Wael Ali Sakr Esa

Outcomes Research Consortium

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Daniel I. Sessler

Outcomes Research Consortium

Alparslan Turan

Cleveland Clinic

Kamal Maheshwari

Cleveland Clinic

Ehab Farag

Cleveland Clinic

Loran Mounir Soliman

Cleveland Clinic

Hesham Elsharkawy

MetroHealth Medical Center

Kurt Ruetzler

Outcomes Research Consortium

Guangmei Mao

Cleveland Clinic

Edward J. Mascha

Cleveland Clinic

Rovnat Babazade

John Sealy Hospital

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Cleveland Clinic

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Outcomes Research Consortium

Case Western Reserve University

American Society of Anesthesiologists

Cleveland Clinic Lerner College of Medicine

Committee on Publication Ethics

Novem (Netherlands)

Universitat de Barcelona

University of California, San Diego

Pain Management Institute

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Patient-centered results from a multicenter study of continuous peripheral nerve blocks and postamputation phantom and residual limb pain: secondary outcomes from a randomized, clinical trial

Regional Anesthesia & Pain Medicine (2023)

Brian M. Ilfeld Bahareh Khatibi Kamal Maheshwari Sarah J. Madison Wael Ali Sakr Esa

Introduction We previously reported that a 6-day continuous peripheral nerve block reduces established postamputation phantom pain. To provide patients and providers with the information to best inform treatment decisions, here we reanalyze the data and present the results in a more patient-centered format. We also provide information on patient-defined clinically relevant benefits to facilitate evaluation of available studies and guide future trial design. Methods The original trial enrolled participants with a limb amputation and phantom pain who were randomized to receive a 6-day continuous peripheral nerve block(s) of either ropivacaine (n=71) or saline (n=73) in a double-masked fashion. Here we calculate the percentage of each treatment group that experienced a clinically relevant improvement as defined by previous studies as well as present what the participants of our study defined as small, medium, and large analgesic improvements using the 7-point ordinal Patient Global Impression of Change scale. Results Among patients who were given a 6-day ropivacaine infusion, 57% experienced at least a 2-point improvement on the 11-point numeric rating scale in their average and worst phantom pain 4 weeks postbaseline as compared with 26% (p<0.001) for average and 25% (p<0.001) for worst pain in patients given a placebo infusion. At 4 weeks, the percentage of participants rating their pain as improved was 53% for the active vs 30% for the placebo groups (95% CI 1.7 (1.1, 2.7), p = 0.008). For all patients combined, the median (IQR) phantom pain Numeric Rating Scale improvements at 4 weeks considered small, medium, and large were 2 (0–2), 3 (2–5), and 5 (3–7), respectively. The median improvements in the Brief Pain Inventory interference subscale (0–70) associated with small, medium, and large analgesic changes were 8 (1–18), 22 (14–31), and 39 (26–47). Conclusions Among patients with postamputation phantom pain, a continuous peripheral nerve block more than doubles the chance of a clinically relevant improvement in pain intensity. Amputees with phantom and/or residual limb pain rate analgesic improvements as clinically relevant similarly to other chronic pain etiologies, although their smallest relevant improvement in the Brief Pain Inventory was significantly larger than previously published values. Trial registration number NCT01824082 .

Phantom pain

Phantom limb

10.1136/rapm-2023-104389

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Citations (9)

Bilateral Continuous Quadratus Lumborum Block for Acute Postoperative Abdominal Pain as a Rescue After Opioid-Induced Respiratory Depression

A & A Case Reports (2015)

Mohamed Shaaban Wael Ali Sakr Esa Kamal Maheshwari Hesham Elsharkawy Loran Mounir Soliman

We present a case of acute postoperative abdominal pain after proctosigmoidectomy and colorectal anastomosis that was treated by bilateral continuous quadratus lumborum block. The block was performed in the lateral position under ultrasound guidance with a 15-mL bolus of 0.5% bupivacaine injected anterior to the quadratus lumborum muscle followed by bilateral catheter placement. Each catheter received a continuous infusion of 0.1% bupivacaine at 8 mL/h and an on-demand bolus 5 mL every 30 minutes. Sensory level was confirmed by insensitivity to cold from T7 through T12. The block was devoid of hemodynamic side effects or motor weakness. This case demonstrates that bilateral continuous quadratus lumborum catheters can provide extended postoperative pain control.

Bolus (digestion)

10.1213/xaa.0000000000000188

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Citations (36)

Axillary Brachial Plexus Block

Elsevier eBooks (2024)

Wael Ali Sakr Esa Cecile E. Skinner

10.1016/b978-0-443-11221-8.00011-7

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Citations (0)

Naloxegol and Postoperative Urinary Retention: A Randomized Trial

Journal of Clinical Medicine (2022)

Alparslan Turan Jonathan Fang Wael Ali Sakr Esa Hassan Hamadnalla Steve Leung

Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. However, the effect of naloxegol on opioid-induced bladder dysfunction remains unknown.patients given naloxegol have lower residual bladder urine volume than those given placebo.136 patients scheduled for elective hip and knee surgery were randomized to oral naloxegol or placebo given the morning of surgery, and on the first two postoperative mornings. Residual urine volume was measured ultrasonographically within 30 min after voiding once in the morning and once in the afternoon for two postoperative days. Opioid-related Symptom Distress Scale (ORSDS), the need for indwelling urinary catheterization, and quality of recovery (QoR) score were secondary outcomes.67 were randomized to naloxegol and 64 to placebo. We did not identify a significant effect on urine residual volume, with an estimated ratio of geometric means of 0.9 (0.3, 2.6), p = 0.84. There were no significant differences in ORSDS or QoR. There were 19 (29%) patients assigned to naloxegol who needed indwelling urination catheterization versus 7 (11%) patients in the placebo group, p = 0.012.Our results do not support use of naloxegol for postoperative urinary retention after hip and knee surgery.

Urinary retention

10.3390/jcm11020454

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Citations (1)

Myastheniccrisis

Cambridge University Press eBooks (2011)

Wael Ali Sakr Esa

The major factors in predicting neurologic dysfunction secondary to cardiac arrest involve the extent of brain insult as a function of time to return of circulation. The use of induced hypothermia has been studied as a way to combat neurologic injury for nearly five decades. This chapter presents a case study of a 37-year-old female with a history of chronic back pain and depression following a witnessed cardiac arrest 1 week after beginning risperidone therapy. The use of therapeutic hypothermia is widely accepted as the standard of care for preserving neurologic function following cardiac arrest. Cooling should be performed in all postcardiac arrest patients regardless of documented dysrhythmia, but supportive data are strongest for patients who are post ventricular fibrillation. Therapeutic hypothermia has been shown to be relatively safe and effective, and should be considered in the treatment of comatose patients following cardiac arrest.

Depression

10.1017/cbo9780511997426.096

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Citations (1)

Sugammadex Versus Neostigmine for Reversal of Rocuronium Neuromuscular Block in Patients Having Catheter-Based Neurointerventional Procedures: A Randomized Trial

Anesthesia & Analgesia (2021)

Ehab Farag Eva Rivas Mauro Bravo Shazam Hussain Maged Argalious

BACKGROUND: Catheter-based endovascular neurointerventions require deep neuromuscular blocks during the procedure and rapid subsequent recovery of strength to facilitate neurological evaluation. We tested the primary hypothesis that sugammadex reverses deep neuromuscular blocks faster than neostigmine reverses moderate neuromuscular blocks. METHODS: Patients having catheter-based cerebral neurointerventional procedures were randomized to: (1) deep rocuronium neuromuscular block with posttetanic count 1 to 2 and 4-mg/kg sugammadex as the reversal agent or (2) moderate rocuronium neuromuscular block with train-of-four (TOF) count 1 during the procedure and neuromuscular reversal with 0.07-mg/kg neostigmine to a maximum of 5 mg. Recovery of diaphragmatic function was assessed by ultrasound at baseline before the procedure and 90 minutes thereafter. The primary outcome—time to reach a TOF ratio ≥0.9 after administration of the designated reversal agent—was analyzed with a log-rank test. Secondary outcomes included time to successful tracheal extubation and the difference between postoperative and preoperative diaphragmatic contraction speed and distance. RESULTS: Thirty-five patients were randomized to sugammadex and 33 to neostigmine. Baseline characteristics and surgical factors were well balanced. The median time to reach TOF ratio ≥0.9 was 3 minutes (95% confidence interval [CI], 2-3 minutes) in patients given sugammadex versus 8 minutes (95% CI, 6-10 minutes) in patients given neostigmine. Sugammadex was significantly faster by a median of 5 minutes (95% CI, 3-6 minutes; P < .001). However, times to tracheal extubation and diaphragmatic function at 90 minutes did not differ significantly. CONCLUSIONS: Sugammadex reversed deep rocuronium neuromuscular blocks considerably faster than neostigmine reversed moderate neuromuscular blocks. However, times to extubation did not differ significantly, apparently because extubation was largely determined by the time required for awaking from general anesthesia and because clinicians were willing to extubate before full neuromuscular recovery. Sugammadex may nonetheless be preferable to procedures that require a deep neuromuscular block and rapid recovery.

Sugammadex

Neuromuscular monitoring

10.1213/ane.0000000000005533

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Citations (6)

Comparison of Three Techniques for Ultrasound-Guided Femoral Nerve Catheter Insertion

Survey of Anesthesiology (2015)

Ehab Farag Abdülkadir Atım Raktim K. Ghosh Maria Bauer Thilak Sreenivasalu

Farag, Ehab; Atim, Abdulkadir; Ghosh, Raktim; Bauer, Maria; Sreenivasalu, Thilak; Kot, Michael; Kurz, Andrea; Dalton, Jarrod E.; Mascha, Edward J.; Mounir-Soliman, Loran; Zaky, Sherif; Esa, Wael Ali Sakr; Udeh, Belinda L.; Barsoum, Wael; Sessler, Daniel I. Author Information

Femoral nerve

10.1097/sa.0000000000000138

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Citations (1)

The Cleveland Clinic Experience with Supraclavicular and Popliteal Ambulatory Nerve Catheters

The Scientific World JOURNAL (2014)

Ramez Gharabawy Alaa Abd‐Elsayed Hesham Elsharkawy Ehab Farag Kenneth C. Cummings

Continuous peripheral nerve blocks (CPNB) are commonly used for intraoperative and postoperative analgesia. Our study aimed at describing our experience with ambulatory peripheral nerve catheters. After Institutional Review Board approval, records for all patients discharged with supraclavicular or popliteal catheters between January 1, 2009 and December 31, 2011 were reviewed. A licensed practitioner provided verbal and written instructions to the patients prior to discharge. Daily follow-up phone calls were conducted. Patients either removed their catheters at home with real-time simultaneous telephone guidance by a member of the Acute Pain Service or had them removed by the surgeon during a regular office visit. The primary outcome of this analysis was the incidence of complications, categorized as pharmacologic, infectious, or other. The secondary outcome measure was the average daily pain score. Our study included a total of 1059 patients with ambulatory catheters (769 supraclavicular, 290 popliteal). The median infusion duration was 5 days for both groups. Forty-two possible complications were identified: 13 infectious, 23 pharmacologic, and 6 labeled as other. Two patients had retained catheters, 2 had catheter leakage, and 2 had shortness of breath. Our study showed that prolonged use of ambulatory catheters for a median period of 5 days did not lead to an increased incidence of complications.

10.1155/2014/572507

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Citations (9)

Retained Perineural Catheter: A Sentinel Case Report

A&A Practice (2019)

Mohammad Zafeer Khan İlker İnce Wael Ali Sakr Esa Alparslan Turan

We report the rare complication of a retained peripheral nerve block catheter (PNBC). A 45-year-old man with intractable postamputation phantom limb pain was treated with continuous infusions via femoral and sciatic peripheral nerve catheters. The catheters were removed by an emergency department physician 2 days after placement. Five months later, the patient presented with a discharging sinus from the sciatic nerve catheter site. Magnetic resonance imaging (MRI) was inconclusive. Surgical exploration showed 15 cm of retained peripheral nerve catheter, which was removed.

10.1213/xaa.0000000000001063

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Citations (2)

Amputation as an Unusual Treatment for Therapy-Resistant Complex Regional Pain Syndrome, Type 1.

PubMed (2015)

Babak Kateby Kashy Alaa Abd‐Elsayed Ehab Farag Maria Yared Roya Vakili

Complex regional pain syndrome, type 1 (CRPS-1) causes severe pain that can be resistant to multiple treatment modalities. Amputation as a form of long-term treatment for therapy-resistant CRPS-1 is controversial.We report the case of a 38-year-old man who failed all treatment modalities for CRPS-1, including medication, steroid injections, and spinal cord stimulator implantation. Below-the-knee amputation to relieve intractable foot and ankle pain resulted in a favorable outcome for this patient.Select patients with severe CRPS-1 who are unresponsive to all forms of treatment for pain may benefit from amputation as a last option for relief of suffering. Larger studies are needed to prove the efficacy of amputation.

Modalities

10.1043/toj-14-0074

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Citations (9)