DAP, HR to the lower normal values so that no patient needed nalbuphine under 0.6 MAC sevoflurane anesthesia, and postoperatively without analgesic request for a median time of 6 hours. In addition, clonidine administered as adjuvant enhances ropivacaine's analgesic effect for the first postoperative day in the majority of children (p = 0.001). Clonidine and clonidine plus ropivacaine groups also didn’t demonstrate PONV, motor blockade, and moreover, the parents of children expressed their satisfaction with the excellent perioperative management of their children, with satisfaction score 9.74 ± 0.45 and 9.73 ± 0.70 respectively. On the contrary all the patients in the control group required rescue nalbuphine in the recovery room, and postoperatively, along with high incidence of PONV, and the parents of children reported a low satisfaction score (7.50 ± 0.70).ConclusionsClonidine appears promising more as an adjuvant in 0.2% ropivacaine and less than alone in the SLPB plus femoral block in children undergoing mild to moderate painful foot surgery, with no side effects.Trial registrationClinicalTrials.gov, ISRCTN90832436, (ref: CCT-NAPN-20886).

The Role of Regional Anaesthesia Techniques in the Management of Acute Pain

Regional anaesthesia and analgesia techniques are used to effectively manage acute pain after a variety of surgeries. With the rapid growth of ultrasound-guided procedures, anaesthetists are re-examining regional anaesthesia and analgesia and their roles in pain management. In this evolving field previous published data may not reflect current practice. Therefore, a narrative review of recent literature was undertaken to establish the current utility and efficacy of regional anaesthesia and analgesia for the management of acute pain following surgery. Only prospective randomised controlled trials published between March 2009 and March 2011 with outcome measures of analgesia efficacy were included. Sixty-five randomised controlled trials were identified involving 4841 patients. Regional techniques for the management of knee (26%), abdominal (26%) and shoulder (14%) surgery were most frequently studied. The review provides further evidence that regional anaesthesia and analgesia can offer excellent analgesia with acceptable side-effects for the management of postsurgical pain. In addition, the results of this review support the use of ultrasound guidance when performing regional techniques and continuous catheter techniques to prolong analgesia.

The Safety and Efficacy of Regional Anesthesia in an Office-Based Setting

The Safety and Efficacy of Regional Anesthesia in an Office-Based Setting

Regional anaesthesia: spinal and epidural application

The goal of the present chapter is to revisit the conclusion of a review published 5 years ago in terms of the experimental and clinical data published from 1996 to 2000. It intends to provide the anaesthesiologist with an objective idea of what can be expected from this class of substance in the everyday practice of regional anaesthesia/analgesia. The chapter is divided in four parts, scrutinizing respectively the drugs available, the mechanisms of action, the clinical use and the side-effects. It is concluded, in accordance with the first review, that α2-adrenergic receptor agonists improve the reliability and efficacy of regional anaesthesia. The best way to take advantage of these drugs for regional anaesthesia/analgesia is to combine them, at low dose, with other classical drugs via the spinal or epidural route. In particular, clear evidence exists that α2-adrenergic agonists should be combined with the opioids any time the latter are required.