Advances in Regional Anaesthesia and Acute Pain Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 15 November 2024 | Viewed by 5311

Special Issue Editors


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Guest Editor
Anaesthesiology Department, Creta InterClinic Hospital, Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
Interests: regional anaesthesia; acute pain management; cardiothoracic anaesthesia; anaesthesiology; enhanced recovery after surgery; perioperative care

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Guest Editor
1. Department of Anesthesiology, Institut de Cancerologie de Lorraine, 6 avenue de Bourgogne, 54500 Vandoeuvre-lès-Nancy, France
2. INSERM UMR-S 1116 Equipe 2, University of Lorraine, Nancy, France
Interests: regional anaesthesia; thoracic anaesthesia; anaesthesia for breast surgery, anaesthesiology; acute pain; perioperative care

Special Issue Information

Dear Colleagues,

Regional anaesthesia (RA) and acute pain medicine have undergone exciting advances in the past few decades and have emerged as a transformative force to redefine the paradigms of patients’ care. Ultrasound-guided RA techniques have become the gold standard, thanks to the associated improvements in efficacy, ease of performance and safety. As such, the accessibility, clinical use and popularity of RA have increased substantially. The seamless integration of RA with acute pain management protocols has far-reaching implications for patient outcomes. From minimizing opioid usage and associated side-effects to expediting recovery timelines, this holistic approach stands as a testament to the ever-evolving nature of medical science. As we navigate the complexities of this multidimensional landscape, it becomes increasingly apparent that RA and acute pain management are not merely adjuncts, but rather integral components in the continuum of patient-centered care. However, the fields have not yet reached their full potential. Emerging nerve blocks and updated acute pain management practices, though recent, have room for refinement, with certain techniques and protocols warranting meticulous scrutiny. The goal of this Special Issue is to focus on contemporary evidence, underscore prevailing topics and highlight future directions in the aforementioned fields. The journal and the Guest Editors cordially invite you to submit your high-impact findings for review. We look forward to your contributions to this important Special Issue.

Dr. Eleni Moka
Dr. Julien Raft
Guest Editors

Manuscript Submission Information

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Keywords

  • regional anaesthesia
  • central nerve blocks
  • peripheral nerve blocks
  • ultrasound-guided RA
  • acute postoperative pain management
  • enhanced recovery after surgery

Published Papers (7 papers)

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Research

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12 pages, 18316 KiB  
Article
The Anterior Branch of the Medial Femoral Cutaneous Nerve Innervates Cutaneous and Deep Surgical Incisions in Total Knee Arthroplasty
by Siska Bjørn, Thomas Dahl Nielsen, Anne Errboe Jensen, Christian Jessen, Jens Aage Kolsen-Petersen, Bernhard Moriggl, Romed Hoermann and Thomas Fichtner Bendtsen
J. Clin. Med. 2024, 13(11), 3270; https://doi.org/10.3390/jcm13113270 - 31 May 2024
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Abstract
Background/Objectives: The intermediate femoral cutaneous nerve (IFCN), the saphenous nerve, and the medial femoral cutaneous nerve (MFCN) innervate the skin of the anteromedial knee region. However, it is unknown whether the MFCN has a deeper innervation. This would be relevant for total knee [...] Read more.
Background/Objectives: The intermediate femoral cutaneous nerve (IFCN), the saphenous nerve, and the medial femoral cutaneous nerve (MFCN) innervate the skin of the anteromedial knee region. However, it is unknown whether the MFCN has a deeper innervation. This would be relevant for total knee arthroplasty (TKA) that intersects deeper anteromedial genicular tissue layers. Primary aim: to investigate deeper innervation of the anterior and posterior MFCN branches (MFCN-A and MFCN-P). Secondary aim: to investigate MFCN innervation of the skin covering the anteromedial knee area and medial parapatellar arthrotomy used for TKA. Methods: This study consists of (1) a dissection study and (2) unpublished data and post hoc analysis from a randomized controlled double-blinded volunteer trial (EudraCT number: 2020-004942-12). All volunteers received bilateral active IFCN blocks (nerve block round 1) and saphenous nerve blocks (nerve block round 2). In nerve block round 3, all volunteers were allocated to a selective MFCN-A block. Results: (1) The MFCN-A consistently innervated deeper structures in the anteromedial knee region in all dissected specimens. No deep innervation from the MFCN-P was observed. (2) Sixteen out of nineteen volunteers had an unanesthetized skin gap in the anteromedial knee area and eleven out of the nineteen volunteers had an unanesthetized gap on the skin covering the medial parapatellar arthrotomy before the active MFCN-A block. The anteromedial knee area and medial parapatellar arthrotomy was completely anesthetized after the MFCN-A block in 75% and 82% of cases, respectively. Conclusions: The MFCN-A shows consistent deep innervation in the anteromedial knee region and the area of MFCN-A innervation overlaps the skin area covering the medial parapatellar arthrotomy. Further trials are mandated to investigate whether an MFCN-A block translates into a clinical effect on postoperative pain after total knee arthroplasty or can be used for diagnosis and interventional pain management for chronic neuropathic pain due to damage to the MFCN-A during surgery. Full article
(This article belongs to the Special Issue Advances in Regional Anaesthesia and Acute Pain Management)
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9 pages, 887 KiB  
Article
Evaluating the Efficacy of the Erector Spinae Plane Block as a Supplementary Approach to Cardiac Anesthesia during Off-Pump Coronary Bypass Graft Surgery via Median Sternotomy: A Randomized Clinical Trial
by Sujin Kim, Seung Woo Song, Yeong-Gwan Jeon, Sang A. Song, Soonchang Hong and Ji-Hyoung Park
J. Clin. Med. 2024, 13(8), 2208; https://doi.org/10.3390/jcm13082208 - 11 Apr 2024
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Abstract
Background: Pain control after off-pump coronary artery bypass graft (OPCAB) facilitates mobilization and improves outcomes. The efficacy of the erector spinae plane block (ESPB) after cardiac surgery remains controversial. Methods: We aimed to investigate the analgesic effects of ESPB after OPCAB. Precisely 56 [...] Read more.
Background: Pain control after off-pump coronary artery bypass graft (OPCAB) facilitates mobilization and improves outcomes. The efficacy of the erector spinae plane block (ESPB) after cardiac surgery remains controversial. Methods: We aimed to investigate the analgesic effects of ESPB after OPCAB. Precisely 56 patients receiving OPCAB were randomly divided into ESPB and control groups. The primary outcome was visual analog scale (VAS) pain scores at 6, 12, 24, and 48 h postoperatively. Secondary outcomes were the dose of rescue analgesics in terms of oral morphine milligram equivalents, the dose of antiemetics, the length of intubation time, and the length of stay in the intensive care unit (ICU). Results: The VAS scores were similar at all time points in both groups. The incidence of severe pain (VAS score > 7) was significantly lower in the ESPB group (50% vs. 15.4%; p = 0.008). The dose of rescue analgesics was also lower in the ESPB group (19.04 ± 18.76, 9.83 ± 12.84, p = 0.044) compared with the control group. The other secondary outcomes did not differ significantly between the two groups. Conclusions: ESPB provides analgesic efficacy by reducing the incidence of severe pain and opioid use after OPCAB. Full article
(This article belongs to the Special Issue Advances in Regional Anaesthesia and Acute Pain Management)
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10 pages, 1290 KiB  
Article
Continuous Superior Trunk Block versus Single-Shot Superior Trunk Block with Intravenous Dexmedetomidine for Postoperative Analgesia in Arthroscopic Shoulder Surgery: A Prospective Randomized Controlled Trial
by Bora Lee, Jaewon Jang, Joon-Ryul Lim, Eun Jung Kim, Donghu Kim, Yong-Min Chun and Yong Seon Choi
J. Clin. Med. 2024, 13(7), 1845; https://doi.org/10.3390/jcm13071845 - 22 Mar 2024
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Abstract
Background/Objectives: Intravenous dexmedetomidine (DEX) can increase the analgesia duration of peripheral nerve block; however, its effect in combination with superior trunk block (STB) remains unclear. We examined whether combining single-shot STB (SSTB) with intravenous DEX would provide noninferior postoperative analgesia comparable to that [...] Read more.
Background/Objectives: Intravenous dexmedetomidine (DEX) can increase the analgesia duration of peripheral nerve block; however, its effect in combination with superior trunk block (STB) remains unclear. We examined whether combining single-shot STB (SSTB) with intravenous DEX would provide noninferior postoperative analgesia comparable to that provided by continuous STB (CSTB). Methods: Ninety-two patients scheduled for elective arthroscopic rotator cuff repair were enrolled in this prospective randomized trial. Patients were randomly assigned to the CSTB or SSTB + DEX group. Postoperatively, each CSTB group patient received 15 mL of 0.5% ropivacaine and a continuous 0.2% ropivacaine infusion. Each SSTB group patient received a 15 mL postoperative bolus injection of 0.5% ropivacaine. DEX was administered at 2 mcg/kg for 30 min post anesthesia, then maintained at 0.5 mcg/kg/h till surgery ended. Pain scores were investigated every 12 h for 48 h post operation, with evaluation of rebound pain incidence and opioid consumption. Results: The SSTB + DEX group had significantly higher median pain scores at 12 h post operation (resting pain, 8.0 vs. 3.0; movement pain, 8.0 vs. 5.0) and a higher incidence of rebound pain (56% vs. 20%) than the CSTB group. However, no significant between-group differences were observed in pain scores postoperatively at 24, 36, or 48 h. The CSTB group required less opioids and fewer rescue analgesics within 12–24 h post operation than the SSTB + DEX group. Conclusions: Compared with CSTB, SSTB + DEX required additional adjuvant or multimodal analgesics to reduce the risk and intensity of postoperative rebound pain in patients who underwent arthroscopic rotator cuff repair. Full article
(This article belongs to the Special Issue Advances in Regional Anaesthesia and Acute Pain Management)
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10 pages, 971 KiB  
Article
Intraoperative and Postoperative Effects of Dexmedetomidine and Tramadol Added as an Adjuvant to Bupivacaine in Transversus Abdominis Plane Block
by Zeki Korkutata, Arzu Esen Tekeli and Nurettin Kurt
J. Clin. Med. 2023, 12(22), 7001; https://doi.org/10.3390/jcm12227001 - 9 Nov 2023
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Abstract
Background: We aimed to evaluate the intraoperative hemodynamics, opioid consumption, muscle relaxant use, postoperative analgesic effects, and possible adverse effects (such as nausea and vomiting) of dexmedetomidine and tramadol added as adjuvants to bupivacaine in the transversus abdominis plane block (TAP block) to [...] Read more.
Background: We aimed to evaluate the intraoperative hemodynamics, opioid consumption, muscle relaxant use, postoperative analgesic effects, and possible adverse effects (such as nausea and vomiting) of dexmedetomidine and tramadol added as adjuvants to bupivacaine in the transversus abdominis plane block (TAP block) to provide postoperative analgesia. Materials and Methods: This was a prospective, randomized, controlled trial on patients who underwent laparoscopic cholecystectomy. After obtaining ethical approval at the Van Yuzuncu Yil University and written informed consent, this investigation was registered with ClinicalTrials.gov (NCT05905757). The study was conducted with 67 patients with ASA I–II physical status, aged 20–60 years, of either sex who were scheduled for an elective laparoscopic cholecystectomy under general anesthesia. Exclusion criteria were the patient’s refusal, ASA III and above, a history of allergy to the study drugs, patients with severe systemic diseases, pregnancy, psychiatric illness, seizure disorder, and those who had taken any form of analgesics in the last 24 h. The patients were equally randomized into one of two groups: Group T (TAP Block group) and Group D (Dexmedetomidin group). Standard general anesthesia was administered. After intubation, Group T (Bupivacaine + adjuvant tramadol) = solutions containing 0.250% bupivacaine 15 mL + adjuvant 1.5 mg/kg (100 mg maximum) tramadol 25 mL and Group D (Bupivacaine + adjuvant dexmedetomidine) = solutions containing 0.250% bupivacaine 15 mL + 0.5 mcg/kg and (50 mcg maximum) dexmedetomidine 25 mL; in total, 40 mL and 20 mL was applied to groups T and D, respectively. A bilateral subcostal TAP block was performed by the same anesthesiologist. Intraoperative vital signs, an additional dose of opioid and muscle relaxant requirements, complications, postoperative side effects (nausea, vomiting), postoperative analgesic requirement, mobilization times, and the zero-hour mark (patients with modified Aldrete scores of 9 and above were recorded as 0 h), the third-hour, and sixth-hour visual analog scale (VAS) scores were recorded. The main outcome measurements were the effect on pain scores and analgesic consumption within the first 6 h postoperatively, postoperative nausea and vomiting (PONV), and time to ambulation. The secondary aim was to evaluate intraoperative effects (on hemodynamics and opioid and muscle relaxant consumption). Results: It was observed that dexmedetomidine and tramadol did not have superiority over each other in terms of postoperative analgesia time, analgesic consumption, side effect profile, and mobilization times (p > 0.05). However, more stable hemodynamics were observed with dexmedetomidine as an adjuvant. Conclusions: We think that the use of adjuvant dexmedetomidine in the preoperative TAP block procedure will provide more stable intraoperative hemodynamic results compared with the use of tramadol. We believe that our study will be a guide for new studies conducted with different doses and larger numbers of participants. Full article
(This article belongs to the Special Issue Advances in Regional Anaesthesia and Acute Pain Management)
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Review

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13 pages, 3595 KiB  
Review
Peripheral Nerve Blocks for Hip Fractures
by Iyabo O. Muse, Brittany Deiling, Leon Grinman, Michael M. Hadeed and Nabil Elkassabany
J. Clin. Med. 2024, 13(12), 3457; https://doi.org/10.3390/jcm13123457 - 13 Jun 2024
Viewed by 108
Abstract
The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (<48 h) is often recommended to reduce morbidity/mortality. In addition, [...] Read more.
The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (<48 h) is often recommended to reduce morbidity/mortality. In addition, adequate pain management is crucial to optimize functional recovery and early mobilization. Pain management often consists of multimodal therapy which includes non-opioids, opioids, and regional anesthesia techniques. In this review, we describe the anatomical innervation of the hip joint and summarize the commonly used peripheral nerve blocks to provide pain relief for hip fractures. We also outline literature evidence that shows each block’s efficacy in providing adequate pain relief. The recent discovery of a nerve block that may provide adequate sensory blockade of the posterior capsule of the hip is also described. Finally, we report a surgeon’s perspective on nerve blocks for hip fractures. Full article
(This article belongs to the Special Issue Advances in Regional Anaesthesia and Acute Pain Management)
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14 pages, 582 KiB  
Review
The Impact of Regional Anesthesia in Masking Acute Compartment Syndrome after Limb Trauma
by Nicole Hilber, Anna Dodi, Stephan Blumenthal, Heinz Bruppacher, Alain Borgeat and José Aguirre
J. Clin. Med. 2024, 13(6), 1787; https://doi.org/10.3390/jcm13061787 - 20 Mar 2024
Viewed by 1038
Abstract
Regional anesthesia has shown to be successful in controlling major pain in trauma patients. However, the possibility of masking acute compartment syndrome (ACS) after peripheral nerve blocks for limb injuries is still controversially discussed. Therefore, we aimed to summarize the current literature regarding [...] Read more.
Regional anesthesia has shown to be successful in controlling major pain in trauma patients. However, the possibility of masking acute compartment syndrome (ACS) after peripheral nerve blocks for limb injuries is still controversially discussed. Therefore, we aimed to summarize the current literature regarding this topic to shed light on the impact of peripheral regional anesthesia on the diagnosis of ACS in trauma patients. We searched Pubmed, Google Scholar and the Cochrane Library for literature following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The analysis of these reports was included in the context of the current literature concerning this topic. We found no (randomized) studies, and only six case reports dealing with the impact of peripheral nerve blocks and ACS in patients after a limb trauma met our criteria and were included in our review. Only one reported a delay in the diagnosis of ACS. In most of the cases (5 of 6), the breakthrough pain, despite the nerve block, proved to be a good indicator of a developing ACS. However, despite some narrative articles about the topic including some recommendations about the possibly safe use of regional anesthesia techniques for limb trauma, there is still no international consensus and only one national guideline focusing on the possibly safe use of peripheral nerve blocks in trauma patients at risk of ACS. After reviewing the respective literature, we consider that intra-articular analgesia, sensory blocks, fascial plane blocks and low-concentration continuous peripheral nerve blocks are effective for analgesia and a low-risk analgesia tool for trauma and postsurgical patients at risk of ACS due to the fact that they do not lead to a dense block. Finally, we summarized suggestions based on the results of the literature for the different regional anesthesia modalities in these patients in a table to facilitate the use of these techniques. Full article
(This article belongs to the Special Issue Advances in Regional Anaesthesia and Acute Pain Management)
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Other

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8 pages, 1005 KiB  
Case Report
Continuous Erector Spinae Plane Block for Pain Management in a Pediatric Kidney Transplant Recipient: A Case Report and Review of the Current Literature
by Paolo Capuano, Gaetano Burgio, Serena Abbate, Giusy Ranucci, Kejd Bici, Davide Cintorino, Antonio Arcadipane and Gennaro Martucci
J. Clin. Med. 2024, 13(4), 1128; https://doi.org/10.3390/jcm13041128 - 17 Feb 2024
Viewed by 836
Abstract
Pain management in patients undergoing kidney transplantation requires careful consideration due to their altered physiology, and potential risks associated with certain analgesic options. In recent years, personalized and multimodal approaches have proven to be pivotal in perioperative pain management, as well as in [...] Read more.
Pain management in patients undergoing kidney transplantation requires careful consideration due to their altered physiology, and potential risks associated with certain analgesic options. In recent years, personalized and multimodal approaches have proven to be pivotal in perioperative pain management, as well as in children. Implementing regional analgesia methods offers a valuable solution in many pediatric surgical settings and the erector spinae plane block (ESPB) could represent a possible analgesic strategy in pediatric patients undergoing renal transplantation. Here, we report the case of a 13-year-old child who underwent living-donor kidney transplantation (LDKx) and received continuous erector spinae plane block (ESPB) for perioperative pain management. This multimodal approach with continuous ESPB resulted in optimal pain control without the need for opioids, allowing for early mobilization and for an optimal postoperative course. Full article
(This article belongs to the Special Issue Advances in Regional Anaesthesia and Acute Pain Management)
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