The impact of general and regional anesthesia on hemodynamics, microcirculation and pain sensation after reconstructive operations on abdominal aorta

2005 ◽  
Vol 30 (5) ◽  
pp. 32-32
Author(s):  
S SITKIN ◽  
Y KAZAKOV ◽  
A OVECHKIN ◽  
D FEDERYAKIN
Keyword(s):  
Regional Anesthesia ◽  
Abdominal Aorta ◽  
Pain Sensation ◽  
Reconstructive Operations ◽  
The Impact

scholarly journals Zastosowanie elektroterapii TENS w łagodzeniu bólu porodowego / Application of TENS electrotherapy in alleviating labour pain

2016 ◽  
Vol 15 (2) ◽  
pp. 59-62
Author(s):  
Magdalena Sowa ◽  
Katarzyna Ciechanowska ◽  
Iwona Głowacka
Keyword(s):  
Electrical Stimulation ◽  
Pain Threshold ◽  
Labour Pain ◽  
Endogenous Opioids ◽  
Transcutaneous Electrical Stimulation ◽  
Pain Sensation ◽  
Transcutaneous Electric Nerve Stimulation ◽  
Obstetric Practice ◽  
Electric Nerve Stimulation ◽  
The Impact

Abstract Introduction. Easing labour pain is an extremely important issue in obstetric practice. Various physiotherapy methods are increasingly often applied in obstetric practice. Transcutaneous electric nerve stimulation (TENS) aiming at central and peripheral modulation of pain sensation is one of them.Aim. The aim of the study was to analyse the impact of transcutaneous electrical stimulation (TENS) on easing labour pain.Summary. The TENS method is regarded as effective since it increases both the pain threshold and secretion of endogenous opioids. Non-pharmacological methods of pain management during labour, including electrotherapy TENS methods are safe and can be used in most patients.

Beware the rebound effect: regional anesthesia increases opioid utilization after humerus fracture surgery

2021 ◽  
pp. 175857322110481
Author(s):  
Daniel J. Cunningham ◽  
Micaela A. LaRose ◽  
Gloria X. Zhang ◽  
Ariana R. Paniagua ◽  
Christopher S. Klifto ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Proximal Humerus ◽  
Rebound Effect ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Opioid Consumption ◽  
Humeral Shaft ◽  
Patients Âgés ◽  
The Impact ◽  
Fracture Surgery

Introduction Regional anesthesia (RA) is used reduce pain in proximal humerus and humeral shaft fracture surgery. The study hypothesis was that RA would decrease opioid demand in patients undergoing fracture surgery. Materials and methods Opioid demand was recorded in all patients ages 18 and older undergoing proximal humerus or humeral shaft fracture surgery at a single, Level I trauma center from 7/2013 – 7/2018 (n = 380 patients). Inpatient opioid consumption from 0–24, 24–48, and 48–72 h and outpatient opioid demand from 1-month pre-operative to 90-days post-operative were converted to oxycodone 5-mg equivalents (OE's). Unadjusted and adjusted models were constructed to evaluate the impact of RA and other factors on opioid utilization. Results Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.8 estimated OE's without RA vs 8.8 estimated OE's with RA from 0–24 h post-op; 10 vs 13.7 from 24–48 h post-op; and 8.7 vs 11.6 from 48–72 h post-op; all p < 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA at all timepoints. Discussion In proximal humerus and humeral shaft fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics.

Abstract 12726: Crucial Role of Jak2 V617f-positive Myeloproliferative Neoplasm in the Development of Aortic Aneurysm

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tetsuro Yokokawa ◽  
Tomofumi Misaka ◽  
Yusuke KIMISHIMA ◽  
Kento Wada ◽  
Keiji Minakawa ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Angiotensin Ii ◽  
Aortic Aneurysm ◽  
Mrna Expression ◽  
Abdominal Aorta ◽  
Myeloproliferative Neoplasms ◽  
Myeloproliferative Neoplasm ◽  
Jak2 V617f ◽  
Vascular Complication ◽  
The Impact

Objective: To investigate the impact of hematopoietic JAK2V617F, which causes myeloproliferative neoplasms (MPNs), on the development of aortic aneurysm (AA). Approach and Results: We applied a bone marrow transplantation (BMT) strategy using the donor cells from Jak2 V617F transgenic (JAK2 V617F ) mice into the lethally irradiated apolipoprotein E-deficient mice. To induce the AA formation and progression, the recipient mice (BMT mice) were subjected to continuous angiotensin II infusion. Abdominal aortic diameter in JAK2 V617F -BMT mice was significantly enlarged compared to the control wild-type (WT)-BMT mice in response to angiotensin II. The incidence of abdominal AA was significantly higher in JAK2 V617F -BMT mice than in WT-BMT mice. Hematopoietic JAK2V617F accelerated aortic elastic lamina degradation as well as activation of matrix metalloproteinase (MMP)-2 and MMP-9 in the abdominal aorta. The numbers of CD68 + macrophages and Ly6B.2 + neutrophils and cytokine expressions such as Ccl6 and Tgfb1 were significantly increased in the abdominal aorta of JAK2 V617F -BMT mice accompanied by STAT3 activation. Bone marrow-derived macrophages carrying JAK2V617F showed elevations of both Mmp2 and Mmp9 mRNA expression. Finally, we found that 23% of MPN patients with JAK2 V617F mutation showed the presence of AA and increases in TGFB3 and IL-8 mRNA expression of the peripheral leukocytes. Conclusions: Hematopoietic JAK2V617F was involved in the development of AA through increases in the infiltration of inflammatory cells and MMP activation. Our findings provide a novel feature of vascular complication of AA in MPNs due to constitutive activation of the hematopoietic JAK-STAT pathway.

The Impact of Radiation on Surgical Outcomes of Immediate Breast Reconstruction

2011 ◽  
Vol 77 (10) ◽  
pp. 1349-1352
Author(s):  
Tuan Tran ◽  
Tu Tran ◽  
Duncan Miles ◽  
Michael Hill ◽  
Sharon S. Lum
Keyword(s):  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Surgical Outcomes ◽  
Immediate Breast Reconstruction ◽  
Partial Mastectomy ◽  
Breast Diseases ◽  
Adjuvant Radiation ◽  
Total Mastectomy ◽  
Reconstructive Operations ◽  
The Impact

We sought to determine the differences in surgical outcomes associated with adjuvant radiation versus no radiation in patients undergoing concurrent breast oncologic and reconstructive operations. A retrospective review of patients who underwent combined oncologic and plastic surgeries for breast diseases from January 2005 to June 2010 was compared for demographic factors and outcomes by receipt of radiation therapy. During the study period, 175 patients were identified; 25.7 per cent received radiation therapy. Mean patient age was 51 years and median follow-up was 355 days. Overall, 80.2 per cent of patients underwent mastectomy; 19.8 per cent partial mastectomy; 42.1 per cent autologous tissue reconstruction; and 54.8 per cent implant-based reconstruction. There were no significant differences between radiated and nonradiated patients in rates of overall or oncoplastic-specific complications. Lymphedema was the only complication seen more frequently in the radiated arm ( P = 0.03). In our series of carefully selected patients undergoing a variety of reconstructive techniques for repair of partial or total mastectomy defects, radiation was not associated with worse outcomes in patients undergoing immediate breast reconstruction. With careful collaboration among plastic surgeons, breast surgeons, and radiation oncologists, patients requiring breast surgery may safely be considered for reconstruction of partial or total mastectomy defects when adjuvant radiation is required.

Influence of Obesity on Surgical Regional Anesthesia in the Ambulatory Setting: An Analysis of 9,038 Blocks

2005 ◽  
Vol 102 (1) ◽  
pp. 181-187 ◽  
Author(s):  
Karen C. Nielsen ◽  
Ulrich Guller ◽  
Susan M. Steele ◽  
Stephen M. Klein ◽  
Roy A. Greengrass ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Regional Anesthesia ◽  
The United States ◽  
Ambulatory Setting ◽  
Efficacy Rate ◽  
Complication Rates ◽  
Obese Patients ◽  
Acute Complications ◽  
Pain At Rest ◽  
The Impact

Background Regional anesthesia is increasing in popularity for ambulatory surgical procedures. Concomitantly, the prevalence of obesity in the United States population is increasing. The objective of the present investigation was to assess the impact of body mass index (BMI) on patient outcomes after ambulatory regional anesthesia. Methods This study was based on prospectively collected data including 9,038 blocks performed on 6,920 patients in a single ambulatory surgery center. Patients were categorized into three groups according to their BMI (&lt;25 kg/m2, 25-29 kg/m2, &gt; or =30 kg/m2). Block efficacy, rate of acute complications, postoperative pain (at rest and with movement), postoperative nausea and vomiting, rate of unscheduled hospital admissions, and overall patient satisfaction were assessed. Linear and logistic multivariable analyses were used to obtain the risk-adjusted effect of BMI on these outcomes. Results Of all patients 34.8% had a BMI &lt;25 kg/m2, 34.0% were overweight (BMI 25-29 kg/m2), and 31.3% were obese (BMI &gt; or = 30 kg/m2). Patients with BMI &gt; or =30 kg/m2 were 1.62 times more likely to have a failed block (P = 0.04). The unadjusted rate of acute complications was higher in obese patients (P = 0.001). However, when compared with patients with a normal BMI, postoperative pain at rest, unanticipated admissions, and overall satisfaction were similar in overweight and obese patients. Conclusions The present investigation shows that obesity is associated with higher block failure and complication rates in surgical regional anesthesia in the ambulatory setting. Nonetheless, the rate of successful blocks and overall satisfaction remained high in patients with increased BMI. Therefore, overweight and obese patients should not be excluded from regional anesthesia procedures in the ambulatory setting.

scholarly journals Persistent Post-Mastectomy Pain: The Impact of Regional Anesthesia Among Patients with High vs Low Baseline Catastrophizing

Pain Medicine ◽  
2021 ◽  
Author(s):  
Nantthasorn Zinboonyahgoon ◽  
Megan E Patton ◽  
Yun-Yun K Chen ◽  
Rob R Edwards ◽  
Kristin L Schreiber
Keyword(s):  
Regional Anesthesia ◽  
Severity Index ◽  
Estimating Equation ◽  
Pain Severity ◽  
Psychosocial Assessment ◽  
Emotional Impact ◽  
Opioid Use ◽  
Variable Success ◽  
Long Term Impact ◽  
The Impact

Abstract Background Persistent post-mastectomy pain (PPMP) varies both in its severity and impact, with psychosocial factors such as catastrophizing conferring greater risk. Preoperative regional anesthesia (RA) is an important nonopioid therapy, but with variable success at preventing PPMP in previous reports. We previously reported that RA was associated with lower acute post-mastectomy pain and opioid use, but more prominently among patients with higher baseline catastrophizing. The current longitudinal investigation at 3, 6, and 12 months postop aimed to detect differential long-term impact of RA on PPMP among patients with high vs low catastrophizing. Methods In this prospective observational study, patients (n = 123) completed preoperative psychosocial assessment and underwent mastectomy either with (n = 56) or without (n = 67) preoperative RA. Generalized estimating equation (GEE) regression analysis assessed impact of baseline catastrophizing, RA, and their interaction, on the primary outcome of pain severity index, as well as secondary outcomes including cognitive and emotional impact of pain, and persistent opioid use. Results We observed a significant interaction between the effect of catastrophizing and RA on PPMP. Specifically, RA was associated with reduced pain severity and pain impact 3, 6, and 12 months postoperatively, but only among those with high baseline catastrophizing scores. In addition, both RA and lower catastrophizing scores were associated with lower incidence of persistent opioid use. Conclusions The efficacy of therapies to prevent PPMP may be importantly influenced by pain-modulatory psychosocial characteristics. These findings underscore the importance of considering individual patient factors when applying preventive treatments, and of including their assessment in future trials.

scholarly journals Evaluation of a Point-of-Care Ultrasound (POCUS) training course for Regional Anesthesiologists – A Single Institution’s Experience

2020 ◽  
Vol 1 (2) ◽  
pp. 1-7
Author(s):  
Alex K. Saltzman ◽  
Thuyvan H. Luu ◽  
Nicole Brunetti ◽  
James D. Beckman ◽  
Mary J. Hargett ◽  
...  
Keyword(s):  
Decision Making ◽  
Regional Anesthesia ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Left Ventricular ◽  
P Value ◽  
Point Of Care Ultrasound ◽  
Training Course ◽  
The Impact

Background and Objectives: Point-of-care ultrasound (POCUS) in the form of focused cardiac ultrasound (FOCUS) is a powerful clinical tool for anesthesiologists to supplement bedside evaluation and optimize cardiopulmonary resuscitation in the perioperative setting. However, few courses are available to train physicians. At Hospital for Special Surgery (HSS), from March of 2013 to May of 2016, nine basic Focused Assessed Transthoracic Echocardiography (FATE) training courses were held. A large percentage of the participants were practicing regional anesthesiologists or trainees in fellowship for regional anesthesia and acute pain. In this study, a survey was used to assess clinical utilization as well as potential barriers to use for regional anesthesiologists. Methods: Following IRB approval, 183 past participants of the basic FATE training course were contacted weekly from November 22nd, 2016, through January 3rd, 2017, via email and sent a maximum 40-item electronic survey hosted on REDCap. Responses were analyzed by a blinded statistician. Results: 92 participants responded (50%), and 65 of the 92 (70.7%) indicated they had regional anesthesiology training or practice regional anesthesia regularly. Of the total number of respondents, 50% (95% CI: 40.3%, 59.8%; P-value = 0.001) have used FOCUS to guide clinical decision making. Of the regional anesthesiologists, 27 (45.8%) have used FOCUS to guide clinical decision making with left ventricular function assessment (40.7%) and hypovolemia (39.0%) being the most common reasons. Regional anesthesiologists utilized FOCUS in the following settings: preoperatively (44.6%), intraoperatively (41.5%), postoperatively (41.5%), and in the Intensive Care Unit (40.0%). Limitations were due to lack of opportunities (52.3%), resources (36.9%), and comfort with performance (30.8%). 84.4% agreed that basic FOCUS training should be a required part of anesthesia residents or fellows’ curriculum. Conclusions: This study is the first formal evaluation of the impact of the implementation of a FOCUS training course on regional anesthesiologists’ current practice. Nearly 50% of regional anesthesiologists used FOCUS to guide clinical decision-making following formal training. The limitations to the use of FOCUS were a lack of relevant opportunities and resources. This evaluation of clinical use following training provides insight into how FOCUS is used by regional anesthesiologists and the limitations to implementation in the perioperative setting.

scholarly journals A Survey of Regional Anesthesia Use In Greece And The Impact of A Structured Regional Anesthesia Course On Regional Techniques Knowledge And Practice

2021 ◽  
Author(s):  
Kassiani Theodoraki ◽  
Eleni Moka ◽  
Alexandros Makris ◽  
Evmorfia Stavropoulou
Keyword(s):  
Regional Anesthesia ◽  
Ultrasound Guidance ◽  
Electronic Database ◽  
Nerve Blocks ◽  
Training Course ◽  
Hands On ◽  
Lower Limb Surgery ◽  
Knowledge And Attitude ◽  
Ra Training ◽  
The Impact

Abstract Background: Due to the growing interest in regional anesthesia (RA) techniques and the realization of the need for formalized education in them, the Greek Chapter of the European Society of Regional Anesthesia and Pain Therapy (ESRA-Hellas) has established a structured hands-on training Course held annually since 2009, which is quite popular in the community of Greek anesthesiologists. The aim of the current survey was two-fold: first to provide an overview about the current practice of RA in Greece and secondly to evaluate the effect the aforementioned training Course has on participants’ knowledge and attitude towards RA.Methods: An electronic questionnaire was uploaded on SurveyMonkey and a link giving access to the questionnaire was forwarded via email to an electronic database of 825 practicing Greek anesthesiologists held in the electronic database of ESRA Hellas. The survey was totally anonymous and no identifying information was collected throughout. It contained questions relating to the anesthesiologists’ demographic characteristics, their RA practice and information pertaining to the RA training Course.Results: A total of 424 fully completed questionnaires were received, representing an overall response rate of 51.4%. Attendants of the Course are more familiar with the performance of peripheral nerve blocks with neurostimulation and/or ultrasound guidance as compared to non-attendants (p<0.001). Attendants are also less likely to practice exclusively general anesthesia, more likely to use peripheral blocks for lower limb surgery and more likely to consider taking the European Diploma of RA in comparison to non-attendants (p<0.001, p=0.018 and p=0,002, respectively). Both cohorts consider the Course of value and agree that the main reason to use regional techniques is to ensure optimal postoperative analgesia while the main hindrance to RA practice is the lack of relevant education in the techniques, especially those under ultrasound guidance. Regarding improvement of the Course, most participants suggested devoting ampler time in ultrasound hands-on practice and application.Conclusion: Greek anesthesiologists seek educational activities in the field of RA and the Course seems to fulfil the majority of attendants’ expectations. There will be further effort by the organizers to improve weaknesses of the current Course and undertake further educational initiatives in the field of RA according to international recommendations.

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