Suchergebnisse

Nguyen Truong Giang,1 Nguyen Van Nam,1 Nguyen Ngoc Trung,1 Le Viet Anh,1 Nguyen Manh Cuong,2 Ngo Van Dinh,2 Dinh Cong Pho,2 Phillip Geiger,3 Nguyen Trung Kien2 1Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 2Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 3Department of Anesthesiology, Perioperative, and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA Background: Paravertebral block has been proven to be an efficient method to provide post-thoracotomy pain management. This study aimed to compare patient-controlled paravertebral analgesia (PCPA) and intravenous patient-controlled analgesia (IVPCA) in terms of analgesic efficiency, respiratory function, and adverse effects after video-assisted thoracoscopic surgery (VATS) lobectomy.Patients and methods: The prospective randomized trial study was carried out on 60 patients who underwent VATS lobectomy (randomly allocated 30 patients in each group). In the PCPA group, an initial dose of 0.3 mL/kg of 0.125% bupivacaine with fentanyl 2 µg/mL was administered, followed by a 3 mL/h continuous infusion with patient-controlled analgesia (2 mL bolus, 10-minute lockout interval, 25 mL/4 h limit). In the IVPCA group with morphine 1 mg/mL solution, an infusion device was programmed to deliver a 1.0 mL demand bolus with no basal infusion rate, with a 10-minute lockout interval and a maximum of 20 mL/4 h period. Postoperative pain was assessed by visual analog scale at rest and on coughing. Arterial blood gas and spirometry were monitored and recorded for the first 3 postoperative days. Side effects to include were also recorded.Results: The PCPA group had statistically significant lower pain scores (P<0.0001) at rest at all times. Lower pain scores on coughing were statistically significant in PCPA group in the first 4 hours. Postoperative spirometry showed that both the groups had comparable recovery trajectories for their pulmonary function. Arterial blood gas analysis showed pH and PaCO2 were in a normal range in both the groups. The incidence of headache was higher in the IVPCA group (13.3% vs 0%; P=0.038).Conclusion: PCPA effectively managed pain after VATS lobectomy, with lower pain scores, similar respiratory function, and fewer side effects than standard IVPCA treatment. Keywords: patient-controlled paravertebral analgesia, PCPA, intravenous patient controlled analgesia, IVPCA, video-assisted thoracoscopic surgery, VATS

Nguyen Trung Kien,1 Nguyen Truong Giang,2 Bui Van Manh,1 Nguyen Manh Cuong,3 Ngo Van Dinh,3 Dinh Cong Pho,4 Vu The Anh,3 Dao Thi Khanh,5 Luu Quang Thuy,6 Pham Van Dong71Center of Emergency, Critical Care Medicine, and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 2Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 3Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 4Faculty of Medicine, Vietnam Military Medical University, Hanoi, Vietnam; 5Department of Pharmacy, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 6Center of Anesthesia and Surgical Intensive Care, Vietduc University Hospital, Hanoi, Vietnam; 7Anesthesia and Pain Medicine, Cho Ray Hospital, Ho Chi Minh City, VietnamBackground: Local anesthetic systemic toxicity (LAST) is a life-threatening complication that may follow application of LAs through various routes. Despite increasing usage of LA techniques in a large number of health-care settings, contemporary awareness of LAST and understanding of its management are inadequate.Case presentation: We report two cases who suffered LAST following brachial plexus block for surgery on the upper extremity. The first patient received an ultrasound-guided supraclavicular block with 300 mg lidocaine (6 mg/kg) and 50 mg ropivacaine (1 mg/kg) in 25 mL without epinephrine, and the second patient received an ultrasound guided interscalene block with 200 mg lidocaine (4.5 mg/kg) and 45 mg ropivacaine (1 mg/kg) supplemented with epinephrine 1:200,000. Both patients presented with symptoms of central nervous and respiratory system depression, the first roughly 10 minutes after injection, and the second immediately after withdrawal of the needle. In both cases, thorough recovery was obtained using lipid-emulsion therapy.Conclusion: The complication of LAST following ultrasound-guided brachial plexus block could be treated successfully applying the American Society of Regional Anesthesia and Pain Medicineprotocol of intravenous administration of lipid emulsion.Keywords: local anesthetic system toxicity, lipid emulsion