The objective of the study was to assess the analgesic effects of dexamethasone (DEX) added to peripheral nerve block in knee surgery. We searched for relevant randomized controlled trials (RCTs) in PubMed and the Cochra...The objective of the study was to assess the analgesic effects of dexamethasone (DEX) added to peripheral nerve block in knee surgery. We searched for relevant randomized controlled trials (RCTs) in PubMed and the Cochrane Database of Systematic Reviews. The latest search was done on September 11, 2024. Search terms included knee surgery, regional anesthesia, and DEX. Data extraction, statistical analysis, and risk of bias assessment followed established protocols. Seven RCTs with 551 patients were included. In the DEX 4 mg group, no reduction of pain at rest was found. However, for the DEX 8 mg group, pain management at rest was more effective; the mean difference (MD) with 95% CI was -0.34 [-0.50, -0.18]. For pain with movement, the model favors the DEX 4 mg group (MD with 95% CI was -1.03 [-1.84, -0.22]). Only one study reported the differences in pain intensity scores with movement between the DEX 8 mg and control groups. For morphine consumption, the model did not reveal any reduction in the DEX 4 mg group (MD -0.68 [-1.87, 0.5]) or DEX 8 mg group (MD -10.44 [-23.92, 3.03]). Pain with movement may be reduced with a lower dose, and pain without movement with a higher dose of DEX.
Abdelhaleem Abdelrahman RA, Khalil Abdelrahman R, Elsayed Ibrahim Elalfy I
… +6 more, Mohamed ElSharkawy A, Arafa Elsaid M, Elabd Hassan A, Hussini Ismail Elsayed A, Elabd Hassan I, Abdelbadie M
BACKGROUND: Dural puncture epidural anesthesia (DPEA) has become effective during normal labor. There were insufficient data about DPEA during cesarean section (CS). METHODS: A total of 110 ASA I and II parturients aged...BACKGROUND: Dural puncture epidural anesthesia (DPEA) has become effective during normal labor. There were insufficient data about DPEA during cesarean section (CS). METHODS: A total of 110 ASA I and II parturients aged 20-35 years old underwent scheduled CS using DPEA with either 25G or 27G Whitacre needles. A T10 sensory block was achieved and maintained using a low concentration of bupivacaine with fentanyl through the epidural catheter until the end of surgery. Epidural extension anesthesia was initiated inside the operating room. The primary outcome was time taken from the start of epidural extension until achievement of bilateral T6 sensory block. The secondary outcome was quality of DPEA (composite). RESULTS: The primary outcome, median (IQR) time to surgical anesthesia, was 9.12 (8.71-18.54) minutes in the 25G-DPEA group and 14.18 (12.43-23.56) minutes in the 27G-DPEA group. The difference in the onset time of sensory block between the 2 groups was 5.06 (3.72-5.02) min, which was statistically significant (HR: 2.3; 95% CI: 1.79-3.14%; P < 0.0001). Failure of DPEA was observed in 9 of 55 parturients (16.4%) in the 25-DPEA group compared with 37 of 55 parturients (67.3%) in the 27-DPEA group (OR = 0.095; 95% CI: 0.04-0.24 %; P < 0.0001). Adverse effects and neonatal outcomes were comparable between the two groups. CONCLUSIONS: 25G-DPEA resulted in faster onset and improved block quality during epidural extension compared with 27G-DPEA. Further studies are needed to confirm these findings in the setting of intra-partum CS.
BACKGROUND: As a multimodal anesthesia adjuvant, magnesium sulfate (MgSO4) plays an important role in the anesthetic arsenal, due to its properties and substantial synergistic effects with other drugs such as opioids, hy...BACKGROUND: As a multimodal anesthesia adjuvant, magnesium sulfate (MgSO4) plays an important role in the anesthetic arsenal, due to its properties and substantial synergistic effects with other drugs such as opioids, hypnotics and neuromuscular blocking drugs (NMBD). Rocuronium is a non-depolarizing NMBD used widely in general anesthesia, and its association with MgSO4 is still a concern. This study aimed to evaluate the influence of MgSO4 at a dose of 30 mg kg-1 on the pharmacodynamic characteristics of rocuronium. METHODS: It was a double-blinded, randomized controlled trial in adult female patients scheduled for open hysterectomies with total intravenous anesthesia. Patients were allocated randomly to receive MgSO4 (30 mg kg-1) diluted in 100 mL of saline, 10 minutes before induction, or 100 mL of saline. Primary outcome: Influence of MgSO4 on latency (onset time), clinical duration (CD25%) and time to recover 90% of T4/T1 - train of four (TOF = 0.9). In total, 70 patients were enrolled, 35 per group. RESULTS: The baseline characteristics were similar. A comparative analysis showed a significant difference between the groups regarding latency in seconds (lower with MgSO4) 40.00 (35-45 [30-68]) compared to saline 53.00 (50-60 [40-90]) (P < 0.001), CD25% in minutes (longer with MgSO4) 61.00 (53-70 [30-110]), saline 38.00 (35-48 [30-87 (P <0.001), and TOF = 0.9 in minutes, longer with MgSO4 98.00 (88-111 [53-176]), saline 60.00 (55-78 [44-130]) (P < 0.001). MgSO4 was found to reduce opioid consumption in the postanesthetic care unit. CONCLUSIONS: The strong impact of MgSO4 on the pharmacodynamics of rocuronium confirms the indispensable role of quantitative neuromuscular blockade monitoring to guide reversal.
BACKGROUND: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures are being performed more and more frequently. Since these procedures carry an indirect risk of perioperative complications, practice s...BACKGROUND: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures are being performed more and more frequently. Since these procedures carry an indirect risk of perioperative complications, practice standards are warranted to minimise the incidence of adverse events. A survey-based study was carried out to identify the patterns of anaesthesiology practice in Polish hospitals. METHODS: A survey was conducted among anaesthetists nationwide using the LimeSurvey application. The questions concerned the intraoperative and postoperative periods and focused mainly on the determination of anaesthetic methods for total joint replacement (TJR) procedures and postoperative pain management. Questionnaires included both single and multiple-choice questions. RESULTS: A total of 258 responses from anaesthetists from 112 Polish healthcare institutions were included in the analysis. The subarachnoid block is performed by 86.0% of anaesthetists for TKA and 88.0% for THA. For TKA procedures, 30.6% of respondents state that they do not perform any additional peripheral block, and for THA this percentage is 44.6%. The most commonly performed peripheral nerve block for TKA is the femoral nerve block (46.5%) and for THA it is the fascia iliaca compartment block (42.6%). More than 90% of anaesthetists report routine use of systemic analgesics in TJR, with opioid use exceeding 80%. CONCLUSIONS: The study showed that anaesthetic perioperative care in Poland requires several modifications to better adhere to clinical standards. The most important issues include increasing the number of regional blocks, decreasing the use of opioid analgesics for post-operative pain management and introducing perioperative troponin screening.
Am S, Patel N, Kumar R
… +6 more, Ranjith KR, Muthiah T, Ayub A, Singh AK, Khanna P, Ray BR
Anaesthesiol Intensive Ther
· 2024 · PMID 39451167
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INTRODUCTION: Costoclavicular brachial plexus block has become a procedure of choice for surgical anaesthesia or analgesia in upper limb surgery. The technique is not standardised yet, and two approaches are currently em...INTRODUCTION: Costoclavicular brachial plexus block has become a procedure of choice for surgical anaesthesia or analgesia in upper limb surgery. The technique is not standardised yet, and two approaches are currently employed: the medial and lateral approach. Our study aims to compare the two approaches in terms of performance time and patient-specific clinical outcomes. MATERIAL AND METHODS: The primary outcome assessed was performance time. The secondary outcomes were imaging time, needling time, block onset time, total anaesthesia time, anaesthesia success, and performer difficulty score. RESULTS: Of 59 patients, 30 patients were randomized to Group M and 29 patients were randomized to Group L. We conducted statistical analysis using a modified intention-to-treat approach. The mean ± SD for performance time (in minutes) was 11.9 ± 3.8 in Group M and 9.4 ± 4.1 in Group L with a difference between means (95% CI) of 2.4 (0.3 to 4.5) ( P < 0.05). The median (interquartile range) needling time of Group M was 9.5 minutes (5-16) vs. 7 (4-19) in Group L ( P = 0.035). Among patients, 40%, 26.67%, 33.3% in Group M had grade 3, 2, 1 performer difficulty whereas 10.3%, 37.9%, 51.7% in Group L had grade 3, 2, 1 performer difficulty, respectively ( P = 0.032). The mean performance time was 9.95 minutes in patients with body mass index (BMI) 25 ( P = 0.0243). CONCLUSIONS: Our study revealed that the medial approach has no significant advantage over the lateral approach with regards to performance time, imaging time, needling time, and performer difficulty. Both performance time and performer difficulty increase with BMI and depth of the cords, with a larger difference in the medial approach.
Sinha C, Kumari P, Kumar A
… +5 more, Kumar A, Kumar A, Bhar D, S K A, Vamshi C
Anaesthesiol Intensive Ther
· 2024 · PMID 39451166
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INTRODUCTION: Ultrasound (US)-guided interscalene (IS) block is a commonly performed block for shoulder and humerus surgery. Though it provides excellent analgesia, it is associated with hemidiaphragmatic paralysis and d...INTRODUCTION: Ultrasound (US)-guided interscalene (IS) block is a commonly performed block for shoulder and humerus surgery. Though it provides excellent analgesia, it is associated with hemidiaphragmatic paralysis and dyspnoea. Superior trunk (ST) block has been described, wherein the local anaesthetic is deposited around the ST block (formed by fusion of C5 and C6 nerve roots). This study aimed to determine whether ST block provides similar analgesic efficacy with lower incidence of diaphragmatic paresis in patients undergoing proximal humerus surgery. MATERIAL AND METHODS: A total of 62 patients scheduled to undergo unilateral internal fixation (plating) for proximal or mid shaft humerus fracture were randomised to 2 groups. Patients in group I received US-guided ST block while those in group II received US-guided IS block. Both groups received 15 mL of 0.5% bupivacaine. Diaphragmatic excursion was noted at baseline and after 30 minutes after the block. Postoperatively, the numerical rating scale score and requirement of opioids were documented. RESULTS: The incidence of complete/incomplete paresis was statistically significantly lower in the ST group. Thirty eight percent of the patients (11) had complete paresis in the IS group, compared to none in the ST group. Partial paresis was observed in 62% of patients in the IS block group and 19% in the ST block group ( P < 0.001). The percentage reduction of movement was significantly higher in the IS group vs. the ST group ( P < 0.001). There was no difference in pain scores or the amount of opioid consumption between groups. CONCLUSIONS: ST block provides similar analgesia to IS block for proximal/mid humerus surgery with better preservation of diaphragmatic function. This could be a viable alternative in patients with compromised respiratory functions scheduled for such surgery.
Anaesthesiol Intensive Ther
· 2024 · PMID 39451165
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INTRODUCTION: Urine output is markedly reduced by isoflurane, but it is unclear whether the decrease is a specific effect of volatile anaesthetics. Therefore, this study compared the diuretic response to crystalloid volu...INTRODUCTION: Urine output is markedly reduced by isoflurane, but it is unclear whether the decrease is a specific effect of volatile anaesthetics. Therefore, this study compared the diuretic response to crystalloid volume loading during surgical procedures performed with volatile anaesthetics or intravenous anaesthesia. MATERIAL AND METHODS: Data from two clinical trials in which patients were randomized between isoflurane and propofol anaesthesia (open thyroid surgery, n = 29) and between sevoflurane and propofol anaesthesia (open hysterectomy; n = 25) were analysed. Urine volume was measured and the diuretic response to volume loading with 1.7-1.8 L of Ringer's solution over 30 min was studied by population volume kinetic analysis. The kinetic method used 631 measurements of plasma dilution based on blood haemoglobin and plasma albumin and 138 measurements of urine output to quantify the diuretic response to volume loading in the four study groups. RESULTS: The urine output after 150 min of thyroid surgery was 132 (77-231) mL in the propofol group and 218 (80-394) mL in the isoflurane group ( P = 0.50; median and interquartile range). The corresponding volumes were 50 (45-65) mL for propofol and 60 (34-71) mL for sevoflurane at 90 min in the hysterectomy patients ( P = 0.81). The kinetic analysis, which corrected for differences in infused volume, body weight, and plasma volume expansion, did not reveal any statistically significant differences in diuretic response to volume loading between the two inhaled anaesthetics and intravenous anaesthesia. CONCLUSIONS: Isoflurane and sevoflurane did not affect urine output more strongly than propofol.
Siriopol I, Grigoras I, Rusu D
… +4 more, Popa R, Ristescu I, Kanbay M, Siriopol D
Anaesthesiol Intensive Ther
· 2024 · PMID 39451164
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INTRODUCTION: Hypovolaemia is presumed to be a common risk factor of postinduction hypotension (PIH), despite worldwide improvement in preoperative volume optimization. Correct assessment of fluid status in patients unde...INTRODUCTION: Hypovolaemia is presumed to be a common risk factor of postinduction hypotension (PIH), despite worldwide improvement in preoperative volume optimization. Correct assessment of fluid status in patients undergoing general anaesthesia remains a major challenge for anaesthesiologists. Bioimpedance analysis (BIA) is a sensitive method that allows objective assessment of patient fluid status as it can detect subclinical changes. The study's main purpose was to determine the correlation between the preoperative BIA assessed fluid status and PIH. MATERIAL AND METHODS: This was an observational single centre study that included patients undergoing elective surgery. We defined PIH as the blood pressure decrease occurring during the first 10 minutes after induction of anaesthesia and orotracheal intubation before surgical incision. We standardized BIA evaluation, patient pre anaesthetic and preoperative preparation, technique and monitoring of anaesthesia. RESULTS: Our study included 115 patients. The mean age of the population was 58.1 years and the median values for total and intracellular water were 35.1 L and 19.3 L, respectively. In the univariable and multivariable analysis, only total body and intracellular water were associated with different definitions of PIH. There was no correlation between any of the BIA-derived parameters of fluid status and the duration of PIH. CONCLUSIONS: Our study shows that in elective surgery, bioimpedance could detect subtle, subclinical fluid parameters that are associated with PIH.
Królicki T, Molsa M, Tukiendorf A
… +2 more, Gawda R, Czarnik T
Anaesthesiol Intensive Ther
· 2024 · PMID 39451163
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INTRODUCTION: The superior vena cava collapsibility index (SVC-CI) is a potential marker of fluid responsiveness (FR) in mechanically ventilated patients. Few studies reporting its diagnostic performance are currently av...INTRODUCTION: The superior vena cava collapsibility index (SVC-CI) is a potential marker of fluid responsiveness (FR) in mechanically ventilated patients. Few studies reporting its diagnostic performance are currently available. MATERIAL AND METHODS: A systematic search, using the PRISMA approach, was performed using the Medline and EMBASE databases. Prospective studies evaluating the SVC-CI as a marker of FR in ventilated adult patients were included. A bivariate random-effect model was utilised to generate the summary receiver operating characteristic (SROC) curve. The area under the ROC curve (AUC), the sensitivity and specificity of the curve operating point were calculated. RESULTS: We included eight studies with a total of 857 patients, in whom SVC-CI was evaluated a total of 1083 times prior to the volume expansion trial. In 609 (56.23%) trial cases FR was present. The SROC curve demonstrated that the test's operating point has a sensitivity and specificity of 80.8% (95% CI: 66.3-90%) and 81.4% (95% CI: 76.4-85.5%), respectively. The model's AUC was equal to 0.848 (95% CI: 0.824-0.863) with P < 0.001. No significant inter-study heterogeneity was found (I 2 = 0%). A subgroup analysis revealed a significantly lower sensitivity of SVC-CI in patients with higher levels of positive end-expiratory pressure (PEEP) (> 5 cm H 2 O) (χ 2 = 7.753, df = 2, P = 0.0207). The study setting and type of intervention for volume expansion did not significantly change the performance of the test. CONCLUSIONS: SVC-CI is a reliable predictor of FR for mechanically ventilated patients in intensive care units and operating rooms. A PEEP level exceeding 5 cm H 2 O may impair the sensitivity of the test.