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Michiaki Yamakage - One of the best experts on this subject based on the ideXlab platform.
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quadratus lumborum block analgesic effects and chronological ropivacaine concentrations after laparoscopic Surgery
Regional Anesthesia and Pain Medicine, 2016Co-Authors: Takeshi Murouchi, Soshi Iwasaki, Michiaki YamakageAbstract:Background and Objectives The quadratus lumborum block (QLB) is an abdominal truncal block, similar to transversus abdominis plane block (TAPB). However, the characteristics of QLB with regard to its duration and safety are not well known. The primary aim of this study was to determine the block duration and the cutaneous sensory block area. Our secondary analysis included assessment of the chronological change in arterial local anesthetic concentrations after QLB. Methods This study included 11 patients scheduled for laparoscopic Ovarian Surgery under general anesthesia. The patients received bilateral single-injection QLBs (20 mL of 0.375% ropivacaine per side). Arterial blood was sampled at 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. The results were retrospectively compared with the results of our previous study on lateral TAPB. Results The median duration of analgesia after QLB exceeded 24 hours and was significantly longer than the duration of lateral TAPB (P = 0.003). Quadratus lumborum block affected the T7-T12 dermatomes, whereas TAPB affected T10-T12. Arterial ropivacaine levels after block peaked at comparable time in the QLB and lateral TAPB groups (Tmax: 35 [SD, 13] vs 35 [SD, 11] minutes; P = 0.93). Peak ropivacaine concentrations were significantly lower in QLB than in lateral TAPB (Cmax: 1.0 [SD, 0.5] vs 1.8 [SD, 0.4] μg/mL; P = 0.0003). Conclusions Quadratus lumborum block resulted in a widespread and long-lasting analgesic effect after laparoscopic Ovarian Surgery and resulted in lower peak arterial ropivacaine concentrations as compared with those of lateral TAPB after 150 mg ropivacaine injection.
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chronological changes in ropivacaine concentration and analgesic effects between transversus abdominis plane block and rectus sheath block
Regional Anesthesia and Pain Medicine, 2015Co-Authors: Takeshi Murouchi, Soshi Iwasaki, Michiaki YamakageAbstract:Background and Objectives Transversus abdominis plane block (TAPB) and rectus sheath block (RSB) are popular methods of controlling postoperative pain. Chronological changes in blood concentrations of local anesthetics have not been described, although a large amount of local anesthetic is required to block these compartments. We postulated that blood concentrations of anesthetics would peak earlier during TAPB than RSB (primary end point). Secondary end points were elapsed time from block until first postoperative rescue analgesia and affected dermatomes. Methods This prospective, randomized study included 22 patients scheduled for laparoscopic Ovarian Surgery under general anesthesia. The patients were randomized to receive either a bilateral single-shot TAPB or a bilateral RSB (15 mL of 0.5% ropivacaine per side). Arterial blood was sampled 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. This trial was registered at the UMIN-Clinical Trials Registry (UMIN000012133) before patient recruitment. Results Arterial ropivacaine levels after block peaked earlier in the TAPB than in RSB [Tmax: 35 (12) vs 53 (16) minutes; P = 0.02], whereas peak ropivacaine concentrations did not significantly differ between the groups [Cmax: 1.83 (0.41) vs 1.79 (0.33) μg/mL; P = 0.54]. Peak ropivacaine concentrations exceeded 2.2 μg/mL in 1 and 2 patients in the RSB and TAPB groups, respectively, although symptoms of local anesthetic systemic toxicity were not evident in any of them. The median [interquartile range] duration of analgesia was significantly longer for TAPB than RSB (421 [335–536] vs 196 [168–277] minutes; P = 0.01). Conclusions Peak ropivacaine concentrations were comparable during TAPB and RSB, but peaked earlier during TAPB. Although 150 mg of ropivacaine remained effective significantly longer during TAPB than RSB during laparoscopic Surgery, this dose could cause local anesthetic systemic toxicity. The analgesic effects of blocks with less ropivacaine should be assessed.
Takeshi Murouchi - One of the best experts on this subject based on the ideXlab platform.
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quadratus lumborum block analgesic effects and chronological ropivacaine concentrations after laparoscopic Surgery
Regional Anesthesia and Pain Medicine, 2016Co-Authors: Takeshi Murouchi, Soshi Iwasaki, Michiaki YamakageAbstract:Background and Objectives The quadratus lumborum block (QLB) is an abdominal truncal block, similar to transversus abdominis plane block (TAPB). However, the characteristics of QLB with regard to its duration and safety are not well known. The primary aim of this study was to determine the block duration and the cutaneous sensory block area. Our secondary analysis included assessment of the chronological change in arterial local anesthetic concentrations after QLB. Methods This study included 11 patients scheduled for laparoscopic Ovarian Surgery under general anesthesia. The patients received bilateral single-injection QLBs (20 mL of 0.375% ropivacaine per side). Arterial blood was sampled at 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. The results were retrospectively compared with the results of our previous study on lateral TAPB. Results The median duration of analgesia after QLB exceeded 24 hours and was significantly longer than the duration of lateral TAPB (P = 0.003). Quadratus lumborum block affected the T7-T12 dermatomes, whereas TAPB affected T10-T12. Arterial ropivacaine levels after block peaked at comparable time in the QLB and lateral TAPB groups (Tmax: 35 [SD, 13] vs 35 [SD, 11] minutes; P = 0.93). Peak ropivacaine concentrations were significantly lower in QLB than in lateral TAPB (Cmax: 1.0 [SD, 0.5] vs 1.8 [SD, 0.4] μg/mL; P = 0.0003). Conclusions Quadratus lumborum block resulted in a widespread and long-lasting analgesic effect after laparoscopic Ovarian Surgery and resulted in lower peak arterial ropivacaine concentrations as compared with those of lateral TAPB after 150 mg ropivacaine injection.
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chronological changes in ropivacaine concentration and analgesic effects between transversus abdominis plane block and rectus sheath block
Regional Anesthesia and Pain Medicine, 2015Co-Authors: Takeshi Murouchi, Soshi Iwasaki, Michiaki YamakageAbstract:Background and Objectives Transversus abdominis plane block (TAPB) and rectus sheath block (RSB) are popular methods of controlling postoperative pain. Chronological changes in blood concentrations of local anesthetics have not been described, although a large amount of local anesthetic is required to block these compartments. We postulated that blood concentrations of anesthetics would peak earlier during TAPB than RSB (primary end point). Secondary end points were elapsed time from block until first postoperative rescue analgesia and affected dermatomes. Methods This prospective, randomized study included 22 patients scheduled for laparoscopic Ovarian Surgery under general anesthesia. The patients were randomized to receive either a bilateral single-shot TAPB or a bilateral RSB (15 mL of 0.5% ropivacaine per side). Arterial blood was sampled 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. This trial was registered at the UMIN-Clinical Trials Registry (UMIN000012133) before patient recruitment. Results Arterial ropivacaine levels after block peaked earlier in the TAPB than in RSB [Tmax: 35 (12) vs 53 (16) minutes; P = 0.02], whereas peak ropivacaine concentrations did not significantly differ between the groups [Cmax: 1.83 (0.41) vs 1.79 (0.33) μg/mL; P = 0.54]. Peak ropivacaine concentrations exceeded 2.2 μg/mL in 1 and 2 patients in the RSB and TAPB groups, respectively, although symptoms of local anesthetic systemic toxicity were not evident in any of them. The median [interquartile range] duration of analgesia was significantly longer for TAPB than RSB (421 [335–536] vs 196 [168–277] minutes; P = 0.01). Conclusions Peak ropivacaine concentrations were comparable during TAPB and RSB, but peaked earlier during TAPB. Although 150 mg of ropivacaine remained effective significantly longer during TAPB than RSB during laparoscopic Surgery, this dose could cause local anesthetic systemic toxicity. The analgesic effects of blocks with less ropivacaine should be assessed.
Soshi Iwasaki - One of the best experts on this subject based on the ideXlab platform.
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quadratus lumborum block analgesic effects and chronological ropivacaine concentrations after laparoscopic Surgery
Regional Anesthesia and Pain Medicine, 2016Co-Authors: Takeshi Murouchi, Soshi Iwasaki, Michiaki YamakageAbstract:Background and Objectives The quadratus lumborum block (QLB) is an abdominal truncal block, similar to transversus abdominis plane block (TAPB). However, the characteristics of QLB with regard to its duration and safety are not well known. The primary aim of this study was to determine the block duration and the cutaneous sensory block area. Our secondary analysis included assessment of the chronological change in arterial local anesthetic concentrations after QLB. Methods This study included 11 patients scheduled for laparoscopic Ovarian Surgery under general anesthesia. The patients received bilateral single-injection QLBs (20 mL of 0.375% ropivacaine per side). Arterial blood was sampled at 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. The results were retrospectively compared with the results of our previous study on lateral TAPB. Results The median duration of analgesia after QLB exceeded 24 hours and was significantly longer than the duration of lateral TAPB (P = 0.003). Quadratus lumborum block affected the T7-T12 dermatomes, whereas TAPB affected T10-T12. Arterial ropivacaine levels after block peaked at comparable time in the QLB and lateral TAPB groups (Tmax: 35 [SD, 13] vs 35 [SD, 11] minutes; P = 0.93). Peak ropivacaine concentrations were significantly lower in QLB than in lateral TAPB (Cmax: 1.0 [SD, 0.5] vs 1.8 [SD, 0.4] μg/mL; P = 0.0003). Conclusions Quadratus lumborum block resulted in a widespread and long-lasting analgesic effect after laparoscopic Ovarian Surgery and resulted in lower peak arterial ropivacaine concentrations as compared with those of lateral TAPB after 150 mg ropivacaine injection.
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chronological changes in ropivacaine concentration and analgesic effects between transversus abdominis plane block and rectus sheath block
Regional Anesthesia and Pain Medicine, 2015Co-Authors: Takeshi Murouchi, Soshi Iwasaki, Michiaki YamakageAbstract:Background and Objectives Transversus abdominis plane block (TAPB) and rectus sheath block (RSB) are popular methods of controlling postoperative pain. Chronological changes in blood concentrations of local anesthetics have not been described, although a large amount of local anesthetic is required to block these compartments. We postulated that blood concentrations of anesthetics would peak earlier during TAPB than RSB (primary end point). Secondary end points were elapsed time from block until first postoperative rescue analgesia and affected dermatomes. Methods This prospective, randomized study included 22 patients scheduled for laparoscopic Ovarian Surgery under general anesthesia. The patients were randomized to receive either a bilateral single-shot TAPB or a bilateral RSB (15 mL of 0.5% ropivacaine per side). Arterial blood was sampled 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. This trial was registered at the UMIN-Clinical Trials Registry (UMIN000012133) before patient recruitment. Results Arterial ropivacaine levels after block peaked earlier in the TAPB than in RSB [Tmax: 35 (12) vs 53 (16) minutes; P = 0.02], whereas peak ropivacaine concentrations did not significantly differ between the groups [Cmax: 1.83 (0.41) vs 1.79 (0.33) μg/mL; P = 0.54]. Peak ropivacaine concentrations exceeded 2.2 μg/mL in 1 and 2 patients in the RSB and TAPB groups, respectively, although symptoms of local anesthetic systemic toxicity were not evident in any of them. The median [interquartile range] duration of analgesia was significantly longer for TAPB than RSB (421 [335–536] vs 196 [168–277] minutes; P = 0.01). Conclusions Peak ropivacaine concentrations were comparable during TAPB and RSB, but peaked earlier during TAPB. Although 150 mg of ropivacaine remained effective significantly longer during TAPB than RSB during laparoscopic Surgery, this dose could cause local anesthetic systemic toxicity. The analgesic effects of blocks with less ropivacaine should be assessed.
Gianfranco Scarselli - One of the best experts on this subject based on the ideXlab platform.
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Ovarian Surgery for bilateral endometriomas influences age at menopause
Human Reproduction, 2011Co-Authors: Maria Elisabetta Coccia, Francesca Rizzello, Giulia Mariani, Carlo Bulletti, Antonio Palagiano, Gianfranco ScarselliAbstract:Background Questions remain as to whether surgical excision of Ovarian endometriomas might cause damage to Ovarian function. To test the hypothesis that Ovarian Surgery for endometrioma compromises Ovarian function and accelerates Ovarian failure. Methods In a tertiary university Clinic, longitudinal prospective cohort study. Patients who underwent laparoscopy for endometriosis between March 1993 and November 2007 were assessed for inclusion in the study. A prospective follow-up at 3, 6 and 12 months then yearly was conducted. Evolution of menstrual pattern, symptoms and reproductive outcomes were investigated. Results From over the 14-year period, 302 patients were included in the study. The mean age (±SD) of patients was 32.6 ± 5.6 years; the median duration of follow-up was 8.5 years (range 2-17 years). Menopause was documented in 43 women (14.3%) at a mean age of 45.3 ± 4.3 years (range 32-52 years). Women previously submitted to bilateral cystectomy were younger at menopause than those with monolateral endometrioma (42.1 ± 5.1 years versus 47.1 ± 3.5 years, P = 0.003). Premature Ovarian failure (POF) was observed in 7 of 43 (16.3%) menopausal patients; the majority (4, 57.1%) after bilateral cystectomy. The relationship between the preoperative Ovarian endometriomas total diameter and menopausal age was significant in case of Surgery for bilateral endometriomas (R(2) = 0.754, P = 0.002). Conclusions Patients who had been operated on for bilateral endometriomas have an increased risk of POF. Ovarian parenchyma loss at the time of Surgery seems related to cyst diameter. In the case of unilateral Ovarian endometrioma, the contralateral intact ovary might adequately compensate.
Jiyoun Sung - One of the best experts on this subject based on the ideXlab platform.
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Ovarian remnant syndrome at the trochar site a report of a rare complication following laparoscopic Ovarian Surgery
Korean Journal of Pathology, 2013Co-Authors: Kiyong Na, Jiyoun SungAbstract:drome usually occurs as a result of improper tissue removal or an inappropriate blunt dissection. Endometriosis, pelvic inflam matory disease or previous gynecologic surgeries have been known to increase the risk. Such conditions make removal of Ovarian tissue difficult, due to the increased likelihood of dense fibrotic adhesions between an ovary and surrounding structures. Furthermore, with an increase in the number of laparoscopic Ovarian surgeries performed, implantation of Ovarian tissue also has been recognized as an important cause of Ovarian remnant syndrome. 2 Various locations have been identified where residual Ovarian tissue was detected after laparoscopic Ovarian Surgery, including the pelvic wall, cervix, vagina, and bladder. 1 However, reports of residual Ovarian tissue detected in an abdominal wall have been rare. This report describes a case of Ovarian remnant syndrome caused by residual Ovarian tissue at the trochar site after a laparoscopic Ovarian cystectomy. that was palpable one week prior to her visit. The mass was not painful and did not show a change in size. Her past medical history was remarkable because she had undergone laparoscopic bilateral Ovarian cystectomy due to endometriosis 3 years prior to her visit. Physical examination revealed a surgical scar on her left lower abdomen and an index finger tip-sized mass was pal pable in the abdominal wall under the scar. It was smooth and movable, and was not tender. The laboratory findings were un remarkable. Ultrasonography demonstrated an approximately 1.6×0.9 cmsized hypoechoic mass in the subcutaneous adipose tissue (Fig. 1). An excisional biopsy was performed. The mass was well demarcated from the adjacent soft tissue by a thin fibrous capsule. The cut surface showed a yellow, glistening lobular parenchyma with areas of blood-filled cystic spaces. Histologically, the pa renchyma was composed of luteinized granulosa and theca cell layers, suggesting corpus luteum of the ovary (Fig. 2). There was no evidence of endometriosis. A review of the operation record of the laparoscopic Surgery that was performed 3 years prior showed that the patient had 5.4×4.5×4.0 cm- and 3.2×3.0×1.5 cm-sized endometriotic cysts in bilateral ovaries with an associated dense pelvic adhesion. After a cystectomy, the specimens were fragmented and extracted using forceps through the trochar on her left lower abdomen. The patient was discharged after the abdominal wall mass excision and was healthy with no recurrence of the lesion at a follow-up at 32 months.