Ultrasound-guided Fascia Iliaca Plane Block for the treatment of donor site pain in the burn injured patient: a randomized control trial

Abstract Burn injuries requiring surgical intervention often result in split- thickness skin grafting procedures, with donor skin frequently harvested from the patient’s anterolateral thigh. The donor site is often reported as the primary site of post-operative pain due to the damage sustained to localised nociceptors.A randomised control trial was undertaken to evaluate the impact an ultrasound-guided regional nerve block would have on patient reported pain scores in donor site wounds, and associated rescue analgesia consumption. Twenty participants requiring split-skin grafting for burn injuries of <15% total body surface area were enrolled from a tertiary burns unit and randomised to control (10 participants) or intervention group (10 participants). The intervention group received the addition of an ultrasound-guided facia iliaca plane block prior to their surgery. Primary outcome was pain score in the donor site during the postoperative phase; while secondary outcome was pain on day 1 post-surgery as measured by the numeric pain score (0-10). During the post-operative phase, the intervention group had a significantly lower median donor site pain score of 0 (interquartile range (IQR) 0 - 0), compared to the control group median 6 (IQR 4 - 7) (p < 0.001). Day 1 post-surgery the intervention group had a median pain score of 0 (IQR 0 – 4) compared to control group median 4.5 (IQR 2 – 6) (p= 0.043).The study findings demonstrated that regional anaesthesia was an effective way to reduce pain scores and requirement for additional analgesics during the postoperative phase.

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Analgesic Efficacy of Ultrasound-Guided Paravertebral Block in Patients Undergoing Percutaneous Nephrolithotomy: A Randomised, Controlled Clinical Study

10.21203/rs.3.rs-39588/v2 ◽

2020 ◽

Author(s):

Ferda Yaman ◽

Devrim Tuglu

Keyword(s):

Percutaneous Nephrolithotomy ◽

Statistical Significance ◽

Intervention Group ◽

Analgesic Efficacy ◽

Paravertebral Block ◽

Visual Analogue Scale Pain ◽

Control Group ◽

Opioid Use ◽

Ultrasound Guided ◽

Post Surgery

Abstract Background: Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCN). Methods: A total of forty-four patients, falling in categories I to III of the American Society of Anesthesiologists, and aged between 18 and 65 years, who were scheduled for PCN, were randomly distributed into two groups. The anaesthetic intervention group (PVB) contained 22 individuals, who were injected at level T8-T9 with 20mL 0.25% bupivacaine as a single administration. In the control group C, also containing 22 individuals, the intervention was not carried out. The groups were compared after PCN in terms of opioid use, pain score, opioid adverse effects profile and the need for supplemental analgesia.Results: Visual analogue scale pain scores whilst at rest or moving were lower at the level of statistical significance in the PVB group compared to controls at 2 and 4 hours post-surgery. At 6 and 8 hours post-surgery, the control group had a lower VAS score when moving, and this result reached statistical significance (p<0.05). The controls used more opioid relief than the PVB group and had lower scores for satisfaction (p<0.05).Conclusion: Ultrasound-guided PVB using bupivacaine and an in-plane technique provides effective analgesia in PNL. It is associated with high scores on patient satisfaction and minimal complications.Trial registration: ClinicalTrials.gov, NCT04406012. Registered retrospectively, on 27 May 2020.

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Analgesic efficacy of ultrasound guided paravertebral block in percutaneous nephrolithotomy patients: a randomized controlled clinical study

BMC Anesthesiology ◽

10.1186/s12871-020-01169-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ferda Yaman ◽

Devrim Tuglu

Keyword(s):

Percutaneous Nephrolithotomy ◽

Statistical Significance ◽

Intervention Group ◽

Analgesic Efficacy ◽

Paravertebral Block ◽

Visual Analogue Scale Pain ◽

Control Group ◽

Opioid Use ◽

Ultrasound Guided ◽

Post Surgery

Abstract Background Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCN). Methods A total of 44 patients, falling in categories I to III of the American Society of Anesthesiologists, and aged between 18 and 65 years, who were scheduled for PCN, were randomly distributed into two groups. The anaesthetic intervention group (PVB) contained 22 individuals, who were injected at level T8-T9 with 20 mL 0.25% bupivacaine as a single administration. In the control group C, also containing 22 individuals, the intervention was not carried out. The groups were compared after PCN in terms of opioid use, pain score, opioid adverse effects profile and the need for supplemental analgesia. Results Visual analogue scale pain scores whilst at rest or moving were lower at the level of statistical significance in the PVB group compared to controls at 2 and 4 h post-surgery. At 6 and 8 h post-surgery, the control group had a lower VAS score when moving, and this result reached statistical significance (p < 0.05). The controls used more opioid relief than the PVB group and had lower scores for satisfaction (p < 0.05). Conclusion Ultrasound-guided PVB using bupivacaine and an in-plane technique provides effective analgesia in PNL. It is associated with high scores on patient satisfaction and minimal complications. Trial registration ClinicalTrials.gov, NCT04406012. Registered retrospectively, on 27 May 2020.

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Analgesic Efficacy of Ultrasound-Guided Paravertebral Block in Patients Undergoing Percutaneous Nephrolithotomy: A Randomised, Controlled Clinical Study

10.21203/rs.3.rs-39588/v1 ◽

2020 ◽

Author(s):

Ferda Yaman ◽

Devrim Tuglu

Keyword(s):

Percutaneous Nephrolithotomy ◽

Statistical Significance ◽

Intervention Group ◽

Analgesic Efficacy ◽

Paravertebral Block ◽

Visual Analogue Scale Pain ◽

Control Group ◽

Opioid Use ◽

Ultrasound Guided ◽

Post Surgery

Abstract Background Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCN).Methods A total of forty-four patients, falling in categories I to III of the American Society of Anesthesiologists, and aged between 18 and 65 years, who were scheduled for PCN, were randomly distributed into two groups. The anaesthetic intervention group (PVB) contained 22 individuals, who were injected at level T8-T9 with 20 mL 0.25% bupivacaine as a single administration. In the control group C, also containing 22 individuals, the intervention was not carried out. The groups were compared after PCN in terms of opioid use, pain score, opioid adverse effects profile and the need for supplemental analgesia.Results Visual analogue scale pain scores whilst at rest or moving were lower at the level of statistical significance in the PVB group compared to controls at 2 and 4 hours post-surgery. At 6 and 8 hours post-surgery, the control group had a lower VAS score when moving, and this result reached statistical significance (p < 0.05). The controls used more opioid relief than the PVB group and had lower scores for satisfaction (p < 0.05).Conclusion Ultrasound-guided PVB using bupivacaine and an in-plane technique provides effective analgesia in PNL. It is associated with high scores on patient satisfaction and minimal complications.Trial registration: ClinicalTrials.gov, NCT04406012. Registered retrospectively, on 27 May 2020.

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Preprocedural intravenous Ibuprofen for post-repair pain relief after traumatic wound management: A randomized Clinical Trial

10.32592/ircmj.2021.23.9.783 ◽

2021 ◽

Keyword(s):

Pain Score ◽

Normal Saline ◽

Wound Repair ◽

Controlled Trial ◽

Intervention Group ◽

Wound Management ◽

Control Group ◽

Patients Satisfaction ◽

Pain Scores ◽

Traumatic Wound

Introduction: Wound repair may cause extra pain and inflammation leading to post-repair discomfort. Previous studies showed that Pre-operative use of NSAIDs may reduce pain after surgery but data on traumatic wound repair are lacking. Methods: This is a double-blind randomized controlled trial. Based on inclusion and exclusion criteria, 194 participants were randomly assigned to either intervention or control groups. In the intervention group Ibuprofen 800 mg in 100 cc normal saline infused before wound repair while the control group received 100 cc normal saline. Numeric pain scores were recorded at the beginning of wound repair and 30 minutes after that. Patients’ satisfaction with analgesia was also recorded 15 minutes after drug infusion, during wound repair, and 6 hours after wound repair. Results: Mean pain scores during wound repair, before local anesthesia with lidocaine, were similar in both groups mean pain score 30 minutes after the repair was significantly lower in patients who received Ibuprofen, 3.86±1.93 vs 4.46±1.89 (p=0.043). Patients’ satisfaction with pain management 6 hours after wound repair was higher in the intervention group (p=0.000). Conclusion: use of IV Ibuprofen before wound repair can reduce pain score after repair and is accompanied by improved patients’ satisfaction.

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Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10030394 ◽

2021 ◽

Vol 10 (3) ◽

pp. 394

Author(s):

Jannis Löchel ◽

Viktor Janz ◽

Vincent Justus Leopold ◽

Michael Krämer ◽

Georgi I. Wassilew

Keyword(s):

Postoperative Pain ◽

Periacetabular Osteotomy ◽

Opioid Consumption ◽

Transversus Abdominis ◽

Control Group ◽

Block Group ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Ultrasound Guided ◽

Pain Scores

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg ± 2.8 vs. 10.8 mg ± 5.6, p < 0.0001), 24 (18.4 ± 16.2 vs. 30.8 ± 16.4, p = 0.01) and 48 h (29.1 mg ± 30.7 vs. 54.7 ± 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

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Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs

Animals ◽

10.3390/ani11051275 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1275

Author(s):

Vincenzo Cicirelli ◽

Pasquale Debidda ◽

Nicola Maggio ◽

Michele Caira ◽

Giovanni M. Lacalandra ◽

...

Keyword(s):

Postoperative Pain ◽

General Anaesthesia ◽

Spermatic Cord ◽

Postoperative Pain Management ◽

Control Group ◽

Ultrasound Guided ◽

Hemodynamic Stability ◽

Pain Scores ◽

Lower Pain ◽

Ropivacaine Hydrochloride

Orchiectomy is a common surgical procedure performed on small animals, and it requires postoperative pain management despite its relative simplicity. This study aimed to evaluate the hemodynamic stability, intraoperative administration of additional hypnotic and/or analgesic drugs, and postoperative pain scores following the combination of ultrasound-guided injection of ropivacaine hydrochloride into the spermatic cord and infiltration by the same anaesthetic of the incisional prescrotal line (ROP) or general anaesthesia. Dogs in the ROP group showed greater intraoperative hemodynamic stability and lower pain scores than the control group. The locoregional approach used in this study proved effective in minimising the responses to the surgical stimulus and ensured adequate analgesia intra- and postoperatively. This method, called ultrasound-guided funicular block, allows orchiectomy to be performed under deep sedation without general anaesthesia.

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Does meloxicam provide adequate pain management as a post-operative analgesic in canine ovariohysterectomy patients?

The Veterinary Nurse ◽

10.12968/vetn.2020.11.4.192 ◽

2020 ◽

Vol 11 (4) ◽

pp. 192-197

Author(s):

Gavin Goldsbrough ◽

Helen Reynolds

Keyword(s):

Pain Management ◽

Pain Score ◽

Pain Scale ◽

Short Term ◽

Post Surgery ◽

Pain Scores ◽

Significant Difference ◽

Time Frames ◽

Adequate Pain Management

Background: Meloxicam is an analgesic agent with anti-inflammatory properties, commonly used in veterinary practices to treat a variety of different long-term medical conditions and is also used as a short-term pain relief following particularly traumatic surgeries. Aims: An observational study was conducted to determine whether meloxicam provides adequate pain management as a post-operative analgesic for canine ovariohysterectomies. Methods: 13 canines were admitted for ovariohysterectomy. Each patient was assessed using the Glasgow composite pain scale (CMPS) prior to surgery during the admission procedure, 15 minutes post-operatively, at discharge and at their post-operative check (POC) 3–5 days after surgery. Results: Data were statistically analysed to determine the overall effectiveness of meloxicam in reducing pain following canine ovariohysterectomy. The results showed a statistically significant difference (Kruskal-Wallis test: H3 =12.98, p=0.005) in pain scores between admission, 15 minutes post operatively, discharge and 3–5 days POC. The greatest decrease in pain score was between 15 minutes post-operatively and POC (Mann-Whitney U test: W=236, n=13, 13, p=0.0014) and between discharge and POC (Mann-Whitney U test: W=227, n=13, 13, p=0.0060). Overall, this demonstrated that there was an improvement in pain suggesting meloxicam is effective between these time frames. In addition, 69.2% (n=9) of patients in the study showed a pain score of 0, indicating an absence of pain, on their final POC. Statistical analysis was also used to determine if there was any difference in pain score between the 3, 4 or 5 day POC pain score. The results show there was no significant difference (Kruskal-Wallis test: H2 =0.090, p=0.638) suggesting that meloxicam's effectiveness was similar across this range of time post surgery. Conclusion: The results from the study indicate that meloxicam is an effective post-operative analgesic for canine patients undergoing an ovariohysterectomy.

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The Effectiveness of a Non-Invasive Shot Blocking Device for Reducing Pain of In-office Injections in Hand Surgery

Hand ◽

10.1177/1558944719884655 ◽

2019 ◽

pp. 155894471988465

Author(s):

Brian D. Rinker ◽

David A. Atashroo ◽

Megan A. Stout ◽

F. Ryan Wermeling

Keyword(s):

Pain Score ◽

Pain Perception ◽

Hand Surgery ◽

Pain Tolerance ◽

Rank Test ◽

Control Group ◽

Pain Scores ◽

Gate Control Theory ◽

Gate Control ◽

Blocking Device

Background: The gate control theory asserts that non-painful stimuli can block pain perception. The ShotBlocker™ device is a plastic disk with blunt projections that rests on the skin, and we hypothesize that it will reduce pain during hand injections. Methods: This is a prospective randomized trial of 117 patients undergoing injections for common hand conditions. Patients were randomized into 3 groups: device, placebo (device with projections removed), and control. Patients recorded on an analog pain scale the pain severity of the injection, as well as their most recent tetanus shot. A normalized pain score was obtained from the difference between the injection and tetanus shot pain scores. The mean non-normalized and normalized scores for each treatment group were compared to the control group using the Wilcoxon signed rank test. Results: There were 91 women and 26 men. Common diagnoses included trigger finger (n = 53), DeQuervain’s tendonitis (n = 33), and basal joint arthritis (n = 22). The groups did not differ significantly in age, gender, or diagnosis. Mean pain score in the device group was 5.2 out of 10, and it was 5.7 for the control group. The normalized pain score in the device group was significantly lower than the control group. Normalized and non-normalized pain scores for the placebo group were not significantly lower than the control group. Conclusions: The shot blocking device effectively reduced pain of injection versus controls when pain scores were normalized for pain tolerance. The modified device did not reduce the pain of injection, suggesting that gate control is the mechanism of action.

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Regional Anesthetic Blocks for Donor Site Pain in Burn Patients: A Meta-Analysis on Efficacy, Outcomes, and Cost

Plastic Surgery ◽

10.1177/2292550320928562 ◽

2020 ◽

Vol 28 (4) ◽

pp. 222-231

Author(s):

Katherine A. Grunzweig ◽

Ji Son ◽

Anand R. Kumar

Keyword(s):

Side Effects ◽

Regional Anesthesia ◽

Meta Analysis ◽

Donor Site ◽

Single Shot ◽

Burn Patients ◽

Pain Scores ◽

Donor Site Pain ◽

Graft Donor ◽

Site Pain

Background: Skin graft donor site pain significantly affects pain management, narcotic use, and hospital length of stay. This study is intended to evaluate the efficacy of regional anesthesia in the burn population to decrease narcotic consumption and to assess the impact on hospitalization costs. Methods: PubMed/MEDLINE, Embase, and ScienceDirect were searched with the following inclusion criteria: comparative studies, adult populations, burn patients, autologous skin grafting, regional nerve blocks, and traditional narcotic regimens. Outcomes assessed included narcotic consumption, pain scores, and opioid side effects. Meta-analysis obtained pooled values for morphine consumption and side effects. Cost analysis was performed using published data in the literature. Results: Final analysis included 101 patients. Cumulative morphine consumption at 72 hours was lower for patients treated with regional anesthesia versus patient-controlled analgesia (PCA; single shot 25 ± 12 mg, continuous regional 23 ± 16 mg, control 91.5 ± 24.5 mg; P < .05). Regional anesthesia decreased nausea/vomiting ( P < .05) and lowered subjective pain scores. Regional anesthesia interventions cost less than PCA, single shot less than continuous ( P < .05). Conclusion: Regional anesthesia at skin graft donor sites significantly decreases narcotic consumption in burn patients. Regional anesthesia is cost-effective, decreases side effects, and may result in shorter hospital stays due to improved pain management.

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Evaluation of the effectiveness of preoperative outpatient pulmonary preparation in patients undergoing esophageal surgery

Fisioterapia em Movimento ◽

10.1590/1980-5918.031.ao06 ◽

2018 ◽

Vol 31 (0) ◽

Author(s):

Fernanda Maria Rodrigues da Cunha ◽

Marisa de Carvalho Borges ◽

Júlia Maria Vergani Fanan ◽

Paulo Fernando de Oliveira ◽

Márcia Souza Volpe ◽

...

Keyword(s):

Muscle Strength ◽

Pulmonary Function ◽

Functional Capacity ◽

Intervention Group ◽

Pulmonary Complications ◽

Esophageal Surgery ◽

Inspiratory Muscle ◽

Control Group ◽

Partial Recovery ◽

Post Surgery

Abstract Introduction: Preoperative inspiratory muscle training (IMT) can minimize the occurrence of complications after esophagectomy. Objective: To evaluate the effects of preoperative IMT in patients undergoing esophageal surgery by determining respiratory muscle strength (PImax and PEmax), pulmonary function (FEV1, FVC, FEV1/FVC) and functional capacity by the 6-minute walk test (6MWT). Methods: Twenty-two patients were randomized into two groups: a control group (CG; n = 10) and an intervention group (IG; n = 12). Only IG performed IMT for a minimum period of 2 weeks. The assessments were conducted pre- and post-surgery. Results: An increase of PImax was observed in IG, but not in CG, in the second preoperative assessment (p = 0.014). Assessment on postoperative day 1 showed a reduction in maximal respiratory pressures in the two groups, but the reduction was more marked in IG (p < 0.05). Partial recovery of the variables evaluated was observed at discharge in the two groups. These variables had fully returned to initial values on postoperative day 30. The distance walked in the 6MWT was greater in IG, but the difference was not significant (p = 0.166). There was no difference in the frequency of pulmonary complications between groups. Conclusion: Preoperative IMT performed in our study improved inspiratory muscle strength but did not influence the postoperative pulmonary function or functional capacity of patients undergoing esophagectomy.

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