{"id":1344,"date":"2021-03-17T11:50:13","date_gmt":"2021-03-17T11:50:13","guid":{"rendered":"http:\/\/www.esraitalia.it\/?p=1344"},"modified":"2021-03-18T12:00:01","modified_gmt":"2021-03-18T12:00:01","slug":"articolo-di-marzo","status":"publish","type":"post","link":"https:\/\/www.esraitalia.it\/index.php\/2021\/03\/17\/articolo-di-marzo\/","title":{"rendered":"Articolo di Marzo"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text]<\/p>\n

Questo mese il tema portante della nostra newsletter sar\u00e0 quello dei blocchi di fascia in cardiochirurgia. Il tema \u00e8 molto attuale, e come vedete \u00e8 argomento di discussione anche nella rivista online ufficiale della American Society of Anesthesiologists (ASA) dove \u00e8 stata appena pubblicata \u00a0questa interessante intervista:<\/p>\n

https:\/\/doi.org\/10.1097\/01.ASM.0000737124.92835.9d<\/a><\/p>\n

Di seguito invece due recenti lavori, tutti italiani, dei quali raccomandiamo la lettura:<\/p>\n

Capuano P, Toscano A, Rinaldi M, Brazzi L. Ultrasound-guided thoracic wall nerve blocks in cardiac surgery: has the best yet to come?<\/strong> Minerva Anestesiol. 2020 Oct 15. https:\/\/pubmed.ncbi.nlm.nih.gov\/33054024\/<\/a><\/em><\/p>\n

Sepolvere G, Tedesco M, Fusco P, Scimia P, Cristiano L. Fascial plane blocks in cardiac surgery: a future to discover. <\/em>Minerva Anestesiol. 2020 Dec 17. https:\/\/www.minervamedica.it\/en\/journals\/minerva-anestesiologica\/article.php?cod=R02Y2021N03A0382<\/a><\/em><\/p>\n

Questo mese la rivista che propone gli articoli pi\u00f9 interessanti, a nostro parere, \u00e8 Anesthesia & Analgesia.<\/p>\n

\"\"<\/p>\n

Doveroso inoltre segnalare questa review appena pubblicata su “Anaesthesia” della quale riportiamo l’abstract<\/p>\n

Chin KJ, Versyck B, Pawa A. Ultrasound-guided fascial plane blocks of the chest wall: a state-of-the-art review.<\/strong> Anaesthesia. 2021 Jan;76 Suppl 1:110-126.\u00a0https:\/\/pubmed.ncbi.nlm.nih.gov\/32239539\/<\/a><\/p>\n

Summary<\/p>\n

Ultrasound-guided fascial plane blocks of the chest wall are increasingly popular alternatives to established techniques such as thoracic epidural or paravertebral blockade, as they are simple to perform and have an appealing safety profile. Many different techniques have been described, which can be broadly categorised into anteromedial, anterolateral and posterior chest wall blocks. Understanding the relevant clinical anatomy is critical not only for block performance, but also to match block techniques appropriately with surgical procedures. The sensory innervation of tissues deep to the skin (e.g. muscles, ligaments and bone) can be overlooked, but is often a significant source of pain. The primary mechanism of action for these blocks is a conduction blockade of sensory afferents travelling in the targeted fascial planes, as well as of peripheral nociceptors in the surrounding tissues. A systemic action of absorbed local anaesthetic is plausible but unlikely to be a major contributor. The current evidence for their clinical applications indicates that certain chest wall techniques provide significant benefit in breast and thoracic surgery, similar to that provided by thoracic paravertebral blockade. Their role in trauma and cardiac surgery is evolving and holds great potential. Further avenues of research into these versatile techniques include: optimal local anaesthetic dosing strategies; high- quality randomised controlled trials focusing on patient-centred outcomes beyond acute pain; and comparative studies to determine which of the myriad blocks currently on offer should be core competencies in anaesthetic practice.<\/p>\n

 <\/p>\n

In particolare ci hanno colpito tre articoli che segnaliamo di seguito:<\/p>\n

OPEN MIND: THE OPEN MIND<\/strong>
\nFascial Plane Blocks: More Questions Than Answers?
\nBlack, Nick D. MB BCh BAO, FRCA*; Stecco, Carla MD\u2020; Chan, Vincent W. S. MD, FRCPC\u2021
\nAuthor Information
\nAnesthesia & Analgesia: March 2021 – Volume 132 – Issue 3 – p 899-905
\nhttps:\/\/journals.lww.com\/anesthesia-analgesia\/Citation\/2021\/03000\/Fascial_Plane_Blocks__More_Questions_Than_Answers_.38<\/a>.asp<\/a><\/p>\n

\"\"<\/p>\n

Il primo articolo, alla firma dell\u2019irlandese Nick Black, vede come coautori Vincent Chan, uno dei pi\u00f9 importanti e premiati riferimenti per l\u2019anestesia locoregionale nel mondo, assieme alla Professoressa Carla Stecco, orgoglio tutto Italiano, forse l\u2019autorit\u00e0 mondiale principale, quando si parla di sistema fasciale umano. Il loro lavoro ci illustra come siamo ben lontani dal poter considerare i blocchi di fascia come una metodica scientificamente validata. Raccomandiamo senz\u2019altro la lettura, fonte di molti spunti di riflessione e di ricerca.<\/p>\n

OPEN MIND: THE OPEN MIND<\/strong>
\nPerioperative Lidocaine Infusion: Does the Risk Outweigh the Benefit?
\nWeinberg, Guy L. MD
\nAuthor Information
\nAnesthesia & Analgesia: March 2021 – Volume 132 – Issue 3 – p 906-909<\/p>\n

https:\/\/pubmed.ncbi.nlm.nih.gov\/33438966\/<\/a><\/p>\n

Il secondo articolo \u00e8 opera di Guy Weinberg, forse non noto a tutti, ma \u00e8 grazie a lui se abbiamo le soluzioni lipidiche nei nostri protocolli per la gestione della tossicit\u00e0 sistemica da anestetici locali.
\nNel suo articolo Weinberg mette in risalto come, con lo scopo di ridurre il consumo degli oppioidi, considerati pericolosi, si stia diffondendo l\u2019utilizzo della lidocaina endovenosa. Tale pratica, allo stato attuale significa evitare un rischio ben noto e gestibile legato agli oppioidi, con un rischio assolutamente imprevedibile e non quantificabile, legato alla ancora scarsa conoscenza della farmacologia degli anestetici locali per via endovenosa. Anche qui le riflessioni sono doverose.<\/p>\n

PAIN AND ANALGESIC MECHANISMS<\/strong>
\nComparison of Liposomal Bupivacaine and Conventional Local Anesthetic Agents in Regional
\nAnesthesia: A Systematic Review
\nJin, Zhaosheng MBBS*; Ding, Olivia MD\u2020; Islam, Ali BE\u2021; Li, Ru PhD*; Lin, Jun MD, PhD*
\nAuthor Information
\nAnesthesia & Analgesia: February 24, 2021 – Volume – Issue – 10.1213\/ANE.0000000000005406 https:\/\/journals.lww.com\/anesthesia-analgesia\/Abstract\/9900\/Comparison_of_Liposomal_Bupivacaine_and.88.aspx<\/a><\/p>\n

Abstract
\nBACKGROUND:
\nPain is one of the most common adverse events after surgery. Regional anesthesia techniques are effective for pain control but have limited duration of action. Liposomal bupivacaine is a long-acting formulation of bupivacaine. We conduct this systematic review to assess whether liposomal bupivacaine may prolong the analgesic duration of regional anesthesia compared to conventional local anesthetic agents.
\nMETHODS:
\nWe systematically searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, Web of Science citation index, US clinical trials register, and recent conference abstracts for relevant studies.
\nRESULTS:
\nWe identified 13 randomized controlled trials that compared the use of liposomal bupivacaine to conventional local anesthetics in regional anesthesia. There were 5 studies on transversus abdominis plane (TAP) block, 3 of which reported longer duration of analgesia with liposomal bupivacaine. One study reported comparable analgesia with liposomal
\nbupivacaine TAP block compared to TAP block catheter. There were 3 studies on brachial plexus block, 2 of which reported
\nthat liposomal bupivacaine may provide longer analgesia. Studies on other techniques did not report significantly longer
\nanalgesia with liposomal bupivacaine.
\nCONCLUSIONS:
\nCurrently, there is limited evidence suggesting that liposomal bupivacaine provides longer analgesia than conventional local anesthetics when used in regional anesthesia. The analyses of multiple studies on liposomal bupivacaine for TAP blocks and brachial plexus blocks have yielded conflicting results. As a result, no definitive conclusions can be drawn about its efficacy compared to plain bupivacaine.
\n___________________________________________________________________________________<\/p>\n

[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

[vc_row][vc_column][vc_column_text] Questo mese il tema portante della nostra newsletter sar\u00e0 quello dei blocchi di fascia in cardiochirurgia. Il tema \u00e8 molto attuale, e come vedete \u00e8 argomento di discussione anche…<\/p>\n","protected":false},"author":1,"featured_media":1351,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[9],"tags":[],"class_list":["post-1344","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news-marzo","category-9","description-off"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/posts\/1344","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/comments?post=1344"}],"version-history":[{"count":4,"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/posts\/1344\/revisions"}],"predecessor-version":[{"id":1350,"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/posts\/1344\/revisions\/1350"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/media\/1351"}],"wp:attachment":[{"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/media?parent=1344"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/categories?post=1344"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.esraitalia.it\/index.php\/wp-json\/wp\/v2\/tags?post=1344"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}