The Effect of Postoperative Tranexamic Acid and Dexamethasone on Quality of Recovery After Arthroscopic Rotator Cuff Repair: a Double-Blinded, Randomized Controlled Trial

Journal of Pain Research, Год журнала: 2025, Номер Volume 18, С. 259 - 270

Опубликована: Янв. 1, 2025

Arthroscopic rotator cuff repair (ARCR) commonly results in significant postoperative pain. Adjuncts like dexamethasone (DEX) and tranexamic acid (TXA) are used to enhance recovery. This study aimed determine whether the combined application of TXA DEX could improve recovery during first 24 hours ARCR patients. Our goal is relieve acute pain promote fast rapid discharge for Ninety-six patients who underwent from December 2023 March 2024 were enrolled this double-blinded, randomized control trial (Registration number, ChiCTR2300078507). Patients intravenously receive 200mL normal saline (control group), 1g (TXA or 200 mL 5mg (TXA+DEX group) within 2 postoperatively. The primary outcome was Quality Recovery-15 (QoR-15) score at post-surgery. Secondary outcomes included mean visual analog scale (VAS) scores every four hours, blood test day after surgery, American Shoulder Elbow Surgeons (ASES) 3 months No differences QoR-15 observed among groups [control, 127.0 (112.8, 138.0); TXA, 125.0 (116.5, 136.8); TXA+DEX, 132.0 (120.3, 140.8), p = 0.176]. VAS 5-8 (placebo vs 0.014; 0.002), 9-12 0.008; < 0.001), 13-16 0.035; 0.013) postoperatively showed a decrease TXA+DEX group compared with group. There no ASES Postoperative alone not facilitate Although combination presented better levels between 5 16 than alone, it did significantly quality. Further large-scale multi-center investigation required if beneficial

Язык: Английский

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Evidence for regional anesthesia in preventing chronic postsurgical pain

Regional Anesthesia & Pain Medicine, Год журнала: 2025, Номер 50(2), С. 153 - 159

Опубликована: Фев. 1, 2025

Chronic postsurgical pain (CPSP) is a common adverse outcome following surgical procedures. Despite ongoing research, the risk factors and effective strategies for mitigating CPSP remain uncertain. Regional anesthesia potentially beneficial yet debated intervention of CPSP. This review will delve into mechanistic aspects regional critically assess current literature to provide thorough understanding its role effectiveness. The incidence severity are linked nerve damage, neuroplastic changes immunological responses. Although numerous mechanisms contributing have been identified, translational research sparse, findings often inconsistent. Evidence suggests that anesthetic techniques could in reducing across various clinical scenarios. Techniques studied include wound infiltration, peripheral blocks, fascial plane thoracic paravertebral blocks epidural anesthesia. Current data indicate might decrease thoracotomy, infiltration may be after major breast surgery cesarean delivery, serratus anterior block or pectoralis/interpectoral surgery. However, existing evidence limited marked by several constraints especially multifactorial causes, underscoring need further this area.

Язык: Английский

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

Pain and Therapy, Год журнала: 2025, Номер unknown

Опубликована: Фев. 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.

Язык: Английский

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Opioid-sparing Anesthesia Significantly Improves Early Postoperative Recovery after Cardiac Surgery: A Retrospective Cohort Study

Cardiovascular Innovations and Applications, Год журнала: 2025, Номер 10(1)

Опубликована: Янв. 1, 2025

Background: Mounting evidence indicates that opioid-sparing anesthesia (OSA) decreases opioid-related adverse events. Our goal was to determine whether OSA might improve initial recovery after cardiac surgery. Methods: Data from patients who underwent elective heart surgery between July 2023 and 2024 were analyzed. Eligible divided into an group or a control group. Patients in the received 0.5 1 μg·kg −1 sufentanil ultrasound-guided nerve block anesthetic induction, whereas traditional high-dose opioid management. both groups managed with same sedatives, muscle relaxants, other drugs. The main outcome overall 15-item Quality of Recovery (QoR-15) survey score 24 hours Results: A total 1916 scanned, 1218 included analysis: 392 826 QoR-15 global measured 119.29 ± 3.25 113.87 3.44 (P < 0.001). had lower numeric rating scale scores 72 0.001) than median (interquartile range) postoperative mechanical ventilation time 1.0 (0–5) 8.0 (6–14) 0.001), duration hospitalization 11.5 (9–14) days 12 (10–14) days, respectively = 0.012). Conclusion: based on blocks significantly improved is expected be reasonable analgesic protocol prognosis patients.

Язык: Английский

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Comment on treatment of gastritis and gastroparesis symptoms with erector spinae plane block in the emergency department

The American Journal of Emergency Medicine, Год журнала: 2025, Номер unknown

Опубликована: Март 1, 2025

Язык: Английский

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Analgesic Efficacy of Thoracoscopic Direct-View Versus Ultrasound-Guided Thoracic Paravertebral Block in Multi-Port Video-Assisted Thoracoscopic Lung Surgery: A Randomized Controlled Non-Inferiority Study

Drug Design Development and Therapy, Год журнала: 2025, Номер Volume 19, С. 1825 - 1838

Опубликована: Март 1, 2025

Purpose: This study compares the analgesic effects of Thoracoscopic Direct-view Thoracic Paravertebral Nerve Block (DTPVB) with those Ultrasound-guided (UTPVB), providing a clinical reference. Patients and Methods: Sixty-eight patients undergoing three-port video-assisted thoracic surgery (VATS) general anesthesia were randomly assigned to either DTPVB group (Group D, n = 34) or UTPVB U, 34). Both groups received 10 mL injection 0.75% ropivacaine at T4 T7 interspaces. Primary outcomes cumulative sufentanil equivalents from start lung manipulation 24 hours postoperatively, differences assessed against non-inferiority margin 5 μg (Δ). Secondary include postoperative pain scores, consumption, patient satisfaction, adverse effects, other related indicators. Results: The use postoperatively was 35.0 ± 6.1 in Group D 33.2 5.6 no significant difference (P 0.217). minus U) 1.8 (95% CI − 1.07, 4.65), within Postoperative complications similar between groups. However, associated lower anxiety higher satisfaction (P< 0.001). At 15 minutes post-block, plasma concentrations (P=0.024). Conclusion: DTPVB, via transmural pleural puncture, non-inferior efficacy beginning lungs operation 24h postoperatively. provides good alternative, especially for who are anxious before surgery, have difficulty cooperating UTPVB, cases where puncture fails. when using high ropivacaine, greater vigilance toxicity is required. Keywords: paravertebral block, TPVB, thoracoscopic VATS, management

Язык: Английский

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Comparison of Ultrasound-Guided Thoracic Paravertebral Block Versus Thoracic Paravertebral Block Combined With Serratus Anterior Plane Block or Erector Spinae Block Following Video-Assisted Thoracoscopic Lobectomy

Therapeutics and Clinical Risk Management, Год журнала: 2025, Номер Volume 21, С. 343 - 353

Опубликована: Март 1, 2025

Compared the efficacy of ultrasound-guided thoracic paravertebral block (TPVB) and combined with serratus anterior plane (SAPB) or erector spinae (ESPB) following video-assisted thoracoscopic lobectomy(VATL). This retrospective study analyzed medical records 295 patients who underwent VATL surgery between August 2021 January 2023. Patients were divided into three groups: TPVB (92 patients), SAPB (106 ESPB (97 patients). The primary outcomes postoperative pain levels, measured using an 11-point visual analogue scale (VAS) both at rest during coughing 2, 6, 12, 24, 48 hours postoperatively, as well cumulative oxycodone consumption within 24 postoperatively. Postoperative was significantly lower in TPVB+SAPB TPVB+ESPB groups compared to group (P < 0.001), no significant difference groups. exhibited higher VAS scores 2 6 postoperatively other two 0.005). Within Area Under Curve (AUC) for than 0.05), while AUC = 0.049). Nausea vomiting occurred more frequently 0.016). provides superior analgesic effects alone after lobectomy, techniques showing comparable efficacy. However, may offer slightly better analgesia rest, have a potential advantage reducing nausea vomiting.

Язык: Английский

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Sugammadex or neostigmine for reversal of neuromuscular block on the quality of postoperative recovery in older adults undergoing video-assisted thoracoscopic lobectomy: a randomised controlled trial

Research Square (Research Square), Год журнала: 2025, Номер unknown

Опубликована: Март 20, 2025

Background Pulmonary nodules, especially prevalent in older adults, are increasingly diagnosed due to improved imaging technologies. Video-assisted thoracoscopic surgery (VATS) is the preferred treatment its minimal invasiveness and quicker recovery compared open thoracotomy. However, prolonged use of muscle relaxants during VATS can result postoperative residual neuromuscular block (PRNB), particularly leading pulmonary complications. While neostigmine has been traditionally used for reversal, sugammadex offers a faster, more complete reversal with fewer side effects. This study compares efficacy versus enhancing recovery. Methods prospective, randomized, double-blind trial included 80 patients aged ≥ 65 undergoing video-assisted lobectomy. Patients were randomly assigned receive either (2 mg/kg) or (0.04 atropine reversal. The primary outcome was quality at day 1, assessed by QoR-15 questionnaire. Secondary outcomes extubation time, PACU stay, incidence hypoxaemia, PRNB, complications (PPCs). Statistical analysis performed using t-tests, chi-square tests, Mann-Whitney U tests. Results Eighty randomized (39 sugammadex, 38 neostigmine). Sugammadex significantly reduced time (18 vs. 27.5 minutes, P = 0.001) stay (52 62 0.001). Hypoxaemia (28% 53%, 0.029) PRNB (5% 24%, 0.020) less frequent group. scores higher group 1 (125 122, < Although had PPCs, difference not statistically significant (26% 45%, 0.079). Conclusions demonstrated superior reducing times, minimizing hypoxaemia improving early adults lobectomy neostigmine. These findings suggest that may offer enhanced benefits, elderly patients. Trial registration: Retrospectively registered, Chinese Clinical Registry, ChiCTR2400089863(Date:18/09/2024).

Язык: Английский

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Comparison of the analgesic effects of liposomal bupivacaine in ultrasound-guided erector spinae plane block and surgeon-administered intercostal nerve block following video-assisted thoracoscopic lung resection: protocol for a randomized controlled trial

Frontiers in Medicine, Год журнала: 2025, Номер 12

Опубликована: Март 31, 2025

Background The analgesic efficacy of liposomal bupivacaine (LB) for ultrasound-guided erector spinae plane block (ESPB) and thoracoscopic intercostal nerve (ICNB) in thoracic surgery remains uncertain. This study aims to evaluate the anesthesiologist-performed ESPB using LB versus surgeon-administrated ICNB with patients undergoing video-assisted (VATS) lung resection. Methods single-center, prospective, randomized, double-blinded trial will include 120 adult scheduled VATS Patients be randomly assigned 1:1 group or group. Each patient receive either an at end surgery, along patients-controlled intravenous analgesia (PCIA) as part a postoperative multimodal analgesia. primary outcome is average numeric rating scale (NRS) pain scores rest over 72 h postoperatively (average three 24-h time points: 24, 48, h). Secondary outcomes NRS during activity postoperatively, Quality Recovery 15 first press on PCIA device, total opioid consumption within initiate independent bedside mobilization, length hospital stay, incidence chronic (defined score ≥ 1) 3 months post-surgery. Analyses performed modified intention-to-treat population. Discussion We hypothesize that result lower compared findings this aim provide evidence optimize regimens Clinical registration http://www.chictr.org.cn , identifier ChiCTR2400092927.

Язык: Английский

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Impact of erector spinae plane block on postoperative recovery quality in spinal surgery: a systematic review and meta-analysis

European Spine Journal, Год журнала: 2025, Номер unknown

Опубликована: Апрель 3, 2025

Postoperative recovery quality (QoR) is a key indicator for evaluating the restoration of patients' functional status and overall life post-surgery. Moreover, it an essential metric assessing effectiveness patient-centered anesthetic care. The erector spinae plane block (ESPB) innovative regional analgesia technique that has garnered considerable attention its potential use in spinal surgeries. Although some studies suggest ESPB may improve QoR, results remain contentious inconclusive. This meta-analysis aims to systematically evaluate effects on subjective patients undergoing surgery, with objective providing more robust evidence support clinical application. On September 23, 2024, we conducted systematic search across PubMed, Embase, Web Science, Cochrane Library, Scopus databases identify randomized controlled trials (RCTs) relevant ESPB. evaluated effect compared conventional QoR surgery. primary outcome measure this study was postoperative 24-hour score, as assessed by validated scales (QoR-15 QoR-40). Secondary measures included score at 48 h postoperatively, incidence nausea vomiting (PONV), consumption opioid analgesics first 24 postoperatively. eight studies, total 578 patients. demonstrated that, control group, group showed improvements QoR-15 scores (mean difference [MD]: 9.76; 95% confidence interval [CI]: 8.39-11.13; P < 0.01; I² = 0%) QoR-40 (MD: 11.8; CI: 6.35-17.25; 0.000), indicating clinically meaningful benefits. Additionally, although 3.69; 2.60-4.78; 2.31%) 5.70; 0.11-11.29; 0.046) postoperatively statistical improvement, magnitude change did not reach threshold relevance. reduced PONV (log odds ratio [log(OR)]: -0.63; -1.11--0.14; 24.62%) consumption(SMD: -0.56; -0.83--0.29; 0%). associated improvement within along reduction consumption. However, while statistically significant, significance limited. These findings be beneficial adjunct enhancing recovery, but further are needed validate long-term impact applicability.

Язык: Английский

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