Improving recovery after microvascular decompression surgery for hemifacial spasm: experience from 530 cases with enhanced recovery after surgery (ERAS) protocol

Wang, Dongliang; Fang, Jixia; Liu, Jiayu; Hao, Qingpei; Ding, Hu; Liu, Bo; Liu, Zhi; Song, Haidong; Ouyang, Jia; Liu, Ruen

doi:10.1080/02688697.2021.1888876

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…ERAS protocols for craniotomy have recently been developed [16,17,27], and a scalp block is one of the main anesthetic elements. As Wang et al emphasize [20], effective pain control using a scalp nerve block after MVD is important not only for analgesia, but also to improve the quality of recovery. Although the induction time of the block group was 5.7 min longer than in the control group, it did not lengthen the overall surgery time or anesthetic time.…”

Section: Discussionmentioning

confidence: 99%

“…Scalp nerve block has been introduced and implemented in various neurosurgeries to stabilize surgical procedures, manage postoperative pain, and reduce opioid consumption [13][14][15]. The ERAS protocol for elective craniotomy recommends the use of a scalp block in addition to NSAID [16][17][18][19][20], but evidence on this topic is lacking. Therefore, in this study, we evaluated the efficacy of a regional scalp nerve block in HFS patients undergoing MVD via the lateral suboccipital approach, a region associated with severe postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

Lee,

Kwon

et al. 2023

JCM

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The scalp nerve block, created by injecting local anesthetics around the scalp nerves, is reported to effectively reduce pain after surgery. In this study, we evaluated the efficacy of scalp nerve block in patients with hemifacial spasm (HFS) undergoing microvascular decompression (MVD). Seventy-four patients who underwent MVD for HFS were enrolled. The block group received scalp nerve block with 0.5% ropivacaine before surgery. The primary outcome was cumulative dose of rescue analgesics 24 h postoperatively. The secondary outcomes were included pain scores, postoperative antiemetic consumption, and Quality of Recovery-15 scale. The cumulative dose of rescue analgesics at 24 h postoperatively was not significantly different between the two groups (4.80 ± 3.64 mg vs. 5.92 ± 3.95 mg, p = 0.633). However, the pain score was significantly reduced in the block group at 6, 12, and 24 h postoperatively. Postoperative antiemetic consumption was lower in the block group than the control group at 12 h. There were no significant differences between the two groups for other secondary outcomes. In MVD for HFS, a preoperative scalp nerve block might reduce postoperative pain in the early postoperative period, but a larger study using a multimodal approach is needed to confirm the efficacy of a scalp block.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

Lee,

Kwon

et al. 2023

JCM

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“…They are most common in women around the age of 50 and are mainly unilateral, which is consistent with the results of this study. Since Jannetta first systematically elaborated the theory of MVD in 1975, MVD has gradually been accepted by most neurosurgeons and it has become the main treatment for HFS ( 3 ). Although the cure rate of MVD for HFS is 70 to 98% ( 4 ), there is a 3.3 to 20% recurrence rate within 5 years after surgery ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Neurovascular compression (NVC), proposed by Jannetta, which causes short circuits of nerve conduction due to microvascular compression, is currently recognized by most scholars as the pathogenesis of primary HFS ( 2 ). Microvascular decompression (MVD), based on Jannetta's peripheral nerve theory, has been proven to be effective ( 3 ). Although the cure rate of MVD for HFS is 70 to 98% ( 4 ), there is a 3.3 to 20% recurrence rate within five years after the operation ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Long-Term Retrospective Analysis of Re-do Microvascular Decompression in Patients With Hemifacial Spasm

Liu

et al. 2021

Front. Neurol.

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Objective: To explore the clinical characteristics of patients with persistent or recurrent hemifacial spasm (HFS) and the experience of microvascular decompression (MVD) in the treatment of such patients to accumulate additional clinical evidence for optimal treatment protocols.Methods: We retrospectively analyzed the clinical data, surgical methods and treatment efficacies of 176 patients with persistent or recurrent HFS from January 2009 to January 2018.Results: Missing compression zones was the main reason for symptom persistence (87.50%) or recurrence (71.50%) after MVD treatment of HFS. We divided the surgical area into three zones. Most persistent or recurrent cases had decompression only in the root exit zone (REZ) (Zone 1) but missed the ventrolateral pons-involved area (Zone 2) or the bulbopontine sulcus-involved area (Zone 3) in the first MVD. Too much use of Teflon (12.50%), arachnoid adhesions (5.60%) and Teflon granulomas (10.40%) can also cause a recurrence. The difference between preoperative and postoperative Cohen scores was statistically significant in persistent or recurrent HFS patients (p<0.05). The postoperative follow-up time ranged from 36 to 108 months (71.75 ± 22.77).Conclusions: MVD should be performed in the compression site, which is mostly located at the brainstem/facial REZ. Intraoperative exploration should be conducted in accordance with the abovementioned zones to effectively avoid missing offending vessels. Re-do MVD is effective in patients with persistent or recurrent HFS.

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Enhanced recovery after spine surgery: state of the art in the Russian Federation

et al. 2023

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Objective. To analyze the attitude of neurosurgeons to the technology of enhanced recovery after spine and spinal cord surgery in the Russian Federation.Material and Methods. In March 2022, a continuous cohort comparative sociological study was conducted among 83 neurosurgeons of the Russian Federation, during which they were asked to fill out a specially designed online questionnaire consisting of 22 questions on the Google Forms platform.Results. The vast majority of respondents (95.2 %) noted the lack of information in the Russian literature on the technology of enhanced recovery after surgery (ERAS). Nevertheless, most neurosurgeons, regardless of specialization, are familiar with the terms “fast track” (79.5 %) and “ERAS” (60.2 %). Only 44.6 % of specialists declared the implementation of ERAS recommendations into their daily clinical practice, while 78.3 % of neurosurgeons draw attention to the existence of problems that hamper adoption of enhanced recovery protocols (ERP) in Russia. The interviewed respondents are confident that it is possible to introduce ERP into spinal neurosurgery in adults (91.6 %) and children (85.5 %) in Russia. Every second respondent (50.6 %) considers it possible to directly extrapolate foreign ERP into clinical practice in Russian healthcare. Spinal neurosurgeons are more aware of ERAS than cerebral neurosurgeons (p = 0.017), and they also more often use elements of ERAS in their clinical practice (p = 0.002). In other parameters, the respondents did not differ significantly depending on their specialization. Only 7.2 % of interviewed neurosurgeons work in private clinics. All of them are engaged in spinal surgery and introduce the ERAS technology into their clinical practice. Less than half (40.0 %) of neurosurgeons in public clinics implement elements of the ERAS (p = 0.007). More than half (69.7 %) of specialists and every second manager consider the introduction of ERAS in a neurosurgical clinic to be progressive, and only a few of them (3.6 %), on the contrary, believe that the quality of medical care may decrease with the introduction of ERAS. Neurosurgeons (n = 13) identified 7 clinics of the Russian Federation, where the enhanced recovery protocol after spine surgery is implemented. In total, according to the results of the study, 23 elements of the ERAS protocol are implemented in the practice of respondents (n = 20) in the conditions of Russian healthcare.Conclusions. Despite the lack of publications in the Russian literature and the existing organizational problems in the context of domestic healthcare, neurosurgeons have a positive attitude towards the introduction of ERAS protocol into clinical practice. This protocol or its individual elements are already successfully implemented in a group of clinics in Russia.

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Improving recovery after microvascular decompression surgery for hemifacial spasm: experience from 530 cases with enhanced recovery after surgery (ERAS) protocol

Cited by 3 publications

References 25 publications

The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

Long-Term Retrospective Analysis of Re-do Microvascular Decompression in Patients With Hemifacial Spasm

Enhanced recovery after spine surgery: state of the art in the Russian Federation

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