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[PMID]:28450772
[Au] Autor:Nazir N; Jain S
[Ad] Endereço:Department of Anesthesiology, School of Medical Sciences & Research, Sharda University, Greater Noida.
[Ti] Título:A Randomized Controlled Trial Study on the Effect of Adding Dexmedetomidine to Bupivacaine in Supraclavicular Block Using Ultrasound Guidance.
[So] Source:Ethiop J Health Sci;26(6):561-566, 2016 Nov.
[Is] ISSN:2413-7170
[Cp] País de publicação:Ethiopia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The benefits of regional anesthetic techniques are well established. Use of additives to local anesthetics can prolong these benefits. The aim of this study was to find out the effect of adding dexmedetomidine to bupivacaine for supraclavicular block. METHODS: In this randomized, double-blind study, 70 ASA I & II patients of either sex undergoing elective surgeries on the upper limb were given supraclavicular block under ultrasound guidance. Group C (n=35) received 38 mL 0.25% bupivacaine + 2mL normal saline and group D received 38 mL 0.25% bupivacaine + 1 µg/kg dexmedetomidine (2mL). Patients were observed for, onset of motor and sensory block, duration of motor and sensory block, duration of analgesia, sedation score, hemodynamic changes and any adverse events. RESULTS: In group D, the onset was faster (P< 0.001), durations of sensory and motor block duration of and analgesia were prolonged as compared to group C (P < 0.0001).There was a significant drop in heart rate (HR) from the baseline in group D (P < 0.05) at 30, 60, 90 and 120 min. However, none of the patients dropped HR below 50/min. Mean Arterial Pressure (MAP) remained unaffected. The patients in group D were more effectively sedated than those in group C (P < 0.05). No adverse event was reported in either group. CONCLUSION: Dexmedetomidine as adjuvant to bupivacaine in supraclavicular block resulted in faster action, prolonged motor and sensory block, prolonged analgesia with hemodynamic stability and adequate sedation.
[Mh] Termos MeSH primário: Analgésicos não Entorpecentes/uso terapêutico
Anestésicos Locais/uso terapêutico
Bloqueio do Plexo Braquial/métodos
Bupivacaína/uso terapêutico
Dexmedetomidina/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Analgesia/métodos
Analgésicos não Entorpecentes/administração & dosagem
Anestésicos Locais/administração & dosagem
Bupivacaína/administração & dosagem
Dexmedetomidina/administração & dosagem
Método Duplo-Cego
Quimioterapia Combinada
Feminino
Hemodinâmica
Seres Humanos
Masculino
Meia-Idade
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Non-Narcotic); 0 (Anesthetics, Local); 67VB76HONO (Dexmedetomidine); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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[PMID]:28953949
[Au] Autor:Shin HW; Ju BJ; Jang YK; You HS; Kang H; Park JY
[Ad] Endereço:Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
[Ti] Título:Effect of tramadol as an adjuvant to local anesthetics for brachial plexus block: A systematic review and meta-analysis.
[So] Source:PLoS One;12(9):e0184649, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Tramadol, a 4-phenyl-piperidine analog of codeine, has a unique action in that it has a central opioidergic, noradrenergic, serotonergic analgesic, and peripheral local anesthetic (LA) effect. Many studies have reported contradictory findings regarding the peripheral analgesic effect of tramadol as an adjuvant to LA in brachial plexus block (BPB). This meta-analysis aimed to evaluate the effects of tramadol as an adjunct to LA in BPB during shoulder or upper extremity surgery. METHODS: We searched the PubMed, EMBASE, Cochrane, KoreaMed databases, and Google Scholar for eligible randomized controlled trials (RCTs) that compared BPB with LA alone and BPB with LA and tramadol. Primary outcomes were the effects of tramadol as an adjuvant on duration of sensory block, motor block, and analgesia. Secondary outcomes were the effects of tramadol as an adjuvant on time to onset of sensory block and motor block and on adverse effects. We performed the meta-analysis using Review Manager 5.3 software. RESULTS: We identified 16 RCTs with 751 patients. BPB with tramadol prolonged the duration of sensory block (mean difference [MD], -61.5 min; 95% CI, -95.5 to -27.6; P = 0.0004), motor block (MD, -65.6 min; 95% CI, -101.5 to -29.7; P = 0.0003), and analgesia (MD, -125.5 min; 95% CI, -175.8 to -75.3; P < 0.0001) compared with BPB without tramadol. Tramadol also shortened the time to onset of sensory block (MD, 2.1 min; 95% CI, 1.1 to 3.1; P < 0.0001) and motor block (MD, 1.2 min; 95% CI, 0.2 to 2.1; P = 0.010). In subgroup analysis, the duration of sensory block, motor block, and analgesia was prolonged for BPB with tramadol 100 mg (P < 0.05) but not for BPB with tramadol 50 mg. The quality of evidence was high for duration of analgesia according to the GRADE system. Adverse effects were comparable between the studies. CONCLUSIONS: In upper extremity surgery performed under BPB, use of tramadol 100 mg as an adjuvant to LA appears to prolong the duration of sensory block, motor block, and analgesia, and shorten the time to onset of sensory and motor blocks without altering adverse effects.
[Mh] Termos MeSH primário: Adjuvantes Farmacêuticos
Anestésicos Locais/farmacologia
Bloqueio do Plexo Braquial
Tramadol/farmacologia
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Adjuvants, Pharmaceutic); 0 (Anesthetics, Local); 39J1LGJ30J (Tramadol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184649


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[PMID]:28609340
[Au] Autor:Melton MS; Monroe HE; Qi W; Lewis SL; Nielsen KC; Klein SM
[Ad] Endereço:From the Departments of *Anesthesiology and †Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina.
[Ti] Título:Effect of Interscalene Brachial Plexus Block on the Pulmonary Function of Obese Patients: A Prospective, Observational Cohort Study.
[So] Source:Anesth Analg;125(1):313-319, 2017 Jul.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The effect of interscalene block (ISB) on pulmonary function of obese participants has not been investigated. The goal of this study is to assess the association of obesity (body mass index [BMI] >29 kg/m vs BMI <25 kg/m) and change in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) after ISB in participants undergoing outpatient shoulder surgery. METHODS: This prospective, observational cohort study compared obese (BMI >29 kg/m) and normal-weight (BMI <25 kg/m) groups undergoing ISB for ambulatory shoulder surgery, on preblock and postblock FVC and FEV1, at 30 minutes postblock and in the postanesthesia care unit (PACU). The primary outcome in this study was FVC% change (percentage change from preblock to postblock values of FVC) at 30 minutes postblock in the supine position. Secondary outcomes included FVC% change at PACU and in the sitting position, FEV1% change (percentage change from preblock to postblock values of FEV1), FVC, FEV1, incidence of diaphragmatic paresis, modified Borg scale for perceived dyspnea, Richmond Agitation-Sedation Scale scores for sedation, and intraoperative airway events. RESULTS: Fourteen participants were recruited to each group. The mean (standard deviation) BMI in the normal-weight and obese groups was 23 (1.7) and 33 (3.1) kg/m, respectively. ISB success rate was 100%. All participants demonstrated hemidiaphragmatic paresis after ISB. Compared to the normal-weight group, in the sitting position, the obese group had a significant decrease in FVC% change at 30 minutes (-30 [10.5] vs -23 [7.2], P = .046) and an FEV1% change in the PACU (-40 [12.6] vs -27 [13.9], P = .02). No difference was found for measurements taken in the supine position. A repeated-measures analysis demonstrated that, adjusted for position, there is no significant group effect on FVC% change or FEV1% change from 30 minutes to PACU. The 2 groups were not different in terms of breathlessness and sedation at 30 minutes (P = .67, P = .48, respectively) and in the PACU (P = .69, P > .99, respectively) nor in the occurrence of intraoperative airway events (P > .99). CONCLUSIONS: ISB is associated with greater FVC and FEV1 reductions in obese participants undergoing shoulder surgery compared to normal-weight participants. Neither time (30 minutes versus PACU) nor position (sitting versus supine) affected this relationship. Despite these changes, obesity was not associated with increased clinical respiratory symptoms or events.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Ambulatórios/efeitos adversos
Bloqueio do Plexo Braquial/efeitos adversos
Pulmão/fisiopatologia
Obesidade/complicações
Paralisia Respiratória/etiologia
Ombro/cirurgia
[Mh] Termos MeSH secundário: Adulto
Período de Recuperação da Anestesia
Índice de Massa Corporal
Feminino
Volume Expiratório Forçado
Seres Humanos
Masculino
Meia-Idade
Obesidade/diagnóstico
Obesidade/fisiopatologia
Posicionamento do Paciente
Estudos Prospectivos
Recuperação de Função Fisiológica
Paralisia Respiratória/diagnóstico
Paralisia Respiratória/fisiopatologia
Fatores de Risco
Ombro/inervação
Decúbito Dorsal
Fatores de Tempo
Resultado do Tratamento
Capacidade Vital
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002180


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[PMID]:28525514
[Au] Autor:El-Boghdadly K; Brull R; Sehmbi H; Abdallah FW
[Ad] Endereço:From the *Department of Anesthesia, University of Toronto; Toronto, Ontario, Canada; †Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Ontario, Canada; ‡Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada; and §Department of Anesthesia and Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
[Ti] Título:Perineural Dexmedetomidine Is More Effective Than Clonidine When Added to Local Anesthetic for Supraclavicular Brachial Plexus Block: A Systematic Review and Meta-analysis.
[So] Source:Anesth Analg;124(6):2008-2020, 2017 Jun.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Clonidine, an α-2 agonist, has long been used as a local anesthetic adjunct with proven efficacy to prolong peripheral nerve block duration. Dexmedetomidine, a newer α-2 agonist, has a more favorable pharmacodynamic and safety profile; however, data comparing its efficacy as an adjunct to that of clonidine are inconsistent. We sought to compare the clinical efficacy of these 2 α-2 agonists by examining their effects on peripheral nerve block characteristics for upper extremity surgery. METHODS: A preliminary search found that the overwhelming majority of randomized controlled trials comparing perineural dexmedetomidine to clonidine for upper extremity surgery were in the setting of supraclavicular brachial plexus block (SCB). Therefore, we performed a systematic review and meta-analysis of randomized controlled trials comparing dexmedetomidine with clonidine as perineural adjuncts to single-injection SCB. Sensory and motor block duration and onset, analgesic duration, α-2 agonist side effects, and block complications were analyzed. Sensory block duration was designated as a primary outcome. Data were combined using random-effects modeling, and ratio-of-means was used to analyze the results. RESULTS: A total of 868 patients from 14 clinical studies were included in the analysis. Compared with clonidine, dexmedetomidine prolonged the duration (ratio of means [95% confidence interval {CI}]) of sensory block by an estimate of 1.2 (1.2-1.3; P< .00001). It also prolonged the duration (ratio of means [99% CI]) of motor block by an estimate of 1.2 (1.1-1.3; P < .00001), and analgesia by an estimate of 1.2 (1.1-1.3; P < .00001). It also hastened the onset of sensory block by an estimate of 0.9 (0.8-1.0; P < .00001) and motor block by an estimate of 0.9 (0.9-1.0; P = .002). Dexmedetomidine was associated with an increased odds ratio (99% CI) of transient bradycardia by an estimate of 7.4 (1.3-40.8; P = .003) and postoperative sedation by an estimate of 11.8 (1.9-73.6; P = .0005). There were no differences in other α-2 agonist-related side effects or block-related complications. CONCLUSIONS: Compared with clonidine as a local anesthetic adjunct for single-injection SCB, perineural dexmedetomidine enhances sensory, motor, and analgesic block characteristics. These benefits should be weighed against the increased risk of transient bradycardia.
[Mh] Termos MeSH primário: Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem
Anestésicos Locais/administração & dosagem
Bloqueio do Plexo Braquial/métodos
Clonidina/administração & dosagem
Dexmedetomidina/administração & dosagem
Extremidade Superior/inervação
Extremidade Superior/cirurgia
[Mh] Termos MeSH secundário: Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos
Anestésicos Locais/efeitos adversos
Bloqueio do Plexo Braquial/efeitos adversos
Bradicardia/induzido quimicamente
Distribuição de Qui-Quadrado
Clonidina/efeitos adversos
Dexmedetomidina/efeitos adversos
Seres Humanos
Atividade Motora/efeitos dos fármacos
Razão de Chances
Limiar da Dor/efeitos dos fármacos
Medição de Risco
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Adrenergic alpha-2 Receptor Agonists); 0 (Anesthetics, Local); 67VB76HONO (Dexmedetomidine); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170520
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002014


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[PMID]:28403100
[Au] Autor:Park HS; Kim HJ; Ro YJ; Yang HS; Koh WU
[Ad] Endereço:Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
[Ti] Título:Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation: A lesson why we should use low concentrated local anesthetics for continuous blocks.
[So] Source:Medicine (Baltimore);96(15):e6598, 2017 Apr.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Recurrent laryngeal nerve block is an uncommon complication that can occur after an interscalene brachial plexus block (ISB), which may lead to vocal cord palsy or paresis. However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion. To the best of our knowledge, there are no reports of bilateral vocal cord paresis, which occurred after a continuous ISB and endotracheal intubation in a patient with no history of vocal cord injury or surgery of the neck. PATIENT CONCERNS: A 59 year old woman was planned for open acromioplasty and rotator cuff repair under general anesthesia. General anesthesia was induced following an ISB using 0.2% ropivacaine and catheter insertion for postoperative pain control. DIAGNOSES: While recovering in the postanesthesia care unit (PACU), however, the patient complained of a sore throat and hoarseness without respiratory insufficiency. On the morning of the first postoperative day, she still complained of mild dyspnea, dysphonia, and slight aspiration. She was subsequently diagnosed with bilateral vocal cord paresis following an endoscopic laryngoscopy examination. INTERVENTIONS: The continuous ISB catheter was immediately removed and the dyspnea and hoarseness symptoms improved, although mild aspiration during drinking water was still present. OUTCOMES: On the 4th postoperative day, a laryngoscopy examination revealed that the right vocal cord movement had returned to normal but that the left vocal cord paresis still remained. LESSONS: When ISB is planned, a detailed history-taking and examination of the airway are essential for patient safety and we recommend that any local anesthetics be carefully injected under ultrasound guidance. We also recommend the use of low concentration of local anesthetics to avoid possible paralysis of the vocal cord.
[Mh] Termos MeSH primário: Bloqueio do Plexo Braquial/efeitos adversos
Intubação Intratraqueal/efeitos adversos
Complicações Pós-Operatórias/etiologia
Paralisia das Pregas Vocais/etiologia
[Mh] Termos MeSH secundário: Anestésicos Locais/administração & dosagem
Anestésicos Locais/efeitos adversos
Bloqueio do Plexo Braquial/métodos
Feminino
Rouquidão/etiologia
Seres Humanos
Meia-Idade
Faringite/etiologia
Período Pós-Operatório
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Local)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170430
[Lr] Data última revisão:
170430
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170414
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006598


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[PMID]:28396863
[Au] Autor:Strid JM; Pedersen EM; Al-Karradi SN; Bendtsen MA; Bjørn S; Dam M; Daugaard M; Hansen MS; Linnet KD; Børglum J; Søballe K; Bendtsen TF
[Ad] Endereço:Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
[Ti] Título:Real-Time Ultrasound/MRI Fusion for Suprasacral Parallel Shift Approach to Lumbosacral Plexus Blockade and Analysis of Injectate Spread: An Exploratory Randomized Controlled Trial.
[So] Source:Biomed Res Int;2017:1873209, 2017.
[Is] ISSN:2314-6141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21-36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; = 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552-1023] versus 196 [167-228], < 0.001 and 333 [254-439] versus 216 [176-294], = 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).
[Mh] Termos MeSH primário: Anestésicos Locais
Plexo Lombossacral/efeitos dos fármacos
Imagem por Ressonância Magnética
Ultrassonografia de Intervenção/métodos
[Mh] Termos MeSH secundário: Adulto
Bloqueio do Plexo Braquial/métodos
Espaço Epidural/efeitos dos fármacos
Epinefrina/administração & dosagem
Feminino
Seres Humanos
Lidocaína/administração & dosagem
Plexo Lombossacral/fisiopatologia
Masculino
Bloqueio Nervoso/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Local); 98PI200987 (Lidocaine); YKH834O4BH (Epinephrine)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170428
[Lr] Data última revisão:
170428
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1155/2017/1873209


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[PMID]:28375887
[Au] Autor:Namdari S; Nicholson T; Abboud J; Lazarus M; Steinberg D; Williams G
[Ad] Endereço:1Department of Orthopaedic Surgery, Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania 2Department of Anesthesia, Sidney Kimmel Medical College at Thomas Jefferson University-Methodist Hospital Division, Philadelphia, Pennsylvania.
[Ti] Título:Randomized Controlled Trial of Interscalene Block Compared with Injectable Liposomal Bupivacaine in Shoulder Arthroplasty.
[So] Source:J Bone Joint Surg Am;99(7):550-556, 2017 Apr 05.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Shortcomings of interscalene brachial plexus blockade include technical failure and rebound pain. Bupivacaine liposome injectable suspension, a sustained release preparation, is used for surgical-site administration. The purpose of this study was to evaluate these 2 postoperative pain management strategies in patients undergoing shoulder arthroplasty. METHODS: In a non-blinded, randomized controlled trial of participants undergoing primary shoulder arthroplasty, patients were randomized to interscalene brachial plexus blockade or intraoperative soft-tissue infiltration of bupivacaine liposome injectable suspension. The primary outcome variable was morphine equivalent units consumed over the first 24 hours postoperatively. Secondary outcomes included morphine equivalent units consumed intraoperatively and a visual analog scale (VAS) for pain at 0, 8, 16, and 24 hours. RESULTS: Seventy-eight patients were randomized to interscalene brachial plexus blockade treatment (the blockade group) and 78 patients were randomized to bupivacaine liposome injectable suspension treatment (the suspension group). The mean total postoperative narcotic consumption (and standard deviation) over 24 hours after the surgical procedure was 14.8 ± 11.3 morphine equivalent units in the blockade group compared with 14.4 ± 16.8 morphine equivalent units in the suspension group (p = 0.849). Intraoperative narcotics were significantly lower (p < 0.001) in the blockade group (8.9 ± 4.1 morphine equivalent units) compared with the suspension group (16.2 ± 7.0 morphine equivalent units). The mean VAS pain score was significantly lower in the blockade group than in the suspension group at 0 hours postoperatively (0.8 ± 2.2 compared with 3.3 ± 2.7 points; p < 0.001) and at 8 hours postoperatively (1.4 ± 2.4 compared with 3.2 ± 2.2 points; p < 0.001), but it was not significantly different at 16 hours postoperatively (4.3 ± 2.8 compared with 3.8 ± 2.4 points; p = 0.348). The VAS pain scores were significantly higher (p = 0.021) in the blockade group (4.9 ± 2.7 points) compared with the suspension group (3.9 ± 2.3 points) at 24 hours postoperatively. CONCLUSIONS: Patients treated with bupivacaine liposome injectable suspension required an equivalent amount of postoperative narcotics and greater intraoperative narcotics compared with patients treated with interscalene brachial plexus blockade. Although interscalene brachial plexus blockade provided improved pain scores for the first 8 hours after the surgical procedure, pain scores were worse at 24 hours. The optimal postoperative pain regimen for shoulder arthroplasty and the cost-effectiveness of analgesic techniques require further investigation. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Anestésicos Locais/administração & dosagem
Artroplastia do Ombro/métodos
Bloqueio do Plexo Braquial/métodos
Bupivacaína/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Analgésicos Opioides/uso terapêutico
Feminino
Seres Humanos
Injeções
Lipossomos
Masculino
Meia-Idade
Morfina/uso terapêutico
Medição da Dor
Dor Pós-Operatória/prevenção & controle
Complicações Pós-Operatórias
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Anesthetics, Local); 0 (Liposomes); 76I7G6D29C (Morphine); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170424
[Lr] Data última revisão:
170424
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.00296


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[PMID]:28372653
[Au] Autor:Sakae TM; Marchioro P; Schuelter-Trevisol F; Trevisol DJ
[Ad] Endereço:Postgraduate Program in Health Sciences, University of Southern Santa Catarina - Unisul, Brazil. Electronic address: thiago.sakae@unisul.br.
[Ti] Título:Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: A randomized, double-blinded clinical trial.
[So] Source:J Clin Anesth;38:133-136, 2017 May.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY OBJECTIVE: The purpose of this study was to evaluate the effect of intravenous or perineural dexamethasone added to ropivacaine on the duration of ultrasound-guided interscalene brachial plexus blocks (BPB). DESIGN: Randomized clinical trial. SETTING, PATIENTS AND INTERVENTIONS: Sixty ASA physical status I-II patients with elective shoulder arthroscopic surgeries under interscalene brachial plexus blocks were randomly allocated to receive 20ml of 0.75% ropivacaine with 1ml of isotonic saline (C group, n=20), 20ml of 0.75% ropivacaine with 1ml (4mg) of perineural dexamethasone (Dpn group, n=20), or 20ml of 0.75% ropivacaine with 1ml of isotonic saline and intravenous 4mg dexamethasone (IV) (Div group, n=20). A nerve stimulation technique with ultrasound was used in all patients. MEASUREMENTS: The onset time and duration of sensory blocks were assessed. Secondary outcomes were pain scores (VAS) and postoperative vomiting and nausea (PONV). MAIN RESULTS: The duration of the motor and sensory block was extended in group Dpn compared with group Div and group C (P<0.05). In addition, within 24h, group Dpn presented lower levels of VAS and lower incidence of PONV as compared with the other groups. Moreover, there was a significant reduction on onset time between group Dpn and the other groups. CONCLUSIONS: Perineural 4mg dexamethasone was more effective than intravenous in extending the duration of ropivacaine in ultrasound-guided interscalene BPB. Moreover, Dpn has significant effects on onset time, PONV, and VAS.
[Mh] Termos MeSH primário: Adjuvantes Anestésicos/uso terapêutico
Amidas/administração & dosagem
Anestésicos Locais/administração & dosagem
Bloqueio do Plexo Braquial/métodos
Dexametasona/uso terapêutico
Dor Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Adjuvantes Anestésicos/administração & dosagem
Administração Intravenosa
Adulto
Idoso
Artroscopia/efeitos adversos
Dexametasona/administração & dosagem
Método Duplo-Cego
Procedimentos Cirúrgicos Eletivos/efeitos adversos
Feminino
Seres Humanos
Incidência
Masculino
Meia-Idade
Medição da Dor
Náusea e Vômito Pós-Operatório/epidemiologia
Náusea e Vômito Pós-Operatório/prevenção & controle
Estudos Prospectivos
Articulação do Ombro/cirurgia
Fatores de Tempo
Ultrassonografia de Intervenção
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Adjuvants, Anesthesia); 0 (Amides); 0 (Anesthetics, Local); 7IO5LYA57N (ropivacaine); 7S5I7G3JQL (Dexamethasone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE


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[PMID]:28368935
[Au] Autor:Fielmuth S; Szalata M; Sievert H; Beier D; Rehberg S; Hahnenkamp K; Mauermann K; Meissner K
[Ad] Endereço:From the *Klinik für Anästhesiologie und Intensivmedizin; †Klinik für Orthopädie, Dietrich Bonhoeffer Klinikum Neubrandenburg, Neubrandenburg, Germany; and ‡Klinik für Anästhesiologie, Universitätsmedizin Greifswald, Greifswald, Germany.
[Ti] Título:Electric Nerve Stimulation Does Not Correctly Predict Needle-Nerve Distance and Potential Local Anesthetic Spread for Interscalene Brachial Plexus Blockade.
[So] Source:Anesth Analg;125(2):632-634, 2017 Aug.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study evaluated electric nerve stimulation as a nerve location tool. After eliciting motor response in 43 patients undergoing shoulder surgery, the needle tip's position, distance from the closest nerve, and spread of saline were evaluated using ultrasound imaging. The needle's tip resided 1 to 4 mm from the closest nerve in 21, in direct contact with it in 7, and 6 to 18 mm away in 15 patients. In 21 patients, subsequent saline dissection did not reach the brachial plexus. Thus, the success rate of electric nerve stimulation for correct needle-nerve distance identification was 48.8%, with correct fluid spread reached in only 51.2% of patients.
[Mh] Termos MeSH primário: Anestésicos Locais/uso terapêutico
Bloqueio do Plexo Braquial/métodos
Plexo Braquial/efeitos dos fármacos
Agulhas
Bloqueio Nervoso/métodos
Ombro/cirurgia
[Mh] Termos MeSH secundário: Anestesia Local
Plexo Braquial/fisiologia
Estimulação Elétrica
Seres Humanos
Reprodutibilidade dos Testes
Ultrassonografia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Local)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170404
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000001982


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[PMID]:28362032
[Au] Autor:Kolny M; Stasiowski MJ; Zuber M; Marciniak R; Chabierska E; Pluta A; Jalowiecki P; Byrczek T
[Ti] Título:Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy.
[So] Source:Anaesthesiol Intensive Ther;49(1):47-52, 2017.
[Is] ISSN:1731-2515
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared. METHODS: This prospective, randomized, clinical study included 109 patients (ASA grades I-III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy. Block onset time, duration, and effectiveness on the Lovett rating scale were assessed. RESULTS: There was no statistically significant intergroup difference in duration of block performance, irrespective of the technique (P = 0.232). Onset time of complete warmth sensation loss (P < 0.001) and muscle strength abolition (P < 0.001) was significantly longer and mean Lovett rating scale score distribution was significantly higher in the N group than in the other groups (P < 0.001). These findings show a statistically significant correlation between the performance of the used block technique and the necessity of conversion to general anesthesia because of insufficient block in the N group (58.54%) than in the U (24.44%) and NU (19.57%) groups. CONCLUSIONS: Peripheral nerve stimulator-confirmed needle placement is not necessary to ensure effectiveness of ultrasound-guided blocks, which is expressed as a lack of necessity of conversion to general anesthesia. Nevertheless, the dual guidance technique is recommended to reduce the risk of complications and might be considered the regional anesthesia of choice for shoulder surgery.
[Mh] Termos MeSH primário: Amidas/administração & dosagem
Artroscopia/métodos
Bloqueio do Plexo Braquial/métodos
Articulação do Ombro/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Anestesia Geral/métodos
Anestésicos Locais/administração & dosagem
Procedimentos Cirúrgicos Eletivos/métodos
Feminino
Seres Humanos
Masculino
Meia-Idade
Agulhas
Estudos Prospectivos
Fatores de Tempo
Ultrassonografia de Intervenção/métodos
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Amides); 0 (Anesthetics, Local); 7IO5LYA57N (ropivacaine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170707
[Lr] Data última revisão:
170707
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170401
[St] Status:MEDLINE
[do] DOI:10.5603/AIT.2017.0009



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