Lumbosacral paraspinal interfascial plane blocks for pain control after feminizing genital gender affirmation surgery

2021 ◽  
Author(s):  
Sudipta Sen ◽  
Johanna B de Haan ◽  
Grace Guvernator ◽  
Andrzej P Kwater ◽  
Xuan T Langridge ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Case Series ◽  
Erector Spinae ◽  
Anesthetic Techniques ◽  
Pain Scores ◽  
Gender Affirmation ◽  
The Usa ◽  
Gender Affirmation Surgery ◽  
Regional Anesthetic

Aim: Feminizing genital gender affirmation surgery (fgGAS) is increasing in prevalence in the USA. Management of postoperative pain following fgGAS is challenging. We report a series of patients where post-fgGAS pain was adequately controlled with paraspinal blocks. Materials & methods: This is a case series of three patients who received bilateral lumbar and sacral erector spinae plane blocks after fgGAS. Block techniques, medications administered, opioid requirements and pain scores were reviewed. Results: Erector spinae plane blocks provided adequate analgesia for 24–48 h following the block. Conclusion: Currently, there are two regional anesthetic techniques described for the treatment of postoperative pain after fgGAS. We describe two additional approaches as options for improved pain management in this patient population.

Single shot erector spinae plane block for intra and postoperative pain control in open nephroureterectomy: a nice surprise

2021 ◽  
Vol 87 (4) ◽  
Author(s):  
Domenico P. SANTONASTASO ◽  
Annabella DE CHIARA ◽  
Stefania MAGNONI ◽  
Costanza MARTINO ◽  
Emanuele RUSSO ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Erector Spinae ◽  
Single Shot ◽  
Postoperative Pain Control ◽  
Erector Spinae Plane Block

Epidural versus PCA Pain Management after Pectus Excavatum Repair: A Multi-Institutional Prospective Randomized Trial

2019 ◽  
Vol 30 (05) ◽  
pp. 465-471
Author(s):  
Joseph A. Sujka ◽  
Charlene Dekonenko ◽  
Daniel L. Millspaugh ◽  
Nichole M. Doyle ◽  
Benjamin J. Walker ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Randomized Trial ◽  
Pain Control ◽  
Pectus Excavatum ◽  
Prospective Randomized Trial ◽  
Epidural Group ◽  
Thoracic Epidural ◽  
Pain Scores

Abstract Introduction Postoperative pain control remains the primary reason for inpatient stay after minimally invasive repair of pectus excavatum. In a previous study, our group reported that early pain control was better in patients managed with a thoracic epidural, while late pain control was better in patients managed with patient-controlled analgesia (PCA). After revising our epidural transition and modifying the PCA protocol, we conducted a multi-institutional prospective randomized trial to evaluate these two pain control strategies. Materials and Methods Patients were randomized to epidural or PCA following minimally invasive repair of pectus excavatum with standard protocols for each arm. Primary outcome was length of stay with secondary variables including mean patient pain scores, complications, and parental satisfaction. Scores were pooled for the two groups and reported as means with standard deviation. Results were compared using t-tests and one-way analysis of variance with p-value < 0.05 determining significance. Results Sixty-five patients were enrolled, 32 epidural and 33 PCA. Enrollment was stopped early when we developed an alternative strategy for controlling these patients' pain. There was no difference in length of stay in hours between the two arms; epidural 111.3 ± 18.5 versus PCA 111.4 ± 51.4, p = 0.98. Longer operative time was found in the epidural group. Nine patients in the epidural group (28%) required a PCA in addition to epidural for adequate pain control. Mean pain scores were lower on postoperative day 0 in the epidural group compared with the PCA groups, but were otherwise similar. Conclusion In our prospective randomized trial, PCA is just as effective as thoracic epidural in decreasing early postoperative pain scores after minimally invasive repair of pectus excavatum.

scholarly journals Use of Intraoperative Analgesic and Anesthetic Substances by Intramuscular Infiltrations during Hip Surgery for Postoperative Pain Monitoring

2019 ◽  
Vol 69 (12) ◽  
pp. 3530-3532
Author(s):  
Bogdan Hogea ◽  
Bogdan Corneliu Andor ◽  
Alina Totorean ◽  
Lavinia Maria Hogea ◽  
Laura Alexandra Nussbaum ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Hip Surgery ◽  
Control Group ◽  
Postoperative Pain Control ◽  
Pain Scores ◽  
Important Benefit ◽  
Active Mobilization ◽  
Management Techniques ◽  
Arthroplasty Surgery

The authors present their intraoperative and postoperative experience in using intramuscular infiltrations with analgesic and anesthetic substances as pain control methods in patients that undergo hip surgery: arthroplasty or hemiarthroplasty. A total of 30 patients that have undergone either an elective total hip arthroplasty surgery or hemiarthroplasty of the hip following a hip fracture, since May 2018 until August 2018. The patients were divided in two equal groups, one group that followed through the protocol and one control group. The intramuscular infiltrations were administered intraoperatively at the timeline of the muscle suture and contained: Bupivacaine 10 mL + Morphine 1 mL + Methylprednisolone 40mg. Postoperative protocol used the visual analogue scale (VAS) pain scores on days 1, 2, 3, 4, 5, 6 and 7 for measuring the postoperative pain control. Intraoperative intramuscular infiltrations, with an analgesic and anesthetic cocktail consisting of Bupivacaine, Morphine and Methylprednisolone, for patients that are going through hip surgery are safe to use with very good results in terms of postoperative pain control. We reduced the consumption of opioids and analgesic drugs, which indirectly leads to decreased direct cost per patient. Another important benefit was an early active mobilization of the patient, with shorter hospitalization time. All things considered, using regional anesthesia and multimodal pain management techniques may lead to a nearly painless hip surgery.

scholarly journals Safety and Effectiveness of Outpatient Total Ankle Arthroplasty

2021 ◽  
Vol 6 (4) ◽  
pp. 247301142110578
Author(s):  
Shahin Kayum ◽  
Sahil Kooner ◽  
Ryan M. Khan ◽  
Mansur Halai ◽  
Adam Awoke ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Pain Control ◽  
Primary Outcome ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Postoperative Pain Control ◽  
Ankle Arthroplasty ◽  
Secondary Outcomes ◽  
Numeric Scale

Background: Total ankle arthroplasty (TAA) is a surgical procedure commonly reserved for patients suffering from symptomatic end-stage ankle arthritis. As the number of TAAs increases, so does the associated economic burden. Given these economic constraints, there has been interest in the feasibility of outpatient TAA. The purpose of this study is to evaluate the safety, efficacy, and satisfaction of patients undergoing outpatient TAA. Methods: This is a retrospective case series of consecutive patients who underwent outpatient TAA from July 2018 to June 2019. Inclusion criteria included any patient undergoing a primary TAA in the outpatient setting. This was defined as discharge on the same day of surgery or within 12 hours of surgery. All surgeries were completed by a single experienced surgeon through an anterior approach using the Cadence Total Ankle System. Prior to surgery, all patients received a popliteal nerve block. Patients were then discharged home with oral analgesic and a popliteal nerve catheter, which they removed after 48 hours. The primary outcome of interest was postoperative pain control, which was measured using a numeric scale. Secondary outcomes included complication rate, readmission rate, and patient satisfaction. A review of the current literature was then completed to supplement our results. Results: In total, 41 patients were included in our analysis. In terms of the primary outcome, the average numeric scale score was 1.98, indicating excellent pain control. Additionally, nearly all 41 patients stated they were very satisfied with their postoperative pain control regimen. In terms of secondary outcomes, the majority of patients stated they were satisfied with discharge on the same day as surgery. There were no readmissions or major complications in our outpatient TAA cohort. When asked if they would recommend the care they experienced to a friend with the same condition, 95% of patients said that they would recommend this care pathway. Our literature review included 5 original studies, which were all retrospective level IV studies. These studies uniformly demonstrated the safety and efficacy of outpatient TAA. Conclusions: The results of our study demonstrate the outpatient TAA is associated with excellent pain control using a multidisciplinary pain approach. The use of standardized outpatient postoperative pathways was effective in preventing readmissions and complications, while still resulting in high patient satisfaction scores. A review of the literature complemented our results, as there are largely no significant differences between outpatient and inpatient TAA. Level of Evidence: Level IV, case series.

Single-injection caudal thoracic paravertebral block improves pain control and recovery quality in female dogs undergoing unilateral radical mastectomy: a randomized controlled trial

2021 ◽  
Vol 260 (S1) ◽  
pp. S53-S58
Author(s):  
Francesco Santoro ◽  
Pasquale Debidda ◽  
Paolo Franci
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Single Injection ◽  
Radical Mastectomy ◽  
Cardiovascular Responses ◽  
Paravertebral Block ◽  
Control Groups ◽  
Thoracic Paravertebral Block ◽  
Pain Scores ◽  
And Control

Abstract OBJECTIVE To test clinical and analgesic effects of a single-injection caudal thoracic paravertebral block (TPVB) after localization of the thoracic paravertebral space with a loss-of-resistance to air injection technique in female dogs undergoing unilateral radical mastectomy. ANIMALS 14 client-owned dogs. PROCEDURES Dogs were premedicated with methadone, anesthetized with propofol and sevoflurane, and randomly assigned to receive a TPVB or no block preoperatively. Rescue analgesia with fentanyl and methadone was provided on the basis of cardiovascular responses during surgery and postoperative pain scores assigned with a validated pain scale. Required dose of rescue opioids; mean end-tidal sevoflurane concentration; episodes of hypotension, bradycardia, and other complications; quality of recovery scores; and postoperative pain scores were compared between groups. RESULTS Median intraoperative fentanyl doses were 0 µg/kg (range, 0 to 2 µg/kg) and 4 µg/kg (range, 2 to 6 µg/kg) for the TPVB and control groups, respectively. Median postoperative methadone doses were 0 mg/kg (range, 0 to 0.2 mg/kg) and 0.6 mg/kg (range, 0.4 to 0.6 mg/kg) for the TPVB and control groups, respectively. Recovery scores and pain scores assigned at the time of and 1 hour after extubation were significantly lower in the TPVB group than in the control group. CONCLUSIONS AND CLINICAL RELEVANCE A single-injection caudal TPVB improved pain control and recovery quality in female dogs undergoing unilateral radical mastectomy. Because the TPVB involves only a single injection, does not take long to perform, and requires only readily available low-cost equipment, the technique may be a valuable option in both referral and first-opinion practice.

Early Postoperative Pain Predicts 2-Year Functional Outcomes following Knee Arthroplasty

2019 ◽  
Vol 33 (11) ◽  
pp. 1132-1139 ◽  
Author(s):  
Akshay Lakra ◽  
Taylor Murtaugh ◽  
Roshan P. Shah ◽  
H. John Cooper ◽  
Jeffrey A. Geller
Keyword(s):  
Postoperative Pain ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Functional Outcomes ◽  
Short Form ◽  
Functional Score ◽  
Womac Pain ◽  
Pain Scores ◽  
Functional Scores

AbstractPain control following knee arthroplasty is extremely important to both patients and surgeons to improve the perioperative experience; however, the implication of early pain control on long-term outcomes following knee arthroplasty remains poorly understood. We hypothesized that poor early pain control results in poor functional outcomes 2 years following total (TKA) and unicondylar knee arthroplasty (UKA). This retrospective study reviewed 242 TKA and 162 UKA performed at a single institution by two surgeons. Mean visual analog scale (VAS) pain scores were collected for first 3 postoperative days. Patients were prospectively evaluated using short form (SF-12), the Western Ontario and McMaster University osteoarthritis index (WOMAC), and the Knee Society functional score (KSFS) questionnaires. Pearson's correlation coefficients were calculated between mean VAS pain scores and functional outcome scores at 2 years. In the TKA group, poorly controlled perioperative pain correlated with poorer functional scores at 2 years. There was a significant negative correlation between early mean VAS pain scores (mean, 3.2 ± 2.0) and most 2-year functional outcomes including SF-12 physical score (r = −0.227, p ≤ 0.01), WOMAC pain scores (r = −0.268, p ≤ 0.01), WOMAC stiffness scores (r = −0.224, p < 0.01), WOMAC function score (r = −0.290, p 0.01), and KSFS (r = −0.175, p = 0.031). Better control of early pain was associated with improved functional outcomes at 2 years following TKA. We also found significant negative correlations between preoperative functional scores and early postoperative pain scores. Collectively, using preoperative and early postoperative pain scores, we identified an “at-risk” patient group that manifested an inferior functional outcome at 2 years; these patients may benefit from closer surveillance and a multidisciplinary approach to pain and function to optimize their clinical outcome following knee arthroplasty.

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