Articles: postoperative-pain.
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Reg Anesth Pain Med · Dec 2023
Case ReportsPostoperative analgesia for Kasai portoenterostomy using external oblique intercostal blocks.
External Oblique Intercostal (EOI) fascial plane blockade is a relatively new regional anesthetic technique used for a variety of upper abdominal surgical procedures. Proponents of this block praise its simple sonoanatomy, extensive local anesthetic (LA) spread, and ease of catheter placement, while avoiding encroachment into the surgical field or dressing sites; nevertheless, it is underutilized in pediatric surgery. Kasai portoenterostomy is a common pediatric surgical procedure for biliary atresia typically done via an open abdominal approach with an extended subcostal incision. Postoperative analgesic management with epidural anesthetic techniques are considered but may be limited by periprocedural coagulopathy concerns. ⋯ The purpose of this report is to describe the outcomes and technical approach in a neonate who received EOI blocks as an alternative to epidural anesthetic management. Further studies are needed to compare the efficacy and complication rate of EOI blockade to epidural analgesia for Kasai portoenterostomy surgery.
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Randomized Controlled Trial
Comparison of intrathecal low-dose bupivacaine and morphine with intravenous patient control analgesia for postoperative analgesia for video-assisted thoracoscopic surgery.
Thoracoscopic surgical techniques continue to advance, yet the intensity of postoperative pain remains significant, impeding swift patient recovery. This study aimed to evaluate the differences in postoperative pain and recuperation between patients receiving intrathecal morphine paired with low-dose bupivacaine and those administered general anesthesia exclusively. ⋯ Intrathecal administration of morphine combined with bupivacaine has been shown to effectively ameliorate acute pain in patients undergoing thoracoscopic surgery.
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Reg Anesth Pain Med · Nov 2023
Efficacy of iliopsoas plane block for patients undergoing hip arthroscopy: a prospective, triple-blind, randomized, placebo-controlled trial.
Intraoperative stretching of the hip joint capsule often generates severe pain during the first 3 hours after hip arthroscopy. The short-lived severe pain mandates high opioid consumption, which may result in adverse events and delay recovery. The femoral nerve nociceptors are located anteriorly in the hip joint capsule. A femoral nerve block reduces pain and opioid demand after hip arthroscopy. It impedes, however, ambulation and home discharge after outpatient surgery. The iliopsoas plane block selectively anesthetizes the femoral sensory nerve branches innervating the hip joint capsule without compromising ambulation. We aimed to assess reduction of opioid consumption after iliopsoas plane block during the short-lived painful postsurgical period of time after hip arthroscopy. ⋯ An iliopsoas plane block reduces opioid consumption after hip arthroscopy. The reduction of opioid consumption during the clinically relevant 3-hour postsurgical period of time was larger than 50% for active versus placebo iliopsoas plane block in this randomized, triple-blind trial.
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The quadratus lumborum block is a technique that is not widely applied in abdominal surgery. The influence of the mode of anesthesia on the outcome of polymorbid patients is a controversial issue in the medical literature. ⋯ On account of the patient's difficult airway, general anesthesia was deemed unsafe for the patient, with a risk of patient death. Percutaneous gastrostomy tube placement under a quadratus lumborum block type 2 was performed successfully.
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Randomized Controlled Trial
The ED50 and ED95 of esketamine for preventing early postoperative pain in patients undergoing laparoscopic cholecystectomy: a prospective, double-blinded trial.
This study aims to estimate the safety, efficacy, and median effective dose (ED50) of esketamine for preventing early postoperative pain in patients undergoing laparoscopic cholecystectomy. ⋯ In this study, esketamine can prevent early postoperative pain effectively. The ED50 and ED95 of esketamine for controlling early postoperative pain were 0.301 mg/kg and 0.379 mg/kg, respectively.