Journal of Yeungnam Medical Science

Original articles

Comparison of the efficacy of erector spinae plane block according to the difference in bupivacaine concentrations for analgesia after laparoscopic cholecystectomy: a retrospective study: Yoo Jung Park, Sujung Chu, Eunju Yu, Jin Deok Joo; J Yeungnam Med Sci. 2023;40(2):172-178. Published online September 23, 2022; DOI: https://doi.org/10.12701/jyms.2022.00500

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Background
Laparoscopic cholecystectomy (LC) is a noninvasive surgery, but postoperative pain is a major problem. Studies have indicated that erector spinae plane block (ESPB) has an analgesic effect after LC. We aimed to compare the efficacy of different ESPB anesthetic concentrations in pain control in patients with LC.
Methods
This retrospective study included patients aged 20 to 75 years scheduled for LC with the American Society of Anesthesiologists physical status classification I or II. ESPB was administered using 0.375% bupivacaine in group 1 and 0.25% in group 2. Both groups received general anesthesia. Postoperative tramadol consumption and pain scores were compared and intraoperative and postoperative fentanyl requirements in the postanesthesia care unit (PACU) were measured.
Results
Eighty-five patients were included in this analysis. Tramadol consumption in the first 12 hours, second 12 hours, and total 24 hours was similar between groups (p>0.05). The differences between postoperative numeric rating scale (NRS) scores at rest did not differ significantly. The postoperative NRS scores upon bodily movement were not statistically different between the two groups, except at 12 hours. The mean intraoperative and postoperative fentanyl requirements in the PACU were similar. The difference in the requirement for rescue analgesics was not statistically significant (p=0.788).
Conclusion
Ultrasound-guided ESPB performed with different bupivacaine concentrations was effective in both groups for LC analgesia, with similar opioid consumption. A lower concentration of local anesthetic can be helpful for the safety of regional anesthesia and is recommended for the analgesic effect of ESPB in LC.

Citations

Citations to this article as recorded by

Bilateral erector spinae plane block on opioid-sparing effect in upper abdominal surgery: study protocol for a bi-center prospective randomized controlled trial
Changzhen Geng, Li Wang, Yaping Shi, Xinnan Shi, Hanyi Zhao, Ya Huang, Qiufang Ji, Yuanqiang Dai, Tao Xu
Trials.2024;[Epub] CrossRef

Digital subtraction angiography vs. real-time fluoroscopy for detection of intravascular injection during transforaminal epidural block: Kibeom Park, Saeyoung Kim; Yeungnam Univ J Med. 2019;36(2):109-114. Published online January 24, 2019; DOI: https://doi.org/10.12701/yujm.2019.00122

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Abstract PDF

Background
Transforaminal epidural block (TFEB) is an effective treatment option for radicular pain. To reduce complications from intravascular injection during TFEB, use of imaging modalities such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA) has been recommended. In this study, we investigated whether DSA improved the detection of intravascular injection during TFEB at the whole spine level compared to RTF.
Methods
We prospectively examined 316 patients who underwent TFEB. After confirmation of final needle position using biplanar fluoroscopy, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under RTF; 30 s later, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under DSA.
Results
Thirty-six intravascular injections were detected for an overall rate of 11.4% using RTF, with 45 detected for a rate of 14.2% using DSA. The detection rate using DSA was statistically different from that using RTF (p=0.004). DSA detected a significantly higher proportion of intravascular injections at the cervical level than at the thoracic (p=0.009) and lumbar (p=0.011) levels.
Conclusion
During TFEB at the whole spine level, DSA was better than RTF for the detection of intravascular injection. Special attention is advised for cervical TFEB, because of a significantly higher intravascular injection rate at this level than at other levels.

Citations

Citations to this article as recorded by

1. Lumbosacral radicular pain
Laurens Peene, Steven P. Cohen, Jan Willem Kallewaard, Andre Wolff, Frank Huygen, Antal van de Gaag, Steegers Monique, Kris Vissers, Chris Gilligan, Jan Van Zundert, Koen Van Boxem
Pain Practice.2024; 24(3): 525. CrossRef
Safety of local anesthetics in cervical nerve root injections: a narrative review
Zachary E. Stewart
Skeletal Radiology.2023; 52(10): 1893. CrossRef
An update on technical and safety practice patterns in transforaminal epidural steroid injections
Ashley E. Gureck, Berkenesh Gebrekristos, Razvan Turcu, Dana Kotler, Alec L. Meleger
Interventional Pain Medicine.2023; 2(4): 100286. CrossRef
Thoracic transforaminal epidural steroid injection for management of thoracic spine pain: A multicenter cross-sectional study of short-term outcomes
Josh Levin, John Chan, Lisa Huynh, Matt Smuck, Jayme Koltsov, Bilge Kesikburun, Graham E. Wagner, Marc Caragea, Keith Kuo, Zachary L. McCormick, Byron Schneider, Evan Berlin, D.J. Kennedy, Serdar Kesikburun
Interventional Pain Medicine.2022; 1(1): 100004. CrossRef
The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain
Mansoor M Aman, Ammar Mahmoud, Timothy Deer, Dawood Sayed, Jonathan M Hagedorn, Shane E Brogan, Vinita Singh, Amitabh Gulati, Natalie Strand, Jacqueline Weisbein, Johnathan H Goree, Fangfang Xing, Ali Valimahomed, Daniel J Pak, Antonios El Helou, Priyanka
Journal of Pain Research.2021; Volume 14: 2139. CrossRef

Original Article

A comparison of 0.075% and 0.15% of ropivacaine with fentanyl for postoperative patient controlled epidural analgesia after laparoscopic gynecologic surgery: Hyun Chul Jung, Hyo Jung Seo, Deok Hee Lee, Sang Jin Park; Yeungnam Univ J Med. 2017;34(1):37-42. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.37

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Abstract PDF: BACKGROUND
A motor blockade of lower limbs interferes with early ambulation and limits the usefulness of patient-controlled epidural analgesia (PCEA). The concentration of local anesthetic solution is a major determinant for motor block with PCEA. We compared the effects of epidural infusion of 0.075% ropivacaine with 0.15% epidural ropivacaine on postoperative analgesia, motor block of lower limbs, and other side effects. METHODS: A total of 70 patients undergoing laparoscopic gynecologic surgery received epidural infusions (group R1, 0.15% ropivacaine with fentanyl; group R2, 0.075% ropivacaine with fentanyl). Pain score, motor block, and side effects (hypotension, nausea, vomiting, pruritus, urinary retention, dizziness, and numbness) were measured. RESULTS: There were no significant differences in the demographic profiles between the groups. Pain scores of the group R1 and the group R2 were not significantly different. Motor block was more frequent in the group R1 (0.15% ropivacaine with fentanyl) than in the group R2 (0.075% ropivacaine with fentanyl). CONCLUSION: Lower concentration of ropivacaine (0.075%), when compared with higher concentration of ropivacaine (0.15%), seemed to provide similar analgesia with less motor blockade of the lower limbs for the purpose of PCEA.

Review

Memory of Pain and Preemptive Analgesia.: Sun Ok Song; Yeungnam Univ J Med. 2000;17(1):12-20. Published online June 30, 2000; DOI: https://doi.org/10.12701/yujm.2000.17.1.12

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Abstract PDF: The memory of pain can be more damaging than its initial experience. Several factors are related the directions of pain memory; current pain intensity, emotion, expectation of pain, and peak intensity of previous pain. The possible mechanisms of memory of pain are neuroplastic changes of nervous system via peripheral and central sensitization. Peripheral sensitization is induced by neurohumoral alterations at the site of injury and nearby. Biochemicals such as K+, prostaglandins, bradykinin, substance P, histamine and serotonin, increase transduction and produce continuous nociceptive input. Central sensitization takes place within the dorsal horn of spinal cord and amplifies the nociceptive input from the periphery. The mechanisms of central sensitization involve a variety of transmitters and postsynaptic mechanisms resulting from the activations of NMDA receptors by glutamate, and activation of NK-1 tachykinnin receptors by substance-P and neurokinnin. The clinical result of peripheral and central sensitization is hyperalgesia, allodynia, spontaneous pain, referred pain, or sympathetically maintained pain. These persistent sensory responses to noxious stimuli are a form of memory. The hypothesis of preemptive analgesia is that analgesia administered before the painful stimulus will prevent or reduce subsequent pain and analgesic requirements in comparison to the identical analgesic intervention administered after the painful stimulus, by preventing or reducing the memory of pain in the nervous system. Conventionally, pain management was initiated following noxious stimuli such as surgery. More recently, many have endorsed preemptive analgesia initiated before surgery. Treatments to control postsurgical pain are often best started before injury activates peripheral nociceptors and triggers central sensitization. Such preemption is not achieved solely by regional anesthesia and drug therapy but also requires behavioral interventions to decrease anxiety or stress. Although the benefit of preemptive analgesia is not obvious in every circumstance, and in many cases may not sufficient to abolish central sensitization, it is an appropriate and human goal of clinical practice.

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