scholarly journals Ultrasound-guided Parasternal Intercostal Nerve Block for Postoperative Analgesia in Mediastinal Mass Resection by Median Sternotomy: a Randomized, Double-blind, Placebo-controlled Trial

2020 ◽  
Author(s):  
Hexiang Chen ◽  
Wenqin Song ◽  
Wei Wang ◽  
Yawen Peng ◽  
Chunchun Zhai ◽  
...  
Keyword(s):  
Nerve Block ◽  
Postoperative Analgesia ◽  
Mediastinal Mass ◽  
Controlled Trial ◽  
Median Sternotomy ◽  
Intercostal Nerve ◽  
Control Group ◽  
Ultrasound Guided ◽  
Intercostal Nerve Block ◽  
Double Blind

Abstract Background: Ultrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear. This study aimed to evaluate the effectiveness of ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in patients undergoing median sternotomy for mediastinal mass resection.Methods: This randomized, double-blind, placebo-controlled trial performed in Renmin Hospital, Wuhan University, enrolled 41 participants aged 18-65 years. The patients scheduled for mediastinal mass resection by median sternotomy were randomly assigned were randomized into 2 groups, and preoperatively administered 2 injections of ropivacaine (PSI) and saline (control) groups, respectively, in the 3rd and 5th parasternal intercostal spaces with ultrasound-guided (USG) bilateral parasternal intercostal nerve block. Sufentanil via patient-controlled intravenous analgesia (PCIA) was administered to all participants postoperatively. Pain score, total sufentanil consumption, and postoperative adverse events were recorded within the first 24 hours.Results: There were 20 and 21 patients in the PSI and control group, respectively. The PSI group required 20% less PCIA-sufentanil compared with the control group (54.05 ± 11.14 μg vs. 67.67 ± 8.92 μg; P < 0.001). In addition, pain numerical rating scale (NRS) scores were significantly lower in the PSI group compared with control patients, both at rest and upon coughing within 24 postoperative hours. Postoperative adverse events were generally reduced in the PSI group compared with controls. Conclusions: USG bilateral parasternal intercostal nerve block effectively reduces postoperative pain and adjuvant analgesic requirement, with good patient satisfaction, therefore constituting a good option for mediastinal mass resection by median sternotomy.

scholarly journals Ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in mediastinal mass resection by median sternotomy: a randomized, double-blind, placebo-controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hexiang Chen ◽  
Wenqin Song ◽  
Wei Wang ◽  
Yawen Peng ◽  
Chunchun Zhai ◽  
...  
Keyword(s):  
Nerve Block ◽  
Postoperative Analgesia ◽  
Mediastinal Mass ◽  
Controlled Trial ◽  
Median Sternotomy ◽  
Intercostal Nerve ◽  
Control Group ◽  
Ultrasound Guided ◽  
Intercostal Nerve Block ◽  
Double Blind

Abstract Background Ultrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear. This study aimed to evaluate the effectiveness of ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in patients undergoing median sternotomy for mediastinal mass resection. Methods This randomized, double-blind, placebo-controlled trial performed in Renmin Hospital, Wuhan University, enrolled 41 participants aged 18–65 years. The patients scheduled for mediastinal mass resection by median sternotomy were randomly assigned were randomized into 2 groups, and preoperatively administered 2 injections of ropivacaine (PSI) and saline (control) groups, respectively, in the 3rd and 5th parasternal intercostal spaces with ultrasound-guided (USG) bilateral parasternal intercostal nerve block. Sufentanil via patient-controlled intravenous analgesia (PCIA) was administered to all participants postoperatively. Pain score, total sufentanil consumption, and postoperative adverse events were recorded within the first 24 h. Results There were 20 and 21 patients in the PSI and control group, respectively. The PSI group required 20% less PCIA-sufentanil compared with the control group (54.05 ± 11.14 μg vs. 67.67 ± 8.92 μg, P < 0.001). In addition, pain numerical rating scale (NRS) scores were significantly lower in the PSI group compared with control patients, both at rest and upon coughing within 24 postoperative hours. Postoperative adverse events were generally reduced in the PSI group compared with controls. Conclusions USG bilateral parasternal intercostal nerve block effectively reduces postoperative pain and adjuvant analgesic requirement, with good patient satisfaction, therefore constituting a good option for mediastinal mass resection by median sternotomy.

scholarly journals Application of preemptive parasternal intercostal nerve block in patients undergoing off pump coronary artery bypass grafting:A Double-Blind,Randomised, Controlled Trial

2019 ◽  
Author(s):  
mengmeng zou ◽  
wei ruan ◽  
junmei xu
Keyword(s):  
Nerve Block ◽  
Postoperative Analgesia ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Saline Group ◽  
Intercostal Nerve ◽  
Total Dosage ◽  
Intercostal Nerve Block ◽  
Double Blind ◽  
The Impact

Abstract Background: Parasternal intercostal nerve block as superficial block has been increasingly used for postoperative analgesia via performed before sternal suture placement, and has shown that this technique can provide effective postoperative analgesia and facilitate rapid-recovery. However, the impact of preemptive parasternal intercostal nerve block has not been researched for cardiac surgery patients. Methods: Sixty-four patients underwent OPCABG were randomly divided into parasternal intercostal nerve block with ropivacaine ( n = 32) group and parasternal intercostal nerve block with saline ( n = 32) group. Before anaesthesia induction, 20ml of 0.35% Ropivacaine along with 1 mg dexamethasone or saline on each side, total dosage 40 ml, via parasternal intercostal injection. 5ml of 0.35% ropivacaine along with 0.5 mg dexamethasone or saline on each leg, total dosage 10 ml, via peripheral saphenous nerve block. Results: The consumptions of intraoperative sufentanil and vasopressor were significantly lower in ropivacaine group(P＜0.05). Analgesia was adequate in the ropivacaine group up to 20 h. VAS score in the ropivacaine group significantly was lower compared with the saline group up to 12 h postoperatively(P＜0.05). The time of first rescue analgesic, anaesthesia recovery and extubation were significantly less in patients of the ropivacaine group(P＜0.05). The majority of the ropivacaine group patients did not need rescue dezocine, while the most of the saline group needed dezocine (P <0.05). The hemodynamic variables were stable in all patients. Few cases reported trivial adverse effects. Conclusions: Preemptive parasternal intercostal nerve block provide adequate analgesia for the first 20 h after surgery and reduce intraoperative sufentanil, intraoperative norepinephrine and postoperative dezocine consumption as well as the time of extubation. Trial registration: The study was registered at chictr.org.cn (identifier: ChiCTR1800017210，Registered 18 July 2018).

scholarly journals Minimum Effective Concentration of Bupivacaine in Ultrasound-Guided Femoral Nerve Block after Arthroscopic Knee Meniscectomy: A Randomized, Double-Blind, Controlled Trial

2016 ◽  
Vol 1;19 (1;1) ◽  
pp. E79-E86
Author(s):  
Rioko K. Sakata
Keyword(s):  
Pain Intensity ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Controlled Trial ◽  
Femoral Nerve ◽  
Pain Intensity Score ◽  
Ultrasound Guided ◽  
Double Blind ◽  
Intensity Score ◽  
Arthroscopic Knee

Background: Adequate analgesia is important for early hospital discharge after meniscectomy. A femoral nerve block may reduce the need for systemic analgesics, with fewer side effects; however, motor block can occur. Ultrasound-guided femoral nerve block may reduce the required local anesthetic concentration, preventing motor block. Objective: The primary objective of this study was to determine the lowest effective analgesic concentration of bupivacaine in 50% (EC50) and in 90% (EC90) of patients for a successful ultrasoundguided femoral nerve block in arthroscopic knee meniscectomy. Study Design: This was a prospective, randomized, double-blind, controlled trial. Settings: This study was conducted at Hospital São Domingos. Methods: A total of 52 patients undergoing arthroscopic knee meniscectomy were submitted to ultrasound-guided femoral nerve block using 22 mL bupivacaine. The bupivacaine concentration given to a study patient was determined by the response of the previous patient (a biased-coin design up–down sequential method). If the previous patient had a negative response, the bupivacaine concentration was increased by 0.05% for the next case. If the previous patient had a positive response, the next patient was randomized to receive the same bupivacaine concentration (with a probability of 0.89) or to have a decrease by 0.05% (with a probability of 0.11). A successful block was defined by a numerical pain intensity scale score < 4 (0 = no pain; 10 = worst imaginable pain) in 3 different evaluations. If the pain intensity score was ≥ 4 (moderate or severe pain) at any time, the block was considered failed. General anesthesia was induced with 30 μg/kg alfentanil and 2 mg/ kg propofol, followed by propofol maintanance, plus remifentanil if needed. Postoperative analgesia supplementation was performed with dipyrone; ketoprofen and tramadol were given if needed. Data Measurements: The following parameters were evaluated: numerical pain intensity score, duration of analgesia, supplementary analgesic dose in 24 hours, and need for intraoperative remifentanil. Results: The EC50 was 0.160 (95% CI: 0.150 – 0.189), and EC90 was 0.271 (95% CI: 0.196 – 0.300). There was no difference in numerical pain intensity score for the different concentrations of bupivacaine. A successful block was achieved in 45 patients, with no difference according to bupivacaine concentration. Time to first analgesic supplementation dose was longer for bupivacaine concentrations ≥ 0.3% (543.8 ± 283.8 min.), compared to 0.25% (391.3 ± 177.8 min.) and < 0.25% (302.3 ± 210.1 min.). There were no differences in supplementary analgesic dose in 24 hours nor in the use of intraoperative remifentanil according to bupivacaine concentration. Limitations: The analgesic effect was measured only during the first 2 hours. Conclusions: Bupivacaine EC50 for ultrasound-guided femoral nerve block was 0.160 (95% CI: 0.150 – 0.189), and EC90 was 0.271 (95% CI: 0.196 – 0.300). Key words: Postoperative analgesia, femoral block, ultrasound-guided, bupivacaíne minimum concentration, arthroscopic meniscectomy

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