scholarly journals Lower Background Infusion of Oxycodone for Patient-Controlled Intravenous Analgesia, Combined with Ropivacaine Intercostal Nerve Block, in Patients Undergoing Thoracoscopic Lobectomy for Lung Cancer: A Randomized, Double-Blind, Controlled Clinical Trial

2021 ◽  
Vol Volume 15 ◽  
pp. 3535-3542
Author(s):  
Yunxiao Zhang ◽  
Wanpu Yan ◽  
Yanyun Chen ◽  
Zhiyi Fan ◽  
Jiheng Chen
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
Nerve Block ◽  
Intercostal Nerve ◽  
Controlled Clinical Trial ◽  
Intercostal Nerve Block ◽  
Double Blind ◽  
Background Infusion ◽  
Intravenous Analgesia ◽  
Lower Background

scholarly journals Anti-nociceptive Effects of Dexmedetomidine Infusion Plus Modified Intercostal Nerve Block During Single-port Thoracoscopic Lobectomy: A Double-blind, Randomized Controlled Trial

2021 ◽  
pp. E565-E572
Keyword(s):  
Nerve Block ◽  
Low Dose ◽  
Single Port ◽  
Intercostal Nerve ◽  
Intercostal Nerve Block ◽  
Double Blind ◽  
Thoracoscopic Lobectomy ◽  
Opioid Sparing ◽  
Alternative Method ◽  
Dexmedetomidine Infusion

BACKGROUND: Multimodal general anesthesia based on modified intercostal nerve block (MINB) has been found as a novel method to achieve an intraoperative opioid-sparing effect. However, there is little information about the effective method to inhibit visceral nociceptive stress during single-port thoracoscopic surgery. OBJECTIVE: To investigate whether a low-dose dexmedetomidine infusion followed by MINB might be an alternative method to blunt visceral stress effectively. STUDY DESIGN: Double-blind, randomized control trial. SETTING: Affiliated hospital from March 2020 through September 2020. METHODS: Fifty-four patients were randomized (1:1), 45 patients were included to receive dexmedetomidine with a 0.4 microgram/kg bolus followed by 0.4 microgram/kg/h infusion (group Dex) or saline placebo (group Con). During the operation, an additional dose of remifentanil 0.05–0.25 microgram/kg/min was used to keep mean arterial pressure (MAP) or heart rate (HR) values around 20% below baseline values. The primary outcome was to evaluate remifentanil consumption. Secondary outcomes included intraoperative hemodynamics, the first time to press an analgesia pump, and adverse effects. RESULTS: Remifentanil consumption during surgery was markedly decreased in the Dex group than in the Con group (0 [0-0] versus 560.0 [337.5-965.0] microgram; P = 0.00). MAP and HR in the Con group during the first 5 minutes after visceral exploration was significantly higher than in the Dex group (P < 0.05). Time to first opioid demand was significantly prolonged (P = 0.04) and postoperative length of stay was shortened slightly in the Dex group (P = 0.05). LIMITATIONS: This study was limited by the measurement of nociception. CONCLUSIONS: This study demonstrates that low-dose dexmedetomidine infusion combined with MINB might be an effective alternative method to blunt visceral stress in patients undergoing single-port thoracoscopic lobectomy. Furthermore, the analgesic effect of MINB was significantly prolonged after dexmedetomidine infusion. KEY WORDS: Opioid-sparing, nociceptive stress, dexmedetomidine, remifentanil

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).

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