scholarly journals THE USE OF DEXMEDETOMIDINE IN PUNCTURE TECHNIQUES FOR DEGENERATIVE DISEASES OF THE LUMBAR SPINE

2021 ◽  
Vol 20 (3) ◽  
pp. 185-188
Author(s):  
VADIM ANATOL’EVICH BYVALTSEV ◽  
VICTORIYA YUR’EVNA GOLOBOROD’KO ◽  
ANDREI ANDREEVICH KALININ ◽  
MIKHAIL YURIEVICH BIRYUCHKOV
Keyword(s):  
Lumbar Spine ◽  
Respiratory Depression ◽  
Case Series ◽  
Pain Syndrome ◽  
Perioperative Period ◽  
Degenerative Diseases ◽  
Sedation Scale ◽  
Level Of Evidence ◽  
Ramsay Sedation Scale ◽  
Endoscopic Discectomy

ABSTRACT Objective To analyze the results of the use of dexmedetomidine (D) in the treatment of patients with degenerative diseases of the lumbar spine using puncture techniques. Methods The study included 77 patients who underwent surgical puncture for degenerative diseases of the lumbar spine with the use of alpha-2-adrenomimetic D: percutaneous laser denervation of the facet joints (n = 46) and posterolateral transforaminal endoscopic discectomy (n = 31). We assessed: the level of sedation using the Ramsay Sedation Scale (RSS) and the Richmond Agitation Sedation Scale (RASS); intraoperative dynamics of the cardiovascular and respiratory system parameters; the level of pain syndrome according to VAS. Results A high intraoperative level of sedation was determined, with RASS -2, -3 and Ramsay III, IV; when transferring a patient to a department (in 90 minutes) this parameter was RASS 0 and Ramsay II. There were no significant changes in central hemodynamics and respiratory depression. The minimum level of pain was determined immediately after surgery, at 30 and 60 minutes after surgery, and before transfer to the department (90 minutes): 6 (4;9); 10 (8;12); 12 (9;13); 16 (13;19) respectively. The absence of the need for additional analgesia on the first postoperative day was verified. Conclusion The use of D significantly reduces the level of pain, while maintaining the necessary verbal contact with the patient, and provides the necessary neurovegetative protection without respiratory depression or lowered hemodynamic parameters during the perioperative period. Level of evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on Disease Outcome. Case series, retrospective study.

scholarly journals Optimization of Surgical Care and Anesthesia in the Treatment of Multilevel Degenerative Diseases of the Lumbar Spine in Patients with Overweight and Obesity

2018 ◽  
Vol 73 (6) ◽  
pp. 401-410 ◽  
Author(s):  
Vadim A. Byvaltsev ◽  
Andrey A. Kalinin ◽  
Victoria Yu. Goloborodko
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Surgical Procedures ◽  
Surgical Techniques ◽  
Surgical Care ◽  
Pain Syndrome ◽  
Overweight And Obesity ◽  
Degenerative Diseases ◽  
Minimally Invasive Surgical ◽  
Paravertebral Muscles

Background: The provision of surgical care in the treatment of degenerative diseases of the lumbar spine in patients with obesity and obesity is associated with significant risks of anesthesia and the development of perioperative complications. Aims: to analyze the results of the introduction of a combination of surgical procedures and anesthesia in the treatment of multilevel degenerative diseases of the lumbar spine in patients with excessive body weight and obesity.Materials and methods: The results of surgical treatment of 86 patients were studied, 2 groups were identified. In the study group (SG, n=37), minimally invasive surgical techniques and original surgical approach, paravertebral musculature infiltration with bupivacaine with epinephrine, and multimodal anesthesia with dexmedetomidine were used. The comparison group (CG, n=49) consisted of patients who used the technique of traditional open transpedicular fixation in combination with the posterior interbody fusion without the above combination of surgical procedures and anesthesia. Observation and clinical evaluation was performed in the early (during hospitalization) and in the distant (on average 36 months) postoperative periods.Results: In SG there were no changes in hemodynamics and better results were obtained on the speed of recovery of psychomotor functions. The use of local anesthetics significantly reduced the local pain syndrome (p0.05) and the need for analgesics (p=0.002). Comparative analysis in the main group revealed significantly better results in indices of the duration of the operation [SG 145 (105; 155) min, CG 185 (100; 205) min; p=0.02], the volume of blood loss [SG 110 (90; 140) ml, CG 510 (390; 640) ml; p0.001], the activation time [SG 1 (1; 2) days, CG 3 (3; 4) days; p=0.01], the length of hospitalization [SG 10 (9; 11) days, CG 13 (12; 15) days; p=0,03], remote clinical parameters of the pain syndrome level from the visual analogue scale in the lower extremities [SG 3 (1; 4) mm, CG 9 (6; 14) mm; p=0.006] and the lumbar spine [SG 6 (4; 9) mm, CG 16 (11; 21) mm; p=0.001], functional state according to ODI [SG 8 (6; 10) points, CG 16 (12; 24) points; p=0.008], subjective satisfaction with the operation performed on the Macnab scale (p=0.01). The number of postoperative complications in SG was 8%, in CG ― 18% (p=0.006).Conclusions: Analysis of the results of the introduction of a combination of surgical and anesthetic support methods in the treatment of multilevel degenerative diseases of the lumbar spine in patients with overweight and obesity, including minimally invasive surgical techniques, infiltration of paravertebral muscles with bupivacaine and epinephrine, multimodal anesthesia with dexmedetomidine showed its high perioperative safety, low number of complications, as well as better and clinical outcomes in the early and late postoperative periods.

scholarly journals CHOICE OF ANESTHESIA METHOD FOR TRANSFORAMINAL ENDOSCOPIC DISCECTOMY (TFED)

2021 ◽  
Vol 2 (46) ◽  
pp. 30
Author(s):  
B. B. Pavlov ◽  
A. A. Nechypurenko
Keyword(s):  
Lumbar Spine ◽  
Side Effects ◽  
Muscle Weakness ◽  
Epidural Anesthesia ◽  
Opioid Analgesic ◽  
Pain Syndrome ◽  
Intervertebral Discs ◽  
Alternative Methods ◽  
Endoscopic Discectomy ◽  
Combined Anesthesia

Transforaminal endoscopic discectomy (TPED) is a modern effective method of removing symptomatic hernias in the lumbar spine that cause therapeutically resistant pain syndromes. It gained its popularity due to its safety and minimally invasiveness. To avoid injury to the nervous system, this operation must be performed with the patient's clear consciousness. Combined anesthesia (CA), which combines a local anesthetic with an opioid analgesic and epidural anesthesia (EA), are alternative methods of anesthesia, which allows to maintain adequate speech contact between the surgeon and the patient.Goals and objectives. Compare the efficacy and side effects of CA and EA during TFED.Materials and methods. The study included 32 patients operated on for herniated intervertebral discs in the lumbar spine during the period 2019-2020.The patients' age was from 24 to 58 years (43 ± 9.8). Among them there were 22 women (68.75%), men - 10 (31, 25%). In 5 cases (15.6%), TFED was performed at the L3L4 level, in 10 cases (31.2%) at the L4L5 level and in 17 cases (52.2%) at the L5S1 level. All patients were divided into 2 groups: a group with combined anesthesia (CA group) and a group with epidural anesthesia (EA group). The first group included 14 (43.75%) patients, the second - 18 (56.25%) patients. Transforaminal endoscopic discectomy was performed according to the standard Maxmorespine® technique. The results of surgical treatment were determined according to the MacNab criteria. The severity of pain syndrome was assessed according to the visual analogue scale (VAS). The following time frames were chosen: before the intervention, intraoperatively, 1 hour after the intervention and 7 days after the operation. Statistical data were processed by the Statistica-10 program. Side effects such as nausea, vomiting, muscle weakness, dysuria, and arterial hypotension were evaluated. Complications in the form of damage to the meninges and neural structures were taken into account.Results and discussion. There were no complications in both groups. All patients were discharged from the hospital in satisfactory condition the next day after the operation. According to MacNab criteria, all patients were treated with good (56.25%) and excellent (43.75%) outcomes. The analysis shows that in the EA group the level of intraoperative analgesia was significantly higher, which ultimately resulted in a higher degree of satisfaction with anesthesia in patients. A similar pattern was observed when comparing the severity of postoperative pain. In the EA group, two patients (11%) had transient muscle weakness in the lower extremities, which we regarded as a result of prolonged action of epidural anesthesia in conditions of insufficiently correct sensory-motor separation. 5 patients (28%) in the CA group had complaints of nausea and vomiting, the probable cause of which was a side effect of opioids. Dysuric phenomena were not registered in any of the groups.Conclusions. EA, in our opinion, is preferable to CA for TFED in the lumbar spine. It has a great analgesic effect and is devoid of the side effects of opioids.Key words: transforaminal endoscopic discectomy, combined anesthesia, epidural anesthesia, efficacy, side effects

High Burden of Associated Injuries Occurring With Major Fractures of the Talus

2019 ◽  
Vol 41 (3) ◽  
pp. 324-330
Author(s):  
Ishaq O. Ibrahim ◽  
Michael Y. Ye ◽  
Jennifer Jacobs ◽  
Jeremy T. Smith ◽  
John Y. Kwon ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Case Series ◽  
High Energy ◽  
Spine Injury ◽  
Associated Injuries ◽  
Level Of Evidence ◽  
Severe Injuries ◽  
Concomitant Injuries ◽  
Orthopedic Injury ◽  
Organ Systems

Background: Talus fractures are severe injuries typically occurring after high-energy trauma. As a result, associated injuries to different anatomic sites and organ systems occur with high frequency. The objective of this study was to determine what injuries occur with high incidence in patients presenting with major fractures of the talus and to identify clinical injury patterns that may warrant special attention in these patients. Methods: We performed a retrospective review of patients presenting to 3 level 1 trauma centers with fractures of the talar neck, body, or head over a 14-year period. Patient charts were reviewed for associated orthopedic and nonorthopedic injuries identified during the initial patient encounter and hospitalization. Results: In total, 262 fractures in 258 unique patients met criteria for inclusion. Overall, 33.3% of talus fractures occurred in isolation. One or more associated injuries were identified in the remainder of cases (66.7%). The incidence of associated injuries was similar across fracture patterns. Mean total number of injuries per patient was 2.2 (range, 0-15). The ipsilateral foot was the most frequent site of associated orthopedic injury. Noncontiguous injuries occurred in 36% of cases. Lumbar spine injury occurred in 10.5% of cases. Lower extremity vascular injury was uncommon but bore significant association with open talus fractures. Conclusion: Talus fractures are commonly associated with injuries to different anatomic sites and organ systems. A similar rate of lumbar spine trauma may occur with major talus fractures as has been historically associated with calcaneal fractures. Thorough evaluation and a high index of suspicion are necessary when evaluating patients with major fractures of the talus to avoid missing concomitant injuries. Level of Evidence: Level IV, retrospective case series.

scholarly journals MINIMALLY INVASIVE EXTREME LATERAL APPROACH IN SPINAL LUMBAR METASTASIS

2018 ◽  
Vol 26 (3) ◽  
pp. 191-193
Author(s):  
LUCAS CASTRILLON CARMO MACHADO ◽  
DOUGLAS KENJI NARAZAKI ◽  
WILLIAN GEMIO JACOBSEN TEIXEIRA ◽  
ALEXANDRE FOGAÇA CRISTANTE ◽  
MANOEL JACOBSEN TEIXEIRA ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Anterior Approach ◽  
Treatment Options ◽  
Spinal Metastases ◽  
Case Series ◽  
Psoas Muscle ◽  
Lateral Approach ◽  
Level Of Evidence ◽  
Transpsoas Approach

ABSTRACT Introduction The extreme lateral approach has been widely used for the treatment of degenerative diseases. The objective of this study is to present a minimally invasive extreme lateral approach for the treatment of metastatic lesions in the lumbar spine without the use of the evoked potential exam (MEP). Methods Two patients with spinal metastases and indication for surgery via the anterior approach were treated in a cancer referral center in Brazil. They were placed in right lateral decubitus, and an oblique incision was made, exposing the psoas muscle. The anterior approach permitted the release of the psoas muscle from vertebral body and disc, without the need for MEP. Conclusions When cancer cure is no longer possible, a minimally invasive extreme lateral approach to treat tumor metastases in the lumbar spine is a viable option, with short hospitalization time and low morbidity. The dislocation of the psoas muscle avoids the use of the transpsoas approach, which requires MEP equipment and a trained physician. Clinical studies are needed to extend these benefits to oncological patients who have treatment options for their primary disease. Level of Evidence IV; Case series.

scholarly journals EVALUATION OF THE RESULTS OF PELVIC FIXATION IN LONG LUMBOSACRAL INSTRUMENTATIONS IN ELDERLY PATIENTS

2018 ◽  
Vol 17 (4) ◽  
pp. 308-312 ◽  
Author(s):  
Marcos Calixto Acchar ◽  
Leonardo Fonseca Rodrigues ◽  
Carlos Alexandre Botelho do Amaral ◽  
Sergio Gurgel Fernandes ◽  
Flavio Cavallari
Keyword(s):  
Lumbar Spine ◽  
Elderly Patients ◽  
Case Series ◽  
Early Years ◽  
Buttock Pain ◽  
Level Of Evidence ◽  
Pelvic Fixation ◽  
Visual Analogue Pain ◽  
Body Fracture ◽  
Iliac Screws

ABSTRACT Objective: Evaluate the initial results and the possible complications of the combination of pelvic fixation using iliac screws in long instrumentations of the lumbar spine in elderly patients. Methods: An analysis of 38 patients who underwent lumbar spine arthrodesis instrumentation with more than 3 levels, in which we included level L5-S1 and extended the fixation to the iliac crest. Radiological assessment of instrumentation through X-ray of the lumbar spine and pelvis, and computed tomography, to investigate the presence of radiological fusion. Clinical evaluation through a questionnaire of buttock pain including the visual analogue pain score (VAS). Complications related to pelvic instrumentation were investigated. Results: All patients had radiological fusion in the lumbosacral transition. A halo was found around the iliac screw on imaging studies in 31% of patients, but without related symptoms. The questionnaire of buttock pain found that 15% of patients had some low intensity buttock pain (VAS 1-2) and no need to or interest in removing the screws. There was infection at the surgical site in 2% of cases, hematoma in the buttocks in 5%, and vertebral body fracture in the cranial level instrumented in 7% of cases. Conclusions: Pelvic fixation through the iliac screws proved to be effective in protecting the S1 screws in long instrumentations including the L5-S1 level in elderly patients, allowing the radiological bone fusion. The overall results for pain were satisfactory, based on a questionnaire of buttock pain. There are no signs of overload or degeneration of the sacroiliac joints in the early years after surgery. Level of Evidence IV; Case series - therapeutic study.

scholarly journals PERCUTANEOUS ENDOSCOPIC DISCECTOMY FOR DEGENERATIVE-DYSTROPHIC DISEASE OF THE LUMBAR SPINE

2006 ◽  
pp. 016-021
Author(s):  
Aleksandr Timofeyevich Khudyaev ◽  
Sergey Vladimirovich Lyulin ◽  
Elena Nikolayevna Schurova
Keyword(s):  
Lumbar Spine ◽  
Intervertebral Disc ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Degenerative Spondylolisthesis ◽  
Pain Syndrome ◽  
Invasive Technique ◽  
Intervertebral Disc Herniation ◽  
Endoscopic Discectomy ◽  
Radicular Syndrome

Objective. To determine a rational surgical strategy and approach to the treatment of patients with degenerativedystrophic disorders of the lumbar spine by percutaneous endoscopic discectomy. Material and Methods. Percutaneous endoscopic nucleotomy was applied in surgical treatment of 60 patients. Out of them 46 patients had L4–L5 intervertebral disc herniation, 7 patients had L3–L4 intervertebral disc herniation, 2 patients – L4–L5 hernia relapse after microdiscectomy, 1 patient – ossificated foraminal hernia at L3–L4, 3 patients – unstable degenerative spondylolisthesis at L4 level, and 1 – the same at L3. Complex examination of patients included acquisition of complaints and anamnestic data, general clinical, neurological, laboratory, and radiologic evaluation. All patients had CT images, in 10 cases they were added by MRI, and in 16 cases – by CT myelography. Pain syndrome intensity was assessed by digital rating and visual-analogue scales allowing the analysis of pain at rest, in motion, and at night. Results. Pain syndrome was arrested in 51 patients. Two patients showed residual radicular syndrome in the early postoperative period, and seven patients – residual reflex pain syndrome. Three months after the operation moderate reflex pain syndrome was observed in 6 cases, radicular syndrome in no one case. No aggravation of neurological deficit occured at the later follow-up period. Conclusion. Percutaneous endoscopic nucleotomy is a minimal invasive technique for lumbar disc hernia removal which reduces hospitalisation terms and risk of postoperative complications.

scholarly journals PREVALENCE AND MANAGEMENT OF REFRACTORY MERALGIA PARESTHETICA IN LUMBAR SPINE SURGERY: 5 YEARS OF EXPERIENCE

2020 ◽  
Vol 19 (1) ◽  
pp. 40-43
Author(s):  
JOSE AUGUSTO MALHEIROS ◽  
CELIA MARIA DE OLIVEIRA ◽  
ALUIZIO AUGUSTO ARANTES JUNIOR ◽  
JONAS SOARES SILVA SANTOS ◽  
SEBASTIÃO NATANAEL SILVA GUSMÃO
Keyword(s):  
Body Mass Index ◽  
Neuropathic Pain ◽  
Lumbar Spine ◽  
Body Mass ◽  
Posterior Approach ◽  
Case Series ◽  
Inguinal Ligament ◽  
Surgical Time ◽  
Level Of Evidence ◽  
Meralgia Paresthetica

ABSTRACT Objective The objective of our study was to report 5 years of experience in the recognition and management of refractory meralgia paresthetica (MP) in patients who had undergone posterior approach lumbar surgery. Methods Patients who were submitted to procedures in the lumbar spine from January 2010 to January 2015 in three different hospital centers in Belo Horizonte/MG were selected for an evaluation of the postoperative development of MP. A prospective observational comparative case series study. Level of evidence III. Evaluation of the following parameters: type of support for the patient, surgical time, body mass index. Results 367 posterior approach lumbar spine surgeries for degenerative pathologies of the lumbar spine were performed. MP was observed in 81 patients (22%). In 65 of those patients (80%), there was complete resolution of the symptoms with conservative management (local measures and medications for neuropathic pain) in less than two months. Twelve patients improved with a corticosteroid depot injection in the inguinal ligament and four patients required a surgical procedure in the third month. Pneumatic support was the least involved in the development of MP, as well as surgical time <1h and body mass index <25. Conclusion Refractory MP may occur in patients submitted to posterior approach lumbar spine surgeries. Management includes local measures, medications for neuropathic pain, and corticosteroid injection in the inguinal ligament. Decompression surgery is reserved for rare refractory cases. Level of evidence III; Prospective observational study with comparative case series.

scholarly journals Efficacy of combination therapy with dexmedetomidine for benzodiazepines-induced disinhibition during endoscopic retrograde cholangiopancreatography

2020 ◽  
Vol 13 ◽  
pp. 175628482091182
Author(s):  
Yuki Ikeda ◽  
Makoto Yoshida ◽  
Kazuma Ishikawa ◽  
Tomohiro Kubo ◽  
Kazuyuki Murase ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Respiratory Depression ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Conscious Sedation ◽  
Sedative Effect ◽  
Completion Rate ◽  
Sedation Scale ◽  
Endoscopic Retrograde ◽  
Ramsay Sedation Scale ◽  
Respiratory Dynamics

Background: Benzodiazepines (BZDs) and analgesics are widely used for conscious sedation during endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP). However, endoscopic procedures are sometimes discontinued because of BZD-induced disinhibitory reactions such as excessive movement. We evaluated the usefulness of dexmedetomidine (DEX) for BZD-induced disinhibition in ERCP. Methods: Between February 2018 and August 2019, 22 patients who underwent EUS or ERCP were enrolled. All patients showed BZD-induced excessive movement at the first examination (BZD group) and received DEX at the second examination (DEX group). The initial DEX dose was 6 μg/kg/h for a 10-min loading, followed by 0.4 μg/kg/h during the procedure. BZDs and analgesics were administered before scope insertion. An additional sedative was administered to achieve a Ramsay sedation scale (RSS) of 4–5. Sedative effect, procedure completion rate, and changes in circulatory and respiratory dynamics were evaluated. Results: Mean RSS scores were significantly higher ( p < 0.001) in the DEX (5.1 ± 0.5) compared with the BZD (4.0 ± 0.5) group. The movement score ( p < 0.001) and number of additional sedatives required ( p < 0.01) were lower in the DEX group. The procedure completion rate was significantly higher in the DEX (95.5%) compared with the BZD group (63.6%; p < 0.05). Significant differences in the frequency of hypotension ( p = 1.00), bradycardia ( p = 0.22), and respiratory depression ( p = 0.68) were not noted between groups. Conclusions: The addition of DEX to BZD therapy yielded better sedative efficacy, lower excessive movement, a reduction in BZDs used, and a higher procedure complete rate. DEX may be used as an alternative method for BZD-induced inhibition during ERCP.

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