Comparison of Hemodynamic Changes in Unilateral Spinal Anesthesia Versus Epidural Anesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial

Kiasari, Alieh Zamani; Babaei, Anahita; Alipour, Abbas; Motevalli, Shima; Baradari, Afshin Gholipour

doi:10.5455/medarh.2017.71.274-279

Cited by 11 publications

(9 citation statements)

References 20 publications

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“…Позитиви СБ: ефективне знеболювання, якісна міорелаксація, відносна простота, економічність і, головне, відсутність наркозу з його відомими побічними ефектами [2]. Оптимізація СБ шляхом застосування однобічного варіанта блоку є клінічно необхідною [4][5][6]. Якщо планується оперативне втручання у ділянці, що локалізована в одному з боків живота, то й необхідно знеболити саме цю зону, не викликаючи анестезію інтактної половини черева.…”

Section: оригінальні дослідження вступunclassified

Односторонняя Субарахноидальная Блокада Для Интраоперационного Обезболивания Пластики Пахового Канала

Byshovets¹,

Dzuba²

2021

ЕМ

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II за ASA) проведено двобічну субарахноїдальну блокаду (ДСБ) 15 мг ізобаричного бупівакаїну у поєднанні з 0,06 мг бупренорфіну при аналогічній операції. ОСБ і ДСБ ефективно забезпечували знеболювання операцій і тривалу післяопераційну аналгезію. При ОСБ гемодинаміка була стабільною внаслідок застосування однобічного, а не двобічного симпатичного блоку на відміну від ДСБ. Покращення якості аналгезії дозволяло проводити ранні активізацію та ентеральне харчування пацієнтів і скорочувало період реабілітації. Субарахноїдальне введення бупівакаїну з додаванням бупренорфіну характеризувалося значно меншою кількістю негативних побічних ефектів порівняно з відповідним уведенням інших опіоїдів.

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Section: оригінальні дослідження вступunclassified

Односторонняя Субарахноидальная Блокада Для Интраоперационного Обезболивания Пластики Пахового Канала

Byshovets¹,

Dzuba²

2021

ЕМ

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“…Regarding postoperative nausea and vomiting and length of stay, locoregional techniques performed better. Unilateral regional techniques are not associated with patient immobilisation, bladder dysfunction and hypotension [ 12 ]. Lastly, recent PROSPECT guidelines do not recommend the use of thoracic epidural after VATS based on a Delphi consensus, however, the patient population was not specifically VATS anatomical lung resection [ 13 ] and this recommendation is not widely accepted due to lack of convincing evidence [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Optimal postoperative pain management after VATS lung resection by thoracic epidural analgesia, continuous paravertebral block or single-shot intercostal nerve block (OPtriAL): study protocol of a three-arm multicentre randomised controlled trial

et al. 2022

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Background Adequate pain control after video-assisted thoracoscopic surgery (VATS) for lung resection is important to improve postoperative mobilisation, recovery, and to prevent pulmonary complications. So far, no consensus exists on optimal postoperative pain management after VATS anatomic lung resection. Thoracic epidural analgesia (TEA) is the reference standard for postoperative pain management following VATS. Although the analgesic effect of TEA is clear, it is associated with patient immobilisation, bladder dysfunction and hypotension which may result in delayed recovery and longer hospitalisation. These disadvantages of TEA initiated the development of unilateral regional techniques for pain management. The most frequently used techniques are continuous paravertebral block (PVB) and single-shot intercostal nerve block (ICNB). We hypothesize that using either PVB or ICNB is non-inferior to TEA regarding postoperative pain and superior regarding quality of recovery (QoR). Signifying faster postoperative mobilisation, reduced morbidity and shorter hospitalisation, these techniques may therefore reduce health care costs and improve patient satisfaction. Methods This multi-centre randomised study is a three-arm clinical trial comparing PVB, ICNB and TEA in a 1:1:1 ratio for pain (non-inferiority) and QoR (superiority) in 450 adult patients undergoing VATS anatomic lung resection. Patients will not be eligible for inclusion in case of contraindications for TEA, PVB or ICNB, chronic opioid use or if the lung surgeon estimates a high probability that the operation will be performed by thoracotomy. Primary outcomes: (1) the proportion of pain scores ≥ 4 as assessed by the numerical rating scale (NRS) measured during postoperative days (POD) 0–2; and (2) the QoR measured with the QoR-15 questionnaire on POD 1 and 2. Secondary outcome measures are cumulative use of opioids and analgesics, postoperative complications, hospitalisation, patient satisfaction and degree of mobility. Discussion The results of this trial will impact international guidelines with respect to perioperative care optimization after anatomic lung resection performed through VATS, and will determine the most cost-effective pain strategy and may reduce variability in postoperative pain management. Trial registration The trial is registered at the Netherlands Trial Register (NTR) on February 1st, 2021 (NL9243). The NTR is no longer available since June 24th, 2022 and therefore a revised protocol has been registered at ClinicalTrials.gov on August 5th, 2022 (NCT05491239). Protocol version: version 3 (date 06-05-2022), ethical approval through an amendment (see ethical proof in the Study protocol proof).

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“…В настоящее время дискутабельным остается вопрос о дозировке и скорости введения раствора местного анестетика в субарахноидальное пространство для достижения эффекта ОСА, а также продолжительности пребывания больного в положении лежа на боку после введения анестетика. Нет указаний о целесообразности использования конкретного типа спинальных игл и в полном объеме не освещены гемодинамические эффекты и уровень стрессреакции организма больного при ОСА [18] Протокол проведения анестезии: 1 группа: Премедикация: в/в -атропин 0,5 мг, дексаметазон 4 мг. В положении больного лежа на боку (на стороне оперируемой конечности), после 3-разовой обработки места предполагаемой пункции LII-LIII 70% раствором этилового спирта проводили пункцию субарахноидального пространства иглой G-25 с апертурой, направленной вниз (в сторону оперируемой конечности) и вводили раствор бупивакаина (гипербарический) в дозе 9-10 мг (1,8-2 мл 0,5% раствора).…”

Section: Introductionunclassified

Unilateral spinal anesthesia and the sciatic nerve block in foot surgery

Gritsenko

Shapoval

Filimonov

2021

Modern Medical Technology

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Purpose of the study. To evaluate the effectiveness of unilateral spinal anesthesia as a method of pain relief during foot surgery. Analyze the effectiveness of unilateral spinal anesthesia versus sciatic nerve block. To develop an algorithm for performing unilateral spinal anesthesia during foot surgery. Materials and methods. We examined 64 patients who were treated in the department of purulent surgery of the 3rd city hospital in Zaporozhye with a diagnosis of diabetic foot syndrome in the period from 2017 to 2019. Research methods. Assessment of the level of pain intensity using the standard visual analogue scale and the concentration of glucose in the blood serum. Monitoring of the parameters of the cardiovascular system, the temperature of the skin of the lower leg during anesthesia, Doppler scanning of the peripheral circulation in the foot. Results. 4 hours after performing anesthesia, the intensity of pain during movement of the lower limb, according to the visual analogue scale in the group with unilateral spinal anesthesia was 2,3 times less than in the group with sciatic nerve block (p < 0,05). After 10 hours – in the sciatic nerve block group there was a 9,4% increase in comparison with the unilateral spinal anesthesia group (p < 0,05). Compared with the unilateral spinal anesthesia group, in the sciatic nerve block group 20 minutes after anesthesia, the heart rate decreased by 7,2% (p < 0,05). After unilateral spinal anesthesia, the level of systolic blood pressure on 1 toe of the foot increased by 18,3% 20 minutes after anesthesia, and 20 minutes after sciatic nerve block – by 13,7% (p < 0,05). In patients with the unilateral spinal anesthesia group, the temperature on the operated lower limb after anesthesia increased by 3,8%, in the sciatic nerve block group – by 2,8% (p < 0,05). Conclusions. Regional anesthesia is the main method of choice for foot surgery compared to general anesthesia. sciatic nerve block does not in all cases lead to 100% surgical anesthesia and requires additional medical analgosedation. For foot surgery, unilateral spinal anesthesia is preferred.

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Comparison of Hemodynamic Changes in Unilateral Spinal Anesthesia Versus Epidural Anesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial

Cited by 11 publications

References 20 publications

Односторонняя Субарахноидальная Блокада Для Интраоперационного Обезболивания Пластики Пахового Канала

Односторонняя Субарахноидальная Блокада Для Интраоперационного Обезболивания Пластики Пахового Канала

Optimal postoperative pain management after VATS lung resection by thoracic epidural analgesia, continuous paravertebral block or single-shot intercostal nerve block (OPtriAL): study protocol of a three-arm multicentre randomised controlled trial

Unilateral spinal anesthesia and the sciatic nerve block in foot surgery

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