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Bi-national survey of Korea and Japan related to the injection site for ultrasound-guided stellate ganglion blocks and anatomic comparisons using cadaver dissection.

韩国和日本关于超声引导星状神经节阻滞注射部位的两国调查以及使用尸体解剖的解剖学比较。

  • 影响因子:3.02
  • DOI:10.1371/journal.pone.0232586
  • 作者列表:"Won HS","Iseki M","Hagihira S","Kuk Y","Kim YD","Kim H
  • 发表时间:2020-05-01
Abstract

:The aims of this study were to investigate the current clinical practice of ultrasound (US)-guided stellate ganglion block (SGB) using a bi-national survey of Korea and Japan, and to clarify the anatomical relation of the cervical sympathetic trunk with the prevertebral fascia at the level of cervical vertebrae. The current clinical practice of US-guided SGB in Korea and Japan was investigated using an Internet survey, which received 206 (10.2%) replies from Korea and 97 (8.8%) replies from Japan. The survey questionnaire addressed the actual clinical practice for US-guided SGB, including where the tip of the injection needle is placed. Additionally, 16 half necks of 8 embalmed cadavers were used in an anatomical study. An in-plane needle approach technique and administering 5 ml of local anesthetic were preferred in both countries. However, the type of local anesthetic differed, being lidocaine in Korea and mepivacaine in Japan. The final position of the needle tip also clearly differed in an US image, being predominantly positioned above the prevertebral fascia in Korea (39.3%) and under the prevertebral fascia in Japan (59.8%). In all of the anatomic dissections, the cervical sympathetic trunk was over the prevertebral fascia at the level of the sixth vertebra and under the prevertebral fascia at the level of the seventh vertebra. These results are expected to improve the knowledge on the current clinical practice and to suggest future studies.

摘要

: 本研究的目的是利用韩国和日本的一项两国调查,调查超声 (US) 引导下星状神经节阻滞 (SGB) 的当前临床实践,并阐明颈椎水平的颈椎交感神经干与椎前筋膜的解剖关系。使用互联网调查对美国指导的SGB在韩国和日本的当前临床实践进行了调查,该调查收到了来自韩国的206 (10.2%) 份答复和来自日本的97 (8.8%) 份答复。调查问卷涉及美国指导的SGB的实际临床实践,包括注射针尖端的位置。此外,在解剖学研究中使用了8具防腐尸体的16个半颈。在这两个国家,首选平面内针入路技术和施用5毫升的局部麻醉剂。然而,局部麻醉剂的类型不同,韩国的利多卡因和日本的甲哌卡因。针尖的最终位置在美国图像中也明显不同,在韩国主要位于椎前筋膜上方 (39.3%),在日本主要位于椎前筋膜下方 (59.8%)。在所有解剖解剖中,颈交感神经干在第6椎骨水平的椎前筋膜之上,在第7椎骨水平的椎前筋膜之下。这些结果有望提高对当前临床实践的认识,并建议未来的研究。

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DOI:10.1213/ANE.0000000000003975
作者列表:["Uppal V","Retter S","Casey M","Sancheti S","Matheson K","McKeen DM"]

METHODS:BACKGROUND:Fentanyl and morphine are the 2 most commonly added opioids to bupivacaine for spinal anesthesia during cesarean delivery. Numerous clinical trials have assessed efficacy and safety of different doses of fentanyl added to intrathecal bupivacaine for spinal anesthesia, yet its benefit, harm, and optimal dose remain unclear. This study aimed to systematically review the evidence of the efficacy of fentanyl when added to intrathecal bupivacaine alone and when added to bupivacaine with morphine for spinal anesthesia during cesarean delivery. METHODS:Key electronic databases (PubMed, Embase, and Cochrane Library) were searched for randomized controlled trials in the cesarean delivery population. The primary outcome was the failure rate of spinal anesthesia, as assessed by the need for either conversion to general anesthesia or intraoperative analgesic supplementation. Two reviewers independently extracted the data using a standardized electronic form. Results are expressed as relative risks or mean differences with 95% CIs. RESULTS:Seventeen randomized controlled clinical trials (most judged as low or unclear risk of bias) with 1064 participants provided data for the meta-analysis. Fentanyl added to intrathecal bupivacaine alone reduced the need for intraoperative supplemental analgesia (relative risk, 0.18; 95% CI, 0.11-0.27; number needed to treat, 4) and the incidence of nausea/vomiting (relative risk, 0.41; 95% CI, 0.24-0.70; number needed to treat, 6.5), with longer time to first postoperative analgesia request (mean difference, 91 minutes; 95% CI, 69-113). No difference was observed regarding the need for conversion to general anesthesia (relative risk, 0.67; 95% CI, 0.12-3.57), the incidence of hypotension, the onset of sensory block, or the duration of motor block. However, the addition of intrathecal fentanyl was associated with higher incidence of intraoperative pruritus (relative risk, 5.89; 95% CI, 2.07-16.79; number needed to harm, 13.5). The inclusion of fentanyl to intrathecal bupivacaine-morphine compared to intrathecal bupivacaine-morphine alone conferred a similar benefit, with a significantly reduced need for intraoperative supplemental analgesia (relative risk, 0.16; 95% CI, 0.03-0.95; number needed to treat, 9). Analysis using a funnel plot indicated a possibility of publication bias in included studies. CONCLUSIONS:Current evidence suggests a benefit of using fentanyl as both an additive to intrathecal bupivacaine alone and to intrathecal bupivacaine combined with morphine for cesarean delivery under spinal anesthesia. The possibility of publication bias, small sample size, and high risk of bias in some of the included studies warrant treating the results with caution.

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DOI:10.1213/ANE.0000000000004012
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