Intraoperative Intercostal Nerve Cryoanalgesia Improves Pain Control Post-Descending, TAAA Repairs

Publication date: Available online 12 September 2019Source: The Annals of Thoracic SurgeryAuthor(s): Akiko Tanaka, Zain Al-Rstum, Samuel D. Leonard, Bri’Ana D. Gardiner, Ibrahim Yazij, Harleen K. Sandhu, Charles C. Miller, Hazim J. Safi, Anthony L. EstreraABSTRACTBackgroundWe reviewed the efficacy of intraoperative intercostal nerve cryoanalgesia for pain control in patients undergoing descending and thoracoabdominal aortic aneurysm (D/TAAA) repairs.MethodsDuring 2013 and 2017, 241 patients underwent D/TAAA repair. Of those, 38 were treated with intraoperative cryoanalgesia to the intercostal nerves at the level of fourth to tenth under electromyography guidance and these were compared with patients who did not receive cryoanalgesia. Both groups received multilevel paravertebral block and local infiltration with liposomal bupivacaine. Numerical pain scale (NPS) and amount of opioid usage in morphine milligram equivalences (MME) on the first to fourth and eighth postoperative days were collected. We excluded patients who were extubated after the third postoperative day or who were reintubated from the study.ResultsA total of 126 patients met the inclusion criteria: 28 in cryoanalgesia and 98 in control. Preoperative patient demographics were similar in two groups, except for more frequent chronic dissection in patients with cryoanalgesia (93% vs. 65%, P=0.004). Postoperative major complications, length of stay, and discharge to home were not significantly different in th...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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ConclusionAcute aortic dissection is a life-threatening disease with a high rate of cardiovascular morbidity and mortality. The most important and common risk factor is systemic hypertension which has been reported in the 70% of the patients with aortic dissection. Most of the aortic dissection observed in young women has been reported to be related to pregnancy. Dissection should be suspected during any acute coronary syndrome, particularly Inferior wall MI.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Abstract BACKGROUND: We reviewed the efficacy of intraoperative intercostal nerve cryoanalgesia for pain control in patients undergoing descending and thoracoabdominal aortic aneurysm (D/TAAA) repairs. METHODS: During 2013 and 2017, 241 patients underwent D/TAAA repair. Of those, 38 were treated with intraoperative cryoanalgesia to the intercostal nerves at the level of fourth to tenth under electromyography guidance and these were compared with patients who did not receive cryoanalgesia. Both groups received multilevel paravertebral block and local infiltration with liposomal bupivacaine. Numerical pain scal...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
En reiseglad 80-åring med ryggsmerter og vekttap. Tidsskr Nor Laegeforen. 2019 Sep 10;139(12): Authors: Leknesund SH, Finjord T, Jordal S Abstract BACKGROUND: This case report presents one of the first documented incidents of chronic Q-fever (C. burnetii) in Norway. A comprehensive workup resulted in an unexpected finding. CASE PRESENTATION: A Norwegian woman in her eighties presented to a district general hospital with lower back pain, decreased general condition and weight loss. Computer tomography (CT) revealed a large thoracic aortic aneurysm presumed to be of mycotic origin, and later ...
Source: Tidsskrift for den Norske Laegeforening - Category: General Medicine Authors: Tags: Tidsskr Nor Laegeforen Source Type: research
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regio...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Zhong-Yan Zhou1,2†, Wai-Rong Zhao1†, Wen-Ting Shi1†, Ying Xiao1, Zi-Lin Ma1, Jin-Gui Xue3, Lun-Qing Zhang4, Qing Ye1, Xin-Lin Chen1* and Jing-Yi Tang1,5* 1Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China 2State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China 3Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China 4Faculty of Health Sciences, University of Macau, Macau, China 5Cardiac Rehabilitation Center of Longhua Hospital, Shanghai Univers...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
AbstractAbdominal aortic aneurysm (AAA) is most commonly defined as a maximal diameter of the abdominal aorta in excess of 3 cm in either anterior-posterior or transverse planes or, alternatively, as a focal dilation ≥ 1.5 times the diameter of the normal adjacent arterial segment. Risk factors for the development of AAA include age>  60, tobacco use, male gender, Caucasian race, and family history of AAA. Aneurysm growth and rupture risk appear to be associated with persistent tobacco use, female gender, and chronic pulmonary disease. The majority of AAAs are asymptomatic and detected incidentally on vario...
Source: Abdominal Imaging - Category: Radiology Source Type: research
AbstractTo assess feasibility, efficacy and safety of carbon dioxide (CO2) digital subtraction angiography (DSA) to guide endovascular aneurysm repair (EVAR) in a cohort of patients with chronic kidney disease (CKD). After Ethical Committee approval, the records of 13 patients (all male, mean age 74.6  ± 8.0 years) with CKD, who underwent EVAR to exclude an abdominal aortic aneurysm (AAA) under CO2 angiography guidance, were reviewed. The AAA to be excluded had a mean diameter of 52.0  ± 8.0 mm. CO2 angiography was performed by automatic (n  = 7) or hand (n&thins...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
Abstract: Chronic contained rupture of an abdominal aortic aneurysm with vertebral body erosion most commonly presents with symptoms of low back pain. Although not well known, vertebral body erosion or destruction may be seen in up to 25% of patients with sealed or contained rupture of an abdominal aortic aneurysm. This appearance on cross-sectional imaging may mimic a malignant or infectious process. Although these cases can present a diagnostic challenge, published cases of chronic contained rupture of an abdominal aortic aneurysm with vertebral body erosion demonstrate clinical and imaging similarities that, when recogn...
Source: Journal of Computer Assisted Tomography - Category: Radiology Tags: Musculoskeletal Radiology Source Type: research
An 85-year-old man presented with dyspnea and mild left precordial pain. He was a heavy smoker with chronic obstructive pulmonary disease, diabetes, hypertension, and a 20-year history of thoracic aortic aneurysm (TAA) that he refused to have repaired. Over the past few weeks he became increasingly dyspneic, dysphonic, and developed solid-food dysphagia.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Medical images Source Type: research
CONCLUSION Right-sided aortic arch presents challenges in the emergency setting. CTA and post-processing reconstructions are very helpful. While the endoleaks prompted additional interventions, the end result was excellent. This case displays the importance of careful attention to detail and follow-up in these complicated patients.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
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