Articles: analgesia.
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Reg Anesth Pain Med · Nov 2024
Earlier preoperative percutaneous intercostal cryoanalgesia improves recovery after pectus excavatum surgery.
Minimally invasive repair of pectus excavatum is associated with intense postoperative pain. We aimed to evaluate the effectiveness of percutaneous intercostal cryoanalgesia according to the different timing of its preoperative application. Outcome variables included pain, drug consumption, time to mobilization, and hospital length of stay. ⋯ This exploratory observational study suggests that the timing of cryoanalgesia may play a crucial role in its efficacy, with earlier placement being associated with improvements in pain, opioid utilization, and length of stay.
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Anesthesia and analgesia · Nov 2024
Cannabinoids and General Anesthetics: Revisiting Molecular Mechanisms of Their Pharmacological Interactions.
Cannabis has been used for recreation and medical purposes for more than a millennium across the world; however, its use's consequences remain poorly understood. Although a growing number of surgical patients are regular cannabis consumers, little is known regarding the pharmacological interactions between cannabis and general anesthetics; consequently, there is not a solid consensus among anesthesiologists on the perioperative management of these patients. The existing evidence about the molecular mechanisms underlying pharmacological interactions between cannabinoids and anesthetic agents, both in animal models and in humans, shows divergent results. ⋯ Animal studies have reported that cannabinoids enhance the analgesic effect of opioids due to a synergistic interaction of the endogenous cannabinoid system (ECS) with the endogenous opioid system (EOS) at the spinal cord level and in the central nervous system. However, human data reveals that cannabis users show higher scores of postoperative pain intensity as well as increased requirements of opioid medication for analgesia. This review aims to improve understanding of the molecular mechanisms and pharmacological interactions between cannabis and anesthetic drugs and the clinical outcomes that occur when these substances are used together.
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Reg Anesth Pain Med · Nov 2024
Successful cutaneous sensory blockade following single-injection and double-injection techniques of ultrasound-guided superficial parasternal intercostal plane block: a randomized clinical trial.
While superficial parasternal intercostal plane blocks can improve analgesia after cardiac surgery, the optimal site and the number of injections remain uncertain. This study aimed to compare the efficacy of single versus double injections of superficial parasternal blocks, hypothesizing that double injections would achieve superior cutaneous sensory blockade. ⋯ Compared with single injection, double injections of superficial parasternal blocks provided more reliable coverage of the T2-T6 dermatomes, crucial for median sternotomy. However, no differences were observed in intraoperative hemodynamic effects or postoperative pain control after cardiac surgery.
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Reg Anesth Pain Med · Nov 2024
Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks.
Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks. ⋯ We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care.
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Reg Anesth Pain Med · Nov 2024
Association of thoracic epidural analgesia and hospital length of stay for patients undergoing thoracotomy: a retrospective cohort analysis.
Regional anesthesia has been shown to be efficacious for analgesia in patients who underwent thoracotomies. The objective of this study was to analyze the association of epidurals and peripheral regional anesthesia with time to hospital discharge for these patients. ⋯ Thoracic epidural use when compared with no regional anesthesia was associated with decreased length of stay following thoracotomy in our primary analysis. The difference was no longer apparent with the sensitivity analysis. Peripheral regional anesthesia was associated with decreased length of stay even after sensitivity analysis.