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Xuesheng Liu - One of the best experts on this subject based on the ideXlab platform.
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opioid sparing effect of modified Intercostal Nerve Block during single port thoracoscopic lobectomy retraction a randomised controlled trial
European Journal of Anaesthesiology, 2021Co-Authors: Xinqi Cheng, Maoyun Zhang, Qi Fang, Dewen Shi, Xiaoci Huang, Xuesheng LiuAbstract:Background Peripheral local anaesthetic Blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal Nerve Block has an opioid-sparing effect after thoracoscopic surgery, but there is little information about an intra-operative opioid-sparing effect. Objective This prospective randomised trial was designed to evaluate the feasibility of a modified Intercostal Nerve Block and its potential opioid-sparing effect during single-port thoracoscopic lobectomy. Design This was a randomised controlled study. Setting The First Affiliated Hospital of Anhui Medical University, Hefei, China, from January 2020 to April 2020. Patients Fifty patients scheduled for single-port thoracoscopic lobectomy were enrolled. Intervention Patients were randomised to receive the Intercostal Nerve Block using 10 ml 0.35% ropivacaine (group MINB) or conventional general anaesthesia (group CGA). Following a bolus of 0.5 to 1.0 μg kg remifentanil, it was then infused at 0.2 to 0.5 μg kg min during surgery to keep mean arterial pressure or heart rate values around 20% below baseline values. Main outcome measures The primary outcome was intra-operative remifentanil consumption. Results Median [IQR] remifentanil consumption was reduced in the MINB group [0 μg (0 to 0 μg)] compared with the CGA group [1650.0 μg (870.0 to 1892.5 μg)]. The median difference was 1650.0 μg (95%CI 1200.0 to 1770.0 μg; P = 0.00). The total number of analgesic demands during the first 24 and 48 h in the MINB group was significantly less than in the CGA group (difference = 1; 95% CI 1 to 3; P = 0.00 and difference = 4; 95% CI 3 to 5; P = 0.00; respectively). The difference in time to first demand for analgesia was significant [difference = 728 min (95% CI 344 to 1381 min), P = 0.00] and also in the number of patients requiring additional tramadol (P = 0.03). Conclusion We have shown intra-operative opioid-sparing with a modified Intercostal Nerve Block during single-port thoracoscopic lobectomy, with opioid-sparing extending 48 h after surgery. However, the opioid-sparing effect was not associated with a reduction in opioid side effects. Trial registration http://www.chictr.org.cn, ChiCTR2000029337.
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anti nociceptive effects of dexmedetomidine infusion plus modified Intercostal Nerve Block during single port thoracoscopic lobectomy a double blind randomized controlled trial
Pain Physician, 2021Co-Authors: Xinqi Cheng, Juan Cheng, Yannan Zhou, Youmei Zuo, Xuesheng LiuAbstract:BACKGROUND Multimodal general anesthesia based on modified Intercostal Nerve Block (MINB) has been found as a novel method to achieve an intraoperative opioid-sparing effect. However, there is little information about the effective method to inhibit visceral nociceptive stress during single-port thoracoscopic surgery. OBJECTIVE To investigate whether a low-dose dexmedetomidine infusion followed by MINB might be an alternative method to blunt visceral stress effectively. STUDY DESIGN Double-blind, randomized control trial. SETTING Affiliated hospital from March 2020 through September 2020. METHODS Fifty-four patients were randomized (1:1), 45 patients were included to receive dexmedetomidine with a 0.4 microgram/kg bolus followed by 0.4 microgram/kg/h infusion (group Dex) or saline placebo (group Con). During the operation, an additional dose of remifentanil 0.05-0.25 microgram/kg/min was used to keep mean arterial pressure (MAP) or heart rate (HR) values around 20% below baseline values. The primary outcome was to evaluate remifentanil consumption. Secondary outcomes included intraoperative hemodynamics, the first time to press an analgesia pump, and adverse effects. RESULTS Remifentanil consumption during surgery was markedly decreased in the Dex group than in the Con group (0 [0-0] versus 560.0 [337.5-965.0] microgram; P = 0.00). MAP and HR in the Con group during the first 5 minutes after visceral exploration was significantly higher than in the Dex group (P < 0.05). Time to first opioid demand was significantly prolonged (P = 0.04) and postoperative length of stay was shortened slightly in the Dex group (P = 0.05). LIMITATIONS This study was limited by the measurement of nociception. CONCLUSIONS This study demonstrates that low-dose dexmedetomidine infusion combined with MINB might be an effective alternative method to blunt visceral stress in patients undergoing single-port thoracoscopic lobectomy. Furthermore, the analgesic effect of MINB was significantly prolonged after dexmedetomidine infusion.
S Sabanathan - One of the best experts on this subject based on the ideXlab platform.
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British Journal of Anaesthesia 1990; 64: 124-126 CORRESPONDENCE THORACIC Nerve Block
2016Co-Authors: R. G. Berrisford, S SabanathanAbstract:Sir,—In his review of developments in local anaesthetic techniques [1], Dr Wildsmith mentions continuous Intercostal Nerve Block. We have conducted a double-blind, randomized controlled trial using this technique in 80 patients undergoing thor-acotomy [2], and have shown that it decreases the post-operative decrease in lung function, improves subsequent restoration, decreases pain scores, and reduces the incidence of pulmonary complications in patients with chronic obstructive airways disease. We have demonstrated also that continuous Intercostal Nerve Block is an effective means of perfusing the paravertebral space after thoracotomy: in 50 patients we infused a mixture of mcthylene blue and bupivacaine before closing the chest, and found that spread occurred consistently over three to five paravertebral spaces. After 4 days of infusion, radiographic contrast confirmed extensive paravertebral spread. As Dr Wildsmith says, paravertebral Block is a very attractive alternative to central Block. We should like to emphasize just how useful this is in patients undergoing thoracotomy
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efficacy of continuous extrapleural Intercostal Nerve Block on post thoracotomy pain and pulmonary mechanics
British Journal of Surgery, 2005Co-Authors: S Sabanathan, Jibah Eng, A J Mearns, P Bickford J Smith, Richard G Berrisford, S R Bibby, Mohammed R MajidAbstract:To assess the efficacy of continuous extrapleural Intercostal Nerve Block on postoperative pain and pulmonary function, a prospective, randomized, double-blind, placebo-controlled trial was conducted on 56 patients undergoing elective thoracotomy. Infusion was started before closing the chest and was continued for 5 days. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for 5 days. There were 29 patients in a group which received bupivacaine and 27 in a control group which received saline. The bupivacaine group had lower pain scores (P less than 0.01) and required less papaveretum (P less than 0.01) than the control group. Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were maximally reduced at 24 h to median values of 56, 60 and 57 per cent, respectively, of preoperative control values in the bupivacaine group, and to 25, 30 and 32 per cent in the control group. These differences are highly significant (P less than 0.01). Restoration of pulmonary function was superior in the bupivacaine group (P less than 0.01). There were no infusion-related complications. After thoracotomy, continuous Intercostal Blockade with bupivacaine is a safe and effective method of pain relief which reduces the early loss of postoperative pulmonary function significantly and more rapidly restores respiratory mechanics.
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continuous Intercostal Nerve Block versus epidural morphine for postthoracotomy analgesia
The Annals of Thoracic Surgery, 1993Co-Authors: J Richardson, S Sabanathan, Jibah Eng, A J Mearns, Christina Rogers, Carolyn S Evans, Jane L Bembridge, Mohammed R MajidAbstract:Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural Intercostal Nerve Block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. Pulse oximetry monitoring was used to determine the incidence of hypoxemia. No significant difference was observed between the groups concerning pain relief (except at 28 hours, in favor of the Intercostal Nerve Block group), respiratory performance, or arterial oxygen saturation. Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural Intercostal Nerve Block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural Intercostal Nerve Block for postthoracotomy analgesia.
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plasma concentrations of bupivacaine and its enantiomers during continuous extrapleural Intercostal Nerve Block
BJA: British Journal of Anaesthesia, 1993Co-Authors: Richard G Berrisford, S Sabanathan, A J Mearns, B J Clarke, A HamdiAbstract:Plasma concentrations of bupivacaine have been measured in 12 patients given bupivacaine through a paravertebral catheter placed under direct vision at thoracotomy. After an initial bolus of 0.5% bupivacaine 20 ml, mean (SEM) CPmax was 1.45 (0.32) fig mt1 and median (range) tCPmax was 25 (10-60) min. A concentration of 4.43 ug mt' measured in one patient was not associated with toxic signs. During continuous infusion of bupivacaine for 120 h, CPmax was 4.9 (0.7) fig mt' and tCPmax 48 (5–96) h. No symptoms or signs of toxicity occurred. Separate measurement of R- and S-bupivacaine concentrations demonstrated significantly different concentration-time profiles. (Br. J. Anaesth. 1993; 70: 201–204)
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site of action of continuous extrapleural Intercostal Nerve Block
Survey of Anesthesiology, 1992Co-Authors: Jibah Eng, S SabanathanAbstract:Continuous extrapleural Intercostal Nerve Block has been shown in a randomized, controlled study to be effective in reducing postoperative pain after thoracotomy and in restoring pulmonary mechanics. To assess the extent of spread of bupivacaine infused through an extrapleurally placed cannula inserted at thoracotomy, iohexol (Omnipaque) was infused at 5 days postoperatively in 5 patients and computed tomography performed. The contrast medium was confined to the paravertebral space covering on average six Intercostal spaces. This study demonstrated that anatomically, the site of action of the bupivacaine infused through an extrapleural cannula was primarily in the paravertebral space.
Mohammed R Majid - One of the best experts on this subject based on the ideXlab platform.
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efficacy of continuous extrapleural Intercostal Nerve Block on post thoracotomy pain and pulmonary mechanics
British Journal of Surgery, 2005Co-Authors: S Sabanathan, Jibah Eng, A J Mearns, P Bickford J Smith, Richard G Berrisford, S R Bibby, Mohammed R MajidAbstract:To assess the efficacy of continuous extrapleural Intercostal Nerve Block on postoperative pain and pulmonary function, a prospective, randomized, double-blind, placebo-controlled trial was conducted on 56 patients undergoing elective thoracotomy. Infusion was started before closing the chest and was continued for 5 days. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for 5 days. There were 29 patients in a group which received bupivacaine and 27 in a control group which received saline. The bupivacaine group had lower pain scores (P less than 0.01) and required less papaveretum (P less than 0.01) than the control group. Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were maximally reduced at 24 h to median values of 56, 60 and 57 per cent, respectively, of preoperative control values in the bupivacaine group, and to 25, 30 and 32 per cent in the control group. These differences are highly significant (P less than 0.01). Restoration of pulmonary function was superior in the bupivacaine group (P less than 0.01). There were no infusion-related complications. After thoracotomy, continuous Intercostal Blockade with bupivacaine is a safe and effective method of pain relief which reduces the early loss of postoperative pulmonary function significantly and more rapidly restores respiratory mechanics.
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continuous Intercostal Nerve Block versus epidural morphine for postthoracotomy analgesia
The Annals of Thoracic Surgery, 1993Co-Authors: J Richardson, S Sabanathan, Jibah Eng, A J Mearns, Christina Rogers, Carolyn S Evans, Jane L Bembridge, Mohammed R MajidAbstract:Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural Intercostal Nerve Block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. Pulse oximetry monitoring was used to determine the incidence of hypoxemia. No significant difference was observed between the groups concerning pain relief (except at 28 hours, in favor of the Intercostal Nerve Block group), respiratory performance, or arterial oxygen saturation. Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural Intercostal Nerve Block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural Intercostal Nerve Block for postthoracotomy analgesia.
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Continuous extrapleural Intercostal Nerve Block after pleurectomy.
Thorax, 1991Co-Authors: E. J. Mozell, S Sabanathan, Mohammed R Majid, P. J. Bickford-smith, G. ZografosAbstract:A randomised, double blind trial was carried out in 16 patients undergoing pleurectomy to assess the effect of continuous extrapleural Intercostal Block on postoperative pain and pulmonary function. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for five days after surgery. Eight patients received bupivacaine and eight placebo (saline). The mean pain scores at 4, 8, 16, and 24 hours were 13.3, 8.5, 6.1, and 10 mm respectively in the bupivacaine group compared with 56.3, 41, 46.7, and 35 in the control group; in addition, the bupivacaine group required less papaveretum. Twenty four hours after surgery mean values of peak expiratory flow, forced expiratory volume in one second, and forced vital capacity were reduced to 82%, 76%, and 76% of preoperative control values in the bupivacaine group, and to 39%, 32%, and 36% in the control group. The speed of recovery of pulmonary function was superior in the bupivacaine group. There were no complications related to the infusion. Continuous extrapleural Intercostal Nerve Blockade with bupivacaine provides safe and effective postoperative analgesia and improves respiratory mechanics after pleurectomy.
Saeyoung Kim - One of the best experts on this subject based on the ideXlab platform.
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serratus anterior plane Block and Intercostal Nerve Block after thoracoscopic surgery
Thoracic and Cardiovascular Surgeon, 2021Co-Authors: Saeyoung Kim, Chaemin Bae, Suyoung Moon, Seung Ik Baek, Deok Heon LeeAbstract:Background This study aimed to compare the postoperative analgesic effect between ultrasound-guided serratus anterior plane Block (Group S, SAPB) and Intercostal Nerve Block (Group I, ICNB) after single port video-assisted thoracoscopic surgery (S-VATS) in primary spontaneous pneumothorax. Methods In this prospective randomized controlled study, 54 patients were randomly assigned to two groups. Patients in Group S underwent the SAPB before the surgical drape by an anesthesiologist, and in Group I, ICNBs were performed just before the wound closure after S-VATS by an attending thoracic surgeon. The primary outcome was the numeric pain rating scale (NRS) score given by the patients for pain at the surgical incision site. NRS was assessed during resting and coughing statuses at 3, 6, and 12 hours postoperatively and at the time of the chest tube removal. The secondary outcomes included the number of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid administration until time to chest tube removal. Results There were no statistical differences between the two groups regarding age, body mass index, duration of operation, duration of anesthesia, and average NRS scores for the assigned time periods. There was no statistical significance in the number of opioid injections; however, NSAIDs were administered 2.8 times per patient in Group I, and 1.9 times per patient in Group S (p = 0.038). Conclusion In the patients who underwent S-VATS with primary spontaneous pneumothorax, the SAPB provided similar postoperative pain relief with reducing the NSAIDs consumption compared with ICNB.
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serratus anterior plane Block versus Intercostal Nerve Block for postoperative analgesic effect after video assisted thoracoscopic lobectomy a randomized prospective study
Medicine, 2020Co-Authors: Jungwon Lee, Deok Heon Lee, Saeyoung KimAbstract:Background Serratus anterior plane Block (SAPB) and Intercostal Nerve Block (ICNB) are attractive options for multimodal analgesia in patients undergoing thoracoscopic surgery, but which Block is superior remains unclear. Objective The present study aimed to assess the effect of SAPB versus ICNB on reducing postoperative pain after video-assisted thoracoscopic surgery (VATS) for lobectomy. Methods This prospective, randomized, active-intervention-controlled, subject-assessor-blinded, single-center, parallel-group trial allocated 18- to 80-year-old patients with American Society of Anesthesiologists status I to III to receive either SAPB or ICNB in a 1:1 ratio. The primary outcome was numerical pain rating scale (NRS) scores during the first 24 hours postoperatively. The secondary outcomes were postoperative cumulative doses of ketorolac and fentanyl, and the occurrence of postoperative adverse effects. Results Among the 57 patients assessed for eligibility, 50 were randomly assigned in a 1:1 ratio. Due to conversion to open thoracotomy and patient-controlled analgesia pump failure, 4 patients were excluded and 46 were analyzed. The intergroup differences in NRS scores were not statistically significant at any time point. Cumulative consumptions of fentanyl and ketorolac were also not significantly different. No perioperative adverse events occurred. Postoperative complications were also absent, except for nausea (2/23 patients [8.7% in both groups]). Conclusion Results of the present study do not clarify whether SAPB or ICNB has a superior effect on reducing pain after VATS, thereby suggesting they may exert similar analgesic effects.
Xinqi Cheng - One of the best experts on this subject based on the ideXlab platform.
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opioid sparing effect of modified Intercostal Nerve Block during single port thoracoscopic lobectomy retraction a randomised controlled trial
European Journal of Anaesthesiology, 2021Co-Authors: Xinqi Cheng, Maoyun Zhang, Qi Fang, Dewen Shi, Xiaoci Huang, Xuesheng LiuAbstract:Background Peripheral local anaesthetic Blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal Nerve Block has an opioid-sparing effect after thoracoscopic surgery, but there is little information about an intra-operative opioid-sparing effect. Objective This prospective randomised trial was designed to evaluate the feasibility of a modified Intercostal Nerve Block and its potential opioid-sparing effect during single-port thoracoscopic lobectomy. Design This was a randomised controlled study. Setting The First Affiliated Hospital of Anhui Medical University, Hefei, China, from January 2020 to April 2020. Patients Fifty patients scheduled for single-port thoracoscopic lobectomy were enrolled. Intervention Patients were randomised to receive the Intercostal Nerve Block using 10 ml 0.35% ropivacaine (group MINB) or conventional general anaesthesia (group CGA). Following a bolus of 0.5 to 1.0 μg kg remifentanil, it was then infused at 0.2 to 0.5 μg kg min during surgery to keep mean arterial pressure or heart rate values around 20% below baseline values. Main outcome measures The primary outcome was intra-operative remifentanil consumption. Results Median [IQR] remifentanil consumption was reduced in the MINB group [0 μg (0 to 0 μg)] compared with the CGA group [1650.0 μg (870.0 to 1892.5 μg)]. The median difference was 1650.0 μg (95%CI 1200.0 to 1770.0 μg; P = 0.00). The total number of analgesic demands during the first 24 and 48 h in the MINB group was significantly less than in the CGA group (difference = 1; 95% CI 1 to 3; P = 0.00 and difference = 4; 95% CI 3 to 5; P = 0.00; respectively). The difference in time to first demand for analgesia was significant [difference = 728 min (95% CI 344 to 1381 min), P = 0.00] and also in the number of patients requiring additional tramadol (P = 0.03). Conclusion We have shown intra-operative opioid-sparing with a modified Intercostal Nerve Block during single-port thoracoscopic lobectomy, with opioid-sparing extending 48 h after surgery. However, the opioid-sparing effect was not associated with a reduction in opioid side effects. Trial registration http://www.chictr.org.cn, ChiCTR2000029337.
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anti nociceptive effects of dexmedetomidine infusion plus modified Intercostal Nerve Block during single port thoracoscopic lobectomy a double blind randomized controlled trial
Pain Physician, 2021Co-Authors: Xinqi Cheng, Juan Cheng, Yannan Zhou, Youmei Zuo, Xuesheng LiuAbstract:BACKGROUND Multimodal general anesthesia based on modified Intercostal Nerve Block (MINB) has been found as a novel method to achieve an intraoperative opioid-sparing effect. However, there is little information about the effective method to inhibit visceral nociceptive stress during single-port thoracoscopic surgery. OBJECTIVE To investigate whether a low-dose dexmedetomidine infusion followed by MINB might be an alternative method to blunt visceral stress effectively. STUDY DESIGN Double-blind, randomized control trial. SETTING Affiliated hospital from March 2020 through September 2020. METHODS Fifty-four patients were randomized (1:1), 45 patients were included to receive dexmedetomidine with a 0.4 microgram/kg bolus followed by 0.4 microgram/kg/h infusion (group Dex) or saline placebo (group Con). During the operation, an additional dose of remifentanil 0.05-0.25 microgram/kg/min was used to keep mean arterial pressure (MAP) or heart rate (HR) values around 20% below baseline values. The primary outcome was to evaluate remifentanil consumption. Secondary outcomes included intraoperative hemodynamics, the first time to press an analgesia pump, and adverse effects. RESULTS Remifentanil consumption during surgery was markedly decreased in the Dex group than in the Con group (0 [0-0] versus 560.0 [337.5-965.0] microgram; P = 0.00). MAP and HR in the Con group during the first 5 minutes after visceral exploration was significantly higher than in the Dex group (P < 0.05). Time to first opioid demand was significantly prolonged (P = 0.04) and postoperative length of stay was shortened slightly in the Dex group (P = 0.05). LIMITATIONS This study was limited by the measurement of nociception. CONCLUSIONS This study demonstrates that low-dose dexmedetomidine infusion combined with MINB might be an effective alternative method to blunt visceral stress in patients undergoing single-port thoracoscopic lobectomy. Furthermore, the analgesic effect of MINB was significantly prolonged after dexmedetomidine infusion.