Articles: anesthetics.
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This prospective, randomized, double-blind trial was performed to investigate the effect on rebound pain incidence of mixing dexmedetomidine (DEX) with local anesthetics in a combined injection interscalene block (ISB) during shoulder arthroscopy. ⋯ Perineural dexmedetomidine added to ISB exerts beneficial effect on the incidence of rebound pain after ISB in patients with pain catastrophizing undergoing shoulder arthroscopy. Perineural dexmedetomidine facilitated the implementation of multimodal analgesia in the early stage after operation.
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Minerva anestesiologica · Dec 2024
A randomized clinical trial comparing different combination of peripheral nerve blocks for intraoperative analgesia in patients on antithrombotic drugs undergoing hip fracture surgery: pericapsular nerve group (PENG) block versus femoral and obturator nerve block.
Locoregional anesthesia is commonly used in orthopedic trauma surgery, particularly in elderly patients. We conducted a prospective, monocentric, randomized controlled trial to evaluate the anesthetic and analgesic efficacy of pericapsular nerve group (PENG) block in patients on antithrombotic drugs undergoing hip fracture surgery, comparing it with femoral and obturator nerve block (FNB+ONB). ⋯ Our results suggest that PENG block is not inferior to FNB + ONB as anesthetic and analgesic technique in patients on antithrombotic drugs undergoing hip fracture surgery.
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Minerva anestesiologica · Dec 2024
New insights into the use of dexamethasone-dexmedetomidine as perineural adjuvants in peripheral nerve and fascial blocks: an up-to-date narrative review.
The discovery of the mechanism of action of local anesthetics, involving the blocking of sodium ion channels is considered a milestone in anesthesia. Potentially lethal toxic effects occur in the case of intravascular injection of local anesthetic (LA) or in case of exceeding dosages, as a result of systemic reabsorption. Attempts to prevent these life-threatening events have been made by developing novel LA and by adding adjuvants. ⋯ The addition of perineural dexamethasone-dexmedetomidine combination has shown a faster onset, longer duration of action and increased intensity of neuronal blockade of regional anesthesia compared to perineural single adjunct. This is consistent with clinical studies (trials, observational studies and reports) of a marked prolongation of the local anesthetic effect. Nevertheless, further studies are needed to ascertain the full potential of this technique and all possible associated risks.
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Curr Opin Anaesthesiol · Dec 2024
Perioperative management of patients with mediastinal mass syndrome.
The mediastinal mass syndrome (MMS) can occur after induction of anesthesia, intraoperatively or even days after the surgical procedure. The focus of this review is on the management of pediatric and adult patients with a significant mediastinal mass. ⋯ Meticulous planning, implementation of anesthetic management protocols and protocols for emergency situations are essential to guarantee patient safety with a mediastinal mass.