151
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Yajnik M, Kou A, Mudumbai SC, Walters TL, Howard SK, Edward Kim T, Mariano ER. Peripheral nerve blocks are not associated with increased risk of perioperative peripheral nerve injury in a Veterans Affairs inpatient surgical population. Reg Anesth Pain Med 2019; 44:81-85. [DOI: 10.1136/rapm-2018-000006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/23/2018] [Accepted: 05/09/2018] [Indexed: 01/21/2023]
Abstract
Background and objectivesPerioperative peripheral nerve injury (PNI) is a known complication in patients undergoing surgery with or without regional anesthesia. The incidence of new PNI in a Veterans Affairs (VA) inpatient surgical population has not been previously described; therefore, the incidence, risk factors, and clinical course of new PNI in this cohort are unknown. We hypothesized that peripheral nerve blocks do not increase PNI incidence.MethodsWe conducted a 5-year review of a Perioperative Surgical Home database including all consecutive surgical inpatients. The primary outcome was new PNI between groups that did or did not have peripheral nerve blockade. Potential confounders were first examined individually using logistic regression, and then included simultaneously together within a mixed-effects logistic regression model. Electronic records of patients with new PNI were reviewed for up to a year postoperatively.ResultsThe incidence of new PNI was 1.2% (114/9558 cases); 30 of 3380 patients with nerve block experienced new PNI (0.9%) compared with 84 of 6178 non-block patients (1.4%; p=0.053). General anesthesia alone, younger age, and American Society of Anesthesiologists physical status <3 were associated with higher incidence of new PNI. Patients who received transversus abdominis plane blocks had increased odds for PNI (OR, 3.20, 95% CI 1.34 to 7.63), but these cases correlated with minimally invasive general and urologic surgery. One hundred PNI cases had 1-year follow-up: 82% resolved by 3 months and only one patient did not recover in a year.ConclusionsThe incidence of new perioperative PNI for VA surgical inpatients is 1.2% and the use of peripheral nerve blocks is not an independent risk factor.
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152
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Vadhanan P, Hussain M, Prakash R. The subcostal nerve as the target for nerve stimulator guided transverse abdominis plane blocks - A feasibility study. Indian J Anaesth 2019; 63:265-269. [PMID: 31000889 PMCID: PMC6460979 DOI: 10.4103/ija.ija_782_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: Transverse Abdominis Plane (TAP) block was originally described as a landmark-based technique. Peripheral nerve stimulator (PNS) guided blocks are still widely performed, where ultrasound is unavailable. Methods: Cadaveric dissections were performed which showed the subcostal nerve following a predictable course at the lateral abdominal wall in the TAP. The subcostal nerve was identified by ultrasound in three volunteers. Stimulation of the subcostal nerve was performed using PNS and landmarks as guidance in and 20 patients. Twitches of the anterior abdominal wall muscles were elicited, and needle position and drug dispersion were confirmed using ultrasound. Results: Out of 32 attempts made, the drug dispersion was appropriate in 24, not appropriate on four insertions and twitches were not elicited in 4 attempts. Conclusion: Nerve stimulator can be used as a guidance for TAP blocks where the availability of ultrasound is limited.
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Affiliation(s)
- Prasanna Vadhanan
- Department of Anaesthesiology, Vinayaka Missions Medical College, Karaikal, Puducherry, India
| | - Mohammed Hussain
- Department of Anaesthesiology, Vinayaka Missions Medical College, Karaikal, Puducherry, India
| | - Revathy Prakash
- Department of Anaesthesiology, Vinayaka Missions Medical College, Karaikal, Puducherry, India
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153
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Ode K, Selvaraj S, Smith AF. Monitoring regional blockade. Anaesthesia 2018; 72 Suppl 1:70-75. [PMID: 28044336 DOI: 10.1111/anae.13742] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 11/28/2022]
Abstract
This review attempts to draw on the published literature to address three practical clinical questions. First, what means of testing the degree of regional blockade pre-operatively are available, and can eventual success or failure be determined soon after injection? Second, is it possible to predict if a block inserted after the induction of general anaesthesia will be effective when the patient wakes? Third, what features, and what duration, should cause concern when a block does not resolve as expected after surgery? Although the relevant literature is limited, we recommend testing of multiple sensory modalities before surgery commences; temperature and thermographic changes may offer additional early warning of success or failure. There are a number of existing methods of assessing nociception under general anaesthesia, but none has yet been applied to gauge the onset of a regional block. Finally, criteria for further investigation and neurological referral when block symptoms persist postoperatively are presented.
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Affiliation(s)
- K Ode
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
| | - S Selvaraj
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
| | - A F Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
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154
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Thoracic epidural hematoma. Can J Anaesth 2018; 66:331-332. [PMID: 30515749 DOI: 10.1007/s12630-018-01266-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/10/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022] Open
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155
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O'Flaherty D, McCartney CJL, Ng SC. Nerve injury after peripheral nerve blockade-current understanding and guidelines. BJA Educ 2018; 18:384-390. [PMID: 33456806 DOI: 10.1016/j.bjae.2018.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- D O'Flaherty
- University College London Hospitals NHS Foundation Trust, London, UK
| | - C J L McCartney
- The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - S C Ng
- University College London Hospitals NHS Foundation Trust, London, UK
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156
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Reply to Dr Orebaugh. Reg Anesth Pain Med 2018; 43:894-895. [PMID: 30339618 DOI: 10.1097/aap.0000000000000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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157
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Barrington MJ, Lirk P. Reducing the risk of neurological complications after peripheral nerve block: what is the role of pressure monitoring? Anaesthesia 2018; 74:9-12. [PMID: 30339281 DOI: 10.1111/anae.14469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M J Barrington
- Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Vic., Australia.,Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Vic., Australia
| | - P Lirk
- Department of Anesthesiology, Peri-operative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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158
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159
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Barrington MJ, Uda Y. Did ultrasound fulfill the promise of safety in regional anesthesia? Curr Opin Anaesthesiol 2018; 31:649-655. [DOI: 10.1097/aco.0000000000000638] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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160
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161
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Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children’s hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children.
Methods
This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy.
Results
There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%).
Conclusions
The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.
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162
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Bomberg H, Wetjen L, Wagenpfeil S, Schöpe J, Kessler P, Wulf H, Wiesmann T, Standl T, Gottschalk A, Döffert J, Hering W, Birnbaum J, Kutter B, Winckelmann J, Liebl-Biereige S, Meissner W, Vicent O, Koch T, Bürkle H, Sessler DI, Volk T. Risks and Benefits of Ultrasound, Nerve Stimulation, and Their Combination for Guiding Peripheral Nerve Blocks. Anesth Analg 2018; 127:1035-1043. [DOI: 10.1213/ane.0000000000003480] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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163
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Saporito A, Quadri C, Capdevila X. The ability of a real-time injection pressure monitoring system to discriminate between perineural and intraneural injection of the sciatic nerve in fresh cadavers. Anaesthesia 2018; 73:1118-1122. [DOI: 10.1111/anae.14330] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A. Saporito
- Bellinzona Regional Hospital; Bellinzona Switzerland
| | - C. Quadri
- Service of Anaesthesia; Lugano Regional Hospital; Lugano Switzerland
| | - X. Capdevila
- Montpellier University Hospital; University Montpellier; France
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164
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Abstract
Regional anesthesia for the acute trauma patient is increasing due to the growing appreciation of its benefits, development of newer techniques and equipment, and more robust training. Block procedures are expanding beyond perioperative interventions performed exclusively by anesthesiologists to paramedics on scene, emergency medicine physicians, and nurse-led services using these techniques early in trauma pain management. Special considerations and indications apply to trauma victims compared with the elective patient and must be appreciated to optimize safety and clinical outcomes. This review discusses current literature and future directions in the growing role of regional anesthesia in acute trauma care.
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Affiliation(s)
- Ian R Slade
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359724, Seattle, WA 98104, USA.
| | - Ron E Samet
- Department of Anesthesiology, Division of Trauma Anesthesiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
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165
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Saraswat A, Gunasekaran S, Choksi N. Safe Use of Epidural Analgesia in a Parturient With Spinocerebellar Ataxia: A Case Report. A A Pract 2018; 11:121-123. [PMID: 29634528 DOI: 10.1213/xaa.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 28-year-old, gravida 7, para 4 woman with medical history of sickle cell trait presented to labor and delivery at 39 weeks of gestation for rupture of membranes. The patient had a history of suspected spinocerebellar ataxia with incomplete workup before the current admission. The patient requested epidural analgesia for labor. Epidural was placed at L3-L4 interspace without any complications and the rest of the labor was uneventful. Magnetic resonance imaging of the brain was performed after the delivery and the diagnosis of spinocerebellar ataxia was confirmed. The patient's neurological status remained stable after the procedure.
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Affiliation(s)
- Aditi Saraswat
- From the Department of Anesthesiology, Pain Medicine and Perioperative Medicine, Henry Ford Hospital, Detroit, Michigan
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166
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Hewson DW, Hardman JG. Physical injuries during anaesthesia. BJA Educ 2018; 18:310-316. [PMID: 33456795 DOI: 10.1016/j.bjae.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- D W Hewson
- Anaesthesia & Critical Care, University of Nottingham, Nottingham, UK
| | - J G Hardman
- Anaesthesia & Critical Care, University of Nottingham, Nottingham, UK
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167
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Çevikkalp E, Erbüyün K, Erbüyün S, Ok G. Ultrasound guided transversus abdominis plane block. Postoperative analgesia in children with spinal dysraphism. Saudi Med J 2018; 39:92-96. [PMID: 29332115 PMCID: PMC5885127 DOI: 10.15537/smj.2018.1.20943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pediatric regional anesthesia is widely used to relieve postoperative pain after abdominal surgery. Commonly used techniques of regional anesthesia include lumbar epidural and caudal block. However, the use of central neuraxial blockade has limitations. It is contraindicated in patients with clotting abnormalities, spinal dysraphism with tethered cord syndrome, meningomyelocele, and following spinal surgery with instrumentation. Ultrasound guided transversus abdominis plane block is a new method of regional anesthesia that can be used in settings where central neuraxial blockade is contraindicated. In this study, we present 5 pediatric cases in which major abdominal surgery was performed but central neuraxial blockade could not be carried out due to spinal abnormalities.
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Affiliation(s)
- Eralp Çevikkalp
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey. E-mail.
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168
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Portela DA, Verdier N, Otero PE. Regional anesthetic techniques for the pelvic limb and abdominal wall in small animals: A review of the literature and technique description. Vet J 2018; 238:27-40. [PMID: 30103913 DOI: 10.1016/j.tvjl.2018.07.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/24/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022]
Abstract
Increasing interest in using peripheral nerve blocks in small animals is evident, given the numerous studies published recently on this topic in important veterinary journals. Initially, research was focused on intraoperative analgesia to the pelvic limb, and several descriptions of lumbosacral plexus, femoral and sciatic nerve blocks have been described in studies. There is recent interest in developing techniques for somatosensory blockade of the abdominal wall. This article is the second part of a two-part review of regional anesthesia (RA) in small animals, and its aim is to discuss the most relevant studies in the veterinary literature, where objective methods of nerve location have been used, and to illustrate in pictures the currently used techniques for providing RA to the abdominal wall and the pelvic limb in small animals.
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Affiliation(s)
- D A Portela
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
| | - N Verdier
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Buenos Aires, Argentina
| | - P E Otero
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Buenos Aires, Argentina
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169
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Emelife PI, Eng MR, Menard BL, Myers AS, Cornett EM, Urman RD, Kaye AD. Adjunct medications for peripheral and neuraxial anesthesia. Best Pract Res Clin Anaesthesiol 2018; 32:83-99. [PMID: 30322466 DOI: 10.1016/j.bpa.2018.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/18/2018] [Indexed: 02/06/2023]
Abstract
Regional and neuraxial anesthesia can provide a safer perioperative experience, greater satisfaction, reduced opioid consumption, and reduction of pain, while minimizing side effects. Ultrasound technology has aided clinicians in depositing local anesthetic medication in precise proximity to targeted peripheral nerves. There are a plethora of adjuvants that have been utilized to prolong local anesthetic actions and enhance effects in peripheral nerve blocks. This manuscript describes the current state of the use of adjuncts, e.g., dexmedetomidine, dexamethasone, clonidine, epinephrine, etc., in regional anesthesia. Additionally, evidence behind dosing and block prolongation is summarized along with patient outcomes, adverse effects, and future directions.
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Affiliation(s)
- Patrick Ifesinachi Emelife
- Department of Anesthesiology, LSU Health Sciences Center, Room 653, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Matthew R Eng
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Bethany L Menard
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Andrew S Myers
- LSU Health Sciences Center, 433 Bolivar St., New Orleans, LA, 70112, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Alan D Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 653, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
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170
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Van Boxem K, Rijsdijk M, Hans G, de Jong J, Kallewaard JW, Vissers K, van Kleef M, Rathmell JP, Van Zundert J. Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group. Pain Pract 2018; 19:61-92. [PMID: 29756333 PMCID: PMC7379698 DOI: 10.1111/papr.12709] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Epidural corticosteroid injections are used frequently worldwide in the treatment of radicular pain. Concerns have arisen involving rare major neurologic injuries after this treatment. Recommendations to prevent these complications have been published, but local implementation is not always feasible due to local circumstances, necessitating local recommendations based on literature review. METHODS A work group of 4 stakeholder pain societies in Belgium, The Netherlands, and Luxembourg (Benelux) has reviewed the literature involving neurological complications after epidural corticosteroid injections and possible safety measures to prevent these major neurologic injuries. RESULTS Twenty-six considerations and recommendations were selected by the work group. These involve the use of imaging, injection equipment particulate and nonparticulate corticosteroids, epidural approach, and maximal volume to be injected. CONCLUSION Raising awareness about possible neurological complications and adoption of safety measures recommended by the work group aim at reducing the risks for these devastating events.
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Affiliation(s)
- Koen Van Boxem
- Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
| | - Mienke Rijsdijk
- Pain Clinic, Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Guy Hans
- Multidisciplinary Pain Center, Antwerp University Hospital, Edegem, Belgium.,Laboratory for Pain Research, University of Antwerp, Wilrijk, Belgium
| | - Jasper de Jong
- Department of Pain Management, Westfriesgasthuis, Hoorn, The Netherlands
| | - Jan Willem Kallewaard
- Department of Anesthesiology and Pain Management, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Maarten van Kleef
- Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - James P Rathmell
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.,Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Jan Van Zundert
- Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium.,Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands
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171
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Pace MM. Axillary Artery Dissection After Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Case Report. A A Pract 2018; 11:19-21. [PMID: 29634561 DOI: 10.1213/xaa.0000000000000725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 52-year-old man with end-stage renal disease underwent ultrasound-guided infraclavicular brachial plexus block for revision of an arteriovenous fistula. On postoperative day 2, the patient developed pain and loss of motor function in the surgical extremity. A computed tomography angiogram revealed complete dissection of the axillary artery. The dissection was emergently treated with a bypass graft, resulting in complete resolution of paralysis and pain. Sensory deficits resolved over the next 3 days. Smoking, hypertension, diabetes mellitus, and chronic intake of a calcineurin inhibitor might have predisposed the patient to iatrogenic arterial dissection.
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Affiliation(s)
- Meredith M Pace
- From the Department of Anesthesiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
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172
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Krol A, Vala A, Phylactides L, Szarko M, Reina MA, De Andres J. Injection pressure mapping of intraneural vs. perineural injections: further lessons from cadaveric studies. Minerva Anestesiol 2018; 84:907-918. [DOI: 10.23736/s0375-9393.18.12230-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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173
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174
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175
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Baeriswyl M, Taffé P, Kirkham KR, Bathory I, Rancati V, Crevoisier X, Cherix S, Albrecht E. Comparison of peripheral nerve blockade characteristics between non-diabetic patients and patients suffering from diabetic neuropathy: a prospective cohort study. Anaesthesia 2018; 73:1110-1117. [PMID: 29858510 DOI: 10.1111/anae.14347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 12/13/2022]
Abstract
Animal data have demonstrated increased block duration after local anaesthetic injections in diabetic rat models. Whether the same is true in humans is currently undefined. We, therefore, undertook this prospective cohort study to test the hypothesis that type-2 diabetic patients suffering from diabetic peripheral neuropathy would have increased block duration after ultrasound-guided popliteal sciatic nerve block when compared with patients without neuropathy. Thirty-three type-2 diabetic patients with neuropathy and 23 non-diabetic control patients, scheduled for fore-foot surgery, were included prospectively. All patients received an ultrasound-guided popliteal sciatic nerve block with a 30 ml 1:1 mixture of lidocaine 1% and bupivacaine 0.5%. The primary outcome was time to first opioid request after block procedure. Secondary outcomes included the time to onset of sensory blockade, and pain score at rest on postoperative day 1 (numeric rating scale 0-10). These outcomes were analysed using an accelerated failure time regression model. Patients in the diabetic peripheral neuropathy group had significantly prolonged median (IQR [range]) time to first opioid request (diabetic peripheral neuropathy group 1440 (IQR 1140-1440 [180-1440]) min vs. control group 710 (IQR 420-1200 [150-1440] min, p = 0.0004). Diabetic peripheral neuropathy patients had a time ratio of 1.57 (95%CI 1.10-2.23, p < 0.01), experienced a 59% shorter time to onset of sensory blockade (median time ratio 0.41 (95%CI 0.28-0.59), p < 0.0001) and had lower median (IQR [range]) pain scores at rest on postoperative day 1 (diabetic peripheral neuropathy group 0 (IQR 0-1 [0-5]) vs. control group 3 (IQR 0-5 [0-9]), p = 0.001). In conclusion, after an ultrasound-guided popliteal sciatic nerve block, patients with diabetic peripheral neuropathy demonstrated reduced time to onset of sensory blockade, with increased time to first opioid request when compared with patients without neuropathy.
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Affiliation(s)
- M Baeriswyl
- Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland
| | - P Taffé
- Institute of Social and Preventive Medicine (IUMSP), Lausanne, Switzerland
| | - K R Kirkham
- Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - I Bathory
- Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland
| | - V Rancati
- Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland
| | - X Crevoisier
- Department of Orthopaedics, Lausanne University Hospital, Lausanne, Switzerland
| | - S Cherix
- Department of Orthopaedics, Lausanne University Hospital, Lausanne, Switzerland
| | - E Albrecht
- Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland
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176
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Abstract
A 76-year-old male presented for reverse total shoulder arthroplasty (TSA) in the beach chair position. A preoperative interscalene nerve catheter was placed under direct ultrasound-guidance utilizing a posterior in-plane approach. On POD 2, the catheter was removed. Three weeks postoperatively, the patient reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated right hemidiaphragm. Pulmonary function testing revealed worsening deficit from presurgical values consistent with phrenic nerve palsy. The patient decided to continue conservative management and declined further invasive testing or treatment. He was followed for one year postoperatively with moderate improvement of his exertional dyspnea over that period of time. The close proximity of the phrenic nerve to the brachial plexus in combination with its frequent anatomical variation can lead to unintentional mechanical trauma, intraneural injection, or chemical injury during performance of ISB. The only previously identified risk factor for PPNP is cervical degenerative disc disease. Although PPNP has been reported following TSA in the beach chair position without the presence of a nerve block, it is typically presumed as a complication of the interscalene block. Previously published case reports and case series of PPNP complicating ISBs all describe nerve blocks performed with either paresthesia technique or localization with nerve stimulation. We report a case of a patient experiencing PPNP following an ultrasound-guided placement of an interscalene nerve catheter.
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177
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Aubuchon A, Arnold WD, Hoyle JC. Reply. Muscle Nerve 2018; 57:E114. [DOI: 10.1002/mus.26019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Adam Aubuchon
- Intermountain Neuroscience Institute; Murray Utah USA
| | - W. David Arnold
- Department of Neurology, Neuromuscular Division; The Ohio State University; Columbus Ohio USA
| | - J. Chad Hoyle
- Department of Neurology, Neuromuscular Division; The Ohio State University; Columbus Ohio USA
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178
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Wiesmann T, Müller S, Müller HH, Wulf H, Steinfeldt T. Effect of bupivacaine and adjuvant drugs for regional anesthesia on nerve tissue oximetry and nerve blood flow. J Pain Res 2018; 11:227-235. [PMID: 29416372 PMCID: PMC5789040 DOI: 10.2147/jpr.s152230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Nerve blood flow has a critical role in acute and chronic pathologies in peripheral nerves. Influences of local anesthetics and adjuvants on tissue perfusion and oxygenation are deemed as relevant factors for nerve damage after peripheral regional anesthesia. The link between low tissue perfusion due to local anesthetics and resulting tissue oxygenation is unclear. Methods Combined tissue spectrophotometry and laser-Doppler flowmetry were used to assess nerve blood flow in 40 surgically exposed median nerves in pigs, as well as nerve tissue oximetry for 60 min. After baseline measurements, test solutions saline (S), bupivacaine (Bupi), bupivacaine with epinephrine (BupiEpi), and bupivacaine with clonidine (BupiCloni) were applied topically. Results Bupivacaine resulted in significant decrease in nerve blood flow, as well as tissue oximetry values, compared with saline control. Addition of epinephrine resulted in a rapid, but nonsignificant, reduction of nerve blood flow and extensive lowering of tissue oximetry levels. The use of clonidine resulted in a reduction of nerve blood flow, comparable to bupivacaine alone (relative blood flow at T60 min compared with baseline, S: 0.86 (0.67-1.18), median (25th-75th percentile); Bupi: 0.33 (0.25-0.60); BupiCloni: 0.43 (0.38-0.63); and BupiEpi: 0.41(0.30-0.54). The use of adjuvants did not result in any relevant impairment of tissue oximetry values (saturation values in percent at T60, S: 91.5 [84-95]; Bupi: 76 [61-86]; BupiCloni: 84.5 [76-91]; and BupiEpi: 91 [56-92]). Conclusion The application of bupivacaine results in lower nerve blood flow, but does not induce relevant ischemia. Despite significant reductions in nerve blood flow, the addition of clonidine or epinephrine to bupivacaine had no significant impact on nerve tissue oximetry compared with bupivacaine alone. Nerve ischemia due to local anesthetics is not enhanced by the adjuvants clonidine or epinephrine.
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Affiliation(s)
- Thomas Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Marburg, Philipps University, Marburg
| | - Stefan Müller
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Marburg, Philipps University, Marburg.,Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen, Justus-Liebig-University, Giessen
| | - Hans-Helge Müller
- Institute of Medical Biometry and Epidemiology, Philipps University, Marburg
| | - Hinnerk Wulf
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Marburg, Philipps University, Marburg
| | - Thorsten Steinfeldt
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Marburg, Philipps University, Marburg.,Department of Anesthesiology and Intensive Care Medicine, Diakoniekrankenhaus Schwäbisch Hall, Schwäbisch Hall, Germany
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179
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Advances of Techniques in Deep Regional Blocks. BIOMED RESEARCH INTERNATIONAL 2018; 2017:7268308. [PMID: 29349079 PMCID: PMC5733986 DOI: 10.1155/2017/7268308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 11/17/2022]
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180
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Hewson DW, Bedforth NM, Hardman JG. Peripheral nerve injury arising in anaesthesia practice. Anaesthesia 2018; 73 Suppl 1:51-60. [DOI: 10.1111/anae.14140] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- D. W. Hewson
- Department of Anaesthesia; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - N. M. Bedforth
- Department of Anaesthesia; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - J. G. Hardman
- Anaesthesia and Critical Care; Division of Clinical Neuroscience; School of Medicine; University of Nottingham; UK
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181
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Hewson DW, Bedforth NM, Hardman JG. Spinal cord injury arising in anaesthesia practice. Anaesthesia 2018; 73 Suppl 1:43-50. [DOI: 10.1111/anae.14139] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 01/07/2023]
Affiliation(s)
- D. W. Hewson
- Department of Anaesthesia; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - N. M. Bedforth
- Department of Anaesthesia; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - J. G. Hardman
- Anaesthesia & Critical Care; School of Medicine; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
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182
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Pontes JPJ, Mendes FF, Vasconcelos MM, Batista NR. [Evaluation and perioperative management of patients with diabetes mellitus. A challenge for the anesthesiologist]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2018; 68:75-86. [PMID: 28571661 PMCID: PMC9391782 DOI: 10.1016/j.bjan.2017.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/04/2017] [Accepted: 04/12/2017] [Indexed: 11/27/2022]
Abstract
Diabetes mellitus (DM) is characterized by alteration in carbohydrate metabolism, leading to hyperglycemia and increased perioperative morbidity and mortality. It evolves with diverse and progressive physiological changes, and the anesthetic management requires attention regarding this disease interference in multiple organ systems and their respective complications. Patient's history, physical examination, and complementary exams are important in the preoperative management, particularly glycosylated hemoglobin (HbA1c), which has a strong predictive value for complications associated with diabetes. The goal of surgical planning is to reduce the fasting time and maintain the patient's routine. Patients with Type 1 DM must receive insulin (even during the preoperative fast) to meet the basal physiological demands and avoid ketoacidosis. Whereas patients with Type 2 DM treated with multiple injectable and/or oral drugs are susceptible to develop a hyperglycemic hyperosmolar state (HHS). Therefore, the management of hypoglycemic agents and different types of insulin is fundamental, as well as determining the surgical schedule and, consequently, the number of lost meals for dose adjustment and drug suspension. Current evidence suggests the safe target to maintain glycemic control in surgical patients, but does not conclude whether it should be obtained with either moderate or severe glycemic control.
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183
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Evaluation and perioperative management of patients with diabetes mellitus. A challenge for the anesthesiologist. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 28571661 PMCID: PMC9391782 DOI: 10.1016/j.bjane.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diabetes mellitus (DM) is characterized by alteration in carbohydrate metabolism, leading to hyperglycemia and increased perioperative morbidity and mortality. It evolves with diverse and progressive physiological changes, and the anesthetic management requires attention regarding this disease interference in multiple organ systems and their respective complications. Patient's history, physical examination, and complementary exams are important in the preoperative management, particularly glycosylated hemoglobin (HbA1c), which has a strong predictive value for complications associated with diabetes. The goal of surgical planning is to reduce the fasting time and maintain the patient's routine. Patients with Type 1 DM must receive insulin (even during the preoperative fast) to meet the basal physiological demands and avoid ketoacidosis. Whereas patients with Type 2 DM treated with multiple injectable and/or oral drugs are susceptible to develop a hyperglycemic hyperosmolar state (HHS). Therefore, the management of hypoglycemic agents and different types of insulin is fundamental, as well as determining the surgical schedule and, consequently, the number of lost meals for dose adjustment and drug suspension. Current evidence suggests the safe target to maintain glycemic control in surgical patients, but does not conclude whether it should be obtained with either moderate or severe glycemic control.
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184
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Tseng KY, Wang HC, Chang LL, Cheng KI. Advances in Experimental Medicine and Biology: Intrafascicular Local Anesthetic Injection Damages Peripheral Nerve-Induced Neuropathic Pain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1099:65-76. [PMID: 30306515 DOI: 10.1007/978-981-13-1756-9_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Peripheral nerve blockade (PNB) is advantageous for patients undergoing surgery to decrease the perioperative opioid consumptions and enhance recovery after surgery.Inadvertent local anesthetic (LA) administration into nerve fiber intrafascicularly easily results in unrecognized nerve injury. Using nerve block guidance either by ultrasound, electrical nerve stimulator, or using pressure devices does not prevent nerve damage, even though most of the nerve injury is transiently. The incidence of neurologic symptoms or neuropathy is in the range of 0.02-2.2%, and no significant difference of postoperative neurologic symptoms is found as compared with using ultrasound or guided nerve stimulator technique. However, intrafascicular lidocaine brought about macrophage migration into the damaged fascicle, Schwann cell proliferation, increased intensity of myelin basic protein, and shorten withdrawal time to mechanical stimuli. In dorsal root ganglion (DRG), intrafascicular LA injection increased the activated transcriptional factor 3 (ATF-3) and downregulated Nav1.8 (Nav1.8). In spinal dorsal horn (SDH), the microglia and astrocytes located in SDH were activated and proliferated after intrafascicular LA injection and returned to baseline gradually at the end of the month. This is a kind of neuropathic pain, so low injection pressure should be maintained, the correct needle bevel used, nerve stimulator or ultrasound guidance applied, and careful and deliberately slow injection employed as important parts of the injection technique to prevent intrafascicular LA administration-induced neuropathic pain.
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Affiliation(s)
- Kuang-Yi Tseng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chen Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lin-Li Chang
- Department of Microbiology and Immunology, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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185
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186
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Transversus Abdominis Plane Catheters for Analgesia Following Abdominal Surgery in Adults. Reg Anesth Pain Med 2018; 43:5-13. [DOI: 10.1097/aap.0000000000000681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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187
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VanderWielen B, Rubenstein L, Shnider M, Ku C, Wakakuwa J. Recognition of a Thoracic Epidural Hematoma in the Setting of Transient Paralysis: A Case Report. ACTA ACUST UNITED AC 2017; 8:294-296. [PMID: 28079662 DOI: 10.1213/xaa.0000000000000492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 71-year-old woman on aspirin presented for a distal pancreatectomy, splenectomy, and partial colectomy with a T8/9 epidural catheter placed preoperatively in 3 attempts. Prophylactic 5000 units of subcutaneous heparin were given before the procedure. After catheter removal on postoperative day 2, the patient developed transient bilateral lower extremity paralysis, with near complete recovery within 30 minutes. An urgent MRI revealed a T4-T8 epidural hematoma prompting an emergent T3-T8 laminectomy. This case presentation highlights the need for heightened awareness regarding complications related to neuraxial analgesia in patients receiving unfractionated heparin for thromboembolism prophylaxis with concurrent aspirin use.
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Affiliation(s)
- Beth VanderWielen
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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188
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Umbrain V, Verborgh C, Chierchia GB, de Asmundis C, Brugada P, Meir ML. One-stage Approach for Hybrid Atrial Fibrillation Treatment. Arrhythm Electrophysiol Rev 2017; 6:210-216. [PMID: 29326837 PMCID: PMC5739889 DOI: 10.15420/2017.36.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/16/2017] [Indexed: 01/13/2023] Open
Abstract
The one-stage approach for hybrid atrial fibrillation involves the simultaneous and close cooperation of different medical specialties. This review attempts to describe its challenging issues, exposing a plan to balance thrombotic risk and bleeding risk. It describes the combined surgical-electrophysiological procedure. Specific topics, involving hemodynamic, fluid and respiratory management during surgery are considered, and problems related to postoperative pain are surveyed.
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Affiliation(s)
- Vincent Umbrain
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels,Free University of Brussels, Belgium
| | - Christian Verborgh
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels,Free University of Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, University Hospital Brussels,Free University of Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, University Hospital Brussels,Free University of Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, University Hospital Brussels,Free University of Brussels, Belgium
| | - Mark La Meir
- Department of Cardiac Surgery, University Hospital Brussels,Free University of Brussels, Belgium
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189
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Barrington MJ, Gray AT. Is temporal association between popliteal-sciatic block and nerve injury sufficient evidence to assign etiology? Muscle Nerve 2017; 57:E113. [PMID: 29178287 DOI: 10.1002/mus.26020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/11/2017] [Accepted: 10/14/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Michael J Barrington
- Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew T Gray
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
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190
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Guay J, Johnson RL, Kopp S. Nerve blocks or no nerve blocks for pain control after elective hip replacement (arthroplasty) surgery in adults. Cochrane Database Syst Rev 2017; 10:CD011608. [PMID: 29087547 PMCID: PMC6485776 DOI: 10.1002/14651858.cd011608.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND It is estimated that over 300,000 total hip replacements are performed each year in the USA. For European countries, the number of hip replacement procedures per 100,000 people performed in 2007 varied from less than 50 to over 250. To facilitate postoperative rehabilitation, pain must be adequately treated. Peripheral nerve blocks and neuraxial blocks have been proposed to replace or supplement systemic analgesia. OBJECTIVES We aimed to compare the relative effects (benefits and harms) of the different nerve blocks that may be used to relieve pain after elective hip replacement in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 12, 2016), MEDLINE (Ovid SP) (1946 to December Week 49, 2016), Embase (Ovid SP) (1980 to December week 49, 2016), CINAHL (EBSCO host) (1982 to 6 December 2016), ISI Web of Science (1973 to 6 December 2016), Scopus (from inception to December 2016), trials registers, and relevant web sites. SELECTION CRITERIA We included all randomized controlled trials (RCTs) performed in adults undergoing elective primary hip replacement and comparing peripheral nerve blocks to any other pain treatment modality. We applied no language or publication status restrictions. DATA COLLECTION AND ANALYSIS Data were extracted independently by two review authors. We contacted study authors. MAIN RESULTS We included 51 RCTs with 2793 participants; of these 45 RCTs (2491 participants: peripheral nerve block = 1288; comparators = 1203) were included in meta-analyses. There are 11 ongoing studies and three awaiting classification.Compared to systemic analgesia alone, peripheral nerve blocks reduced: pain at rest on arrival in the postoperative care unit (SMD -1.12, 95% CI -1.67 to -0.56; 9 trials, 429 participants; equivalent to 3.2 on 0 to 10 scale; moderate-quality evidence); risk of acute confusional status: risk ratio (RR) 0.10 95% CI 0.02 to 0.54; 1 trial, 225 participants; number needed to treat for additional benefit (NNTB) 12, 95% CI 11 to 22; very low-quality evidence); pruritus (RR 0.16, 95% CI 0.04 to 0.70; 2 trials, 259 participants for continuous peripheral nerve blocks; NNTB 4 (95% CI 4 to 8); very low-quality evidence); hospital length of stay (SMD -0.75, 95% CI -1.02 to -0.48; very low-quality evidence; 2 trials, 249 participants; equivalent to 0.75 day). Participant satisfaction increased (SMD 0.67, 95% CI 0.45 to 0.89; low-quality evidence; 5 trials, 363 participants; equivalent to 2.4 on 0 to 10 scale). We did not find a difference for the number of participants walking on postoperative day one (very low-quality evidence). Two nerve block-related complications were reported: one local haematoma and one delayed persistent paresis.Compared to neuraxial blocks, peripheral nerve blocks reduced the risk of pruritus (RR 0.33, 95% CI 0.19 to 0.58; 6 trials, 299 participants; moderate-quality evidence; NNTB 6 (95% CI 5 to 9). We did not find a difference for pain at rest on arrival in the postoperative care unit (moderate-quality evidence); number of nerve block-related complications (low-quality evidence); acute confusional status (very low-quality evidence); hospital length of stay (low quality-evidence); time to first walk (low-quality evidence); or participant satisfaction (high-quality evidence).We found that peripheral nerve blocks provide better pain control compared to systemic analgesia with no major differences between peripheral nerve blocks and neuraxial blocks. We also found that peripheral nerve blocks may be associated with reduced risk of postoperative acute confusional state and a modest reduction in hospital length of stay that could be meaningful in terms of cost reduction considering the increasing numbers of procedures performed annually. AUTHORS' CONCLUSIONS Compared to systemic analgesia alone, there is moderate-quality evidence that peripheral nerve blocks reduce postoperative pain, low-quality evidence that patient satisfaction is increased and very low-quality evidence for reductions in acute confusional status, pruritus and hospital length of stay .We found moderate-quality evidence that peripheral nerve blocks reduce pruritus compared with neuraxial blocks.The 11 ongoing studies, once completed, and the three studies awaiting classification may alter the conclusions of the review once assessed.
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Affiliation(s)
- Joanne Guay
- University of SherbrookeDepartment of Anesthesiology, Faculty of MedicineSherbrookeQuebecCanada
| | - Rebecca L Johnson
- Mayo Clinic College of MedicineDepartment of Anesthesiology and Perioperative Medicine200 First Street SWRochesterMNUSA55905
| | - Sandra Kopp
- Mayo Clinic College of MedicineDepartment of Anesthesiology and Perioperative Medicine200 First Street SWRochesterMNUSA55905
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191
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Kiasari AZ, Babaei A, Alipour A, Motevalli S, Baradari AG. Comparison of Hemodynamic Changes in Unilateral Spinal Anesthesia Versus Epidural Anesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial. Med Arch 2017; 71:274-279. [PMID: 28974849 PMCID: PMC5585788 DOI: 10.5455/medarh.2017.71.274-279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Unilateral spinal anesthesia is used to limit the spread of block. The aim of the present study was to compare hemodynamic changes and complications in unilateral spinal anesthesia and epidural anesthesia below the T10 sensory level in unilateral surgeries. MATERIALS AND METHODS In this double-blind randomized clinical trial in total 120 patients were randomly divided into a unilateral spinal anesthesia group (Group S) and an epidural anesthesia group (Group E). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rates were measured before and immediately after the administration of spinal or epidural anesthesia and then at 5-, 10-, 15-, 20-, 25-, and 30-min intervals. The rates of prescribed ephedrine and intraoperative respiratory arrest were recorded, in addition to postoperative nausea and vomiting, puncture headaches, and back pain during the first 24 h after the surgery. RESULTS SBP, DBP, and MAP values initially showed a statistically significant downward trend in both groups (p = 0.001). The prevalence of hypotension in Group S was lower than in Group E, and the observed difference was statistically significant (p < 0.0001). The mean heart rate change in Group E was greater than in Group S, although the difference was not statistically significant (p = 0.68). The incidence of prescribed ephedrine in response to a critical hemodynamic situation was 5.1% (n = 3) and 75% (n = 42) in Group S and Group E, respectively (p = 0.0001). The incidence of headaches, back pain, and nausea/vomiting was 15.3%, 15.3%, and 10.2% in Group S and 1.8%, 30.4%, and 5.4% in Group E (p = 0.017, 0.07, and 0.49, respectively). CONCLUSION Hemodynamic stability, reduced administration of ephedrine, a simple, low-cost technique, and adequate sensory and motor block are major advantages of unilateral spinal anesthesia.
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Affiliation(s)
- Alieh Zamani Kiasari
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Anahita Babaei
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Epidemiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shima Motevalli
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Afshin Gholipour Baradari
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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192
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Lam SKH, Reeves KD, Cheng AL. Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7920438. [PMID: 29226148 PMCID: PMC5684526 DOI: 10.1155/2017/7920438] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/19/2017] [Accepted: 07/24/2017] [Indexed: 01/29/2023]
Abstract
Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain. The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described. Here we describe ultrasound-guided methods for hydrodissection of deep nerve structures in the upper torso, including the stellate ganglion, brachial plexus, cervical nerve roots, and paravertebral spaces. We retrospectively reviewed the outcomes of 100 hydrodissection treatments in 26 consecutive cases with a neuropathic pain duration of 16 ± 12.2 months and the mean Numeric Pain Rating Scale (NPRS) 0-10 pain level of 8.3 ± 1.3. The mean percentage of analgesia during each treatment session involving D5W injection without anesthetic was 88.1% ± 9.8%. The pretreatment Numeric Pain Rating Scale score of 8.3 ± 1.3 improved to 1.9 ± 0.9 at 2 months after the last treatment. Patients received 3.8 ± 2.6 treatments over 9.7 ± 7.8 months from the first treatment to the 2-month posttreatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half. Our results confirm the analgesic effect of D5W injection and suggest that hydrodissection using D5W provides cumulative pain reduction.
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Affiliation(s)
- Stanley K. H. Lam
- Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- KH Lam Musculoskeletal Pain Management and Sports Injury Centre, Kowloon, Hong Kong
- The Hong Kong Institute of Musculoskeletal Medicine, Tsuen Wan, Hong Kong
| | | | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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194
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Goldberg SF, Pozek JPJ, Schwenk ES, Baratta JL, Beausang DH, Wong AK. Practical Management of a Regional Anesthesia-Driven Acute Pain Service. Adv Anesth 2017; 35:191-211. [PMID: 29103573 DOI: 10.1016/j.aan.2017.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Stephen F Goldberg
- Department of Anesthesiology, Thomas Jefferson University, Suite 8290, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - John-Paul J Pozek
- Department of Anesthesiology, Thomas Jefferson University, Suite 8290, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Thomas Jefferson University, Suite 8290, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA.
| | - Jaime L Baratta
- Department of Anesthesiology, Thomas Jefferson University, Suite 8290, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - David H Beausang
- Department of Anesthesiology, Thomas Jefferson University, Suite 8290, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Andrew K Wong
- Department of Anesthesiology, Thomas Jefferson University, Suite 8290, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA
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Abstract
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. A woman who requests epidural analgesia during labor should not be deprived of this service based on the status of her health insurance. Third-party payers that provide reimbursement for obstetric services should not deny reimbursement for labor analgesia because of an absence of "other medical indications." Anesthesia services should be available to provide labor analgesia and surgical anesthesia in all hospitals that offer maternal care (levels I-IV) (). Although the availability of different methods of labor analgesia will vary from hospital to hospital, the methods available within an institution should not be based on a patient's ability to pay.The American College of Obstetricians and Gynecologists believes that in order to allow the maximum number of patients to benefit from neuraxial analgesia, labor nurses should not be restricted from participating in the management of pain relief during labor. Under appropriate physician supervision, labor and delivery nursing personnel who have been educated properly and have demonstrated current competence should be able to participate in the management of epidural infusions.The purpose of this document is to review medical options for analgesia during labor and anesthesia for surgical procedures that are common at the time of delivery. Nonpharmacologic options such as massage, immersion in water during the first stage of labor, acupuncture, relaxation, and hypnotherapy are not covered in this document, though they may be useful as adjuncts or alternatives in many cases.
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de Neumann L, Clairoux A, Brulotte V, McCartney CJL. In Search of the Perfect Balance: a Narrative Review of Analgesic Techniques for Total Knee Arthroplasty. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0218-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Various nerve blocks with local anaesthetic agents have been used to reduce pain after hip fracture and subsequent surgery. This review was published originally in 1999 and was updated in 2001, 2002, 2009 and 2017. OBJECTIVES This review focuses on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anaesthesia for hip fracture surgery. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards. SEARCH METHODS For the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8), MEDLINE (Ovid SP, 1966 to August week 1 2016), Embase (Ovid SP, 1988 to 2016 August week 1) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to August week 1 2016), as well as trial registers and reference lists of relevant articles. SELECTION CRITERIA We included randomized controlled trials (RCTs) involving use of nerve blocks as part of the care provided for adults aged 16 years and older with hip fracture. DATA COLLECTION AND ANALYSIS Two review authors independently assessed new trials for inclusion, determined trial quality using the Cochrane tool and extracted data. When appropriate, we pooled results of outcome measures. We rated the quality of evidence according to the GRADE Working Group approach. MAIN RESULTS We included 31 trials (1760 participants; 897 randomized to peripheral nerve blocks and 863 to no regional blockade). Results of eight trials with 373 participants show that peripheral nerve blocks reduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.41, 95% confidence interval (CI) -2.14 to -0.67; equivalent to -3.4 on a scale from 0 to 10; I2 = 90%; high quality of evidence). Effect size was proportionate to the concentration of local anaesthetic used (P < 0.00001). Based on seven trials with 676 participants, we did not find a difference in the risk of acute confusional state (risk ratio (RR) 0.69, 95% CI 0.38 to 1.27; I2 = 48%; very low quality of evidence). Three trials with 131 participants reported decreased risk for pneumonia (RR 0.41, 95% CI 0.19 to 0.89; I2 = 3%; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 5 to 72; moderate quality of evidence). We did not find a difference in risk of myocardial ischaemia or death within six months, but the number of participants included was well below the optimal information size for these two outcomes. Two trials with 155 participants reported that peripheral nerve blocks also reduced time to first mobilization after surgery (mean difference -11.25 hours, 95% CI -14.34 to -8.15 hours; I2 = 52%; moderate quality of evidence). One trial with 75 participants indicated that the cost of analgesic drugs was lower when they were given as a single shot block (SMD -3.48, 95% CI -4.23 to -2.74; moderate quality of evidence). AUTHORS' CONCLUSIONS High-quality evidence shows that regional blockade reduces pain on movement within 30 minutes after block placement. Moderate-quality evidence shows reduced risk for pneumonia, decreased time to first mobilization and cost reduction of the analgesic regimen (single shot blocks).
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Affiliation(s)
- Joanne Guay
- University of SherbrookeDepartment of Anesthesiology, Faculty of MedicineSherbrookeQuebecCanada
| | - Martyn J Parker
- Peterborough and Stamford Hospitals NHS Foundation TrustDepartment of OrthopaedicsPeterborough City HospitalCBU PO Box 211, Bretton GatePeterboroughCambridgeshireUKPE3 9GZ
| | - Richard Griffiths
- Peterborough and Stamford Hospitals NHS Foundation TrustDepartment of AnaesthesiaEdith Cavell HospitalBretton GatePeterboroughCambridgeshireUKPE26 2UA
| | - Sandra Kopp
- Mayo Clinic College of MedicineDepartment of Anesthesiology and Perioperative Medicine200 1st St SWRochesterMNUSA55901
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Williams BA, Ibinson JW, Gould AJ, Mangione MP. The Incidence of Peripheral Nerve Injury After Multimodal Perineural Anesthesia/Analgesia Does Not Appear to Differ from That Following Single-Drug Nerve Blocks (2011-2014). PAIN MEDICINE 2017; 18:628-636. [PMID: 26896319 DOI: 10.1093/pm/pnv107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/20/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Brian A Williams
- Department of Anesthesiology, University of Pittsburgh; Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - James W Ibinson
- Department of Anesthesiology, University of Pittsburgh; Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Andrew J Gould
- Robert Packer Memorial Hospital, Sayre, Pennsylvania, USA
| | - Michael P Mangione
- Department of Anesthesiology, University of Pittsburgh; Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Kohan L, Salajegheh R, Hamill-Ruth RJ, Yerra S, Butz J. A review and survey of policies utilized for interventional pain procedures: a need for consensus. J Pain Res 2017; 10:625-634. [PMID: 28360531 PMCID: PMC5364016 DOI: 10.2147/jpr.s126851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Other than the newly published anticoagulation guidelines, there are currently few recommendations to assist pain medicine physicians in determining the safety parameters to follow when performing interventional pain procedures. Little information exists regarding policies for oral intake, cumulative steroid dose limits, driving restrictions with and without sedation, and routine medication use for interventional procedures. Methods A 16-question survey was developed on common policies currently in use for interventional pain procedures. The questionnaire was distributed through the American Society of Regional Anesthesia and Pain Medicine and American Academy of Pain Medicine. We sought to statistically analyze the range of policies being used by pain medicine physicians and to determine if there are any commonly accepted standards. Results A total of 337 physicians out of 4037 members responded to our survey with a response rate of 8.4%. A total of 82% of these respondents used a sedative agent while performing an interventional pain procedure. The majority of respondents required drivers after procedures, except after trigger points. A total of 47% indicated that they have an nil per os (NPO) policy for procedures without sedation. A total of 98% reported that they had an anticoagulation policy before an interventional procedure. A total of 17% indicated that the interval between steroid doses was <2 weeks, while 53% indicated that they waited 2–4 weeks between steroid doses. Conclusion Our study has clearly demonstrated a wide variation in the current practice among physicians regarding sedation, NPO status, steroid administration, and the need for designated drivers. There was much higher endorsement of policies regarding anticoagulation. There is an obvious need for evidence-based guidelines for these aspects of interventional pain care to improve patient safety and minimize the risk of adverse events.
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Affiliation(s)
- Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - Reza Salajegheh
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | | | - Sandeep Yerra
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - John Butz
- West River Anesthesiology Consultants, Rapid City, SD, USA
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