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G Pinto - One of the best experts on this subject based on the ideXlab platform.
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levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery
Minerva Anestesiologica, 2006Co-Authors: F Fattorini, Zaccaria Ricci, A Rocco, R Romano, M A Pascarella, G PintoAbstract:Aim Levobupivacaine, a new local anaesthetic, has been recently introduced into clinical practice because of its lower toxic effects for heart and central nervous system. It has been already investigated in epidural and loco-regional techniques, but more has to be known regarding its characteristics in spinal anaesthesia. The aim of our study was to compare clinical and anaesthetic features of levobupivacaine and racemic bupivacaine when intrathecally administered in 60 patients undergoing major orthopaedic surgical procedures. Methods Three ml of glucose-free levobupivacaine 0.5% (group L) or 3 ml of isobaric bupivacaine 0.5% (group B) were administered in 30 patients each. Sensory and motor blockades were evaluated by the Pinprick Test and a modified Bromage score, respectively. Vital parameters, postoperative VAS and rescue analgesia were recorded as well. Results No statistically significant differences between groups were observed either in anaesthetic potencies or postoperative pain. Either heart rate or mean arterial pressure slightly decreased in both groups, with no preoperative significant differences. Nevertheless, spinal puncture was accompanied by severe hypotension and bradycardia in 2 patients of group B. In both cases, hemodynamics were promptly and successfully treated, with no sequelae. Conclusions In conclusion, levobupivacaine results a valid alternative to racemic bupivacaine for spinal anaesthesia, the latter remaining a cheap and effective local anaesthetic yet. Notwithstanding the complete absence of any significant hemodynamic complications in the patients of group L, further and larger studies are needed in order to assess if levobupivacaine is preferable to bupivacaine for minimizing the possible cardiovascular impact of spinal anaesthesia.
Kimitoshi Nishiwaki - One of the best experts on this subject based on the ideXlab platform.
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spread of quadratus lumborum block to the paravertebral space via intramuscular injection a volunteer study
Regional Anesthesia and Pain Medicine, 2018Co-Authors: Takahiro Tamura, Kana Kitamura, Shuichi Yokota, Shigeki Ito, Yasuyuki Shibata, Kimitoshi NishiwakiAbstract:Background and Objectives Several types of quadratus lumborum block (QLB) are used for postoperative analgesia and are believed to be effective against both somatic and visceral pain via a local anesthetic (LA) effect in the paravertebral space (PVS). However, it remains unclear whether all QLB techniques result in LA spread into the PVS. We hypothesized that LA administered via intramuscular QLB would spread into the paravertebral space and investigated the spread and sensory block area of LA in intramuscular QLB. Methods This volunteer study included 5 healthy men and 1 woman, with no previous medical history. Intramuscular QLB and lateral transversus abdominis plane block were performed under real-time ultrasound guidance for comparison of sensory deprivation range. Two days later, the same procedure was performed on the contralateral side of the body. The spread of LA via intramuscular QLB spread to the PVS was assessed 1 hour after the first injections using magnetic resonance imaging. Sensory perception was also evaluated by the Pinprick Test at 90 minutes after injection. Results In total, we performed 11 intramuscular QLBs and 11 lateral transversus abdominis plane blocks. Magnetic resonance imaging showed that LA did not spread into the PVS after ultrasound-guided intramuscular QLB. The analgesic area corresponded to the side of the body that was ipsilateral to the block. Conclusions Ultrasound-guided intramuscular QLBs are not clinically useful for procedures requiring LA spread into the PVS but do result in an ipsilateral analgesic effect in healthy volunteers. Clinical Trial Registration This study was registered at University Hospital Medical Information Network Clinical Trials Registry, UMIN 000019149.
Jacques E. Chelly - One of the best experts on this subject based on the ideXlab platform.
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The nerve stimulation technique versus the loss of resistance technique for the posterior approach to lumbar plexus block: a randomized, prospective, observer-blinded, pilot study.
Minerva anestesiologica, 2011Co-Authors: G. Danelli, D. Ghisi, F. Bellinghieri, Battista Borghi, G. Fanelli, Jacques E. ChellyAbstract:BACKGROUND This prospective, randomized, observer-blinded, pilot study compares the effects of the nerve stimulation guidance technique (NS) with the loss of resistance technique (LOR) on readiness for surgery during the posterior approach to lumbar plexus block. METHODS Thirty ASA status I-III patients who were 18-85 years old and who were undergoing hip fracture repair were enrolled. After parasacral sciatic nerve block, patients were randomly allocated to receive a continuous posterior lumbar plexus block using nerve stimulation (n=15) or a continuous psoas compartment block using the loss of resistance technique (n=15) with 20 ml of 1.5% mepivacaine. A blinded observer monitored for sensory and motor block onsets every 5 minutes. We defined readiness for surgery as complete numbness to the Pinprick Test and complete motor block on the surgical side. If incomplete, the lumbar plexus block was supplemented with 10 mL of 1.5% mepivacaine through the catheter before surgery. Intraoperative fentanyl or general anesthesia requirements, pain scores, local anesthetic consumption, morphine requirements for breakthrough pain and side effects were monitored. RESULTS The mean time to readiness for surgery was 12±6 min Group NS and 22±6 min in Group LOR (P=0.03). Three patients in Group NS and 9 patients in Group LOR required additional boluses of local anesthetic through the lumbar plexus catheter before surgery (P=0.113). CONCLUSION Nerve stimulation allowed faster readiness for surgery than loss of resistance. Nevertheless, the two techniques seem to be comparable in terms of local anesthetic consumption, morphine requirements and pain scores.
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Ultrasound-guided paravertebral block using an intercostal approach.
Anesthesia and analgesia, 2009Co-Authors: Alon Ben-ari, Milena Moreno, Jacques E. Chelly, Paul E. BigeleisenAbstract:We describe an ultrasound-guided technique of continuous bilateral paravertebral block using an intercostal approach in 12 patients undergoing elective abdominal surgery. Postoperatively, each of the patient's paravertebral catheters was bolused with 10 mL lidocaine (15 mg/mL), and each of the patient's catheters was infused with 0.2% ropivacaine at 10 mL/h. Using a Pinprick Test, the median number of dermatomes blocked after the initial bolus was 5 (interquartile range, 4-6), and 23 of 24 catheters produced a local anesthetic block. The median verbal pain score on postoperative day 1 was 5.5 (interquartile range, 3.5-6), and median dose of IV hydromorphone consumed during the first 24 h after surgery was 1.9 mg (interquartile range, 0.7-5.05). All catheters were removed within 72 h after surgery.
Michiaki Yamakage - One of the best experts on this subject based on the ideXlab platform.
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Injection Volume and Anesthetic Effect in Serratus Plane Block.
Regional anesthesia and pain medicine, 2017Co-Authors: Tatsuya Kunigo, Takeshi Murouchi, Shuji Yamamoto, Michiaki YamakageAbstract:Background and Objectives Serratus plane block is performed for analgesia of the anterior chest wall. However, there has been no study concerning the appropriate volume for this block. This prospective randomized controlled study assesses the dermatomal spread and analgesic effects of serratus plane block. Methods Ultrasound-guided serratus plane block was performed for breast cancer surgery. The patients were randomly assigned to receive 20 or 40 mL of 0.375% ropivacaine. The primary end point was the number of affected dermatomes as assessed by cold Test and Pinprick Test 20 minutes after the block procedure. Secondary end points were the time until the first postoperative analgesic rescue, adverse effects, and complications. Results The number of affected dermatomes assessed by the cold Test for patients receiving 40 mL of 0.375% ropivacaine was significantly larger than that for patients receiving 20 mL (P = 0.002; 6 [5–7] vs 4 [3–4] dermatomes). Similarly, with the Pinprick Test, the affected area was larger for the 40 mL group than for the 20 mL group (P = 0.009; 4 [2–6] vs 2 [1–3] dermatomes). There were no differences between the 2 groups in secondary end points. Conclusions Ultrasound-guided serratus plane block spread in the craniocaudal direction is more widespread with 40 mL than with 20 mL of 0.375% ropivacaine. The time until the first postoperative analgesic rescue dose was not extended by a larger volume of injection. Clinical Trials Registration UMIN Clinical Trials Registry (identifier UMIN000016549).
Onur Selvi - One of the best experts on this subject based on the ideXlab platform.
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ESRA19-0504 Sensorial analysis of lower thoracic erector spinae plane block; missing piece in the puzzle
E-Poster Discussion Abstracts, 2019Co-Authors: Serkan Tulgar, Onur SelviAbstract:Background and aims The erector spinae plane block (ESPB) is a new interfascial plane block that has recently been increasing in popularity. Most anatomic and clinical studies have evaluated ESPB applied at upper thoracic region were evaluated. Herein, we aimed to investigate the presence of sensory blocks in different compartments in the thoracoabdominal region by Pinprick Test in patients who underwent bilateral ESPB from thoracic (Th)9 level. Methods Clinical trial regeneration was performed (NCT03744520) and the study was started in November 2018. Written informed consent was obtained from all patients for procedures, dermatomal analysis and publishing. Bilateral ESPB with 30 mL 0.25% bupivacaine was applied in abdominal surgery patients and sensory analysis was performed with Pinprick Test 3 hours after block application. In the sensory analysis, each dermatome was evaluated separately. They were also divided into four quadrants: dorsomedial-dorsolateral, ventral-lateral and ventromedial, from the posteromedial to the front. Results A total of 25 patients underwent 50 ESPBs. 3 blocks were evaluated as sensory failure in all four quadrants. Dorsomedially 10, dorsolaterally 13, ventral-laterally 6 and ventral-medially 15 blocks were accepted as failed block. the sensory features of the blocks are shown in figure 1. Only half of the applications were able to block 4 quadrants between Th7-Th10. There was a significant difference between the right and left block distributions (IRR Conclusions The ESPB applied at T9 level shows different block characteristics in varying dorsal and ventral quadrants. the success of sensory block in the mid-abdominal and parasternal regions are relatively low.
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ESRA19-0467 Use of the ultrasound guided erector spinae block as an alternative anesthesia method in a selected video assisted thoracoscopy case
E-Poster Viewing Abstracts, 2019Co-Authors: Serkan Tulgar, Onur Selvi, Bilgiser Kiziltunç, A Orki, A Cosar, Zeliha OzerAbstract:Background and aims Video assisted thoracoscopy (VATS) is a frequently used method for both therapeutic and diagnostic purposes. VATS is usually performed under general anesthesia; however, paravertebral block or other regional techniques could be used as an option in selected patients undergoing thoracoscopic diagnostic biopsy. In this case presentation, we present the application of ultrasound guided erector spinae block (ESPB) for the management of a VATS case as a main anesthesia method. Methods A 58 years old male patient who had a chest drain due to chronic right lung empyema after chemotherapy treatment due to lung cancer, was planned for diagnostic VATS. ESPB at level of T5 was applied with out-plane technique in lateral position under sedoanalgesia with midazolam 2 mg and fentanyl 25 mcg. Mixture of local anesthetics composed of 20 mL bupivacaine 0.5% and 10 mL lidocaine 2% was applied between transverse process and erector spinae muscle. Results The sensorial block between T2-T7 dermatomes was confirmed with Pinprick Test after 30 minutes following block application. Deep dermal and subcutaneous surgical tissue biopsies were sampled in 4 abdominal quadrant. The video camera equipment was advanced into thorax cavity. Small lobular pathologies between lung parenchyma and thoracic wall were observed and dissected. The surgery lasted for 25 minutes. Whenever the patient revealed discomfort and mild pain additional 10 mg intravenous ketamine was applied and repeated three times. Conclusions ESPB may be used for anesthesia in suitable diagnostic VAS cases. Further feasibility studies may be needed.