勃起器脊柱平面阻塞用于皮肤通术后的止痛 减少阿片类药物的途径
Jonathan H Berger1, Waseem Abdou2, Jacob L Roberts1
1University of California, San Diego Department of Urology, San Diego, CA, United States.
概括
勃起器脊柱平面 (ESP) 阻塞显著降低了皮肤穿透性利切除术 (PCNL) 患者的疼痛和阿片类药物使用. 这种微创手术在PCNL后提供有效的疼痛管理,改善了患者的康复.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
背景情况:
- 皮肤瘤切除术 (PCNL) 可以引起显著的术后疼痛,可能延迟出院并增加阿片类药物依赖.
- 有效的疼痛管理策略对于优化PCNL患者康复至关重要.
研究的目的:
- 评估勃起器脊柱平面 (ESP) 块在改善手术后疼痛控制和减少PCNL患者阿片类药物消耗方面的疗效.
- 为了比较接受ESP阻断的PCNL患者和没有接受ESP阻断的PCNL患者之间的结果.
主要方法:
- 由单个外科医生进行的连续PCNL病例的回顾性审查.
- 对接受ESP阻塞 (单次注射或连续注射) 患者与未接受ESP阻塞的患者进行比较.
- 对阿片类药物使用 (MME) 和患者在住院后的前24小时内报告的疼痛评分的分析.
主要成果:
- 接受ESP阻塞的患者显示,阿片类药物的使用量显著降低 (18.3MME与81.3MME,p=0.004).
- 在ESP阻断组 (p=0.004) 中,观察到第一个非零疼痛评分的时间明显较长.
- 连续和单次ESP阻断显示了可比的阿片类药物使用.
结论:
- 勃起器脊柱平面 (ESP) 块作为一种有效的补充物,用于经皮瘤切除术 (PCNL) 后的疼痛管理.
- 阻断ESP可能会降低PCNL患者的术后阿片类药物需求,同时确保足够的止痛.
相关概念视频
Local Anesthetics: Clinical Application as Spinal Anesthesia
680
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
680
Local Anesthetics: Clinical Application as Epidural Anesthesia
458
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
458
Analgesia and Pain Management
660
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
660
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
467
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
467
Opioid Analgesics: Synthetic and Semisynthetic Opioids
338
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
338
Skeletal Muscle Relaxants: Therapeutic Uses
515
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
515


