Evaluation of ultrasound-guided rhomboid intercostal nerve block for postoperative analgesia in breast cancer surgery: a prospective, randomized controlled trial

2020 ◽  
Vol 45 (4) ◽  
pp. 277-282 ◽  
Author(s):  
Başak Altıparmak ◽  
Melike Korkmaz Toker ◽  
Ali Ihsan Uysal ◽  
Özcan Dere ◽  
Bakiye Uğur
Keyword(s):  
Postoperative Analgesia ◽  
Radical Mastectomy ◽  
Opioid Consumption ◽  
Control Group ◽  
Axillary Lymph ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Quality Of Recovery ◽  
Pain Scores

Background and objectivesMastectomy has many potential sources of pain. Rhomboid intercostal block (RIB) is a recently described plane block. The primary hypothesis of the study is that ultrasound-guided RIB combined with general anesthesia would accelerate global quality of recovery scores of patients following mastectomy surgery. Secondary hypothesis is that RIB would reduce postoperative opioid consumption, pain scores, and the need for rescue analgesia.MethodsPatients aged between 18 and 70 years, with American Society of Anesthesiologists physical status I–II and scheduled for an elective unilateral modified radical mastectomy surgery with axillary lymph node dissection were enrolled to the study. Following endotracheal intubation, patients were randomly allocated into two groups. Patients in the first group (group R) received ultrasound-guided RIB with 30 mL 0.25% bupivacaine. In the control group (group C), no block intervention was applied. All patients received intravenous dexamethasone 8 mg, dexketoprofen trometamol 50 mg intraoperatively and tramadol 1 mg/kg 30 min before the end of surgery for postoperative analgesia. All patients received intravenous morphine patient-controlled analgesia device at the arrival to the recovery room.ResultsThe descriptive variables of the patients were comparable between group R and group C. Mean quality of recovery-40 score at 24 hours was 164.8±3.9 in group R and 153.5±5.2 in group C (mean difference 11.4 (95% CI 8.8 to 13.9; p<0.001). At 24th hour, median morphine consumption was 5 mg (IQR 4–7 mg) in group R and 10 mg (IQR 8–13 mg) in group C, p<0.001. Intraoperative fentanyl administration, pain scores and the need for rescue postoperative analgesia was similar between groups.ConclusionsIn the current study, ultrasound-guided RIB promoted enhanced recovery and decreased opioid consumption after mastectomy surgery.Trial registration numberACTRN12619000879167.

scholarly journals Transcutaneous Electrical Acupoint Stimulation Improves the Postoperative Quality of Recovery and Analgesia after Gynecological Laparoscopic Surgery: A Randomized Controlled Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Yusheng Yao ◽  
Qiuyan Zhao ◽  
Cansheng Gong ◽  
Yihuan Wu ◽  
Ying Chen ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Control Group ◽  
Patient’S Satisfaction ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
Pacu Stay ◽  
Acupoint Stimulation

Background. We conducted this prospective, randomized, double-blind, placebo-controlled study to evaluate the effects of transcutaneous electric acupoint stimulation (TEAS) on the quality of recovery (QoR) and postoperative analgesia after gynecological laparoscopic surgery.Methods. 74 American Society of Anesthesiologists physical status (ASA) I or II patients undergoing gynecological laparoscopic surgery were randomly allocated to TEAS or control groups. The primary outcome was the quality of recovery, which was assessed on the day before surgery and 24 h after surgery using a 40-item questionnaire. Secondary outcomes included postoperative pain scores, the incidence of postoperative nausea and vomiting (PONV), duration of postanesthesia care unit (PACU) stay, and patient’s satisfaction.Results. The TEAS group had higher QoR scores than control group upon 24 h after surgery (177 versus 165;P<0.001). Compared with the control group, postoperative pain scores and the cumulative number of opioids administered were lower in the TEAS group patients (P=0.04). TEAS reduced the incidence of PONV and dizziness, as well as duration of PACU stay. Simultaneously, the patient’s satisfaction scores were higher in the TEAS group (P=0.002).Conclusion. Preoperative TEAS enhances QoR, improves postoperative analgesia and patient’s satisfaction, alleviates postoperative side effects, and accelerates discharge after general anesthesia for gynecological laparoscopic surgery.

scholarly journals The Effect of Ultrasound Guided Superficial Cervical Plexus Block on Postoperative Opioid Consumption in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgery: A Prospective, Randomized Controlled Study

2021 ◽  
Author(s):  
İrem Ateş ◽  
Erkan Cem Çelik ◽  
Ufuk DEmir ◽  
Muhammed Enes Aydın ◽  
Ali Ahiskalıoğlu
Keyword(s):  
Opioid Consumption ◽  
Anterior Cervical Discectomy ◽  
Controlled Study ◽  
Control Group ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Cervical Discectomy ◽  
Pain Scores ◽  
Significant Difference ◽  
Vas Scores

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) surgery is a procedure that can cause moderate pain in the postoperative period. Superficial cervical block (SCB) is a regional anesthesia technique that can provide analgesia during and after surgery. The aim of this study is to investigate the effect of ultrasound-guided SCB block on pain scores and postoperative opioid consumption in patients undergoing ACDF surgery. METHODS: 48 patients planned to undergo single or two levels of ACDF surgery were randomly divided into two groups, SCB and Control (C). Ultrasonography (USG) guided SCB was performed in the SCB group (n=24) with 10 mL of 0.25% bupivacaine. No attempt was made to the control group (n=24) before the operation. Intravenous 50 mg dexketoprofen was administered to both groups half an hour before the end of the operation and at the 12th hour postoperatively. Patient controlled analgesia (PCA) device containing fentanyl was initiated. Postoperative visual analog scale (VAS) scores, opioid consumption, need for rescue analgesia and side effects were recorded. RESULTS: There was no statistically significant difference between the groups in terms of demographic data, anesthesia and surgery times. Compared to the control group, VAS scores were statistically low at all measurement times in the SCB group (p <0.05). The 24-hour total opioid consumption was statistically significantly higher in the control group than in the SCB group (375.83±235.96 µg vs. 112.50±102.41 µg, respectively p<0.001). The need of rescue analgesia was statistically higher in the control group than the SCB group (12/24 vs. 0/24, respectively, p <0.001). DISCUSSION AND CONCLUSION: We believe that USG-guided SCB can be an effective component of the multimodal analgesia protocol by reducing opioid consumption and pain scores in patients undergoing ACDF surgery.

scholarly journals Efficacy of ultrasound-guided erector spinae plane block on postoperative quality of recovery and analgesia after modified radical mastectomy: randomized controlled trial

2019 ◽  
Vol 45 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Yusheng Yao ◽  
Hao Li ◽  
Qiaolan He ◽  
Tingting Chen ◽  
Yihang Wang ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Radical Mastectomy ◽  
Erector Spinae ◽  
Control Group ◽  
Modified Radical Mastectomy ◽  
Quality Of Recovery ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Pain Scores

BackgroundErector spinae plane block (ESPB) is a novel regional anesthesia technique that is gaining popularity for postoperative pain management. This randomized controlled trial evaluated the effect of ESPB on quality of recovery (QoR) in patients undergoing modified radical mastectomy.MethodsEighty-two female patients undergoing modified radical mastectomy were included. Patients were randomly assigned to receive preoperative ultrasound-guided ESPB with either 0.5% ropivacaine or saline. The primary outcome was QoR, assessed 24 hours postoperatively using the 15-item QoR questionnaire (QoR-15). Secondary outcomes included postoperative pain scores, postoperative cumulative opioid consumption, postanesthesia care unit (PACU) discharge time, postoperative nausea or vomiting and dizziness.ResultsGlobal QoR-15 scores 24 hours postoperatively were significantly higher (indicating better quality) in the ESPB group (median 120, IQR 118–124) compared with the control group (median 110, IQR 108.3–112.8), with a median difference of 10 (95% CI 9 to 12, p<0.001). Compared with the control group, ESPB with ropivacaine reduced pain scores up to 8 hours after surgery, as well as reduced postoperative cumulative opioid consumption and PACU discharge time.ConclusionsA single preoperative injection of ESPB with ropivacaine may improve QoR postoperatively and acute postoperative analgesia in patients undergoing a modified radical mastectomy.Trial registration numberChiCTR-1800019599.

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.

scholarly journals Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery

2018 ◽  
Vol 28 (1) ◽  
pp. 119-126 ◽  
Author(s):  
Lauren K. Dunn ◽  
Marcel E. Durieux ◽  
Lucas G. Fernández ◽  
Siny Tsang ◽  
Emily E. Smith-Straesser ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Rating Scale ◽  
Psychological Intervention ◽  
Opioid Consumption ◽  
Anxiety And Depression ◽  
Opioid Use ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
The Impact

OBJECTIVEPerception of perioperative pain is influenced by various psychological factors. The aim of this study was to determine the impact of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain scores, and quality of recovery in adults who underwent spine surgery.METHODSPatients undergoing spine surgery were enrolled in this study, and the preoperatively completed questionnaires included the verbal rating scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Quality of recovery was assessed using the 40-item Quality of Recovery questionnaire (QoR40). Opioid consumption and pain scores according to the VRS were recorded daily until discharge.RESULTSOne hundred thirty-nine patients were recruited for the study, and 101 completed the QoR40 assessment postoperatively. Patients with higher catastrophizing scores were more likely to have higher maximum pain scores postoperatively (estimate: 0.03, SE: 0.01, p = 0.02), without increased opioid use (estimate: 0.44, SE: 0.27, p = 0.11). Preoperative anxiety (estimate: 1.18, SE: 0.65, p = 0.07) and depression scores (estimate: 1.06, SE: 0.71, p = 0.14) did not correlate with increased postoperative opioid use; however, patients with higher preoperative depression scores had lower quality of recovery after surgery (estimate: −1.9, SE: 0.56, p < 0.001).CONCLUSIONSCatastrophizing, anxiety, and depression play important roles in modulating postoperative pain. Preoperative evaluation of these factors, utilizing a validated tool, helps to identify patients at risk. This might allow for earlier psychological intervention that could reduce pain severity and improve the quality of recovery.

scholarly journals Combined Opioid Free and Loco-Regional Anesthesia Enhances the Quality of Recovery in Sleeve Gastrectomy Done Under ERAS Protocol: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Mohamed Ibrahim ◽  
Ali M Elnabtity ◽  
Ahmed Hegab ◽  
Omar A. Alnujaidi ◽  
Osama El Sanea
Keyword(s):  
Postoperative Pain ◽  
Regional Anesthesia ◽  
Oral Fluid ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
P Value ◽  
Rescue Analgesia ◽  
Quality Of Recovery ◽  
Eras Protocol

Abstract Background: There is still debate as to whether opioid-free anaesthsia (OFA) may offer additional benefit over multimodal analgesia to better achieve the goals of ERAS(Enhanced recovery after surgery) in bariatric surgery.Patients and method: Patients in the OFA group (n=51) were pre-medicated with IV dexmedetomidine 0.1 µg.kg-1 then induced with propofol (2 mg. kg-1) -ketamine (0.5 mg. kg-1) mixture and maintained on dexmedetomidine 0.5µg. kg-1.h-1, ketamine 0.5 mg.kg-1.h-1, and lidocaine 1 mg. kg-1.h-1. Patients in the MMA(Multimodal analgesia) group (n= 52) were induced using IV propofol 2 mg. kg-1, and fentanyl 1 µg. kg-1. Cisatracurium (0.15 mg.kg-1) was given to all patients for muscle relaxation. Ultrasound-guided bilateral oblique subcostal transverse abdominis plane (OSTAP) block was performed in all patients. The postoperative quality of recovery at 6 and 24 hours was measured as a primary outcome. Postoperative pain control; subsequent opioid consumption; time to ambulate; time to tolerate oral fluid; and time to readiness for discharge were measured as secondary outcomes Results: The total QoR-40 (quality of recovery-40) scores at 6 hours were significantly higher in the OFA group (184.84 versus 180.69 in the MMA group with an estimated difference in mean of -4.15, 95% CI, -5.78 to -2.5, and P ˂0.001. The OFA group tolerated oral fluid intake earlier (194.94, 95% CI, 162.59 to 227.30) versus (273, 95% CI, 223.65 to 322.27) for the MMA group (p value=0.009). Readiness for discharge was significantly quicker in the OFA group (447.49, 95% CI, 409.69 to 485.29 versus 544.56, 95% CI, 503.08 to 586.04 in the MMA group, P-value =0.001). The post-anesthesia care unit (PACU) (0 Hour) and the floor 2 and 6-hour numerical rating scales (NRS) for pain were significantly higher in the MMA group. The OFA group needed less opioid rescue analgesia in the PACU and at 24-hours (P value= 0.003 and 0.014; respectively).Conclusion: Combined Opioid free and loco-regional anesthesia provides better early recovery with reduced postoperative pain intensity, and opioid consumption when compared to multimodal analgesia; and is better suited to achieve the goals of ERAS protocol.Clinical trial number: registration number NCT04285255.

scholarly journals Ultrasound-guided Erector Spinae Plane Block for postoperative analgesia: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Jiao Huang ◽  
Jing Chen Liu
Keyword(s):  
Randomized Controlled Trials ◽  
Postoperative Analgesia ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Controlled Trials ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Pain Scores

Abstract Background: Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its safety and effectiveness remain uncertain. This meta-analysis aimed to determine the clinical safety and efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries.Methods: A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Results: A total of 11 RCTs consisting of 540 patients were included. Ultrasound -guided ESPB showed a reduction of iv. opioid consumption 24 h after surgery (SMD=-2.15; 95% confidence interval (CI) -2.76 to -1.5,p<0.00001), pain scores at 1st hour (SMD=-0.97;95% CI -1.84 to -0.1,p=0.03) and pain scores at 6th hour (SMD=-0.64,95% CI -1.05 to -0.23,p=0.002), Also, it lessened the number of patients who required postoperative analgesia ( RR=0.41,95% CI 0.25 to 0.66,p=0,0002) and time to first rescue analgesia (SMD=4.56,95% CI 1.89 to 7.22, p=0.0008). Differences were not significant with the pain score at 12th hour,24th hour and postoperative nausea and vomiting (PONV).Conclusions: Ultrasound-guided ESPB provides postoperative analgesic efficacy in adults undergoing GA surgeries with no increase in PONV.

scholarly journals Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic Cholecystectomy

2011 ◽  
Vol 114 (4) ◽  
pp. 882-890 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Steven B. Greenberg ◽  
Michael J. Avram ◽  
Jeffery S. Vender ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Postanesthesia Care Unit ◽  
Control Group ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
Dexamethasone Group

Background The effect of dexamethasone on quality of recovery after discharge from the hospital after laparoscopic surgery has not been examined rigorously in previous investigations. We hypothesized that preoperative dexamethasone would enhance patient-perceived quality of recovery on postoperative day 1 in subjects undergoing laparoscopic cholecystectomy. Methods One hundred twenty patients undergoing outpatient laparoscopic cholecystectomy were randomized to receive either dexamethasone (8 mg) or placebo-saline. A 40-item quality-of-recovery scoring system (QoR-40) was administered preoperatively and on postoperative day 1 to all subjects. Nausea, vomiting, fatigue, and pain scores were recorded at the time of discharge from the postanesthesia care unit and ambulatory surgical unit. Hospital length of stay was also assessed. Results Global QoR-40 scores on postoperative day 1 were higher in the dexamethasone group (median [range], 178 [130-195]) compared with the control group (161 [113-194]) (median difference [99% CI], -18 [-26 to -8]; P &lt; 0.0001). Postoperative QoR-40 scores in the dimensions of emotional state, physical comfort, and pain were all improved in the dexamethasone group compared with the control group (P &lt; 0.001). Nausea, fatigue, and pain scores were all reduced in the dexamethasone group during the hospitalization, as were postoperative analgesic requirements (P &lt; 0.05). Total hospital length of stay was also reduced in subjects administered steroids (P = 0.003). Conclusions Among patients undergoing outpatient laparoscopic cholecystectomy surgery, the use of preoperative dexamethasone enhanced postdischarge quality of recovery and reduced nausea, pain, and fatigue in the early postoperative period.

scholarly journals Ultrasound-guided bilateral superficial cervical plexus block enhances the quality of recovery of uremia patients with secondary hyperparathyroidism following parathyroidectomy: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shenghong Hu ◽  
Teng Shu ◽  
Siqi Xu ◽  
Xia Ju ◽  
Shengbin Wang ◽  
...  
Keyword(s):  
Ultrasound Guided ◽  
Cervical Plexus ◽  
Total Consumption ◽  
Rescue Analgesia ◽  
Quality Of Recovery ◽  
Superficial Cervical Plexus Block ◽  
Vas Scores ◽  
Cervical Plexus Block ◽  
Plexus Block

Abstract Background Parathyroidectomy has been proposed as a method for reducing parathyroid hormone levels. We evaluated the effects of ultrasound-guided bilateral superficial cervical plexus block (BSCPB) on the quality of recovery of uremia patients with secondary hyperparathyroidism (SHPT) following parathyroidectomy. Methods Eighty-two uremia patients who underwent parathyroidectomy and exhibited SHPT were randomly allocated to the BSCPB group or the control group (CON group). The patients received ultrasound-guided BSCPB with 7.5 ml of ropivacaine 0.5% on each side (BSCPB group) or equal amount of 0.9% normal saline (CON group). The primary outcome of the Quality of Recovery-40(QoR-40) score was recorded on the day before surgery and postoperative day 1(POD1). Secondary outcomes including total consumption of remifentanil, time to first required rescue analgesia, number of patients requiring rescue analgesia, and total consumption of tramadol during the first 24 h after surgery were recorded. The occurrence of postoperative nausea or vomiting (PONV) and the visual analogue scale (VAS) scores were assessed and recorded. Results The scores on the pain and emotional state dimensions of the QoR-40 and the total QoR-40 score were higher in the BSCPB group than in the CON group on POD1 (P = 0.000). Compared with the CON group, the total consumption of remifentanil was significantly decreased in the BSCPB group (P = 0.000). The BSCPB group exhibited longer time to first required rescue analgesia (P = 0.018), fewer patients requiring rescue analgesia (P = 0.000), and lower postoperative total consumption of tramadol during the first 24 h after surgery (P = 0.000) than the CON group. The incidence of PONV was significantly lower in the BSCPB group than in the CON group (P = 0.013). The VAS scores in the BSCPB group were lower than those in the CON group at all time-points after surgery (P = 0.000). Conclusion Ultrasound-guided BSCPB with ropivacaine 0.5% can enhance the quality of recovery, postoperative analgesia, and reduce the incidence of PONV in uremia patients with SHPT following parathyroidectomy. Trial registration ChiCTR1900027185 . (Prospective registered). Initial registration date was 04/11/2019.

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