scholarly journals Systemic dexmedetomidine is not as efficient as perineural dexmedetomidine in prolonging an ulnar nerve block

2019 ◽  
Vol 44 (3) ◽  
pp. 333-340 ◽  
Author(s):  
Jakob Hessel Andersen ◽  
Pia Jaeger ◽  
Ulrik Grevstad ◽  
Stine Estrup ◽  
Anja Geisler ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Nerve Block ◽  
Primary Outcome ◽  
Onset Time ◽  
Sensory Block ◽  
Primary Outcome Measure ◽  
Subsequent Treatment ◽  
Systemic Treatments ◽  
Registration Number ◽  
The Difference

BackgroundWe tested the joint hypotheses that both perineural and systemic dexmedetomidine prolong the duration of an ulnar nerve block (UNB) compared with ropivacaine alone and that systemic dexmedetomidine is noninferior compared with perineural dexmedetomidine in block prolongation.MethodsWe performed bilateral UNBs in 22 healthy volunteers on two separate days. On the first day, each arm was randomized to either 4 mL ropivacaine 5 mg/mL+1 mL dexmedetomidine 100 µg/mL (Perineural) or 4 mL ropivacaine 5 mg/mL+1 mL saline (Systemic). On the subsequent treatment day, each arm was randomized to 1 mL of saline plus 4 mL of ropivacaine at either 7.5 mg/mL(HiRopi) or 5 mg/mL (NoDex). The primary outcome measure was the duration of sensory block assessed by mechanical discrimination.ResultsMean sensory block duration was longer in both the Perineural (14.4 hours, 95% CI 13.1 to 15.6) and Systemic treatments (9.2 hours, 95% CI 8.6 to 9.8) compared with the NoDex treatment (7.1 hours, 95% CI 6.6 to 7.6) (p<0.0001 for both). Systemic dexmedetomidine was inferior (not noninferior) compared with perineural dexmedetomidine, as the 95% CI of the difference (mean difference 5.2 hour, 95% CI 4.2 to 6.1) exceeded the noninferiority limit of 3.6 hour. Onset time did not differ among the groups. The other test modalities demonstrated similar block durations as the primary outcome.ConclusionsAdding dexmedetomidine perineurally to ropivacaine doubles the duration of an UNB. Systemic dexmedetomidine also prolongs the duration of UNB, but has less of an effect compared with the perineural route.Trial registration numberNCT03222323.

Comparison of the effectiveness of circumferential versus non-circumferential spread in median and ulnar nerve blocks. A double-blind randomized clinical trial

2020 ◽  
Vol 45 (5) ◽  
pp. 362-366
Author(s):  
Paula Dieguez-Garcia ◽  
Servando Lopez-Alvarez ◽  
Jorge Juncal ◽  
Ana M Lopez ◽  
Xavier Sala-Blanch
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Motor Block ◽  
Primary Outcome ◽  
Sensory Block ◽  
Nerve Blocks ◽  
Double Blind ◽  
Registration Number ◽  
Tunnel Syndrome ◽  
To Receive

Background and objectivesCircumferential (C) spread of local anesthetic around the nerve is recommended for a successful nerve block. We tested the hypothesis that C spread produces a more complete block than non-circumferential (NC) spread.MethodsWe randomized 124 patients undergoing open carpal tunnel syndrome surgery to receive C or NC spread ultrasound-guided median and ulnar nerve blocks. The primary outcome was the proportion of patients who developed complete sensory block measured at 5, 15 and 30 min. The loss of cold sensation was graded as: 0 (complete block), 1 (incomplete block), or 2 (no block). Secondary outcomes included motor block, nerve swelling and adverse events.ResultsIn group C, complete sensory block at 5 min was 2.4 (95% CI 1.0 to 5.7; p=0.04) times more frequent in the median nerve and 3.0 (95% CI 1.2 to 7.2; p=0.01) times more frequent in the ulnar nerve compared with group C. However, at 15 and 30 min, it was similar between groups. Complete motor block was more frequent in group C than in group NC for both the median nerve: 1.5 (95% CI 1.1 to 2.2; p<0.01) at 15 min, 1.1 (95% CI 1.0 to 1.2; p=0.02) at 30 min, and the ulnar nerve: 1.7 (95% CI 1.2 to 2.6; p<0.01) at 15 min, 1.2 (95% CI 1.0 to 1.4; p<0.01) at 30 min. The incidence of nerve swelling and adverse effects was similar between groups.ConclusionsC spread around the median and ulnar nerves at the level of the antecubital fossa generates more complete sensory and motor blocks compared with NC spread.Trial registration numberEudraCT 2011-002608-34 and NCT01603680

scholarly journals Proof-of-concept single-arm trial of bevacizumab therapy for brain arteriovenous malformation

2021 ◽  
Vol 3 (1) ◽  
pp. e000114
Author(s):  
Rachel Muster ◽  
Nerissa Ko ◽  
Wade Smith ◽  
Hua Su ◽  
Melissa A Dickey ◽  
...  
Keyword(s):  
Pilot Study ◽  
Primary Outcome ◽  
Drug Effects ◽  
Primary Outcome Measure ◽  
Vascular Endothelial ◽  
Bevacizumab Treatment ◽  
Registration Number ◽  
Endothelial Growth Factor ◽  
Dose Dependent ◽  
Radiographic Changes

Brain arteriovenous malformations (bAVMs) are relatively rare, although their potential for secondary intracranial haemorrhage (ICH) makes their diagnosis and management essential to the community. Currently, invasive therapies (surgical resection, stereotactic radiosurgery and endovascular embolisation) are the only interventions that offer a reduction in ICH risk. There is no designated medical therapy for bAVM, although there is growing animal and human evidence supporting a role for bevacizumab to reduce the size of AVMs. In this single-arm pilot study, two patients with large bAVMs (deemed unresectable by an interdisciplinary team) received bevacizumab 5 mg/kg every 2 weeks for 12 weeks. Due to limitations of external funding, the intended sample size of 10 participants was not reached. Primary outcome measure was change in bAVM volume from baseline at 26 and 52 weeks. No change in bAVM volume was observed 26 or 52 weeks after bevacizumab treatment. No clinically important adverse events were observed during the 52-week study period. There were no observed instances of ICH. Sera vascular endothelial growth factor levels were reduced at 26 weeks and returned to baseline at 52 weeks. This pilot study is the first to test bevacizumab for patients with bAVMs. Bevacizumab therapy was well tolerated in both subjects. No radiographic changes were observed over the 52-week study period. Subsequent larger clinical trials are in order to assess for dose-dependent efficacy and rarer adverse drug effects.Trial registration number: NCT02314377.

scholarly journals Efficacy of perineural versus systemic dexamethasone in prolonging analgesia after ultrasound guided femoral and sciatic nerve block for patients undergoing below knee surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A Abdelaziz ◽  
H M Elzahaby ◽  
A A Elshebeiny ◽  
D M Heiba
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Onset Time ◽  
Analgesic Efficacy ◽  
Sensory Block ◽  
Postoperative Pain Management ◽  
Sciatic Nerve Block ◽  
Dexamethasone Group ◽  
Significant Difference ◽  
Group B

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Objective to compare the analgesic efficacy of both, intravenous and perineural administration of dexamethasone during femoral and sciatic nerve block using bupivacaine in patients undergoing below knee surgeries. Patients and Methods In our study, 50 patients were randomly divided into two equal groups: Group A (Perineural Dexamethasone group) [n = 25]: Those cases received 2ml volume of dexamethasone (8mg) combined with the 20 ml of bupivacaine of 0.5% concentration in each block, followed by injecting 5 ml saline intravenous. Group B (Systemic Dexamethasone group) [n = 25]: Those cases received 2 ml of dexamethasone (8mg) diluted over 3 cm saline in a 5 ml syringe following injection of the perineural 20 ml bupivacaine (0.5%) combined with 2 ml saline to have the same syringe volume for each block. Results Our study showed that onset time for sensory block was (25.39 ± 3.79) mins for systemic group and (18.85 ± 4.11) mins in perineural group with a significant statistical difference (P &lt; 0.001) between both groups as the onset of sensory block in perineural group was significantly shorter than the systemic group and the duration of sensory block was (650.00 ± 62.8) mins in systemic group and (718.52 ± 62.06) mins in perineural group. The duration of sensory block was significantly shorter in systemic group than in perineural group with statistically high significant difference between groups (P &lt; 0.001). Onset time for motor block was (30.61 ± 4.89) mins in systemic group and (27.59 ± 3.31) mins in perineural group. Perineural group had shorter time of onset than systemic dexamethasone group with a significant difference between groups (P = 0.013). The duration of analgesia was significantly longer in perineural group than systemic group (P &lt; 0.001) Conclusion Dexamethasone was seen to be a potent adjunct to local anesthetic to prolong post operative analgesia with negligible side effects & better outcome to the perineural route.

COMPARISON OF THE ONSET OF SENSORY BLOCK USING LIDOCAINE 1.5% WITH ADRENALINE OR LIDOCAINE 1.5% WITH ADRENALINE AND DEXAMETHASONE IN ULTRASOUND GUIDED AXILLARY NERVE BLOCK FOR BELOW ELBOW SURGERIES

2021 ◽  
Vol 74 (9) ◽  
pp. 2337-2339
Author(s):  
Nabaa Adnan Ahmed ◽  
Alaa Hussein Altaei ◽  
Mohammed Adel Jasim
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Onset Time ◽  
Sensory Block ◽  
Axillary Nerve ◽  
P Value ◽  
Group A ◽  
Group 2 ◽  
Group B

The aim: To demonstrate the onset of dexamethasone when added to lidocaine in ultrasound regional axillary brachial block. Materials and methods: 30 patients participated in this study in Al-wasity hospital from June 1st to December 1st 2019; all were of ASA I-II type, aged 18-65 years old. All patients were scheduled for upper limb below elbow surgery with peripheral nerve block. They were divided randomly in to 2 groups: Group A: received 20 ml of lidocaine 1.5% with adrenaline 1:200000; Group 2 : received 20 ml of lidocaine with adrenaline and dexamethasone 8 mg. There was no significant differences among the groups regarding the change in pulse rate, MAP and Oxygen saturation. The group B was faster than group A (p value < 0.001) in both the time of cold sensory block onset and pinprick sensory block onset at all dermatome (C5,C6,C7,C8,T1). Results: A variety of adjuvants have been used with peripheral nerve block to decrease the onset time, improve block quality, and prolong analgesia. Steroids have been shown to be beneficial in improving block onset. Conclusions: Adding dexamethasone to lidocaine enhanced the onset time of the block with no hemodynamic effect.

Bilateral Truncal Ligation of the Inferior Thyroid Artery during Bilateral Subtotal Thyroidectomy Causes a Decrease in Parathormone without Clinically Manifest Hypoparathyroidism: A Randomized Clinical Trial

2015 ◽  
Vol 55 (3) ◽  
pp. 141-150 ◽  
Author(s):  
Astrid Kebsch ◽  
Utz Settmacher ◽  
Thomas Lesser
Keyword(s):  
Primary Outcome ◽  
Thyroid Tissue ◽  
Thyroid Volume ◽  
Primary Outcome Measure ◽  
Subtotal Thyroidectomy ◽  
Inferior Thyroid Artery ◽  
Old Patients ◽  
Parathyroid Function ◽  
The Difference ◽  
To Receive

Background: Bilateral truncal ligation (BTL) of the inferior thyroid artery (ITA) is frequently used during subtotal thyroidectomy to reduce the risk of post-operative bleeding as well as to reduce the blood loss intra-operatively. However, its effect on parathyroid function has not been evaluated in relation to age, residual and resected thyroid volume. Methods: A total of 83 patients were randomized to receive non-BTL or BTL. After bilateral resection, the residual thyroid tissue on each side was measured by intra-operative ultrasonography. Laboratory and clinical examinations were performed the day before operation, intra-operatively and on post-operative days 2 and 5. The primary outcome measure was the difference in intact parathormone (PTHi) on post-operative day 5. Secondary outcomes were laboratory-diagnosed hypocalcaemia or hypoparathyroidism and clinically manifest hypoparathyroidism, respectively. Results: PTHi on post-operative day 5 was significantly lower in the BTL group (29.4 vs. 34.7 ng/l in the non-BTL group, p = 0.033), especially in 61- to 80-year-old patients (0 vs. -7.91 ng/l, p = 0.029). The biggest decline in PTHi was found in the BTL group (-14.067 ng/l PTH, p = 0.018) with a residual thyroid volume of 0.5-1.9 ml. There were two cases of asymptomatic hypoparathyroidism in each group (5.1 vs. 4.8%, respectively, p = 1.000). The only case of clinically manifest hypoparathyroidism was in a BTL group patient aged 64 years (2.4%, p = 1.000). Conclusion: BTL of the ITA during subtotal thyroidectomy causes a larger decrease in PTH but does not lead to a significantly higher rate of clinically manifest hypoparathyroidism. BTL of the ITA, age >61 years, and a very small thyroid remnant (<2 ml) may be risk factors for post-operative hypoparathyroidism.

scholarly journals Prematurity detection evaluating interaction between the skin of the newborn and light: protocol for the preemie-test multicentre clinical trial in Brazilian hospitals to validate a new medical device

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e027442 ◽  
Author(s):  
Zilma Silveira Nogueira Reis ◽  
Rodney Nascimento Guimarães ◽  
Maria Albertina Santiago Rego ◽  
Roberta Maia de Castro Romanelli ◽  
Juliano de Souza Gaspar ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Medical Device ◽  
Primary Outcome ◽  
Skin Reflectance ◽  
Registration Number ◽  
Neonatal Skin ◽  
The Difference ◽  
Nested Case Control ◽  
Lung Maturity ◽  
Control Study

IntroductionRecognising prematurity is critical in order to attend to immediate needs in childbirth settings, guiding the extent of medical care provided for newborns. A new medical device has been developed to carry out the preemie-test, an innovative approach to estimate gestational age (GA), based on the photobiological properties of the newborn’s skin. First, this study will validate the preemie-test for GA estimation at birth and its accuracy to detect prematurity. Second, the study intends to associate the infant’s skin reflectance with lung maturity, as well as evaluate safety, precision and usability of a new medical device to offer a suitable product for health professionals during childbirth and in neonatal care settings.Methods and analysisResearch protocol for diagnosis, single­group, single­blinding and single­arm multicenter clinical trial with a reference standard. Alive newborns, with 24 weeks or more of pregnancy age, will be enrolled during the first 24 hours of life. Sample size is 787 subjects. The primary outcome is the difference between the GA calculated by the photobiological neonatal skin assessment methodology and the GA calculated by the comparator antenatal ultrasound or reliable last menstrual period (LMP). Immediate complications caused by pulmonary immaturity during the first 72 hours of life will be associated with skin reflectance in a nested case–control study.Ethics and disseminationEach local independent ethics review board approved the trial protocol. The authors intend to share the minimal anonymised dataset necessary to replicate study findings.Trial registration numberRBR-3f5bm5.

scholarly journals Association between continued residence in temporary prefabricated housing and musculoskeletal pain in survivors of the Great East Japan Earthquake: a longitudinal study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030761 ◽  
Author(s):  
Yasuhito Sogi ◽  
Yutaka Yabe ◽  
Yoshihiro Hagiwara ◽  
Takuya Sekiguchi ◽  
Yumi Sugawara ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Multiple Logistic Regression Analysis ◽  
Panel Study ◽  
Public Support ◽  
Primary Outcome Measure ◽  
Great East Japan Earthquake ◽  
Lower Back ◽  
The Difference ◽  
Prefabricated Houses ◽  
New Onset

ObjectiveProlonged periods of living in prefabricated houses (PHs) may increase the risk of musculoskeletal (MSK) symptoms; however, the association is not clear. This study aimed to investigate the association between continued residence in PHs and MSK pain in a population affected by a natural disaster, the Great East Japan Earthquake (GEJE) survivors.Design, setting and participantsA panel study was conducted including 1059 and 792 survivors at 2 and 4 years, respectively, after the GEJE, using a self-reported questionnaire. Those with no response on living status and those who did not live in a PH were excluded. Participants were classified into two groups by living status: continued residence in a PH (lived in a PH during both periods) or moving out of a PH (lived in a PH in the first period and did not live in a PH in the second).Primary outcome measureMSK pain included lower back, shoulder, knee, hand or foot, and neck pain. Changes in the occurrence of MSK pain during the two periods were assessed and defined as ‘new-onset’ and ‘continuing’ MSK pain. Multiple logistic regression analysis was used to examine the influence of continued residence in a PH on new-onset and continuing MSK pain.ResultsContinued residence in a PH was significantly associated with new-onset MSK pain, even after adjustment for covariates (adjusted OR 2.18, 95% CI 1.25 to 3.79, p=0.006). Participants who continued living in a PH had higher rates of continuing MSK pain than those who moved out; however, the difference was not significant (adjusted OR 1.69, 95% CI 0.94 to 3.05, p=0.079).ConclusionContinued residence in a PH was associated with new-onset MSK pain among survivors. Public support should be provided to such people to ensure a more comfortable life.

scholarly journals The Adverse Impact of the COVID-19 Pandemic on Abdominal Emergencies: A Retrospective Clinico-Pathological Analysis

2021 ◽  
Vol 10 (22) ◽  
pp. 5254
Author(s):  
Elena Vissio ◽  
Enrico Costantino Falco ◽  
Gitana Scozzari ◽  
Antonio Scarmozzino ◽  
Do An Andrea Trinh ◽  
...  
Keyword(s):  
Disease Severity ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Significant Drop ◽  
Abdominal Emergencies ◽  
The Difference ◽  
Pathological Disease ◽  
And Control ◽  
First Time

The COVID-19 pandemic has caused a worldwide significant drop of admissions to the emergency department (ED). The aim of the study was to retrospectively investigate the pandemic impact on ED admissions, management, and severity of three abdominal emergencies (appendicitis, diverticulitis, and cholecystitis) during the COVID-19 pandemic using 2017–2019 data as a control. The difference in clinical and pathological disease severity was the primary outcome measure while differences in (i) ED admissions, (ii) triage urgency codes, and (iii) surgical rates were the second ones. Overall, ED admissions for the selected conditions decreased by 34.9% during the pandemic (control: 996, 2020: 648) and lower triage urgency codes were assigned for cholecystitis (control: 170/556, 2020: 66/356, p < 0.001) and appendicitis (control: 40/178, 2020: 21/157, p = 0.031). Less surgical procedures were performed in 2020 (control: 447, 2020: 309), but the surgical rate was stable (47.7% in 2020 vs. 44.8% in 2017–2019). Considering the clinical and pathological assessments, a higher percentage of severe cases was observed in the four pandemic peak months of 2020 (control: 98/192, 2020: 87/109; p < 0.001 and control: 105/192, 2020: 87/109; p < 0.001). For the first time in this study, pathological findings objectively demonstrated an increased disease severity of the analyzed conditions during the early COVID-19 pandemic.

Safety and tolerability of topical polyhexamethylene biguanide: a randomised clinical trial in healthy adult volunteers

2020 ◽  
pp. bjophthalmol-2020-317848
Author(s):  
Vincenzo Papa ◽  
Ivanka van der Meulen ◽  
Sylvie Rottey ◽  
Guy Sallet ◽  
Jolanda Overweel ◽  
...  
Keyword(s):  
Adverse Events ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Randomised Clinical Trial ◽  
Treatment Groups ◽  
Formal Safety Assessment ◽  
Registration Number ◽  
Potential Benefits ◽  
The Difference ◽  
Adult Volunteers

Background and AimsPolyhexamethyl biguanide (PHMB), a widely used topical treatment for Acanthamoeba keratitis (AK), is unlicensed with no formal safety assessment. This study evaluated its safety and tolerability.MethodsA prospective, randomised, double-masked controlled trial in 90 healthy volunteers. Subjects were treated with topical 0.04%, 0.06%, 0.08% PHMB or placebo (vehicle) 12× daily for 7 days, then 6× daily for 7 days. The rates of dose-limiting adverse events (DLAEs) leading to interruption of dosing, mild adverse events (AEs) (not dose limiting) and incidental AEs (unrelated to treatment) were compared. The primary outcome was the difference between treatments for DLAE rates.Results5/90 subjects developed DLAE within <1–4 days of starting treatment; 2/5 using PHMB 0.06% and 3/5 PHMB 0.08%. These resolved within 1–15 days. There were no significant differences in DLAE between treatment groups. Mild AEs occurred in 48/90 subjects (including placebo). There was no trend for an increased incidence of any AE with increasing concentrations of PHMB, except for corneal punctate keratopathy with PHMB 0.08%, which fully resolved within 7–14 days.ConclusionThese findings are reassuring for PHMB 0.02% users. They also suggest that higher PHMB concentrations may show acceptable levels of tolerance and toxicity in AK subjects, whose susceptibility to AE may be greater than for the normal eyes in this study. Given the potential benefits of higher PHMB concentrations for treating deep stromal invasion in AK, we think that the use of PHMB 0.08% is justified in treatment trials.Trial registration numberNCT02506257.

Clinical Effectiveness of Liposomal Bupivacaine Administered by Infiltration or Peripheral Nerve Block to Treat Postoperative Pain

2020 ◽  
Author(s):  
Brian M. Ilfeld ◽  
James C. Eisenach ◽  
Rodney A. Gabriel
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Primary Outcome ◽  
Peripheral Nerve Block ◽  
Clinical Effectiveness ◽  
Primary Outcome Measure ◽  
Nerve Blocks ◽  
Liposomal Bupivacaine ◽  
Randomized Controlled

The authors provide a comprehensive summary of all randomized, controlled trials (n = 76) involving the clinical administration of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, USA) to control postoperative pain that are currently published. When infiltrated surgically and compared with unencapsulated bupivacaine or ropivacaine, only 11% of trials (4 of 36) reported a clinically relevant and statistically significant improvement in the primary outcome favoring liposomal bupivacaine. Ninety-two percent of trials (11 of 12) suggested a peripheral nerve block with unencapsulated bupivacaine provides superior analgesia to infiltrated liposomal bupivacaine. Results were mixed for the 16 trials comparing liposomal and unencapsulated bupivacaine, both within peripheral nerve blocks. Overall, of the trials deemed at high risk for bias, 84% (16 of 19) reported statistically significant differences for their primary outcome measure(s) compared with only 14% (4 of 28) of those with a low risk of bias. The preponderance of evidence fails to support the routine use of liposomal bupivacaine over standard local anesthetics.

Sign in / Sign up

Export Citation Format

Share Document