Ultrasound versus thoracoscopic-guided paravertebral block during thoracotomy

2020 ◽  
pp. 021849232096501
Author(s):  
Mohammed A Hegazy ◽  
Gehad Awad ◽  
Amr Abdellatif ◽  
Mohamed Elshabrawy Saleh ◽  
Mohammed Sanad
Keyword(s):  
Paravertebral Block ◽  
Ultrasound Guided ◽  
Visual Analogue Pain Score ◽  
Visual Analogue Pain ◽  
Analgesic Consumption ◽  
Needle Pass ◽  
Group A ◽  
Study Participants ◽  
Ultrasound Group ◽  
Thoracoscopic Technique

Background Paravertebral block can be performed with the aid of surgical landmarks, ultrasound, or a thoracoscope. This study was designed to compare ultrasound-guided paravertebral block with the thoracoscopic technique. Methods This prospective randomized comparative study included 40 adults scheduled for elective thoracic surgery. Study participants were randomized to an ultrasound group or a thoracoscope group. A catheter for paravertebral block was inserted prior to thoracotomy with real-time ultrasound visualization in the ultrasound group, and under thoracoscopic guidance in the thoracoscope group. Total analgesic consumption, visual analogue pain score, technical difficulties, and complications were compared between the 2 groups. Results Total analgesic consumption in the first 24 hours was less in the ultrasound group than in the thoracoscope group (rescue intravenous fentanyl 121.25 ± 64.01 µg in the ultrasound group vs. 178.75 ± 91.36 µg in the thoracoscope group; p = 0.027). Total paravertebral bupivacaine consumption was 376.00 ± 33.779 mg in the ultrasound group and 471.50 ± 64.341 mg in the thoracoscope group ( p < 0.001). Technical difficulties and complications in terms of time consumed during the maneuver, more than one needle pass, and pleural puncture were significantly lower in the ultrasound group than in the thoracoscope group. Conclusion Ultrasound-guided paravertebral catheter insertion is more effective, technically easier, and safer than the thoracoscope-assisted technique.

THE ROLE OF MANUAL THERAPY IN THE TREATMENT OF CHRONIC CERVICAL PAINS

2020 ◽  
pp. 1-4
Author(s):  
George-Sebastian Iacob ◽  
Constantin Munteanu
Keyword(s):  
Manual Therapy ◽  
Therapy Group ◽  
Neck Disability Index ◽  
Initial Assessment ◽  
Visual Analogue Pain Scale ◽  
Rehabilitation Protocol ◽  
Visual Analogue Pain ◽  
Therapeutic Exercises ◽  
Group A ◽  
Group B

Cervical back pain is one of the most important and common musculoskeletal disorders in medical recovery clinics and clinics. The main objective of the study was to highlight the effectiveness of an individualized therapeutic program adapted to the particularities of 22 subjects, which combines physical exercise with manual therapy. Subjects were randomly assigned to two equal groups. Group A - rehabilitation protocol consisting of therapeutic exercises (specific to the head, neck and upper limbs). Group B - rehabilitation protocol that included both therapeutic exercises and manual therapy (specific maneuvers of vertebral mobilization, massage, myofascial techniques, stretching and manipulations). The Visual Analogue Pain Scale (VAS) and the Neck Disability Index (NDI) were used to monitor the evolution of the research subjects, both of which have a specific applicability character to chronic pain. According to VAS (p <0.001), Group B showed mean values reduced to 2.2 ± 0.9 at week 12, compared to 7.3 ± 0.92, following the initial assessment. NDI values indicate better functional status after 12 weeks of treatment for both groups of subjects. NDI showed a beneficial decrease for Group B (13.2 ± 2.2 after 12 weeks, compared to 25.8 ± 2.3 in the first week). The mean results of VAS and NDI indicated a better evolution of symptoms in the case of the protocol that combined exercise and manual therapy (group B), but there were no statistically significant differences (compared to group A).

Paravertebral Block versus Thoracic Epidural Analgesia for Postthoracotomy Pain Relief: A Meta-Analysis of Randomized Trials

2021 ◽  
Author(s):  
Mu Xu ◽  
Jiajia Hu ◽  
Jianqin Yan ◽  
Hong Yan ◽  
Chengliang Zhang
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Meta Analysis ◽  
Thoracic Epidural Analgesia ◽  
Paravertebral Block ◽  
Cochrane Library ◽  
Thoracic Epidural ◽  
Analgesic Consumption ◽  
Postthoracotomy Pain

Abstract Objective Paravertebral block (PVB) and thoracic epidural analgesia (TEA) are commonly used for postthoracotomy pain management. The purpose of this research is to evaluate the effects of TEA versus PVB for postthoracotomy pain relief. Methods A systematic literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library (last performed on August 2020) to identify randomized controlled trials comparing PVB and TEA for thoracotomy. The rest and dynamic visual analog scale (VAS) scores, rescue analgesic consumption, the incidences of side effects were pooled. Results Sixteen trials involving 1,000 patients were included in this meta-analysis. The pooled results showed that the rest and dynamic VAS at 12, 24, and rest VAS at 48 hours were similar between PVB and TEA groups. The rescue analgesic consumption (weighted mean differences: 3.81; 95% confidence interval [CI]: 0.982–6.638, p < 0.01) and the incidence of rescue analgesia (relative risk [RR]: 1.963; 95% CI: 1.336–2.884, p < 0.01) were less in TEA group. However, the incidence of hypotension (RR: 0.228; 95% CI: 0.137–0.380, p < 0.001), urinary retention (RR: 0.392; 95% CI: 0.198–0.776, p < 0.01), and vomiting (RR: 0.665; 95% CI: 0.451–0.981, p < 0.05) was less in PVB group. Conclusion For thoracotomy, PVB may provide no superior analgesia compared with TEA but PVB can reduce side effects. Thus, individualized treatment is recommended. Further study is still necessary to determine which concentration of local anesthetics can be used for PVB and can provide equal analgesic efficiency to TEA.

Ultrasound-guided low thoracic paravertebral block versus peritubal infiltration for percutaneous nephrolithotomy: a prospective randomized study

Urolithiasis ◽  
2018 ◽  
Vol 48 (3) ◽  
pp. 235-244 ◽  
Author(s):  
Ahmet Murat Yayik ◽  
Ali Ahiskalioglu ◽  
Saban Oguz Demirdogen ◽  
Elif Oral Ahiskalioglu ◽  
Haci Ahmet Alici ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Randomized Study ◽  
Paravertebral Block ◽  
Prospective Randomized Study ◽  
Ultrasound Guided ◽  
Thoracic Paravertebral Block

scholarly journals Pain and discomfort during the first week of rapid maxillary expansion (RME) using two different RME appliances: A randomized controlled trial

2016 ◽  
Vol 87 (3) ◽  
pp. 391-396 ◽  
Author(s):  
Ingalill Feldmann ◽  
Farhan Bazargani
Keyword(s):  
Pain Intensity ◽  
Rapid Maxillary Expansion ◽  
Maxillary Expansion ◽  
Analgesic Consumption ◽  
Function Impairment ◽  
Group A ◽  
Jaw Function ◽  
Group B ◽  
Median Pain ◽  
Hyrax Appliance

ABSTRACT Objectives: To evaluate and compare perceived pain intensity, discomfort, and jaw function impairment during the first week with tooth-borne or tooth-bone–borne rapid maxillary expansion (RME) appliances. Materials and Methods: Fifty-four patients (28 girls and 26 boys) with a mean age of 9.8 years (SD 1.28 years) were randomized into two groups. Group A received a conventional hyrax appliance and group B a hybrid hyrax appliance anchored on mini-implants in the anterior palate. Questionnaires were used to assess pain intensity, discomfort, analgesic consumption, and jaw function impairment on the first and fourth days after RME appliance insertion. Results: Fifty patients answered both questionnaires. Overall median pain on the first day in treatment was 13.0 (range 0–82) and 3.5 (0–78) for groups A and B, respectively, with no significant differences in pain, discomfort, analgesic consumption, or functional jaw impairment between groups. Overall median pain on the fourth day was 9.0 (0–90) and 2.0 (0–71) for groups A and B, respectively, with no significant differences between groups. There were also no significant differences in pain levels within group A, while group B scored significantly lower concerning pain from molars and incisors and tensions from the jaw on day 4 than on the first day in treatment. There was a significant positive correlation between age and pain and discomfort on the fourth day in treatment. No correlations were found between sex and pain and discomfort, analgesic consumption, and jaw function impairment. Conclusions: Both tooth-borne and tooth-bone–borne RME were generally well tolerated by the patients during the first week of treatment.

scholarly journals Effectiveness of ultrasound guided ethanol motor points block in reduction of spasticity and improvement of upper limb function in hemiplegic patients: a randomized controlled study

2020 ◽  
Vol 7 (9) ◽  
pp. 1409
Author(s):  
Sreejith C. ◽  
Akoijam Joy Singh ◽  
Longjam Nilachandra Singh ◽  
Kanti Rajkumari ◽  
Margaret Chabungbam ◽  
...  
Keyword(s):  
Upper Limb ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Control Group ◽  
Ultrasound Guided ◽  
Limb Function ◽  
Ethanol Injection ◽  
Randomized Controlled ◽  
Upper Limb Function ◽  
Group A

Background: Stroke is the third leading cause of disability in general population commonly causing upper motor neuron syndrome complications like spasticity, which is more common in upper limb. Ethanol injection into spastic muscle is an emerging effective treatment in the spasticity management. Ethanol causes selective destruction of nerve fibers through denaturation of protein.Methods: A randomized controlled study was conducted for a period of 2 years from March 2018 on sixty-eight hemiplegic patients to assess the effectiveness of ethanol muscle block in reduction of spasticity and improvement in functional ability. The patients were allocated into two groups (Group A and B). Group A received ultrasound guided intramuscular ethanol injection along with range of motion (ROM) exercises and wrist hand orthosis (WHO) and Group B received ROM exercises and WHO. The outcomes were measured by modified ashworth scale (MAS) for spasticity and modified version of motor assessment scale for functional improvement.Results: Intervention group showed significant improvement in spasticity shown by reduction of MAS of elbow flexors from 3 at baseline to 1.15±0.3 at 12 weeks as compared to control group with 3 at baseline to 1.76±0.5 at 12 weeks (p<0.05). Upper limb function scale of study group improved from 1.5±0.8 to 3.0±0.6 at 12 weeks compared to control group 1.3±0.8 to 2.8±0.6 (p<0.05).Conclusions: It can thus be concluded that intramuscular injection of ethanol accompanied by wrist hand orthosis have beneficial effect on improvement of spasticity and upper limb function.

scholarly journals Artrodese posterolateral vs artrodese circunferencial no tratamento da espondilolistese degenerativa: avaliação clínica e impacto do IMC nos resultados

2013 ◽  
Vol 12 (3) ◽  
pp. 204-208
Author(s):  
Filipe Rodrigues Duarte ◽  
António Manuel Santos Nogueira de Sousa ◽  
Frederico José Antunes Raposo ◽  
Luís Filipe Almeida Valente ◽  
António Moura Gonçalves ◽  
...  
Keyword(s):  
Pain Score ◽  
Oswestry Disability Index ◽  
Visual Analogue Pain Score ◽  
Visual Analogue Pain

OBJETIVO: O tratamento cirúrgico da espondilolistese degenerativa (ED) apresenta vantagens quando comparado com o tratamento conservador. As técnicas cirúrgicas evoluíram no sentido de optimizar a fixação vertebral após descompressão, com o intuito de aumentar a taxa de artrodese. A fixação pedicular associada à fusão intersomática permite aumentar a área de contacto ósseo e assim a taxa de fusão, mas serão os resultados clínicos e funcionais superiores? MÉTODOS: Estudo retrospectivo incluindo 51 indivíduos (idade média de 61,2 anos) submetidos a artrodese posterolateral (APL) (19) e artrodese circunferencial (360º) (32) de 1996 até 2009 com acompanhamento médio de 5,8 anos (2 a 14 anos). Incluídas apenas descompressões de um nível. Avaliação clínica (VAS - Visual Analogue Pain Score), satisfação global e avaliação funcional (Oswestry disability Index modificado). Cálculo do IMC (índice de massa corporal) - avaliação clínica e funcional IMC ≥30 vs IMC <30. Estudo estatístico com SPSS®. RESULTADOS: Os resultados mostram franca melhoria clínica e funcional no tratamento cirúrgico da espondilolistese degenerativa, independentemente das técnicas estudadas. A taxa de satisfação é igualmente elevada. No confronto entre as duas técnicas de fixação não houve diferenças estatisticamente significativas. Relativamente ao IMC, os pacientes não obesos tiveram melhores resultados clínicos (p<0,05), não havendo diferenças relativas à função entre os dois grupos. CONCLUSÃO: A descompressão seguida de instrumentação vertebral é um tratamento eficaz para os pacientes com espondilolistese degenerativa. A técnica de artrodese utilizada não influencia os resultados clínicos e funcionais

scholarly journals Training of basic laparoscopic skills in surgical education

2013 ◽  
Vol 12 (4) ◽  
pp. 224-232
Author(s):  
Gintaras Simutis ◽  
Mantas Drungilas ◽  
Pavel Petrik ◽  
Eglė Petrik ◽  
Virgilijus Beiša ◽  
...  
Keyword(s):  
Surgical Education ◽  
Practical Skills ◽  
Laparoscopic Skills ◽  
Cumulative Score ◽  
Group A ◽  
Group B ◽  
Study Participants ◽  
Navigation Experience ◽  
Laparoscopic Experience ◽  
Potential Use

Background / objectiveThe study was carried out to evaluate the potential use of laparoscopic simulators to enhance basic laparoscopic skills until proficiency is reached.Materials and methodsThe study participants were divided into two groups according to their experience in laparoscopic procedures: no prior experience (group A; n = 16) and laparoscope navigation experience (group B; n = 16). All the participants performed nineattempts of three basic laparoscopic skill tasks (“Instrument navigation”, “Cutting”, “Clip applying”) on the LapSim® simulator during three sessions within one month. The distribution of practice sessions was standardized by performing three attemptsfor each task per session and no more than one session per week. The assessment of laparoscopic skills was based on the cumulative score for each task measured by the computer system.ResultsTrainees in the group A were younger (22.2 ± 1.3 vs. 26.1 ± 1.3 years, P < 0.001). There were statistically significant differences in cumulative scores for all three tasks after the first five attempts between the two groups (P < 0.001). Comparison of thecumulative scores for the task “Instrument navigation” after the sixth attempt (P = 0.073), for the task “Clip applying” after the seventh attempt (P = 0.287), and for the task “Cutting” after the eighth attempt (P = 0.080) showed no significant differences among the study groups.ConclusionsThe results indicated that a group of trainees with no prior laparoscopic experience acquired the basic laparoscopic skills significantly faster. Proficiency in the laparoscopic basic tasks was achieved within 6–8 repetitions in both groups. These findings suggest that training of practical skills in using laparoscopic simulators should be integrated into medical education much earlier.Key words: surgical education, simulation, laparoscopy, virtual reality simulator, LapSimBazinių laparoskopinių įgūdžių įgijimas studijuojant mediciną TikslasAtlikti tyrimą, siekiant įvertinti kompiuterinių laparoskopinių simuliatorių naudojimą medicinos studijoms mokant pagrindinių laparoskopinių operacijų įgūdžių, kol bus įgyta reikiama patirtis.MetodikaTyrimo dalyviai pagal patirtį buvo suskirstyti į dvi grupes: vienos grupės tiriamieji neturėjo jokios išankstinės laparoskopinių operacijų patirties (A grupė, n=16), o kitos grupės turėjo tik navigacijos laparoskopu patirties (B grupė, n=16). Visi dalyviai pertrejas pratybas su laparoskopiniu virtualiu simuliatoriumi LapSim® atliko trijų pagrindinių laparoskopinių užduočių („Instrumentų navigacija“, „Pjovimas“, „Kabučių uždėjimas“) devynis bandymus. Kiekvieną užsiėmimą atskira užduotis buvo kartojamatris kartus, o užsiėmimas vyko ne dažniau nei kartą per savaitę. Vertintas galutinis užduoties rezultatas. Laparoskopinių operacijų įgūdžiai vertinti kompiuterine sistema pagal išvestinį kaupiamąjį kiekvienos užduoties balą.RezultataiA grupės dalyviai buvo jaunesni (22,2±1,3 vs. 26,1±1,3 metų, p<0,001). Išanalizavus visų trijų užduočių kaupiamuosius balus po pirmųjų penkių bandymų, abi grupės skyrėsi statistiškai reikšmingai (p<0,001). Tyrimą tęsiant ir lyginant išvestinį kaupiamąjįbalą atliekant užduotį „Instrumentų navigacija“ po šešto bandymo (p=0,073), užduotį „Kabučių uždėjimas“ po septinto bandymo (p=0,287), užduotį „Pjovimas“ po aštunto bandymo (p = 0,080), jokių reikšmingų skirtumų tarp tiriamų grupių nerasta.IšvadosTyrimo rezultatai parodė, kad net be laparoskopinių operacijų patirties tokių operacijų pagrindinius įgūdžius laparoskopiniu simuliatoriumi įgyjama greičiau. Chirurginės simuliacijos užduočių kartojimas iki 6–8 bandymų leidžia įgyti gerus pagrindiniųlaparoskopinių operacijų įgūdžius. Šie rezultatai rodo, kad praktinių įgūdžių mokymas naudojant laparoskopinį simuliatorių turėtų būti įtrauktas į medicinos studijų programą.Reikšminiai žodžiai: chirurgijos studijos, simuliacija, laparoskopija, virtualios realybės simuliatorius, LapSim.

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