Annals of palliative medicine
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Supraclavicular brachial plexus block (SCBPB) is a traditional anesthesia technique widely used in upper limb surgery. Ultrasound-guided SCBPB shows the peripheral structure and dynamic local anesthetic diffusion and can greatly shorten the anesthesia operation time, increase the success rate of anesthesia, and reduce the incidence of complications. However, it can still block the phrenic nerve and paralyze the diaphragm, which can be difficult to avoid. This study investigated two different volumes of the same concentration of ropivacaine used in ultrasound-guided SCBPB, and compared the effects on the incidence of diaphragmatic paralysis, pulse oxygen saturation (SpO2) and lung function in patients. ⋯ Both 20 and 30 mL of 0.375% ropivacaine can achieve the ideal brachial plexus block with ultrasound-guided SCBPB, but compared with 20 mL of 0.375% ropivacaine, 30 mL of 0.375% ropivacaine is more likely to cause diaphragmatic paralysis.
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Ketamine has been used as an adjuvant to opioid therapy for the management of refractory cancer pain but the current evidence is insufficient to draw any conclusions regarding its efficacy. We aimed to assess the response to ketamine in patients with refractory cancer pain treated in an oncology palliative care unit. ⋯ These data demonstrated the efficacy and safety of ketamine in a population of patients with refractory cancer pain. The use of more than one coanalgesic was associated with a favorable response to ketamine. Further large and multicentered studies are warranted to confirm these data.