Bilateral ultrasound-guided thoracic erector spinae plane blocks using a programmed intermittent bolus improve opioid-sparing postoperative analgesia in pediatric patients after open cardiac surgery: a randomized, double-blind, placebo-controlled trial

2020 ◽  
Vol 45 (10) ◽  
pp. 805-812
Author(s):  
Philippe Macaire ◽  
Nga Ho ◽  
Vien Nguyen ◽  
Hieu Phan Van ◽  
Kim Dinh Nguyen Thien ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Intermittent Bolus ◽  
Drain Removal ◽  
Group 2 ◽  
Postoperative Morphine ◽  
Group 1

BackgroundPostoperative pain after pediatric cardiac surgery is usually treated with intravenous opioids. Recently, the focus has been on postoperative regional analgesia with the introduction of ultrasound-guided erector spinae plane blocks (ESPBs). We hypothesized that bilateral ESPB with a programmed intermittent bolus (PIB) regimen decreases postoperative morphine consumption at 48 hours and improves analgesia in children who undergo cardiac surgery.MethodsThis randomized, double-blind, placebo-controlled study comprised 50 children who underwent cardiac surgery through midline sternotomy. The patients were allocated randomly into two groups: ultrasound-guided bilateral ESPB at the level of T3–T4 transverse process then PIB with saline infusion (group 1, n=23) or PIB with 0.2% ropivacaine (group 2, n=27). Intravenous morphine at 30 µg/kg/hour was used as rescue analgesia. Postoperative pain was assessed using the COMFORT-B score for extubation, drain removal, and mobilization, and the FLACC (Face, Legs, Activity, Cry, Consolability) scale at 0, 2, 4, 6, 8, 12, 16, 20, 24, 36, and 48 hours after surgery. Adverse events were noted.ResultsThe total dose of morphine in 48 hours was significantly decreased in patients receiving a bilateral ESPB with ropivacaine (120±320 µg/kg) compared with patients with saline infusion (512±560 µg/kg; p=0.03). Fourteen per cent of patients required rescue analgesia with morphine in group 2 compared with 41% in group 1 (p=0.05). The patients in group 2 demonstrated significantly reduced COMFORT-B scores at extubation, drain removal, and mobilization compared with those in group 1 and had reduced FLACC scale levels at 20 and 24 hours postoperatively (p=0.05 and p=0.001, respectively). No differences were reported for extubation and drain removal times or for length of hospital stay. In addition, vomiting episodes were decreased in group 2 (p=0.01).ConclusionsIn pediatric cardiac surgery, the results of this study confirm our hypothesis that bilateral ESPB analgesia with ropivacaine decreases the postoperative morphine consumption at 48 hours and demonstrates better postoperative analgesia compared with a control group.Trial registration numberNCT03593642.

scholarly journals Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Aik Bouzia ◽  
Vassilios Tassoudis ◽  
Menelaos Karanikolas ◽  
George Vretzakis ◽  
Argyro Petsiti ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cardiac Surgery ◽  
Sleep Disturbances ◽  
Median Sternotomy ◽  
Double Blind Study ◽  
Double Blind ◽  
Elective Cardiac Surgery ◽  
Group 2 ◽  
Postoperative Morphine ◽  
Group 1

Introduction. Pain after cardiac surgery affects long-term patient wellness. This study investigated the effect of preoperative pregabalin on acute and chronic pain after elective cardiac surgery with median sternotomy. Methods. Prospective double blind study. 93 cardiac surgery patients were randomly assigned into three groups: Group 1 received placebo, Group 2 received oral pregabalin 75 mg, and Group 3 received oral pregabalin 150 mg. Data were collected 8 hours, 24 hours, and 3 months postoperatively. Results. Patients receiving pregabalin required fewer morphine boluses (10 in controls versus 6 in Group 1 versus 4 in Group 2, p=0.000) and had lower pain scores at 8 hours (4 versus 3 versus 3, p=0.001) and 3 months (3 versus 2 versus 2, p=0.000) and lower morphine consumption at 8 hours (14 versus 13 versus 12 mg, p=0.000) and 24 hours (19.5 versus 16 versus 15 mg, p=0.000). Percentage of patients with sleep disturbances or requiring analgesics was lower in the pregabalin group and even lower with higher pregabalin dose (16/31 versus 5/31 versus 3/31, p=0.000, and 26/31 versus 16/31 versus 10/31, p=0.000, resp.) 3 months after surgery. Conclusion. Preoperative oral pregabalin 75 or 150 mg reduces postoperative morphine requirements and acute and chronic pain after cardiac surgery.

A randomized double blind controlled trial to assess the efficacy of ultrasound-guided erector spinae plane block in cardiac surgery

2021 ◽  
Author(s):  
Doctor Manazir Athar ◽  
Doctor Sania Parveen ◽  
Doctor Mayank Yadav ◽  
Doctor Obaid Ahmad Siddiqi ◽  
Doctor Farah Nasreen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Controlled Trial ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Double Blind ◽  
Erector Spinae Plane Block

Study of efficacy of ultrasonography guided erector spinae plane block for abdominothoracic surgeries

2021 ◽  
Vol 19 (3) ◽  
pp. 100-104
Author(s):  
Amol B Sasane ◽  
Keyword(s):  
Blood Pressure ◽  
Postoperative Analgesia ◽  
Analgesic Efficacy ◽  
Erector Spinae ◽  
Lumbar Region ◽  
Ultrasound Guided ◽  
Erector Spinae Plane Block ◽  
Score Difference ◽  
Group 2 ◽  
Group 1

Background: Erector spinae block (ESPB) provides analgesia by targeting the dorsal and ventral rami of the spinal nerves,performed in the lumbar region for postoperative analgesia of abdomino-thoracic surgeries. This study was aimed to assess the efficacy of Erector spinae block (ESPB) on postoperative analgesia in patients undergoing abdominothoracic surgeries under general anesthesia. Material and Methods: Present study was prospective, randomized, comparative study, conducted in patients with 18-70 years age, ASA grade- I/II, posted for abdominothoracic surgeries, Mallampatti scores - I and II, consented for participation. 120 patients were randomly assigned into two groups of 60 each, to either Erector spine block group (Group 1) or conventional pain killers (Group 2). Results: General characteristics such as age, height, weight, BMI were comparable in both groups and difference was not statistically significant. The postoperative systolic blood pressure, diastolic blood pressure, heart rate and Mean post-operative VAS score difference was statistically significant, from 30 minutes post-operative to 480 mins (8 hours). Group 1 have significantly less amount opioid requirement as none of the patients required inj tramadol more than 100 mg and only 5 (8.33%) cases required 100 mg whereas in the Group 2 73.33% required inj tramadol more than 100 mg and 8.55% required 175 mg. Group 1 have significantly long period of opioid free time as during first 2 hours none of the patients required inj tramadol whereas in the Group 2 83.33% required inj tramadol in the first 2 hours. Conclusion: In our study we concluded that the analgesic efficacy of Ultrasound guided Erector spinae block is an effective procedure over systemic analgesics and provide better patient satisfaction and compliance

scholarly journals Ultrasound guided bilateral erector spinae plane block for post-surgical pain in patients after thoracic surgery

Pain medicine ◽  
2019 ◽  
Vol 4 (1/1) ◽  
pp. 19
Author(s):  
D V Dmytriiev ◽  
E O Glazov ◽  
O V Marchuk ◽  
B V Zaletskiy
Keyword(s):  
Thoracic Surgery ◽  
Rating Scale ◽  
Analgesic Efficacy ◽  
Transverse Process ◽  
Erector Spinae ◽  
Primary Study ◽  
Anesthesia Induction ◽  
Ultrasound Guided ◽  
Group 2 ◽  
Group 1

Objective: To examine the analgesic efficacy of bilateral erector spinae plane (ESP) block compared with conventional treatment for pain after thoracic surgery. Methods: 34 patients with thoracic trauma were divided into 2 groups. Patients in group 1 (ESP block group, n = 14) received ultrasound-guided bilateral ESP block with 3 mg/kg of 0.375 % ropivacaine before anesthesia induction at the T6 transverse process level (Fig. 1). Patients in group 2 (acetaminophen and morphin group, n = 20) received acetaminophen (15 mg/kg every 6 hours – maximum 1 g) and morphine (10 mg every 8 hours) intravenously in the postoperative period. The primary study outcome was to evaluate pain at rest using a 10-point numeric rating scale (NRS). Mann – Whitney U-test was used for comparing NRS scores. Results: The postoperative pain level after extubating and duration of analgesia during which NRS was < 4 of 10 was compared be-tween the groups. The median pain score at rest after extubating in group 1 was 0 of 10 until hour 6, 3 of 10 at hour 8, and 4 of 10 at hours 10 and 12 postextubation. These were significantly less in comparison with group 2 (p = 0.0001). Patients in group 1 had a significantly higher mean duration of analgesia (11.04 ± 0.18 hours), during which NRS was < 4 of 10, compared with group 2 (4.18 ± 0.14 hours) (p = 0.0001). Conclusion: ESP block safely provided significantly better pain relief at rest for longer duration as compared to intravenous acetaminophen and morphine.

scholarly journals Randomized, double-blind, placebo-controlled study of the analgesic effect of intraoperative esmolol for laparoscopic gastroplasty

2019 ◽  
Author(s):  
Vinicius Barros Duarte de Morais ◽  
Rioko Kimiko Sakata ◽  
Ana Paula Santana Huang ◽  
Leonardo Henrique da Cunha Ferraro
Keyword(s):  
Side Effects ◽  
Pain Intensity ◽  
Analgesic Effect ◽  
Multimodal Analgesia ◽  
Controlled Study ◽  
Physical Status ◽  
Double Blind ◽  
Group 2 ◽  
Postoperative Morphine ◽  
Group 1

Abstract Background Patients undergoing bariatric surgery can have respiratory complications in addition to vomiting and ileus. Esmolol can decrease the consumption of opioids, reducing their side effects. The purpose of this study was to evaluate the analgesic effect of esmolol in patients allocated to laparoscopic gastroplasty. Methods Forty patients between 18 and 50 years old, of both genders, physical status ASA I-II, who underwent bypass gastroplasty were divided into two groups. Participants in group 1 received a 0.5 mg/kg bolus of esmolol in 30 mL of saline before induction of anesthesia, followed by infusion of 15µg/kg/min until the end of surgery; those in group 2 received 30 mL of saline bolus and infusion of solution in the same volume as group 1. The anesthesia included fentanyl (5ug/kg), propofol (2-4 mg/kg), rocuronium (0.6 mg/kg), 50% oxygen without nitrous oxide and 2% sevoflurane, with remifentanil if necessary. There were evaluated: remifentanil consumption, time to analgesic supplementation, pain intensity for 24 h and morphine dose over 24 h. Side effects were noted. Results Intraoperative remifentanil supplementation, time to recovery, and postoperative morphine supplementation were lower in the esmolol group; there was no difference in time for the first supplementation. Pain intensity was lower, except at T0 and after 12 h. There were no differences in side effects. Conclusions Intraoperative esmolol promotes an analgesic effect without causing adverse effects, making it an effective drug for multimodal analgesia for gastroplasty.

Cephradine and cefazolin plasma levels during cardiac surgery

Perfusion ◽  
1986 ◽  
Vol 1 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Sergio V Moran ◽  
Francisco Montiel ◽  
Guillermo Acuña ◽  
Jeanette Vergara ◽  
Manuel J Irarrazaval ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Plasma Levels ◽  
Early Postoperative Period ◽  
Good Choice ◽  
Double Blind Study ◽  
Double Blind ◽  
Postoperative Course ◽  
Group 2 ◽  
Group 1

A prospective, randomized, double-blind study was carried out to evaluate two prophylactic regimes in patients undergoing cardiac surgery with cardiopulmonary bypass. Antibiotic plasma levels were measured in fifty consecutive adult patients undergoing valve and coronary surgery. They were divided into two comparable groups of 25 patients, each matched in age, sex, type of operation and duration of cardiopulmonary bypass. Group 1 received 1 g of cephradine with the anaesthetic premedication, 1 g in the prime of the oxygenator and 1 g every six hours during the first 72 hours of the postoperative course. Group 2 received cefazolin following the same protocol except that they received 1 g every eight hours during the postoperative course. There were no allergic or toxic reactions and no infections up to two months follow-up in both groups. Antibiotic plasma levels were significantly higher (p < 0·001) in the cefazolin group in four out of five sampling periods. Antibiotic plasma levels for group 1 versus group 2 were as follows: initial level 11·7 ± 5.2 mcg/ml vs 31 4 ± 35·4 mcg/ml. During cardiopulmonary bypass 26·6 ± 9·5 mcg/ml vs 51·7 ± 21 ·1 mcg/ml. Final levels 13·6 ± 7·0 mcg/ml vs 32·2 ± 17·8 mcg/ml. Baseline levels 2·7 ± 2·3 mcg/ml vs 6·· ± 7·7 mcg/ml and peak level 44·0 ± 16·2 mcg/ml vs 51·2 ± 23·4 mcg/ml (NS). The results of this study demonstrate that cefazolin achieved significantly higher plasma levels during the different phases of the operation and early postoperative period. Also, cefazolin and cephradine levels are above the minimal inhibitory concentrations for the gram positive and gram negative susceptible bacteria, except for the basal levels obtained by cephradine. The favourable pharmacokinetic characteristics of cefazolin, makes it a good choice for prophylactic use during cardiac surgery.

scholarly journals Erector Spinae Plane Block for Perioperative Analgesia after Percutaneous Nephrolithotomy

2021 ◽  
Vol 18 (7) ◽  
pp. 3625
Author(s):  
Piotr Bryniarski ◽  
Szymon Bialka ◽  
Michal Kepinski ◽  
Anna Szelka-Urbanczyk ◽  
Andrzej Paradysz ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Visual Analogue Scale ◽  
Percutaneous Nephrolithotomy ◽  
Analogue Scale ◽  
Erector Spinae ◽  
Rescue Analgesia ◽  
Erector Spinae Plane Block ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Erector spinae plane block was recently introduced as an alternative to postoperative analgesia in surgical procedures including thoracoscopies and mastectomies. There are no clinical trials regarding erector spinae plane block in percutaneous nephrolithotomy. The aim of our study was to test the efficacy and safety of erector spinae plane block after percutaneous nephrolithotomy. We analyzed 68 patients, 34 of whom received erector spinae plane block. The average visual analogue scale score 24 h postoperatively was the primary endpoint. The secondary endpoints were nalbuphine consumption and the need for rescue analgesia. Safety measures included the mean arterial pressure, Ramsey scale score, and rate of nausea and vomiting. The visual analogue scale, blood pressure, and Ramsey scale were assessed simultaneously at 1, 2, 4, 6, 12, and 24 h postoperatively. The average visual analogue scale was 2.9 and 3 (p = 0.65) in groups 1 (experimental) and 2 (control), respectively. The visual analogue scale after 1 h postoperatively was significantly lower in the erector spinae plane block group (2.3 vs. 3.3; p = 0.01). The average nalbuphine consumption was the same in both groups (46 mL vs. 47.2 mL, p = 0.69). The need for rescue analgesia was insignificantly different in both groups (group 1, 29.4; group 2, 26.4%; p = 1). The mean arterial pressure was similar in both groups postoperatively (91.8 vs. 92.5 mmHg; p = 0.63). The rate of nausea and vomiting was insignificantly different between the groups (group 1, 17.6%; group 2, 14.7%; p = 1). The median Ramsey scale in all the measurements was two. Erector spinae plane block is an effective pain treatment after percutaneous nephrolithotomy but only for a very short postoperative period.

Postoperative Morphine Use and Hyperalgesia Are Reduced by Preoperative but Not Intraoperative Epidural Analgesia

2003 ◽  
Vol 98 (6) ◽  
pp. 1449-1460 ◽  
Author(s):  
Joel Katz ◽  
Lorenzo Cohen ◽  
Roger Schmid ◽  
Vincent W.S. Chan ◽  
Adarose Wowk
Keyword(s):  
Morphine Consumption ◽  
Gynecologic Surgery ◽  
Control Group ◽  
Epidural Administration ◽  
Blinded Manner ◽  
Group 3 ◽  
Group 2 ◽  
Double Blinded ◽  
Postoperative Morphine ◽  
Group 1

Background The aim of this study was to evaluate the postoperative morphine-sparing effects and reduction in pain and secondary mechanical hyperalgesia after preincisional or postincisional epidural administration of a local anesthetic and an opioid compared with a sham epidural control. Methods Patients undergoing major gynecologic surgery by laparotomy were randomly assigned to three groups and studied in a double-blinded manner. Group 1 received epidural lidocaine and fentanyl before incision and epidural saline 40 min after incision. Group 2 received epidural saline before incision and epidural lidocaine and fentanyl 40 min after incision. Group 3 received a sham epidural control (with saline injected into a catheter taped to the back) before and 40 min after incision. All patients underwent surgery with general anesthesia. Results One hundred forty-one patients completed the study (group 1, n = 45; group 2, n = 49; group 3, n = 47). Cumulative patient-controlled analgesia morphine consumption at 48 h was significantly lower (P = 0.04) in group 1 (89.8 +/- 43.3 mg) than group 3 (112.5 +/- 71.5 mg) but not group 2 (95.4 +/- 60.2 mg), although the hourly rate of morphine consumption between 24 and 48 h after surgery was significantly lower (P &lt; 0.0009) in group 1 (1.25 +/- 0.02 mg/h) than group 2 (1.41 +/- 0.02 mg/h). Twenty-four hours after surgery, the visual analog scale pain score on movement was significantly less intense (P = 0.005) in group 1 (4.9 +/- 2.2 cm) than group 3 (6.0 +/- 2.6 cm) but not group 2 (5.3 +/- 2.5 cm), and the von Frey pain threshold near the wound was significantly higher (P = 0.03) in group 1 (6.4 +/- 0.6 log mg) than in group 3 (6.1 +/- 0.8 log mg) but not group 2 (6.2 +/- 0.7 log mg). Conclusions Preincisional administration of epidural lidocaine and fentanyl was associated with a significantly lower rate of morphine use, lower cumulative morphine consumption, and reduced hyperalgesia compared with a sham epidural condition. These results highlight the importance of including a standard treatment control group to avoid the problems of interpretation that arise when two-group studies of preemptive analgesia (preincisional vs. postsurgery) fail to find the anticipated effects.

scholarly journals Hypogammaglobulinemia as a Predictive Factor of Postoperative Complications in Pediatric Cardiac Surgery

2021 ◽  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Heart Defects ◽  
Blood Stream ◽  
Neonatal Unit ◽  
Pediatric Cardiac Surgery ◽  
Impact On Survival ◽  
Group 2 ◽  
Attending Physician ◽  
Group 1

Hypogammaglobulinemia, developed as a result of cardiac surgery accompanied by cardiopulmonary bypass (CPB), may be caused by hemodilution, destruction of immunoglobulin, extravasation into the interstitial space related to systemic inflammation, and capillary leak syndrome. Therefore, to address this gap, we analyzed the characteristics of the infants who developed hypogammaglobulinemia after cardiac surgery and could benefit from Immunoglobulin supplementation. Methods: This is a retrospective study evaluating infants undergoing surgery for repair of congenital heart defects from October 1, 2019 to June 30th, 2020 in the neonatal unit of our institution. Due to its retrospective design, informed consent was not required. Patients were divided in two groups: Group 1 (IgG >= 340mg/dL) and Group 2 (IgG < 340mg/dL). The value cut point was defined taking into consideration p10 level of Immunoglobulin according to Fujimura. Results: From October 1, 2019 to June 30th, 2020, 62 children were born or admitted in our neonatal unit. Among them, 19 (30%) have their IgG dosed, according to attending physician decision. Among patients with hypogammaglobulinemia, Pseudomonas sp was present in 87.5% of blood stream and/or tracheal secretion cultures. Regarding survival analysis, mortality was not different between Group 1 and 2. Conclusion: Hypogammaglobulinemia has proved to be a predictor factor of postoperative complications in pediatric cardiac surgery. However, prospective trials are needed to determine the incidence of this problem, its real impact on survival, and the appropriate therapy.

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