Browsing by Subject "Local anesthetics"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Evaluation of a modified ultrasound-assisted technique for mid-thoracic epidural placement: a prospective observational study
    (Springer Nature, 2024-01-19) Huang, Chanyan; Chen, Ying; Kou, Mengjia; Wang, Xuan; Luo, Wei; Zhang, Yuanjia; Guo, Yuting; Huang, Xiongqing; Meng, Lingzhong; Xiao, Ying; Anesthesia, School of Medicine
    Background: Although mid-thoracic epidural analgesia benefits patients undergoing major surgery, technical difficulties often discourage its use. Improvements in technology are warranted to improve the success rate on first pass and patient comfort. The previously reported ultrasound-assisted technique using a generic needle insertion site failed to demonstrate superiority over conventional landmark techniques. A stratified needle insertion site based on sonoanatomic features may improve the technique. Methods: Patients who presented for elective abdominal or thoracic surgery requesting thoracic epidural analgesia for postoperative pain control were included in this observational study. A modified ultrasound-assisted technique using a stratified needle insertion site based on ultrasound images was adopted. The number of needle passes, needle skin punctures, procedure time, overall success rate, and incidence of procedure complications were recorded. Results: One hundred and twenty-eight subjects were included. The first-pass success and overall success rates were 75% (96/128) and 98% (126/128), respectively. In 95% (122/128) of patients, only one needle skin puncture was needed to access the epidural space. The median [IQR] time needed from needle insertion to access the epidural space was 59 [47-122] seconds. No complications were observed during the procedure. Conclusions: This modified ultrasound-assisted mid-thoracic epidural technique has the potential to improve success rates and reduce the needling time. The data shown in our study may be a feasible basis for a prospective study comparing our ultrasound-assisted epidural placements to conventional landmark-based techniques.
  • Thumbnail Image
    Item
    Intravenous Lidocaine Infusion for the Management of Early Postoperative Pain: A Comprehensive Review of Controlled Trials
    (MedWorks Media, 2020-10-15) Chu, Robert; Umukoro, Nelly; Greer, Tiashi; Roberts, Jacob; Adekoya, Peju; Odonkor, Charles A.; Hagedorn, Jonathan M.; Olatoye, Dare; Urits, Ivan; Orhurhu, Mariam Salisu; Umukoro, Peter; Viswanath, Omar; Hasoon, Jamal; Kaye, Alan D.; Orhurhu, Vwaire; Medicine, School of Medicine
    Previously used as anti-arrhythmic, intravenous lidocaine infusion is becoming popular for use in management of acute pain. There is still much to be understood about its pharmacokinetics and pharmacodynamics, especially with regard to optimal dosing to avoid side effects. In this article, we selected and reviewed randomized controlled trials to summarize the pharmacokinetics, antinociceptive effects, anti-hyperalgesic effects, anti-inflammatory effects, side effects, and role of intravenous lidocaine in the management of early postoperative pain. The mechanisms of action of lidocaine are still unclear but there are many theories postulated. Optimal dosing of lidocaine is not known but general consensus indicates that a loading dose of 1-2 mg/kg, followed by 1-2 mg/kg/hr continuous infusion during early postoperative pain control while recovering from anesthesia to achieve therapeutic levels of 0.5-5 mcg/kg clearly improves analgesia in the immediate postoperative period. Although lidocaine was initially studied and proven to have clear analgesic effects following laparoscopic and open abdominal surgeries, it has now been shown to be applicable in different clinical settings perioperatively including following spinal, breast, ENT and other surgeries. It is generally safe, with hypotension, headache and vomiting being the more common side effects. Serious adverse effects include cardiovascular block and arrhythmias, neuro-excitability and hypersensitivity, although the frequency of these are not known.
  • Thumbnail Image
    Item