Ultrasound-Guided Thoracic Wall Nerve Blocks to Reduce Postoperative Pain and Eliminate Opioid Consumption in Patients Undergoing Implant-Based Breast Reconstruction

2016 ◽  
Vol 138 (3) ◽  
pp. 543e-544e ◽  
Author(s):  
Stefano Bonomi ◽  
André Salval ◽  
Sara Crippa
Keyword(s):  
Postoperative Pain ◽  
Breast Reconstruction ◽  
Opioid Consumption ◽  
Thoracic Wall ◽  
Ultrasound Guided ◽  
Nerve Blocks

Ultrasound-guided thoracic wall nerve blocks for effective pain control in cardiac surgery

2020 ◽  
Vol 86 (6) ◽  
Author(s):  
Giuseppe Sepolvere ◽  
Mario Tedesco ◽  
Pierfrancesco Fusco ◽  
Paolo Scimia ◽  
Loredana Cristiano
Keyword(s):  
Cardiac Surgery ◽  
Pain Control ◽  
Thoracic Wall ◽  
Ultrasound Guided ◽  
Nerve Blocks

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

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.

Ultrasound-guided anterior and posterior quadratus lumborum block for analgesia after laparoscopic hysterectomy

2021 ◽  
Vol 11 (1) ◽  
pp. 5-8
Author(s):  
Neha Singh ◽  
Parnandi Bhaskar Rao ◽  
Anirudh Elayat
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Laparoscopic Hysterectomy ◽  
Multimodal Analgesia ◽  
Total Laparoscopic Hysterectomy ◽  
Opioid Consumption ◽  
Ultrasound Guided ◽  
Analog Scale ◽  
Quadratus Lumborum

Aim: Laparoscopic procedures are now preferred over open surgeries, and total laparoscopic hysterectomy is becoming increasingly popular. Quadratus lumborum (QL) block is an evolving technique for abdominal surgeries that blocks T5–L1 nerve branches. Methods: We used a combination of anterior and posterior QL block given bilaterally in two patients and evaluated perioperative opioid consumption, postoperative pain score and patient satisfaction. Results: There was reduced perioperative opioid consumption along with postoperative visual analog scale for pain over the first 24 h. Both patients appreciated the level and standard of pain relief. Conclusion: QL block is promising as a part of multimodal analgesia for laparoscopic abdominal surgeries. Further studies are needed to determine the best possible combination of different approaches to QL block.

scholarly journals Intraoperative Intercostal Nerve Block for Postoperative Pain Control in Pre-Pectoral versus Subpectoral Direct-To-Implant Breast Reconstruction: A Retrospective Study

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 325 ◽  
Author(s):  
Jin-Woo Park ◽  
Jeong Hoon Kim ◽  
Kyong-Je Woo
Keyword(s):  
Postoperative Pain ◽  
Breast Reconstruction ◽  
Intercostal Nerve ◽  
Control Group ◽  
Intercostal Nerve Block ◽  
Nerve Blocks ◽  
Vas Score ◽  
Vas Scores ◽  
Lower Maximum ◽  
And Control

Background and Objectives: Patients undergoing mastectomy and implant-based breast reconstruction have significant acute postsurgical pain. The purpose of this study was to examine the efficacy of intercostal nerve blocks (ICNBs) for reducing pain after direct-to-implant (DTI) breast reconstruction. Materials and Methods: Between January 2019 and March 2020, patients who underwent immediate DTI breast reconstruction were included in this study. The patients were divided into the ICNB or control group. In the ICNB group, 4 cc of 0.2% ropivacaine was injected intraoperatively to the second, third, fourth, and fifth intercostal spaces just before implant insertion. The daily average and maximum visual analogue scale (VAS) scores were recorded by the patient from operative day to postoperative day (POD) seven. Pain scores were compared between the ICNB and control groups and analyzed according to the insertion plane of implants. Results: A total of 67 patients with a mean age of 47.9 years were included; 31 patients received ICNBs and 36 patients did not receive ICNBs. There were no complications related to ICNBs reported. The ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 6, p = 0.047), lower maximum VAS scores on the operative day (5 versus 7.5, p = 0.030), and POD 1 (4 versus 6, p = 0.030) as compared with the control group. Among patients who underwent subpectoral reconstruction, the ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 7, p = 0.005), lower maximum VAS scores on the operative day (4.5 versus 8, p = 0.004), and POD 1 (4 versus 6, p = 0.009), whereas no significant differences were observed among those who underwent pre-pectoral reconstruction. Conclusions: Intraoperative ICNBs can effectively reduce immediate postoperative pain in subpectoral DTI breast reconstruction; however, it may not be effective in pre-pectoral DTI reconstruction.

Combination Lower Extremity Nerve Blocks and Their Effect on Postoperative Pain and Opioid Consumption: A Systematic Review

2021 ◽  
Vol 60 (1) ◽  
pp. 121-131
Author(s):  
Arianna L. Gianakos ◽  
Filippo Romanelli ◽  
Naina Rao ◽  
Malaka Badri ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Lower Extremity ◽  
Opioid Consumption ◽  
Nerve Blocks

scholarly journals Comparison of ultrasound-guided abdominal nerve blocks and subarachnoid block as an anaesthetic technique for appendectomy: a retrospective study

2017 ◽  
Vol 4 (1) ◽  
pp. 16-22 ◽  
Author(s):  
Prajjwal Raj Bhattarai ◽  
Anuj Jung Rayamajhi ◽  
Rupesh Kumar Yadav ◽  
Subash Chandra Paudel ◽  
Anang Pangeni ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Opioid Consumption ◽  
Block Group ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Hospital Records ◽  
Subarachnoid Block ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
The Mean

Background: Ultrasound guided abdominal nerve blocks are increasingly being used for anaesthesia and analgesia for surgeries like appendectomy, hernia repair in our centre. The aim of the study was to compare abdominal nerve blocks and subarachnoid block for appendectomy.Method: Retrospective data of patients that underwent appendectomy either under subarachnoid block (Group-S) or abdominal nerve blocks (Group-A) for three months were collected from hospital records. The groups were compared for conversion to general anaesthesia as a primary end point of study and also for the time taken for the procedure, the first requirement of opioids, total opioid consumption and length of hospital stay.Result: Out of 116 patients studied, 75 surgeries were performed under subarachnoid block and 41 under abdominal plane blocks. Two patients in Group-S and 1 patient in Group-A were converted to general anaesthesia due to inadequate blockade. The time taken to perform the block was around four minutes in Group-S and 12 minutes in Group-A. The mean pethidine consumption in 24 hours was 62.33+16.63 mg and 23.17+15.19 mg in Group-S and Group-A respectively. The time to the first dose of pethidine in Group-S groups was 224.66+43.56 minutes and 813.17+361.80 minutes in Group-A. The mean duration of hospital stay in Group-S was 5.14+0.72 days and Group-A was 2.24+0.58 days.Conclusion: Appendectomy can be safely performed under subarachnoid block as well as the abdominal nerve blocks. The abdominal nerve block technique is found to be advantageous in terms of better postoperative analgesia, less opioid consumption and early hospital discharge.

scholarly journals A prospective, randomized comparison of ultrasonographic visualization of proximal intercostal block vs paravertebral block

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kamen Vlassakov ◽  
Avery Vafai ◽  
David Ende ◽  
Megan E. Patton ◽  
Sonia Kapoor ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Nerve Block ◽  
Opioid Consumption ◽  
Paravertebral Block ◽  
Anatomical Landmarks ◽  
Ultrasound Guided ◽  
Paravertebral Space ◽  
Pain Scores ◽  
Performance Times ◽  
Intercostal Block

Abstract Background Thoracic paravertebral blockade is an accepted anesthetic and analgesic technique for breast surgery. However, real-time ultrasound visualization of landmarks in the paravertebral space remains challenging. We aimed to compare ultrasound-image quality, performance times, and clinical outcomes between the traditional parasagittal ultrasound-guided paravertebral block and a modified approach, the ultrasound-guided proximal intercostal block. Methods Women with breast cancer undergoing mastectomy (n = 20) were randomized to receive either paravertebral (n = 26) or proximal intercostal blocks (n = 32) under ultrasound-guidance with 2.5 mg/kg ropivacaine prior to surgery. Block ultrasound images before and after needle placement, and anesthetic injection videoclips were saved, and these images and vidoes independently rated by separate novice and expert reviewers for quality of visualization of bony elements, pleura, relevant ligament/membrane, needle, and injectate spread. Block performance times, postoperative pain scores, and opioid consumption were also recorded. Results Composite visualization scores were superior for proximal intercostal compared to paravertebral nerve block, as rated by both expert (p = 0.008) and novice (p = 0.01) reviewers. Notably, both expert and novice rated pleural visualization superior for proximal intercostal nerve block, and expert additionally rated bony landmark and injectate spread visualization as superior for proximal intercostal block. Block performance times, needle depth, opioid consumption and postoperative pain scores were similar between groups. Conclusions Proximal intercostal block yielded superior visualization of key anatomical landmarks, possibly offering technical advantages over traditional paravertebral nerve block. Trial registration ClinicalTrials.gov, NCT02911168. Registred on the 22nd of September 2016.

Transmuscular quadratus lumborum block for total laparoscopic hysterectomy: a double-blind, randomized, placebo-controlled trial

2020 ◽  
Vol 46 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Christian Hansen ◽  
Mette Dam ◽  
Martin Vedel Nielsen ◽  
Katrine B Tanggaard ◽  
Troels Dirch Poulsen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Isotonic Saline ◽  
Oral Morphine ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Opioid Consumption ◽  
Common Denominator ◽  
Ultrasound Guided ◽  
Analgesic Regimen ◽  
Quadratus Lumborum

BackgroundThe population of patients scheduled for total laparoscopic hysterectomy at our surgical center is heterogeneous concerning a multitude of demographic variables such as age, collateral surgery and malign or benign pathogenesis. A common denominator is moderate to severe postoperative pain and a substantial opioid consumption. A recent procedure specific postoperative pain management (PROSPECT) review found no gain from the regional techniques included. The transmuscular quadratus lumborum (TQL) block has shown promising results in recent trials for other types of surgery. The aim of the current study was to investigate the analgesic efficacy of the ultrasound-guided TQL block for total laparoscopic hysterectomy.MethodsWe enrolled 70 patients and randomly allocated participants to preoperative bilateral ultrasound-guided TQL block with either 60 mL 0.375% ropivacaine or 60 mL isotonic saline. Preoperatively, all patients received the TQL block (active or placebo) as well as a standardized multimodal analgesic regimen consisting of oral paracetamol, ibuprofen and dexamethasone. Intraoperatively, intravenous sufentanil 0.2 µg/kg was administered 30 min prior to emergence.Primary outcomeOpioid consumption during the first 12 postoperative hours.Secondary outcomesPain scores, times to first opioid demand and first ambulation, nausea and vomiting, and total opioid consumption during the first 24 postoperative hours.ResultsNo significant intergroup differences were observed for any outcome. Mean (SD) oral morphine equivalent consumption the first 12 postoperative hours was 58.4 mg (48.3) vs 62.9 mg (48.5), p=0.70, for group ropivacaine versus group saline.ConclusionPreoperative bilateral ultrasound-guided TQL block did not reduce opioid consumption after total laparoscopic hysterectomy.Trial registration numbersNCT 03650998, EudraCT (2017-004593-34).

Sign in / Sign up

Export Citation Format

Share Document