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[PMID]:28468607
[Au] Autor:Kuchálik J; Magnuson A; Tina E; Gupta A
[Ad] Endereço:Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
[Ti] Título:Does local infiltration analgesia reduce peri-operative inflammation following total hip arthroplasty? A randomized, double-blind study.
[So] Source:BMC Anesthesiol;17(1):63, 2017 05 03.
[Is] ISSN:1471-2253
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Postoperative inflammation following total hip arthroplasty (THA) can lead to delayed mobilization and return of hip function. Our primary aim was to assess whether local infiltration analgesia (LIA) during surgery can prevent postoperative inflammation. METHODS: This is a sub-analysis of data from a broader double-blind study where 56 patients received spinal anaesthesia for THA. Additionally, Group FNB (Femoral Nerve Block) received an ultrasound-guided femoral nerve block using 30 mL of ropivacaine 7.5 mg/mL (225 mg), and 151.5 mL of saline peri-articularly intra-operatively. Group LIA received 30 mL saline in the femoral nerve block and ropivacaine 2 mg/mL, 300 mg (150 mL) + ketorolac 30 mg (1 mL) + adrenaline 0.5 mg (0.5 mL) peri-articularly. After 23 h, the LIA mixture (22 mL) was injected via a catheter placed peri-articularly in Group LIA and 22 mL saline in Group FNB. A battery of pro- and anti-inflammatory cytokines was assessed using a commercially available kit preoperatively and after 4 h and 3 days postoperatively. Additionally, CRP, platelet count and white blood count was determined pre- and postoperatively. RESULTS: There was a general trend towards an increase in pro-inflammatory cytokines postoperatively, which returned to normal levels after 3 days. IL-6 concentration was significantly lower 4 h postoperatively in Group LIA compared to Group FNB (p = 0.015). No other significant differences were found between the groups in other cytokines. CRP levels were significantly higher in Group FNB compared to Group LIA 3 days postoperatively (p < 0.001). No other significant differences were seen between the groups. CONCLUSION: Local infiltration analgesia has a modest but short-lasting effect on postoperative inflammation in patients undergoing total hip arthroplasty. This is likely to be due to local infiltration of ketorolac and/or local anaesthetics in the LIA mixture. Future studies should be directed towards assessing whether the use of LIA translates into better patient outcomes. TRIAL REGISTRATION: EudraCT Number 2012-003875-20 . Registered 3 December 2012.
[Mh] Termos MeSH primário: Artroplastia de Quadril/efeitos adversos
Inflamação/tratamento farmacológico
Bloqueio Nervoso
[Mh] Termos MeSH secundário: Amidas/administração & dosagem
Anestésicos Locais/administração & dosagem
Anti-Inflamatórios não Esteroides/administração & dosagem
Proteína C-Reativa/análise
Citocinas/sangue
Método Duplo-Cego
Feminino
Nervo Femoral
Seres Humanos
Inflamação/etiologia
Cetorolaco/administração & dosagem
Masculino
Meia-Idade
Complicações Pós-Operatórias/tratamento farmacológico
Complicações Pós-Operatórias/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Amides); 0 (Anesthetics, Local); 0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Cytokines); 7IO5LYA57N (ropivacaine); 9007-41-4 (C-Reactive Protein); YZI5105V0L (Ketorolac)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171204
[Lr] Data última revisão:
171204
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1186/s12871-017-0354-y


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[PMID]:28860790
[Au] Autor:Al Wahbi AM
[Ad] Endereço:Division of Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
[Ti] Título:Evaluation of pain during endovenous laser ablation of the great saphenous vein with ultrasound-guided femoral nerve block.
[So] Source:Vasc Health Risk Manag;13:305-309, 2017.
[Is] ISSN:1178-2048
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Endoluminal laser ablation is now considered the method of choice for treating greater saphenous vein insufficiency. General anesthesia and peripheral nerve blocks with sedation have the risk of post-procedural delay in discharge and prolonged immobilization with the risk of deep vein thrombosis. The main pain experienced by patients during the procedure is during the laser ablation and the multiple needle punctures given along and around the great saphenous vein. The aim of our study was to evaluate the safety and efficacy of blocking the femoral nerve only under ultrasound-guidance without sedation, to reduce or prevent pain during injectable tumescent anesthesia in endovenous laser ablation of the greater saphenous vein. METHODS: Sixty patients in two groups underwent endovenous laser ablation for the greater saphenous vein insufficiency at an outpatient clinic. All patients received tumescent anesthesia. However, one group received a femoral nerve block (FNB) under ultrasound guidance before the procedure. All patients were asked to record the pain or discomfort, using the visual analog score, from the start of the procedure until the end of the great saphenous vein laser ablation. The length of the great saphenous vein and duration of the procedure were also recorded. The results were analyzed using statistical methods. RESULTS: No complications from FNB were observed. The pain associated with application of tumescent anesthesia and laser ablation was more intense in the group without an FNB ( < 0.001). There was no significant difference between the two groups in the length of the great saphenous vein or procedure duration. CONCLUSION: Ultrasound-guided FNB (without other peripheral nerve blocks) is a safe, adequate, and effective option to decrease and/or eliminate the intraoperative discomfort associated with tumescent anesthesia injections and laser ablation during endoluminal laser ablation of the greater saphenous vein.
[Mh] Termos MeSH primário: Nervo Femoral
Terapia a Laser/efeitos adversos
Bloqueio Nervoso/métodos
Dor/prevenção & controle
Veia Safena/cirurgia
Ultrassonografia de Intervenção
Varizes/cirurgia
Insuficiência Venosa/cirurgia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
Bloqueio Nervoso/efeitos adversos
Dor/diagnóstico
Dor/etiologia
Medição da Dor
Veia Safena/diagnóstico por imagem
Fatores de Tempo
Resultado do Tratamento
Varizes/diagnóstico por imagem
Insuficiência Venosa/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170902
[St] Status:MEDLINE
[do] DOI:10.2147/VHRM.S135308


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[PMID]:28685533
[Au] Autor:Hong XY; Hong X; Gu WW; Lin J; Yin WT
[Ad] Endereço:Department of Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
[Ti] Título:Femoral nerve repair using an h-type nerve regeneration chamber in rats.
[So] Source:J Biol Regul Homeost Agents;31(2):335-341, 2017 Apr-Jun.
[Is] ISSN:0393-974X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Peripheral nerve injury in surgical trauma patients is very common. The femoral nerve can be divided into two branches: one regarding the quadricep muscles and one the skin. After nerve transection and suture, the motor axons have an equal opportunity to regenerate into the original muscle branch, or regenerate into the sensory skin nerves. These anatomical features of femoral nerve have made it important in nerve regeneration research. Thus, this study was designed to examine the effects of an H-type nerve regeneration chamber on motor nerve regeneration after femoral nerve injury. We performed femoral nerve injuries in adult rats and assessed nerve recovery over a 4-week post-operative period. Additionally, we evaluated nerve regeneration in the same animals anatomically, using several histological staining methods to provide structure analyses. We found that H-type nerve regeneration chamber provided enhanced improvement in nerve regeneration without nerve anastomosis, as compared with nerve anastomosis. Furthermore, incorrect nerve anastomosis reduced the nerve fiber diameter and thickness of myelin sheaths in regenerated nerve fibers. Finally, H-type nerve regeneration chamber provided enhanced functional recovery of nerve fibers, particularly for motor nerves. Together, our results suggest that direct nerve suture cannot effectively improve the functional recovery of damaged nerves, and nerve chemotaxis coupled with nerve regeneration chamber can effectively improve the effects of nerve regeneration, and enhance the prognosis of nerve injury repair.
[Mh] Termos MeSH primário: Nervo Femoral/lesões
Nervo Femoral/fisiologia
Neurônios Motores/fisiologia
Regeneração Nervosa
Traumatismos dos Nervos Periféricos/terapia
[Mh] Termos MeSH secundário: Animais
Feminino
Ratos
Ratos Wistar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[St] Status:MEDLINE


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[PMID]:28682892
[Au] Autor:van Beek R; Zonneveldt HJ; van der Ploeg T; Steens J; Lirk P; Hollmann MW
[Ad] Endereço:aDepartment of Anesthesiology, Westfriesgasthuis, Hoorn, The Netherlands bWestfriesleerhuis, Westfriesgasthuis, Hoorn, The Netherlands cDepartment of Orthopedic Surgery, Westfriesgasthuis, Hoorn, The Netherlands dDepartment of Anesthesiology, Academic Medical Center, University of Amsterdam, The Netherlands.
[Ti] Título:In patients undergoing fast track total knee arthroplasty, addition of buprenorphine to a femoral nerve block has no clinical advantage: A prospective, double-blinded, randomized, placebo controlled trial.
[So] Source:Medicine (Baltimore);96(27):e7393, 2017 Jul.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Several adjuvants have been proposed to prolong the effect of peripheral nerve blocks, one of which is buprenorphine. In this randomized double blinded placebo controlled trial we studied whether the addition of buprenorphine to a femoral nerve block prolongs analgesia in patients undergoing total knee arthroplasty in a fast track surgery protocol. METHODS: The treatment group (B) was given an ultrasound-guided femoral nerve block with ropivacaine 0.2% and 0.3mg buprenorphine. We choose to use 2 control groups. Group R was given a femoral nerve block with ropivacaine 0.2% only. Group S also received 0.3 mg buprenorphine subcutaneously. Only patients with a successful block were enrolled in the study. RESULTS: We found no difference in our primary outcome parameter of time to first rescue analgesic. We found lower opioid use and better sleep quality the first postoperative night in patients receiving buprenorphine perineurally or subcutaneously. Buprenorphine did not lead to any significant change in pain or mobilization. We found a high overall incidence of nausea and vomiting. CONCLUSION: In patients undergoing total knee arthroplasty, in the setting of a fast track surgery protocol, the addition of buprenorphine to a femoral nerve block did not prolong analgesia.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Artroplastia do Joelho
Buprenorfina/uso terapêutico
Bloqueio Nervoso
Dor Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Amidas/uso terapêutico
Anestésicos Locais/uso terapêutico
Método Duplo-Cego
Quimioterapia Combinada
Feminino
Nervo Femoral/diagnóstico por imagem
Nervo Femoral/efeitos dos fármacos
Seres Humanos
Masculino
Meia-Idade
Medição da Dor
Fatores de Tempo
Falha de Tratamento
Ultrassonografia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Amides); 0 (Analgesics, Opioid); 0 (Anesthetics, Local); 40D3SCR4GZ (Buprenorphine); 7IO5LYA57N (ropivacaine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007393


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[PMID]:28682889
[Au] Autor:Wang X; Sun Y; Wang L; Hao X
[Ad] Endereço:Anesthesiology Department, The First Hospital of Hebei Medical University, Hebei, China.
[Ti] Título:Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty: A meta-analysis from randomized controlled trials.
[So] Source:Medicine (Baltimore);96(27):e7382, 2017 Jul.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This meta-analysis aimed to perform a meta-analysis to compare the efficiency and safety between femoral nerve block (FNB) and fascia iliaca block (FIB) for postoperative pain control in patients undergoing total knee and hip arthroplasties. METHODS: A systematic search was performed in Medline (1966-2017.05), PubMed (1966-2017.05), Embase (1980-2017.05), ScienceDirect (1985-2017.05) and the Cochrane Library. Inclusion criteria (1) Participants: Only published articles enrolling adult participants that with a diagnosis of end-stage of osteoarthritis and prepared for unilateral TKA or THA; (2) Interventions: The intervention group received FIB for postoperative pain management; (3) Comparisons: The control group was received FNB for postoperative pain control; (4) Outcomes: Visual analogue scale (VAS) scores in different periods, opioids consumption, length of stay and postoperative complications; (5) Study design: clinical randomized control trials (RCTs) were regarded as eligible in our study. Cochrane Hand book for Systematic Reviews of Interventions was used for assessment of the included studies and risk of bias was shown. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Sensitivity analysis was conducted and publication bias was assessed. Meta-analysis was performed using Stata 11.0 software. RESULTS: Five RCTs including 308 patients met the inclusion criteria. The present meta-analysis indicated that there were no significant differences between groups in terms of visual analog scale (VAS) score at 12 hours (SMD = -0.080, 95% CI: -0.306 to 0.145, P = .485), 24 hours (SMD = 0.098, 95% CI: -0.127 to 0.323, P = .393), and 48 hours (SMD = -0.001, 95% CI: -0.227 to 0.225, P = .993). No significant differences were found regarding opioid consumption at 12 hours (SMD = 0.026, 95% CI: -0.224 to 0.275, P = .840), 24 hours (SMD = 0.037, 95% CI: -0.212 to 0.286, P = .771), and 48 hours (SMD = -0.016, 95% CI: -0.265 to 0.233, P = .900). In addition, no significant increase of complications was identified between groups. CONCLUSION: There is no significant differences of VAS scores at 12-48 hour and opioids consumption at 12-48 hour between two groups following total joint arthroplasty. No increased risk of nausea, vomiting and pruritus was observed in both groups. More high-quality large RCTs with long follow-up period are necessary for proper comparisons of the efficacy and safety of FNB with FIB. The present meta-analysis exists some limitations that should be noted: (1) Only five articles were included in present meta-analysis, although all of them are recently published RCTs, the sample size are relatively small; (2) Functional outcome is an important parameter, due to the insufficiency of relevant data, we cannot perform a meta-analysis. (3) Dose and types of local anesthetics are varied, which may influence the results; (4) The duration of follow up is relatively short which leads to underestimating complications. (5) Publication bias in present meta-analysis may influence the results.
[Mh] Termos MeSH primário: Artroplastia de Quadril
Artroplastia do Joelho
Bloqueio Nervoso
Dor Pós-Operatória/terapia
[Mh] Termos MeSH secundário: Fáscia/inervação
Nervo Femoral
Seres Humanos
Ílio/inervação
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007382


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[PMID]:28663395
[Au] Autor:Wall PDH; Parsons NR; Parsons H; Achten J; Balasubramanian S; Thompson P; Costa ML; , P. D. H. Wall on behalf of A. P. Sprowson,† M. L. Costa, PAKA Study Group
[Ad] Endereço:Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK .
[Ti] Título:A pragmatic randomised controlled trial comparing the efficacy of a femoral nerve block and periarticular infiltration for early pain relief following total knee arthroplasty.
[So] Source:Bone Joint J;99-B(7):904-911, 2017 07.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The aim of this study was to compare the effectiveness of a femoral nerve block and a periarticular infiltration in the management of early post-operative pain after total knee arthroplasty (TKA). PATIENTS AND METHODS: A pragmatic, single centre, two arm parallel group, patient blinded, randomised controlled trial was undertaken. All patients due for TKA were eligible. Exclusion criteria included contraindications to the medications involved in the study and patients with a neurological abnormality of the lower limb. Patients received either a femoral nerve block with 75 mg of 0.25% levobupivacaine hydrochloride around the nerve, or periarticular infiltration with 150 mg of 0.25% levobupivacaine hydrochloride, 10 mg morphine sulphate, 30 mg ketorolac trometamol and 0.25 mg of adrenaline all diluted with 0.9% saline to make a volume of 150 ml. RESULTS: A total of 264 patients were recruited and data from 230 (88%) were available for the primary analysis. Intention-to-treat analysis of the primary outcome measure of a visual analogue score for pain on the first post-operative day, prior to physiotherapy, was similar in both groups. The mean difference was -0.7 (95% confidence interval (CI) -5.9 to 4.5; p = 0.834). The periarticular group used less morphine in the first post-operative day compared with the femoral nerve block group (74%, 95% CI 55 to 99). The femoral nerve block group reported 39 adverse events, of which 27 were serious, in 31 patients and the periarticular group reported 51 adverse events, of which 38 were serious, in 42 patients up to six weeks post-operatively. None of the adverse events were directly attributed to either of the interventions under investigation. CONCLUSION: Periarticular infiltration is a viable and safe alternative to femoral nerve block for the early post-operative relief of pain following TKA. Cite this article: 2017;99-B:904-11.
[Mh] Termos MeSH primário: Analgésicos Opioides/administração & dosagem
Anestésicos Locais/administração & dosagem
Anti-Inflamatórios não Esteroides/administração & dosagem
Artroplastia do Joelho
Bupivacaína/análogos & derivados
Nervo Femoral
Cetorolaco/administração & dosagem
Morfina/administração & dosagem
Bloqueio Nervoso/métodos
Manejo da Dor/métodos
Dor Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Bupivacaína/administração & dosagem
Epinefrina/administração & dosagem
Feminino
Seres Humanos
Injeções Intra-Articulares
Masculino
Medição da Dor
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Anesthetics, Local); 0 (Anti-Inflammatory Agents, Non-Steroidal); 76I7G6D29C (Morphine); A5H73K9U3W (levobupivacaine); Y8335394RO (Bupivacaine); YKH834O4BH (Epinephrine); YZI5105V0L (Ketorolac)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170701
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B7.BJJ-2016-0767.R2


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[PMID]:28627290
[Au] Autor:Gudmundsdottir S; Franklin JL
[Ad] Endereço:a Department of Orthopedic Surgery , Akureyri Hospital , Akureyri , Iceland.
[Ti] Título:Continuous adductor canal block added to local infiltration analgesia (LIA) after total knee arthroplasty has no additional benefits on pain and ambulation on postoperative day 1 and 2 compared with LIA alone.
[So] Source:Acta Orthop;88(5):537-542, 2017 Oct.
[Is] ISSN:1745-3682
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and purpose - The additional effects of a continuous adductor canal block (ACB) compared with a single-dose local infiltration anesthesia (LIA) after total knee arthroplasty (TKA) has not been widely researched. Both methods have good effect individually. We hypothesized that a continuous ACB added to a single-dose LIA would lower pain scores while ambulating on postoperative day 1 (POD1) and postoperative day 2 (POD2). Patients and methods - 69 participants were included in this prospective, randomized, double-blind, placebo-controlled trial. The TKA was performed under spinal analgesia and every participant was given single-dose LIA intraoperatively. Patients were then randomized into 2 groups, treatment group receiving 0.2% ropivacaine and control group receiving normal saline. First a 20 mL bolus was given into the adductor canal and 4 hours later a continuous flow at 6 mL/h was initiated for 2 postoperative days through a catheter placed in the adductor canal. Results - Worst pain score during movement of the operated knee on POD1 and POD2 was similar between the groups. No other ambulation tests done on POD1 and POD2 showed any statistically significant difference. Morphine consumption on the day of surgery, POD1 and POD2 was similar between the groups. Interpretation - The results indicate no benefit of continuous infusion ACB added to a single-dose LIA compared with LIA alone on pain while ambulating on POD1 and POD2. Furthermore, the ACB showed no superiority in ambulation ability on the 2 postoperative days.
[Mh] Termos MeSH primário: Analgesia/métodos
Artroplastia do Joelho/métodos
Bloqueio Nervoso/métodos
Dor Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Amidas/administração & dosagem
Amidas/uso terapêutico
Anestésicos Locais/administração & dosagem
Anestésicos Locais/uso terapêutico
Artroplastia do Joelho/efeitos adversos
Método Duplo-Cego
Feminino
Nervo Femoral
Seres Humanos
Masculino
Meia-Idade
Medição da Dor
Período Pós-Operatório
Recuperação de Função Fisiológica/efeitos dos fármacos
Caminhada
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Amides); 0 (Anesthetics, Local); 7IO5LYA57N (ropivacaine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171001
[Lr] Data última revisão:
171001
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE
[do] DOI:10.1080/17453674.2017.1342184


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[PMID]:28502684
[Au] Autor:Candy N; Young A; Allinson K; Carr O; McMillen J; Trivedi R
[Ad] Endereço:Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
[Ti] Título:Metastatic Neuroendocrine Carcinoma of Unknown Origin Arising in the Femoral Nerve Sheath.
[So] Source:World Neurosurg;104:1047.e1-1047.e6, 2017 Aug.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Metastatic neuroendocrine carcinoma of unknown origin is a rare condition, usually presenting with lesions in the liver and/or lung. We present the first reported case of a metastatic neuroendocrine carcinoma of unknown origin arising in the femoral nerve sheath. CASE DESCRIPTION: Magnetic resonance imaging demonstrated what was thought to be a schwannoma in the left femoral nerve sheath in the proximal femoral triangle, immediately inferior to the anterior inferior iliac spine. At the time of operation, the tumor capsule was invading surrounding tissue, as well as three trunks of the femoral nerve. The patient underwent a subtotal resection, preserving the integrity of the residual functioning femoral nerve trunks. Histologic evaluation determined that the tumor had features consistent with a metastatic neuroendocrine carcinoma of unknown primary origin. The patient recovered well postoperatively, and subsequent radiologic evaluation failed to demonstrate a potential primary site. Unfortunately, the patient re-presented with disease progression and was subsequently referred to palliative care. CONCLUSIONS: We recommend that there is a definite role for surgery in the management of solitary neuroendocrine carcinoma of unknown origin.
[Mh] Termos MeSH primário: Carcinoma Neuroendócrino/secundário
Nervo Femoral
Neoplasias Primárias Desconhecidas/diagnóstico por imagem
Neoplasias da Bainha Neural/secundário
[Mh] Termos MeSH secundário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Neoplasias Ósseas/secundário
Carboplatina/administração & dosagem
Carcinoma Neuroendócrino/diagnóstico por imagem
Carcinoma Neuroendócrino/cirurgia
Quimioterapia Adjuvante
Etoposídeo/administração & dosagem
Feminino
Fluordesoxiglucose F18
Seres Humanos
Neoplasias Pulmonares/secundário
Imagem por Ressonância Magnética
Meia-Idade
Recidiva Local de Neoplasia/radioterapia
Neoplasias da Bainha Neural/diagnóstico por imagem
Neoplasias da Bainha Neural/cirurgia
Cuidados Paliativos
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
Compostos Radiofarmacêuticos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Radiopharmaceuticals); 0Z5B2CJX4D (Fluorodeoxyglucose F18); 6PLQ3CP4P3 (Etoposide); BG3F62OND5 (Carboplatin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170516
[St] Status:MEDLINE


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[PMID]:28499420
[Au] Autor:Álvarez NER; Ledesma RJG; Hamaji A; Hamaji MWM; Vieira JE
[Ad] Endereço:Hospital das Clínicas, Divisão de Anestesia, Rua Dr. Ovídio Pires de Campos, 471, Cerqueira César, São Paulo, SP, Brazil, CEP 05403-010.
[Ti] Título:Continuous femoral nerve blockade and single-shot sciatic nerve block promotes better analgesia and lower bleeding for total knee arthroplasty compared to intrathecal morphine: a randomized trial.
[So] Source:BMC Anesthesiol;17(1):64, 2017 May 12.
[Is] ISSN:1471-2253
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Knee arthroplasty leads to postoperative pain. This study compares analgesia and postoperative bleeding achieved by intrathecal morphine with a continuous femoral plus single-shot sciatic nerve block. METHODS: A randomized non-blinded clinical trial enrolled patients aged over 18 years old, ASA I to III who underwent total knee arthroplasty. All patients underwent spinal anesthesia with isobaric bupivacaine, 20 mg. One group received 100 mcg of intrathecal morphine (M group), and the other received a femoral nerve block by continuous infusion plus a "single shot" block of the sciatic nerve at the end of the surgery (FI group). Pain score from verbal numeric rating scale (VNRS) and morphine consumption during the first 72 h, as well as motor blockade, adverse effects, and postoperative bleeding were recorded. Analysis of variance of repeated measures with Bonferroni post-test, t-test and Fisher exact test were used for statistical analysis. RESULTS: Thirty nine patients completed the study (M = 20; FI = 19 patients) and were similar except for higher age in the FI group. Motor blockade as well as movement pain during postanesthesia care unit (PACU) staying were not different between the groups, but movement pain was significantly lower in FI group after 24 h. Postoperative bleeding (ml) was lower in FI group. CONCLUSIONS: Continuous femoral nerve block combined with sciatic nerve block provides effective for postoperative analgesia in patients undergoing total knee arthroplasty, with lower pain scores after 24 h and a lower incidence of adverse effects and bleeding compared to intrathecal morphine. TRIAL REGISTRATION: Retrospectively registered on https://clinicaltrials.gov/ under identifier NCT02882152 , 23 December, 2016.
[Mh] Termos MeSH primário: Artroplastia do Joelho
Nervo Femoral
Bloqueio Nervoso
Dor Pós-Operatória/prevenção & controle
Hemorragia Pós-Operatória/prevenção & controle
Nervo Isquiático
[Mh] Termos MeSH secundário: Idoso
Analgésicos Opioides/administração & dosagem
Raquianestesia
Feminino
Seres Humanos
Injeções Espinhais
Masculino
Meia-Idade
Morfina/administração & dosagem
Medição da Dor
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); 76I7G6D29C (Morphine)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170514
[St] Status:MEDLINE
[do] DOI:10.1186/s12871-017-0355-x


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[PMID]:28489762
[Au] Autor:Zhang Z; Yang Q; Xin W; Zhang Y
[Ad] Endereço:Department of Anesthesiology, Huaihe Hospital, Henan University, Kaifeng, China.
[Ti] Título:Comparison of local infiltration analgesia and sciatic nerve block as an adjunct to femoral nerve block for pain control after total knee arthroplasty: A systematic review and meta-analysis.
[So] Source:Medicine (Baltimore);96(19):e6829, 2017 May.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To perform a meta-analysis to assess the efficiency and safety between local infiltration analgesia (LIA) and sciatic nerve block (SNB) when combined with femoral nerve block (FNB) for pain control following total knee arthroplasty (TKA). METHODS: We systemically searched the following electronic databases for potentially relevant articles: Embase (1980-2017.01), Medline (1966-2017.01), PubMed (1966-2017.01), ScienceDirect (1985-2017.01), web of science (1950-2017.01) and the Cochrane Library. Only studies published in English that were accessible online were considered. Furthermore, we only considered studies that were published from 1966 to 2017. Only studies that met the following inclusion criteria were considered: (a) patients were adult human subjects who were set to undergo TKA; (b) the intervention was either SNB combined with FNB or LIA combined with FNB; (c) the outcomes of the studies, such as visual analog scale (VAS) scores, morphine consumption, length of stay and postoperative adverse effects, including the risk of nausea, vomiting and falls, were reported; (d) studies were either RCTs or non-RCT. Meta-analysis was performed using Stata 11.0 software. Modified Jadad score (7-points scale) which was based on Cochrane Handbook for Systematic Reviews of Interventions is used for assessment of RCTs. The Methodological Index for Nonrandomized Studies (MINORS) scale was used to assess non-RCTs with scores ranging 0 to 24. The synthesis of the outcomes for all studies was calculated as the weighted average rate by using a fixed or random effect model which depends on statistical heterogeneity. Systematic review registration number is CRD42017110661. RESULTS: Three randomized controlled trials (RCTs) and 2 nonrandomized controlled trials (Non-RCTs), including 240 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analog scale (VAS) score at 12 hours (SMD = -0.337, 95% CI: -0.593 to -0.081, P =.010), VAS score at 24 hours (SMD = -0.337, 95% CI: -0.612 to -0.061, P =.017), morphine equivalent consumption at 24 hours (SMD = -0.371, 95% CI: -0.627 to -0.114, P = .005) and incidence of nausea (RD = 0.215, 95% CI: 0.078 to 0.353, P = .002) and vomiting (RD = 0.143, 95% CI: 0.026 to 0.260, P = .017). CONCLUSION: FNB combined with SNB provided decreased VAS scores and less morphine consumption at 12 and 24 hours compared with FNB combined with LIA in total knee arthroplasty. In addition, it was associated with lower risks of nausea and vomiting. We assessed the quality of the evidence as low to very low; therefore, our confidence in the effect estimate is limited, and the true effect may be substantially different from our estimates. Further studies should focus on surgeries that are known to be associated with significant postoperative pain, particularly surgeries where improved pain control may deliver significant clinical benefits through reduced morbidity, or cost-effectiveness benefits through faster rehabilitation and discharge. The present meta-analysis has the following limitations: (1) only 5 studies were included in the meta-analysis. Although all of them are recently published studies, the sample sizes are relatively small; (2) Functional outcome is an important parameter; however, owing to the insufficiency of relevant data, we failed to perform a meta-analysis on functional outcome; (3) The doses of anesthetics and the concomitant pain management regimes varied between the studies, which may have influenced the results; (4) The duration of follow-up was relatively short, which might have led to an underestimating of complications; and (5) publication bias present in the meta-analysis may have influenced the results.
[Mh] Termos MeSH primário: Anestesia Local
Artroplastia do Joelho
Bloqueio Nervoso
Dor Pós-Operatória/tratamento farmacológico
[Mh] Termos MeSH secundário: Ensaios Clínicos Controlados como Assunto
Nervo Femoral
Seres Humanos
Nervo Isquiático
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170612
[Lr] Data última revisão:
170612
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170511
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006829



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