Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Drug Design Development and Therapy, Journal Year: 2023, Volume and Issue: Volume 17, P. 1463 - 1484

Published: May 1, 2023

Peripheral nerve block technology is important to balanced anesthesia technology. It can effectively reduce opioid usage. the key enhance clinical rehabilitation as an part of multimodal analgesia scheme. The emergence ultrasound has accelerated peripheral development. directly observe shape, surrounding tissue, and diffusion path drugs. also dosage local anesthetics by improving positioning accuracy while enhancing block's efficacy. Dexmedetomidine a highly selective drug α2-adrenergic receptor agonist. characteristics sedation, analgesia, anti-anxiety, inhibition sympathetic activity, mild respiratory inhibition, stable hemodynamics. Numerous studies have revealed that dexmedetomidine in blocks shorten onset time prolong sensory motor blocks. Although was approved European Drug Administration for sedation 2017, it not yet been US Food (FDA). used non-label adjuvant. Therefore, risk-benefit ratio must be evaluated when using these drugs adjuvants. This review explains pharmacology mechanism dexmedetomidine, effect on various adjuvant, compare with other types We summarized reviewed application progress adjuvant look forward its future research direction.

Language: Английский

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A comparison of regional anesthesia techniques in patients undergoing video-assisted thoracic surgery: A network meta-analysis

International Journal of Surgery, Journal Year: 2022, Volume and Issue: 105, P. 106840 - 106840

Published: Aug. 24, 2022

Language: Английский

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Development and validation of a prediction model for chronic post-surgical pain risk: a single-center prospective study of video-assisted thoracoscopic lung cancer surgery

Journal of Cardiothoracic Surgery, Journal Year: 2025, Volume and Issue: 20(1)

Published: Jan. 23, 2025

Language: Английский

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Bayesian Network Meta-Analysis of Postoperative Analgesic Techniques in Thoracoscopic Lung Resection Patients

Pain and Therapy, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 22, 2025

Postoperative analgesia in thoracoscopic lung resection is crucial, with several nerve block techniques—including thoracic epidural anesthesia (TEA), paravertebral (PVB), erector spinae plane (ESPB), intercostal (INB), and serratus anterior (SAPB)—commonly employed. However, there remains ongoing debate regarding the optimal technique. To evaluate compare effectiveness of these methods, a systematic review was conducted across multiple databases, including PubMed, Embase, Web Science, Cochrane Library, identifying relevant randomized clinical trials (RCTs). A Bayesian network meta-analysis performed to assess postoperative pain management, subgroup analyses meta-regression examine key factors influencing outcomes, such as risk bias, continuous catheter analgesia, patient-controlled (PCA). The results revealed that for 12-h resting visual analog scale (VAS) scores, surface under cumulative ranking curve (SUCRA) TEA > PVB ESPB control INB SAPB, whereas at 24 h, it shifted SAPB. For coughing VAS ranked highest, followed by PVB, ESPB, control. At TEA, INB, inconsistency test showed good consistency, minimal publication neither study quality nor local anesthetic infiltration incision site significantly impacted outcomes. Excluding studies without PCA did not change SUCRA rankings. consistently highest 24-h scores. Clustered plots indicated were most suitable techniques analgesia. emerged analgesic resection. While superior efficacy, offered fewer side effects, providing safety advantage. considered less due its excessive effects.

Language: Английский

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Acute pain management after thoracoscopic lung resection: a systematic review and explorative meta-analysis

Interdisciplinary CardioVascular and Thoracic Surgery, Journal Year: 2023, Volume and Issue: 36(1)

Published: Jan. 1, 2023

Pain after thoracoscopic surgery may increase the incidence of postoperative complications and impair recovery. Guidelines lack consensus regarding analgesia. We performed a systematic review meta-analysis to determine mean pain scores different analgesic techniques (thoracic epidural analgesia, continuous or single-shot unilateral regional analgesia only systemic analgesia) anatomical lung resection.Medline, Embase Cochrane databases were searched until 1 October 2022. Patients undergoing at least >70% resections through thoracoscopy reporting included. Due high inter-study variability an explorative next analytic was performed. The quality evidence has been evaluated using Grading Recommendations Assessment, Development Evaluation system.A total 51 studies comprising 5573 patients Mean 24, 48 72 h with 95% confidence interval on 0-10 scale calculated. Length hospital stay, nausea vomiting, additional opioids use rescue analysed as secondary outcomes. A common-effect size estimated extreme heterogeneity for which pooling not appropriate. An exploratory demonstrated acceptable Numeric Rating Scale <4 all techniques.This extensive literature attempt pool demonstrates that is gaining popularity over thoracic in resection, despite great limitations current precluding such recommendations.ID number 205311.

Language: Английский

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Ultrasound-guided erector spinae plane block for perioperative analgesia in patients undergoing laparoscopic nephrectomy surgery: A randomized controlled trial

Heliyon, Journal Year: 2024, Volume and Issue: 10(4), P. e26422 - e26422

Published: Feb. 1, 2024

Study objectiveKidney neoplasms have a high incidence, and radical nephrectomy or partial are the main treatment options. Our study aims to investigate use of ultrasound-guided erector spinae plane block for perioperative analgesia in patients undergoing laparoscopic surgery.DesignProspective, randomized, double-blind.SettingUniversity hospital.PatientsOur included 50 (ASA I-III) who underwent at hospital Second Affiliated Hospital Army Medical University.InterventionsThe were divided into two groups: ESPB group control group. In group, mixture 10 mL 1% lidocaine, 0.7% ropivacaine, 0.5 μg/kg dexmedetomidine, 5 mg dexamethasone was administered. 20 0.9% saline administered.MeasurementsThe primary outcome measure total consumption sufentanil during intraoperative period. Secondary measures visual analogue scale (VAS) pain scores rest coughing 1 h, 6 12 24 48 h postoperatively, remifentanil, frequency rescue analgesic administration, incidence postoperative nausea vomiting within h.ResultsThe exhibited lower sufentanil, analgesia, as well VAS first compared However, no significant differences observed vomiting, need analgesia.ConclusionsUltrasound-guided performed demonstrated substantial decrease opioid consumption,

Language: Английский

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Effects of thoracic paravertebral block combined with s-ketamine on postoperative pain and cognitive function after thoracoscopic surgery

Heliyon, Journal Year: 2022, Volume and Issue: 8(12), P. e12231 - e12231

Published: Dec. 1, 2022

To assess the effects of thoracic paravertebral block and s-ketamine on postoperative pain perioperative neurocognitive disorder (PND) in video-assisted thoracoscopic surgery.Patients (n = 120) aged 45-65 undergoing surgery were allocated randomly into following three groups: patients C group received general anaesthesia; group, i.e. TP anaesthesia ultrasound-guided block; combined with nerve TS anaesthesia, which was administered as follows: + (a bolus 0.3 mg/kg, followed by an infusion 0.2 mg/kg/h until 30 min before end surgical procedure).Cognitive function measured using Mini-Mental State Examination 1 day preoperatively, postoperatively, 3 months postoperatively. Z-score used to determine incidence PND. Postoperative assessed visual analogue scale at 0.5 24 h The use opioid drugs, intraoperative vital signs, other secondary outcomes also recorded. final analysis included a total 110 patients. heart rate mean arterial pressure groups lower than that for (P＜0.05). After surgery, exhibited significantly scores (P＜0.001 P 0.004,respectively) well rates nausea, vomiting, pulmonary complications PND those who anaesthesia. However, there no significant difference between (P＞0.05).Ultrasound-guided decreased acute improved quality recovery. did not improve cognitive under block.

Language: Английский

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Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis

Videosurgery and Other Miniinvasive Techniques, Journal Year: 2023, Volume and Issue: unknown, P. 52 - 68

Published: Jan. 23, 2023

Nerve block is widely used for pain management after video-assisted thoracoscopic surgery (VATS). Thoracic paravertebral (TPVB), erector spinae plane (ESPB), serratus anterior (SAPB), and intercostal nerve (ICNB) are alternative treatments.Network meta-analysis based on Bayesian analyses was performed to obtain results direct comparison, indirect network make rankings probabilities. Covariates were adjusted determine the effect of covariates this study.The study identified 61 randomized controlled trials (RCTs) (4468 patients). There probability ranking first ("best" treatment): 24 h morphine consumption, TPVB > ESPB ICNB SAPB. Covariate adjustment allowed four treatments change somewhat in likelihood best choice.TPVB ranks our analysis. a viable alternative. SAPB seem play limited role postoperative management.

Language: Английский

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Erector spinae plane block versus paravertebral block for postoperative pain management in thoracic surgery: a systematic review and meta-analysis

Minerva Anestesiologica, Journal Year: 2023, Volume and Issue: 89(11)

Published: Sept. 6, 2023

The 2018 guidelines for enhanced recovery in thoracic surgery recommend paravertebral block (PVB) postoperative pain management. However, recent studies demonstrate that erector spinae plane (ESPB) achieves similar control with reduced block-related complications.We conducted a meta-analysis of randomized controlled trials to evaluate the analgesic efficacy and safety ESPB versus PVB management after surgery. PubMed, Embase, Scopus were searched through December 2022 (PROSPERO registration - CRD42023395593). Primary outcomes scores, resting at 6, 12, 24, 48 hours, movement 24 hours. Secondary included opioid consumption incidence nausea vomiting or complications first hours.Ten enrolling total 624 patients included. There no significant differences movement, any time points except scores 12 hours (mean difference [MD]) 0.60, 95% confidence interval [CI] 0.32 0.88). Opioid demonstrated hours; (MD 0.40, CI -0.09 0.89). vomiting. exhibited nonsignificant trend toward cumulative (risk [RD] 0.05, -0.10 0.00).Compared PVB, is safe demonstrates clinically

Language: Английский

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Application of multimodal analgesia combined with opioid-free anesthetics in a non-intubated video-assisted thoracoscopic surgery bullectomy: A case report

Frontiers in Surgery, Journal Year: 2023, Volume and Issue: 10

Published: Feb. 13, 2023

Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been increasingly applied worldwide owing to its benefits of enhanced recovery after (ERAS). Anesthetic management for patients with asthma should focus on minimizing airway stimulation.A 23-year-old male patient a history was diagnosed left-sided spontaneous pneumothorax. The then underwent NIVATS bullectomy under general anesthesia preserved breathing. Left thoracic paravertebral nerve block (TPVB) an injection 0.375% ropivacaine (30 ml) performed in the 6th space ultrasound guidance. Anesthesia induction commenced until cold sensation surgical area had disappeared. General induced by midazolam, penehyclidine hydrochloride, esketamine, and propofol maintained using esketamine. Surgery positioned right lateral recumbency. collapse left lung satisfactory, operative field ensured artificial procedure uneventful, intraoperative arterial blood gases were within normal ranges, vital signs stable. awakened rapidly without any adverse reactions at end transferred ward. During postoperative follow-up, experienced mild pain 48 h surgery. discharged from hospital 2 days postoperatively developed no nausea, vomiting, or other complications.The present case suggests feasibility TPVB combination non-opioid anesthetics provide high-quality undergoing bullectomy.

Language: Английский

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