Articles: anesthetics.
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Minerva anestesiologica · Dec 2024
ReviewUnderstanding the anatomy of pelvic fascia: implications for regional anesthesia.
The fascia, a continuous structure around the whole body across various anatomical locations, remains underexplored in regional anesthesia. The pelvic fascia is a particularly controversial and complicated anatomical structure. It holds significant relevance not only for surgeons but also in the realms of regional anesthesia and pain management. ⋯ A thorough understanding of pelvic fascia anatomy is crucial for understanding the potential pathways and barriers for spread of local anesthetics, enhancing analgesia, and minimizing side effects. Currently, a systematic discussion of pelvic fascia from the perspective of regional anesthesia and pain therapy is notably absent. This narrative review aims to consolidate knowledge on the anatomy of pelvic fascia pertinent to regional anesthesia and pain management, detailing relevant pelvic nerves, and associated peripheral nerve blocking techniques.
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Meta Analysis
Lidocaine patch for treatment of acute localized pain in the emergency department: a systematic review and meta-analysis.
Lidocaine patches are commonly prescribed for acute localized pain. Most of the existing evidence is, however, derived from postoperative or chronic pain. The objective of this study is to assess the efficacy and safety of lidocaine patch compared to placebo patch or nonsteroidal anti-inflammatory drugs (NSAIDs) for acute localized pain. ⋯ The risk of adverse events was similar between the groups (risk ratio: 0.90; 95% CI: 0.48-1.67; moderate-quality evidence). In the two trials comparing lidocaine patches with NSAIDs, there was no statistically significant difference in pain relief between the treatments. Low to moderate-quality evidence from small trials supports the efficacy and safety of lidocaine patch for the treatment of acute localized pain.
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Minerva anestesiologica · Dec 2024
Randomized Controlled Trial Comparative StudyComparison of postoperative awakening between ciprofol and propofol in elderly patients undergoing hip replacement surgery: a single-blind, randomized, controlled trial.
The aim of this paper was to compare the impact of continuous infusion of ciprofol versus propofol on postoperative awakening in elderly patients following hip replacement surgery. ⋯ Compared to propofol, the administration of ciprofol in elderly patients following hip replacement surgery is associated with prolonged awakening time, spontaneous breathing recovery time, and extubation. The average intravenous maintenance dosage of ciprofol in geriatric patients under general anesthesia was 0.8 mg·kg-1·h-1.
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Curr Opin Anaesthesiol · Dec 2024
ReviewDepth of anesthesia monitoring: an argument for its use for patient safety.
There have been significant advancements in depth of anesthesia (DoA) technology. The Anesthesia Patient Safety Foundation recently published recommendations to use a DoA monitor in specific patient populations receiving general anesthesia. However, the universal use of DoA monitoring is not yet accepted. This review explores the current state of DoA monitors and their potential impact on patient safety. ⋯ There is evidence that DoA monitoring may decrease the incidence of awareness, postoperative delirium, POCD and improve several postoperative outcomes. In children, DoA monitoring may decrease the incidence of awareness and emergence delirium, but long-term effects are unknown. While there are key limitations to DoA monitoring technology, we argue that DoA monitoring shows great promise in improving patient safety in most, if not all anesthetic populations.
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Randomized Controlled Trial
Effect of Epidural Volume Extension Using Low-Dose Sufentanil Combined with Low-Concentration Ropivacaine on Visceral Pain During Cesarean Sections: A Randomized Trial.
Visceral pain is common in cesarean sections conducted under combined spinal-epidural anesthesia (CSE). Epidural volume extension (EVE) is a technique for enhancing the effect of intrathecal blocks by inducing epidural fluid boluses in the CSE. Whether EVE that uses different drugs can reduce visceral pain during cesarean sections is rarely studied. ⋯ EVE at 15 minutes after spinal anesthesia with a 10 mL combination of low-dose sufentanil (10 mu-g) and low-concentration (0.15%) ropivacaine can effectively reduce the incidence and severity of visceral pain in cesarean sections under CSE. At the same time, using EVE in this way can reduce postoperative opioid consumption and improve intraoperative satisfaction.