AIMS: One treatment option for refractory ventricular arrythmias is stellate ganglion block (SGB). We examined differences in SGB success by patient and arrhythmia characteristics and predictors of successful SGB. METHODS AND RESULTS: This was a multicenter analysis of patients treated for refractory ventricular arrythmias in the Czech Republic and the United States. The primary outcome was absence of ventricular arrythmias at 24 h post SGB. SGB effectiveness was examined according to aetiology of cardiomyopathy, arrhythmia type, laterality of SGB, presence of inotropes, and presence of mechanical circulatory support. Binary logistic regression was used to examine variables associated with the primary outcome. In total there were 117 patients with refractory ventricular arrythmias treated with SGB. Overall, the mean age was 63.5 ± 11.0 years, majority of patients were male (94.0%), White (87.2%), and had an implantable cardioverter defibrillator in situ (70.1%). There were no differences in efficacy of SGB based on aetiology of cardiomyopathy (P = 0.623), arrhythmia type (0.852), laterality of block (P = 0.131), and presence of inotropes (P = 0.083). Multivariable analysis demonstrated that increased age was associated with decreased odds of SGB success (odds ratio: 0.96, confidence interval: 0.92-0.99, P = 0.039) whereas increased left ventricular ejection fraction trended towards increased odds of SGB success (odds ratio: 1.05, confidence interval: 0.995-1.11, P = 0.077). CONCLUSIONS: In this multicentre experience, SGB was similarly effective despite the aetiology of cardiomyopathy, type of arrhythmia, laterality, and inotropic or mechanical support. SGB was less effective for the suppression of ventricular arrythmias at 24 h for the elderly.
- MeSH
- Autonomic Nerve Block * methods MeSH
- Stellate Ganglion * MeSH
- Tachycardia, Ventricular therapy physiopathology etiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Recurrence MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Czech Republic MeSH
- United States MeSH
BACKGROUND: Orofacial clefts are the most common congenital abnormalities. Cleft lip reconstruction is performed mostly in 3 months of life including the neonatal period. The consumption of opioids during anesthesia is one of the monitored parameters of anesthesia safety. We investigated the effect of using an infraorbital nerve block for reducing opioid consumption during cleft lip surgery in neonates. PATIENTS/METHODS: Overall, 100 patients who underwent primary cleft lip surgery in neonatal age between 2018 and 2021 were included in the study. The primary outcome was to compare opioid requirements during cleft lip surgery with and without using regional anesthesia. Secondary outcomes included a first oral intake from surgery between neonates with and without regional anesthesia and complications rate of infraorbital nerve block. RESULTS: Data from 100 patients (46 patients with and 64 without regional anesthesia) were retrospectively analyzed and classified into two groups according to whether regional anesthesia during neonatal cleft lip surgery had been performed or not. The use of infraorbital block was found to be positively correlated with lower doses of opioids used during the general anesthesia for the surgery (mean 0.48 μg/kg vs 0.29 μg/kg, p < 0.05). The postoperative course was evaluated based on the interval from surgery to first oral intake which was statistically insignificant shorter (p = 0.16) in the group of patients using regional anesthesia. No complications were recorded in the group of patients with regional anesthesia. CONCLUSIONS: Regional anesthesia is associated with reduced opioid consumption during anesthesia thereby increasing the safety of anesthesia in neonates. GOV IDENTIFIER: NCT06067854https://clinicaltrials.gov/study/NCT06067854?cond=NCT06067854&rank=1.
- MeSH
- Humans MeSH
- Nerve Block * methods MeSH
- Infant, Newborn MeSH
- Analgesics, Opioid * therapeutic use MeSH
- Pain, Postoperative drug therapy prevention & control MeSH
- Retrospective Studies MeSH
- Cleft Palate * surgery MeSH
- Cleft Lip * surgery MeSH
- Anesthesia, Conduction * methods MeSH
- Plastic Surgery Procedures methods adverse effects MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life-threatening conditions and can be refractory to conventional drug and device interventions. Stellate ganglion blockade (SGB) has been described as an adjunct, temporizing intervention in patients with refractory ventricular arrhythmia. We examined the association of SGB with VT/VF in a multicenter registry. OBJECTIVES: This study examined the efficacy of SGB for treatment/temporization of refractory VT/VF. METHODS: The authors present the first analysis from a multicenter registry of patients treated for refractory ventricular arrhythmia at a clinical site in the Czech Republic and the United States. Data were collected between 2016 and 2022. SGB was performed at the bedside by anesthesiologists and/or cardiologists. Outcomes of interest were VT/VF burden and defibrillations at 24 hours before and after SGB. RESULTS: In total, there were 117 patients with refractory ventricular arrhythmias treated with SGB at Duke (n = 49) and the Institute for Clinical and Experimental Medicine (n = 68). The majority of patients were male (94.0%), were White (87.2%), and had an implantable cardioverter-defibrillator (70.1%). The most common etiology of heart disease was ischemic cardiomyopathy (52.1%), and monomorphic VT was the most common morphology (70.1%). Within 24 hours before SGB (0-24 hours), the median episodes of VT/VF were 7.5 (Q1-Q3: 3.0-27.0), and 24 hours after SGB, the median decreased to 1.0 (Q1-Q3: 0.0-4.5; P < 0.001). At 24 hours before SGB, the median defibrillation events were 2.0 (Q1-Q3: 0.0-8.0), and 24 hours after SGB, the median decreased to 0.0 (Q1-Q3: 0.0-1.0; P < 0.001). CONCLUSIONS: In the largest cohort of patients with treatment-refractory ventricular arrhythmia, we demonstrate that SGB use was associated with a reduction in the ventricular arrhythmia burden and need for defibrillation therapy.
- MeSH
- Autonomic Nerve Block * methods MeSH
- Defibrillators, Implantable MeSH
- Adult MeSH
- Ventricular Fibrillation * therapy MeSH
- Stellate Ganglion * MeSH
- Tachycardia, Ventricular * therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Registries MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
- United States MeSH
Cieľ štúdie: Zistiť výhody supraklavikulárnej blokády brachiálneho plexu pri vytváraní artériovenóznych fistúl pre hemodialyzačnú liečbu, porovnanie periférnej nervovej blokády, celkovej anestézie a lokálnej infiltračnej anestézie pri tvorbe artériovenóznych fistúl. Typ štúdie: Prospektívna nerandomizovaná štúdia. Schválená etickou komisiou JLF UK v Martine. Typ pracoviska: Klinické pracovisko univerzitnej nemocnice. Materiál a metóda: Súbor pacientov, ktorým bola vytvorená artériovenózna fistula, bol rozdelený do 3 skupín. Skupina 20 pacientov bola operovaná v periférnej nervovej blokáde, skupina 20 pacientov bola operovaná v lokálnej infiltračnej anestézii a skupina 5 pacientov bola operovaná v celkovej anestézii. Hlavným sledovaným parametrom bola zachovaná funkcia fistuly 24 hodín a 6 týždňov po operácii. Inklúzne kritériá pacientov boli: vek 19–75 rokov, ASA 3–4, hmotnosť 40–120 kg, BMI do 40. Použili sa štatistické metódy: Mannov-Whitneyov U test a exaktný obojstranný test, Shapirov-Wilkov test, Fisherov obojstranný exaktný test, párový Wilcoxonov exaktný obojstranný test. Výsledky: Po 24 hodinách boli funkčné všetky fistuly vytvorené v periférnej nervovej blokáde, 90 % v lokálnej infiltračnej anestézii a 80 % v celkovej anestézii. Nepreukázala sa štatisticky významná závislosť medzi funkčnosťou fistuly a niektorým typom anestézie. Po 6 týždňoch bolo funkčných 80 % fistúl vytvorených v celkovej anestézii alebo periférnej nervovej blokáde a iba 50 % fistúl v lokálnej infiltračnej anestézii. Štatisticky významný rozdiel bol zistený medzi skupinou pacientov operovaných v periférnej nervovej blokáde a lokálnej infiltračnej anestézii, a to v prospech periférnej nervovej blokády (p < 0,05). Záver: Periférna nervová blokáda sa v našej štúdii spájala s lepším prežívaním fistuly oproti lokálnej infiltračnej anestézii. Pri celkovej anestézii bolo prežívanie fistuly porovnateľné ako pri periférnej nervovej blokáde, bola však spojená s vyšším výskytom komplikácií.
Objective: To determine the advantages of supraclavicular blockade of the brachial plexus in the formation of arteriovenous fistulas for hemodialysis treatment. Comparison of peripheral nerve block, general and local infiltration anesthesia in the formation of fistulas. Design: Prospective non-randomized study. Approved by the ethics committee of JLF UK in Martin. Setting: University hospital. Material and methods: Three groups of patients who were created arteriovenous fistula. A group of 20 patients were operated under peripheral nerve block anesthesia, 20 patients were operated under local infiltration anesthesia and 5 patients were operated under general anesthesia. The main monitored parameter was the preserved function of the fistula 24 hours and 6 weeks after the operation. Inclusion criteria: age 19–75 years, ASA 3–4, weight 40–120 kg, BMI up to 40. Statistical methods: Mann-Whitney U test and exact two-tailed test, Shapiro-Wilk test, Fisher's two-tailed exact test, paired Wilcoxon's exact two-tailed test. Results: After 24 hours, all fistulas created under peripheral nerve block anesthesia were functional, 90 % under local infiltration anesthesia and 80 % under general anesthesia. There was no statistically significant dependence between the functionality of the fistula and any type of anesthesia. After 6 weeks, 80 % of fistulas created under general or peripheral nerve block anesthesia and only 50 % of fistulas under local infiltration anesthesia were functional. For peripheral nerve block anesthesia and local infiltration anesthesia, a statistically significant difference was found in favor of peripheral nerve block anesthesia (p < 0.05). Conclusion: Peripheral nerve block anesthesia was associated with better fistula survival compared to local infiltration anesthesia in our study. General anesthesia had fistula survival comparable to peripheral nerve block anesthesia, but was associated with a higher incidence of complications.
- MeSH
- Arteriovenous Fistula * surgery MeSH
- Brachial Plexus Block * methods MeSH
- Anesthesia, General MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Anesthesia, Local MeSH
- Non-Randomized Controlled Trials as Topic MeSH
- Nerve Block methods MeSH
- Prospective Studies MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- MeSH
- Amiodarone therapeutic use MeSH
- Adrenergic beta-Antagonists therapeutic use MeSH
- Biomarkers analysis MeSH
- Autonomic Nerve Block methods MeSH
- Defibrillators, Implantable standards MeSH
- Stellate Ganglion drug effects MeSH
- Catheter Ablation MeSH
- Humans MeSH
- Death, Sudden, Cardiac * etiology prevention & control MeSH
- Arrhythmias, Cardiac etiology complications therapy MeSH
- Heart Failure * complications MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
AIM: To evaluate the feasibility of ultrasound (US) in identification of nerve lesions after breast cancer surgery in patients with neuropathic pain and assess the effect of a targeted US-guided therapy. MATERIAL AND METHODS: Patients with neuropathic pain after breast cancer surgery underwent US examination. Nerve lesions identified by US were treated by a US-guided application of a mixture of local anesthetics and corticoids. The patients reported pain relief on a 100-point scale (0% = no effect, 100% = complete relief) and its duration in the next 18 months. RESULTS: We performed 17 interventions in 11 women. A neuroma was observed in 2 patients, edema of the nerve in 5 patients, and scarring across the nerve in 4 patients. The affected nerves were the intercostobrachial nerve (5 patients), the long thoracic nerve (4), cutaneous branch of the pectoral nerve (1), and both the intercostobrachial and the long thoracic nerve (1). After 15 (88%) interventions, the patients reported relief (55±32%) with a median duration of 3 months (0.5-18 months). CONCLUSION: In patients after breast cancer surgery, ultrasound can reliably identify small painful neural lesions which can be efficiently treated by ultrasound-guided intervention.
- MeSH
- Chronic Pain etiology drug therapy classification MeSH
- Humans MeSH
- Analgesics, Non-Narcotic administration & dosage MeSH
- Nerve Block methods MeSH
- Analgesics, Opioid administration & dosage MeSH
- Pelvic Pain * diagnosis etiology drug therapy MeSH
- Radiofrequency Ablation methods instrumentation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
PURPOSE: To report atypical anatomical variation of an osseous suprascapular canal, and to elaborate on its clinical significance as a potential anatomical factor that could obscure a direct posterior surgical approach and suprascapular nerve block. METHODS: Osteological observational study of the scapula with emphasis on the suprascapular space. The pool of investigated sample size was collectively 768 specimens composed of 529 adult dry scapulae (240 paired, 289 un-paired), 54 children dry scapulae, 135 wet scapulae observed during cadaveric dissections, 47 retrospective 3D CT reconstructions, and 3 retrospective full sequence shoulder MRI. The two reported cases came from the 240 (120 skeleton) observed paired scapulae. Furthermore, the osseous suprascapular canal was examined by X-rays and its internal path was exposed by CT sections. A narrative review was conducted to investigate any relevant reports on the subject matter. RESULTS: Two left dry bone scapulae with unilateral osseous suprascapular canal were found. The incidence of this atypical morphology of an osseous canal is probably five cases reported in three studies including this cases study. CONCLUSIONS: The reported cases aid in explaining additional possible anatomical factors that could lead to below threshold anesthetic effect in posterior suprascapular nerve block procedures. Therefore, it is more practical to visualize the suprascapular canal by some imaging method before attempting to blindly access the suprascapular nerve in nerve block or posterior surgical approach due to the rare potential existence of an ossified barrier hindering the procedure. LEVEL OF EVIDENCE: V Basic Science Research.
- MeSH
- Child MeSH
- Adult MeSH
- Humans MeSH
- Scapula anatomy & histology MeSH
- Nerve Block * adverse effects MeSH
- Observational Studies as Topic MeSH
- Shoulder anatomy & histology MeSH
- Retrospective Studies MeSH
- Nerve Compression Syndromes * etiology MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
PURPOSE OF THE STUDY Many physicians believe that loco-regional anaesthesia and analgesia improve the postoperative course of patients indicated for total hip arthroplasty compared to general anaesthesia. However, there are many patients who refuse subarachnoid or epidural anaesthesia, or have contraindications or conditions making the use of such techniques impossible. An alternative option is the combination of general anaesthesia and a peripheral nerve blockade. The aim of this prospective randomized open-label clinical trial was to compare the efficacy and quality of postoperative analgesia between fascia iliaca block combined with general anaesthesia (GA) and subarachnoid anaesthesia with morphine and bupivacaine (SAB). MATERIAL AND METHODS After having obtained the ethics committee approval and the patients consent, a prospective, open-label, randomized trial was conducted in patients referred for total hip arthroplasty (THR). The GA group was administered ultrasound-guided fascia iliaca block with 40 ml of 0.25% bupivacaine solution after the induction of general anaesthesia. In the SAB group, subarachnoid blockade was performed with a mixture of 3 ml of 0.5% bupivacaine with 0.150 mg morphine prepared in the hospital pharmacy. Right after surgery the patients were taken to the ICU for 24 hours, after which they were transferred to a general ward. In addition to vital signs monitoring, pain intensity using a 0-10 numeric rating scale (NRS), first morphine administration at NRS >4, total morphine consumption and potential adverse effects were observed over the period of 72 hours. RESULTS There was no statistical difference between the GA (14 persons) and the SAB (14 persons) group in demographic parameters, time to first morphine administration (10 hrs vs. 19 hrs, p=0.10), number of persons with no need for morphine after surgery (5 vs. 7), tingling sensation (1 vs. 0) or numbness of the limb (0 vs. 1). There was no difference in cardiorespiratory parameters or side effects of therapy. In neither case was there respiratory depression or delayed rehabilitation. No patient developed delirium after surgery, and no patient reported dissatisfaction with pain management. DISCUSSION The fascia iliaca block and subarachnoid anaesthesia using local anaesthetic with opioid addition have been repeatedly published for patients after total hip arthroplasty, but this study is unique by comparing the two methods. The study added a new piece of knowledge to the findings of several recent meta-analyses on the comparable outcomes of general and subarachnoid anaesthesia for hip replacement in the perioperative period. CONCLUSIONS If subarachnoid anaesthesia cannot be used in hip arthroplasty, general anaesthesia with fascia iliaca block provides comparable analgesia and quality of postoperative course. Key words: total hip arthroplasty, general anaesthesia, fascia iliaca block, subarachnoid anaesthesia, postoperative analgesia, postoperative course.
- MeSH
- Bupivacaine therapeutic use MeSH
- Anesthesia, General MeSH
- Fascia MeSH
- Humans MeSH
- Morphine therapeutic use MeSH
- Arthroplasty, Replacement, Hip * adverse effects MeSH
- Nerve Block * methods MeSH
- Pain, Postoperative drug therapy etiology prevention & control MeSH
- Prospective Studies MeSH
- Check Tag
- Humans MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
- Randomized Controlled Trial MeSH
