Nerve Blocks for Post-Surgical Pain Management: A Narrative Review of Current Research

Journal of Pain Research, Journal Year: 2024, Volume and Issue: Volume 17, P. 3217 - 3239

Published: Oct. 1, 2024

Opioids remain the mainstay of post-surgical pain management; however, concerns regarding addiction and side effects necessitate exploration alternatives. This narrative review highlights potential nerve blocks as a safe effective strategy for control. explores use various block techniques tailored to specific surgical procedures. These include abdominal surgeries; fascial plane chest arm lower limb surgery including; femoral, hip, knee surgeries. By targeting nerves, these can provide targeted relief without negative associated with opioids. Emerging evidence suggests that be opioids in managing pain, while potentially offering additional benefits such faster recovery, improved patient satisfaction, reduced reliance on However, effectiveness varies depending type surgery, individual patients. Rebound which temporary increase after wears off, occur. In addition, some require specialized guidance accurate placement. conclusion, show great promise alternatives pain. They reduce need their effects, leading better outcomes satisfaction. Future studies should assess long-term impacts mortality rates, cost-effectiveness, incorporation into multimodal management approaches further enhance care.

Language: Английский

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Systematic reviews and meta-analyses for cardiothoracic surgeons: part 7 — synthesizing evidence

Indian Journal of Thoracic and Cardiovascular Surgery, Journal Year: 2025, Volume and Issue: unknown

Published: April 21, 2025

Language: Английский

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Evolution of pain management in lung cancer surgery: from opioid-based to personalized analgesia

Anesthesia and Pain Medicine, Journal Year: 2025, Volume and Issue: 20(2), P. 109 - 120

Published: April 30, 2025

Pain management in lung cancer resection has undergone a paradigm shift from opioid-centric approaches to multimodal analgesia, and more recently, personalized strategies that integrate the principles of precision medicine. Historically, opioids have been mainstay perioperative analgesia. However, concerns regarding opioid-related adverse effects, including respiratory depression, immunosuppression, potential oncologic implications, driven adoption opioid-sparing techniques. Current emphasize combining nonsteroidal antiinflammatory drugs, acetaminophen, regional anesthesia, adjunctive agents enhance pain control while minimizing opioid exposure. growing evidence suggests analgesics may differentially influence tumor biology depending on molecular genetic factors, necessitating tailored approach. This led emergence oncoanesthesia, which aims tumor-specific genomic insights into management. Although promising, clinical implementation oncoanesthesia remains its early stages, with key challenges lack large-scale prospective studies, limited real- time profiling anesthetic planning, variability patient responses analgesics. Future research should focus identifying biomarkers predict individual analgesia establishing evidence-based guidelines for precision- based By evolving beyond traditional reliance standard analgesic protocols, surgery can align emerging medicine approaches, ensuring effective optimized outcomes.

Language: Английский

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Perioperative pain management for cardiac surgery

Current Opinion in Anaesthesiology, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 29, 2024

Acute postsurgical pain after cardiac surgery is challenging to treat. Adverse effects related the high dose opioids which have traditionally been used perioperatively in led adoption of alternative analgesic strategies. This review aims highlight current evidence-based approaches managing surgery.

Language: Английский

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Superficial parasternal intercostal plane block: Anatomical landmark-guided technique

Indian Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: 68(9), P. 833 - 835

Published: Aug. 16, 2024

Dear Editor, The superficial parasternal intercostal plane block (SPIPB), formerly the pecto-intercostal fascial block, is a valuable addition to anterior thoracic wall blocks. Ultrasound-guided SPIPB has proven highly effective for anteromedial chest analgesia, significantly reducing opioid consumption in breast surgery (as supplementary block), cardiac (midline sternotomy, sternotomy wound debridement) and trauma (sternal fractures).[1] offers less-invasive, simpler safer alternative deeper blocks (deep plane, paravertebral or epidural blocks), minimising risk of complications such as inadvertent injury vessels, pleura neuraxis.[2] targets cutaneous branches T2–T6 nerves, providing sensory innervation wall, including skin, soft tissue sternum [Figure 1a]. In cadaveric study, Douglas et al.[3] demonstrated that dye spread beyond midclavicular line following was performed 2 cm lateral sternal margin at T3–4 space. Samerchua al.[4] suggested triple injections second, fourth fifth spaces achieve consistent over second sixth spaces. Song al.[2] reported loss T1–T8 dermatomes lines bilateral administration 40 ml 0.3% ropivacaine third ribs. ultrasound-guided method, refined by Fusco colleagues from initial description Torre al.,[1] involves administering local anaesthetic (LA) into between pectoralis major muscle (PMM) external membrane internal (IIM), approximately 2–3 away border space Scimia al.[5] modification targeting rib facilitate more homogeneous longitudinal desired 1b]. However, limited access ultrasound machines trained regional anaesthesiologists could impede widespread adoption this innovative technique.Figure 1: SPIPB: (a) transverse cross-sectional anatomy T3–T4 space; (b) level costal cartilage; (c) needle entry point landmark-guided SPIPB. Red asterisk point. ACN = nerve, CC cartilage, IIM muscle, LCN PM TTM transversus thoracis muscleWe propose novel anatomical approach patient positioned supine identification through medial palpatory method. identifying first immediately below half clavicle. begins locating manubriosternal joint angle Louis, corresponding articulation cartilage rib. both approaches, subsequent counting locates traces 5 midline 3 1c]. mobile subcutaneous PMM are anchored against underlying prevent overshooting potential injuries pleura, lung mediastinum. Under aseptic conditions, nerve (22 gauge, 25–50 mm, short bevelled) blunt-tipped hypodermic inserted perpendicularly until it contacts 2a]. Upon hitting bone, slightly (1–2 mm) withdrawn periosteal injection, positioning tip After confirming negative aspiration blood air, LA 3–5 aliquots administered. Depending on indications, 15–20 can be administered unilaterally bilaterally. backflow upon syringe disconnection may indicate proper drug deposition 2b]. Based injected volume, disperses several levels craniocaudal mediolateral directions.Figure 2: Patient position direction insertion. Post-block image showing sonoanatomy spread. Schematic diagram distribution (mammary) anaestheticWhile executing crucial exercise caution regarding vessels. They run bilaterally, parallel within cm, 2c]. From space, vessels lie midpoint costochondral junction.[3] To minimise select least midline. This precaution due progressive increase length towards lower Landmark-guided not suitable obese patients, large breasts excess fatty tissue, precise difficult. Further clinical studies warranted validate its efficacy, safety reliability compared techniques. Financial support sponsorship Nil. Conflicts interest There no conflicts interest.

Language: Английский

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Image-guided peripheral nerve interventions- applications and techniques

Techniques in vascular and interventional radiology, Journal Year: 2024, Volume and Issue: 27(3), P. 100982 - 100982

Published: Aug. 24, 2024

Language: Английский

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Successful cutaneous sensory blockade following single-injection and double-injection techniques of ultrasound-guided superficial parasternal intercostal plane block: a randomized clinical trial

Regional Anesthesia & Pain Medicine, Journal Year: 2024, Volume and Issue: unknown, P. rapm - 105736

Published: Nov. 5, 2024

Background While superficial parasternal intercostal plane blocks can improve analgesia after cardiac surgery, the optimal site and number of injections remain uncertain. This study aimed to compare efficacy single versus double blocks, hypothesizing that would achieve superior cutaneous sensory blockade. Methods 70 patients undergoing median sternotomy were randomly assigned receive either or bilaterally. Each patient received 40 mL 0.25% bupivacaine with epinephrine 5 µg/mL dexamethasone 10 mg. The single-injection group 20 mL/side at third costal cartilage, while double-injection mL/injection second fourth cartilages. primary outcome was a successful block, defined as loss in T2–T6 dermatomes. Secondary outcomes included block T1, T7, T8 dermatomes, block-related complications, intraoperative hemodynamics, postoperative pain intensity, opioid consumption, recovery quality. Results Double achieved an overall higher success rate compared technique (81% vs 51%, relative risk 1.6; 95% CI 1.2, 2.0; p<0.001). Additionally, blockade percentages observed dermatomes T1 (83% 59%, p=0.003), T7 (67% 46%, p=0.017), (61% 39%, p=0.011) injections. Other secondary did not differ significantly between groups. Conclusions Compared injection, provided more reliable coverage crucial for sternotomy. However, no differences hemodynamic effects control surgery. Trial registration TCTR20230408004.

Language: Английский

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Erector spinae plane block for cancer pain relief: a systematic review

Journal of Anesthesia Analgesia and Critical Care, Journal Year: 2024, Volume and Issue: 4(1)

Published: Nov. 15, 2024

Abstract Background Despite advances in pain management, cancer-related remains a critical issue for many patients. In recent years, there has been growing interest the use of fascial plane blocks, such as Erector Spinae Plane Block (ESPB), managing chronic pain, including oncology field. We conducted systematic review to synthetize existing evidence on ESPB cancer management. Methods selected studies published between January 2016 April 2024. A search Pubmed and Embase databases was performed. The strategy included following keywords and/or MeSH terms according controlled vocabulary sought: ((erector spinae block) OR (ESP (ESPB) AND ((cancer pain). considered eligible Randomized, nonrandomized studies, case series reports reporting data patients with pain. Results revealed 34 studies. Among these, we found one RCT, three retrospective two series, 28 total 135 Studies described management various types across different conditions, thoracic abdominal visceral related bone metastases. Single-shot performed 26 while continuous peripheral nerve catheter analgesia were 8 Neurolytic 6 10 There high clinical heterogeneity technique, drugs, adjuvants. lack comparators major flaw, together low level majority Conclusions supporting is currently scarce, heterogeneous, quality. To better understand its potential provide robust guidance, future research needs focus rigorous comparative standardization techniques larger sample sizes.

Language: Английский

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Ministernotomy

Published: Jan. 1, 2024

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Enhanced Recovery After Surgery (ERAS) Recommendations

Published: Jan. 1, 2024

Language: Английский

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