scholarly journals Pain management with ultrasound-guided lidocaine-ropivacaine caudal block in hypospadias repair: A single-surgeon comparative study

2019 ◽  
Author(s):  
Shuangbo Dai ◽  
Min Chen ◽  
Shaohua HE
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
Physiological Stress ◽  
Vital Statistics ◽  
Early Postoperative Period ◽  
Epidural Block ◽  
Hypospadias Repair ◽  
Ultrasound Guided ◽  
Analgesic Requirement ◽  
General Anesthesia Group

Abstract Background: Postoperative pain management in hypospadias surgery can be challenging, especially with the occurrence of postoperative penile erection, which is usually accompanied with bleeding and often interferes with wound healing. Ultrasound-guided caudal epidural block is easy to administer and can attenuate postoperative physiological stress response. In this study, we compared the effect of pain control among patients receiving standard general anesthesia (Group G) and among those receiving caudal analgesics of lidocaine-ropivacaine (Group GC). Methods: A total of 100 patients needing hypospadias repair for the first time were consecutively enrolled; 50 patients received caudal analgesics depending on available anesthesiologists. All patients were operated on by the same experienced surgeon. Primary outcome included pain and sedation scores, and the incidence of painful erections within 24 hours following surgery. Heart rate (HR) and analgesic requirement were also compared. Results: Baseline characteristics and vital statistics did not differ between the two groups. Postoperative erections were significantly less frequent in the GC than in the G group (22% vs. 64%, P < 0.05). The HRs and pain scores of the GC group were lower than those of the G group (P < 0.05) in the first 12 hours. Postoperative sedative effect was better and analgesic requirement less for the GC than the G group (P < 0.05) in the first 24 hours. Conclusion : Caudal lidocaine + ropivacaine can provide effective pain management in the early postoperative period and reduce the occurrence of painful erections. Further volume dosing studies are needed to refine the strategy for optimal pain control.

Postoperative Management and Radiography

2015 ◽  
Author(s):  
John Goodfellow ◽  
John O'Connor ◽  
Hemant Pandit ◽  
Christopher Dodd ◽  
David Murray
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Pain Control ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Multimodal Approach ◽  
Invasive Approach ◽  
Opiate Use ◽  
Total Knee ◽  
Good Pain Control

In the early postoperative period, good pain control is essential. Regimes of pain management appropriate for total knee arthroplasty may not be suited to the very rapid mobilisation that is possible after UKA through a minimally invasive approach. A multimodal approach is best with minimal opiate use. Different regimes are used successfully in different institutions.

scholarly journals A Novel Technique to Reduce Reliance on Opioids for Analgesia from Acute Appendicitis: The Ultrasound-guided Erector Spinae Plane Block

2019 ◽  
Vol 3 (3) ◽  
pp. 248-251 ◽  
Author(s):  
Daniel Mantuani ◽  
Josh Luftig ◽  
Andrew Herring ◽  
Andrea Dreyfuss ◽  
Arun Nagdev
Keyword(s):  
Pain Management ◽  
Acute Appendicitis ◽  
Pain Control ◽  
Single Injection ◽  
Femoral Nerve ◽  
Injured Patient ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Hospital System

Single injection, ultrasound-guided nerve blocks have drastically changed the multimodal approach to pain management of the acutely injured patient in the emergency department (ED). Ultrasound-guided femoral nerve blocks in the ED have become standard aspects of multiple, hospital system pain management protocols, with early evidence demonstrating improved patient outcomes. Developing a multimodal pain management strategy can improve analgesia while reducing reliance on opioids in this era of opioid addiction.1 The single injection, ultrasound-guided erector spinae plane (ESP) block is a technique safely used for pain control for rib fractures that can be easily performed at the bedside and integrated into optimal emergency care. A more inferiorly located ultrasound-guided ESP block has been recently described in the anesthesia literature for perioperative pain control for various abdominal surgeries but has not yet been described for patients with acute appendicitis. Here we describe a single injection, lower ESP block performed by emergency physicians that successfully alleviated pain from acute appendicitis in an ED patient awaiting definitive surgical treatment. Along with allowing clinicians to actively manage pain without reliance on opioids, this novel ED technique may improve patient care outcomes.

A Comparative Study between Caudal and Penile Blockade in Pediatric Patients Undergoing Hypospadias Repair

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mona Ismail Mohammed Fadl Eldemirdash ◽  
Raouf Ramzy Gadalla ◽  
Neveen Gerges Fahmy ◽  
Yahia Mamdouh Hassan Maky
Keyword(s):  
Pain Score ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Epidural Block ◽  
Hypospadias Repair ◽  
Success Rates ◽  
University Hospitals ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Randomized Clinical Study

Abstract Background Regional anesthesia, in combination with general anesthesia, is frequently used for children undergoing surgical procedures. Aim of the Work to compare postoperative analgesia between caudal block and penile block with bupivacaine in elective hypospadias repair cases in pediatric patients. Patients and Methods This study is a randomized clinical study conducted in the operating theaters of pediatric surgery unit in Ain shams university hospitals. The study was performed after ethical committee approval and informed consent from the parents after full explanation of the procedure, possible side effects and complications. This study was done in the period between March 2019 and August 2019.it included sixty male children undergoing hypospadias repair. Results Postoperative pain was evaluated by FLACC pain score at PACU, 2, 4 and 8, 12, 16 and 24 hrs. There was a significant increase in the pain score in group C starting from the fourth hour postoperativly and thereafter every hour, while the lowest pain scores were recorded in group P (P &lt; 0.05). Also, the time to first need for rescue analgesia was significantly shorter in group C (240 +/-105 min) compared with group P (720 +/-301) (P&gt;0.01).The total rescue analgesic requirement was significantly lower in group P (168.26 +/22.69) than group C (573.8+/- 124.1) (P &lt; 0.01).Postoperative time of ambulation was significantly lower in group C (6.95+/- 3.22) compared with group P (5.28+/-1.99) (P &lt; 0.01). Conclusion Dorsal penile nerve block in children undergoing penile surgery provides effective and a longer duration of postoperative analgesia and decreased postoperative analgesic requirements with more hemodynamic stability both intraoperatively and postoperatively, as it is safer and easier to perform, with higher success rates than caudal epidural block, which is invasive and shows some difficulty in practice.

Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations

2019 ◽  
Vol 85 (7) ◽  
Author(s):  
Theodosios Saranteas ◽  
Iosifina Koliantzaki ◽  
Olga Savvidou ◽  
Marina Tsoumpa ◽  
Georgia Eustathiou ◽  
...  
Keyword(s):  
Pain Management ◽  
Peripheral Nerve ◽  
Acute Pain ◽  
Ultrasound Guided ◽  
Acute Pain Management ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

Ultrasound-guided thoracic wall nerve blocks for effective pain control in cardiac surgery

2020 ◽  
Vol 86 (6) ◽  
Author(s):  
Giuseppe Sepolvere ◽  
Mario Tedesco ◽  
Pierfrancesco Fusco ◽  
Paolo Scimia ◽  
Loredana Cristiano
Keyword(s):  
Cardiac Surgery ◽  
Pain Control ◽  
Thoracic Wall ◽  
Ultrasound Guided ◽  
Nerve Blocks

A Multimodal Pain Management Regimen for Open Treatment of Distal Radius Fractures: A Randomized Blinded Study

Hand ◽  
2020 ◽  
pp. 155894472097514
Author(s):  
Julian Zangrilli ◽  
Nura Gouda ◽  
Armen Voskerijian ◽  
Mark L. Wang ◽  
Pedro K. Beredjiklian ◽  
...  
Keyword(s):  
Pain Management ◽  
Distal Radius ◽  
Bone Healing ◽  
Pain Control ◽  
Distal Radius Fractures ◽  
Study Group ◽  
Radius Fractures ◽  
Multimodal Pain Management ◽  
Regional Block ◽  
Rebound Increase

Background Adequate pain control is critical after outpatient surgery where patients are not as closely monitored. A multimodal pain management regimen was compared to a conventional pain management method in patients undergoing operative fixation for distal radius fractures. We hypothesized that there would be a decrease in the amount of narcotics used by the multimodal group compared to the conventional pain management group, and that there would be no difference in bone healing postoperatively. Methods Forty-two patients were randomized into 2 groups based on pain protocols. Group 1, the control, received a regional block, acetaminophen, and oxycodone. Group 2 received a multimodal pain regimen consisting of daily doses of pregabalin, celecoxib, and acetaminophen up until postoperative day (POD) #3. They also received a regional block with oxycodone for breakthrough pain. Results From POD#3 to week 1, there was a significant increase in oxycodone use in the study group correlating with the point in time when the multimodal regimen was discontinued. The shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) scores taken at 2 weeks postoperation showed a significantly lower average score in the study group compared to the control. There was no difference in bone healing. Conclusions The 2 regimens yielded similar pain control after surgery. The rebound increase in narcotic use after the multimodal regimen was discontinued, and significant difference in QuickDASH scores seen at 2 weeks postoperatively supported that multimodal regimens may not necessarily lead to decreased narcotic use in outpatient upper extremity surgery, but in the short term are shown to improve functional status.

scholarly journals Ultrasound-guided thermal radiofrequency ablation to treat refractory knee and hip pain: Outcomes of a case series

2021 ◽  
Vol 28 ◽  
pp. 221049172110033
Author(s):  
Ismael Carneiro ◽  
Joana Silva ◽  
Tiago Lopes ◽  
José Luís Carvalho
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Control ◽  
Case Series ◽  
Hip Pain ◽  
Ultrasound Guided ◽  
Symptomatic Knee ◽  
Pain Outcomes

A number of options are currently available to treat symptomatic knee and hip pain. Among them, there is the use of thermal radiofrequency ablation. It is a more recent technique and we still have a lack regarding safety and effectiveness. In this report, we briefly present a case series of patients with refractory knee and hip pain, treated with thermal radiofrequency ablation, where we discuss the results in safety and effectiveness, concerning not only the pain control, but also the return to participation in activities.

scholarly journals Pain management practice patterns after hip arthroscopy: an international survey

2020 ◽  
Author(s):  
Flávio L Garcia ◽  
Brady T Williams ◽  
Bhargavi Maheshwer ◽  
Asheesh Bedi ◽  
Ivan H Wong ◽  
...  
Keyword(s):  
Pain Management ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Sports Medicine ◽  
Management Practice ◽  
Professional Organizations ◽  
International Survey ◽  
Nerve Blocks ◽  
Optimal Approach ◽  
Answer Choice

Abstract Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons’ responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as &gt; 80% of respondents selecting a single answer choice, while general agreement was defined as &gt;60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.

scholarly journals International survey: real-world pain management strategies

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Hagen ◽  
A Georgescu
Keyword(s):  
Pain Management ◽  
Real World ◽  
Pain Control ◽  
Online Survey ◽  
Management Strategies ◽  
Pain Medication ◽  
International Survey ◽  
Nationally Representative ◽  
Online Panels ◽  
Control Pain

Abstract Background Pain is a nearly universal experience, but little is known about how people treat pain. This international survey assessed real-world pain management strategies. Methods From 13-31 January, 2020, an online survey funded by GSK Consumer Healthcare was conducted in local languages in Australia, Brazil, Canada, China, Colombia, France, Germany, India, Italy, Japan, Saudi Arabia, Malaysia, Mexico, Poland, Russia, Spain, Sweden, UK, and USA. Adults were recruited from online panels of people who agreed to participate in surveys. Quotas ensured nationally representative online populations based on age, gender, and region. Results Of 19,000 people (1000/country) who completed the survey, 18,602 (98%) had ever experienced physical pain; 76% said they would like to control their pain better. Presented with 17 pain-management strategies and asked to select the ones they use in the order of use, respondents chose an average of 4 strategies each. The most commonly selected strategies were pain medication (65%), rest/sleep (54%), consult a doctor (31%), physical therapy (31%), and nonpharmacologic action (eg, heat/cold application; 29%). Of those who use pain medication, 56% take some other action first. Only 36% of those who treat pain do so immediately; 56% first wait to see if it will resolve spontaneously. Top reasons for waiting include a desire to avoid medication (37%); willingness to tolerate less severe pain (33%); concerns about side effects (21%) or dependency (21%); and wanting to avoid a doctor's visit unless pain is severe or persistent (21%). Nearly half (42%) of those who take action to control pain have visited ≥1 healthcare professional (doctor 31%; pharmacist 18%; other 17%) about pain. Conclusions This large global survey shows that people employ a range of strategies to manage pain but still wish for better pain control. Although pain medication is the most commonly used strategy, many people postpone or avoid its use. Key messages More than three-quarters (76%) of respondents across countries seek better pain control. Pain medication and rest/sleep consultation are the most common pain management strategies. More than half of respondents (56%) wait to see if pain will resolve spontaneously before taking any action, and 56% of those who use pain medication try some other approach first.

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