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Abdel Fattah ME, Ibrahim OS, Gouda NM, Abdel-Hak MM. Effectiveness of Ultrasound Guided Erector Spinae Plane Block Compared to Ultrasound Guided Modified Pectoral Nerves Block in Modified Radical Mastectomy: A Randomized Single Blinded Study. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2129134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mohamed Elsaid Abdel Fattah
- Anesthesia, Surgical ICU and Pain Management Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Osama Sayed Ibrahim
- Anesthesia, Surgical ICU and Pain Management Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nevine Mahmoud Gouda
- Anesthesia, Surgical ICU and Pain Management Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Mohamed Abdel-Hak
- Anesthesia, Surgical ICU and Pain Management Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Regional anesthesia and analgesia for trauma: an updated review. Curr Opin Anaesthesiol 2022; 35:613-620. [PMID: 36044292 DOI: 10.1097/aco.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW This narrative review is an updated summary of the value of regional anesthesia and analgesia for trauma and the special considerations when optimizing pain management and utilizing regional analgesia for acute traumatic pain. RECENT FINDINGS In the setting of the opioid epidemic, the need for multimodal analgesia in trauma is imperative. It has been proposed that inadequately treated acute pain predisposes a patient to increased risk of developing chronic pain and continued opioid use. Enhanced Regional Anesthesia techniques along with multimodal pain therapies is thought to reduce the stress response and improve patient's short- and long-term outcomes. SUMMARY Our ability to save life and limb has improved, but our ability to manage acute traumatic pain continues to lag. Understanding trauma-specific concerns and tailoring the analgesia to a patient's specific injuries can increase a patient's immediate comfort and long-term outcome as well.
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Aguirre JA, Wolmarans M, Borgeat A. Acute Extremity Compartment Syndrome and (Regional): Anesthesia: The Monster Under the Bed. Anesthesiol Clin 2022; 40:491-509. [PMID: 36049877 DOI: 10.1016/j.anclin.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Acute compartment syndrome (ACS) is a potential orthopedic emergency that leads, without prompt diagnosis and immediate treatment with surgical fasciotomy, to permanent disability. The role of regional anesthesia (RA) for analgesia in patients at risk for ACS remains unjustifiably controversial. This critical review aims to improve the perception of the published literature to answer the question, whether RA techniques actually delay or may even help to hasten the diagnosis of ACS. According to literature, peripheral RA alone does not delay ACS diagnosis and surgical treatment. Only in 4 clinical cases, epidural analgesia was associated with delayed ACS diagnosis.
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Affiliation(s)
- José A Aguirre
- Institute of Anaesthesiology, Triemli City Hospital Zurich, Birmensdorferstrasse 497, 8063 Zürich, Switzerland; Balgrist Campus, Lengghalde 5, 8008 Zürich, Switzerland.
| | - Morné Wolmarans
- Department of Anesthesia, Norfolk and Norwich University Hospital NHS Trust, Regional Anesthesia UK (RA-UK), Colney Lane, Norwich NR4 7UY, UK
| | - Alain Borgeat
- Balgrist Campus, Lengghalde 5, 8008 Zürich, Switzerland; Department of Surgery, University of Illinois at Chicago, 402 CSB MC 958840 South Wood Street, Chicago, IL 60612, USA
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Pain management strategies in orthopedic extremity trauma. Int Anesthesiol Clin 2021; 59:48-57. [PMID: 33710002 DOI: 10.1097/aia.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kolstadbraaten KM, Spreng UJ, Wisloeff‐Aase K, Gaarder C, Naess PA, Raeder J. Incidence of chronic pain 6 y after major trauma. Acta Anaesthesiol Scand 2019; 63:1074-1078. [PMID: 31012096 DOI: 10.1111/aas.13380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Life saving measures is the main focus in the initial treatment of major trauma. In surviving patients, chronic pain may be a serious problem, but the long term incidence and potential risk factors are not very well studied. METHODS All adult trauma patients included in the institutional trauma registry in 2007 were assessed for eligibility. Among exclusion criteria were: Injury Severity Score < 9, endotracheal intubation before or during admission, spinal cord lesion, known chronic drug or substance abuse, major surgery within 3 h after admission. A patient questionnaire was sent out 6 y after injury focusing on frequency and intensity of pain. A subgroup analysis was done in patients with thoracic injuries, comparing patients with epidural analgesia (EDA) and patients without. RESULTS Sixty-eight patients were included in the study. Sixty-nine percent reported pain 6 y after injury and 24% had severe pain. The severity of the injury was a risk factor for development of chronic pain, whereas pain during initial hospital stay was not. In patients with thoracic injuries there was no correlation between initial treatment with EDA and decreased incidence of chronic pain, however patient numbers were small. Opioids were the main analgesics used initially; no patients received non-steroidal anti-inflammatory drugs or peripheral nerve blocks during the first 24 h. CONCLUSION Two thirds of the trauma patients had chronic pain 6 y after injury and one out of four had severe pain. The initial pain treatment was focused on opioids.
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Affiliation(s)
| | | | - Kristin Wisloeff‐Aase
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
- Faculty of Medicine, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Christine Gaarder
- Department of Traumatology Oslo University Hospital Oslo Norway
- Faculty of Medicine, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Paal Aksel Naess
- Department of Traumatology Oslo University Hospital Oslo Norway
- Faculty of Medicine, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Johan Raeder
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
- Faculty of Medicine, Institute of Clinical Medicine University of Oslo Oslo Norway
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Petrucci E, Pizzi B, Scimia P, Conti G, Di Carlo S, Santini A, Fusco P. Wireless and Low-Weight Technologies: Advanced Medical Assistance During a Cave Rescue: A Case Report. Wilderness Environ Med 2018; 29:248-251. [PMID: 29804622 DOI: 10.1016/j.wem.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 11/17/2022]
Abstract
Trauma care in cave rescue is a unique situation that requires an advanced and organized approach with medical and technical assistance because of the extreme environmental conditions and logistical factors. In caving accidents, the most common injuries involve lower limbs. We describe an advanced medical rescue performed by the Italian Corpo Nazionale del Soccorso Alpino e Speleologico, in which extended focused assessment with sonography for trauma and an ultrasound-guided adductor canal block were performed on a patient with a knee distortion directly in the cave. The rescue team inside the cave shared data on patient monitoring and the ultrasound scanning in real time with rescuers at the entrance, using a video conference powered by the new Ermes system. The use of handheld, battery-powered, low-weight, multiparametric monitors, ultrasound machines, and digital data transmission systems could ensure complete medical assistance in harsh environmental conditions such as those found in a cave.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anaesthesia and Intensive Care Unit, SS Filippo e Nicola Academic Hospital of Avezzano, L'Aquila, Italy.
| | - Barbara Pizzi
- Department of Anaesthesia and Intensive Care Unit, SS Filippo e Nicola Academic Hospital of Avezzano, L'Aquila, Italy
| | - Paolo Scimia
- Department of Anaesthesia, Analgesia and Perioperative Medicine, ASST of Cremona, Cremona, Italy
| | - Giuseppe Conti
- Italian Corpo Nazionale Soccorso Alpino e Speleologico (CNSAS), Milan, Italy
| | - Stefano Di Carlo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonella Santini
- Italian Corpo Nazionale Soccorso Alpino e Speleologico (CNSAS), Milan, Italy
| | - Pierfrancesco Fusco
- Department of Anaesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
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Abstract
Regional anesthesia has become invaluable for the treatment of pain during and after a wide range of surgical procedures. However, its benefits in the nonsurgical setting have been less well studied. Regional anesthesia is an appealing modality for critically ill patients, providing focused and sustained pain control with beneficial systemic effect profiles. Indications for regional anesthesia in this patient group are not limited to surgical and postsurgical analgesia but expand to the management of trauma-related issues, medical conditions, and painful procedures at the bedside. Patients in the critical care unit present special challenges to the regional anesthesiologist, including coagulopathies, infections, immunocompromised states, sedation- and ventilation-associated problems, and factors potentially increasing the risk for systemic toxicity. This review is intended to evaluate the role of regional anesthesia in critically ill patients, to discuss potential benefits, and to provide a summary of the published evidence on the subject.
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Case Scenario: Compartment Syndrome of the Forearm in Patient with an Infraclavicular Catheter. Anesthesiology 2013; 118:1198-205. [DOI: 10.1097/aln.0b013e31828afa96] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pasquier M, Ruffinen GZ, Brugger H, Paal P. Pre-hospital wrist block for digital frostbite injuries. High Alt Med Biol 2012; 13:65-6. [PMID: 22429237 DOI: 10.1089/ham.2011.1072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chelly JE, Ghisi D, Fanelli A. Continuous peripheral nerve blocks in acute pain management. Br J Anaesth 2011; 105 Suppl 1:i86-96. [PMID: 21148658 DOI: 10.1093/bja/aeq322] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The indications for continuous nerve blocks for the perioperative pain management in hospitalized and ambulatory patients have extended well beyond orthopaedics. These techniques are not only used to control pain in patients undergoing major upper and lower extremity surgery, but also to provide perioperative analgesia in patients undergoing abdominal, plastic, urological, gynaecological, thoracic, and trauma surgeries. Infusion regimens of local anaesthetics and supplements must take into consideration the condition of the patient before and after surgery, the nature and intensity of the surgical stress associated with the surgery, and the possible need for immediate functional recovery. Continuous nerve blocks have proved safe and effective in reducing opioid consumption and related side-effects, accelerating recovery, and in many patients reducing the length of hospital stay. Continuous nerve blocks provide a safer alternative to epidural analgesia in patients receiving thromboprophylaxis, especially with low molecular-weight heparin.
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Affiliation(s)
- J E Chelly
- Division of Regional Anesthesia and Acute Interventional Perioperative Pain Service, Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Siemers F, Mailänder P. Inhalationstrauma, Kohlenmonoxid- und Cyanidintoxikation. Notf Rett Med 2010. [DOI: 10.1007/s10049-009-1250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gregoretti C, Decaroli D, Piacevoli Q, Mistretta A, Barzaghi N, Luxardo N, Tosetti I, Tedeschi L, Burbi L, Navalesi P, Azzeri F. Analgo-sedation of patients with burns outside the operating room. Drugs 2009; 68:2427-43. [PMID: 19016572 DOI: 10.2165/0003495-200868170-00003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Following the initial resuscitation of burn patients, the pain experienced may be divided into a 'background' pain and a 'breakthrough' pain associated with painful procedures. While background pain may be treated with intravenous opioids via continuous infusion or patient-controlled analgesia (PCA) and/or less potent oral opioids, breakthrough pain may be treated with a variety of interventions. The aim is to reduce patient anxiety, improve analgesia and ensure immobilization when required. Untreated pain and improper sedation may result in psychological distress such as post-traumatic stress disorder, major depression or delirium. This review summarizes recent developments and current techniques in sedation and analgesia in non-intubated adult burn patients during painful procedures performed outside the operating room (e.g. staple removal, wound-dressing, bathing). Current techniques of sedation and analgesia include different approaches, from a slight increase in background pain therapy (e.g. morphine PCA) to PCA with rapid-onset opioids, to multimodal drug combinations, nitrous oxide, regional blocks, or non-pharmacological approaches such as hypnosis and virtual reality. The most reliable way to administer drugs is intravenously. Fast-acting opioids can be combined with ketamine, propofol or benzodiazepines. Adjuvant drugs such as clonidine or NSAIDs and paracetamol (acetaminophen) have also been used. Patients receiving ketamine will usually maintain spontaneous breathing. This is an important feature in patients who are continuously turned during wound dressing procedures and where analgo-sedation is often performed by practitioners who are not specialists in anaesthesiology. Drugs are given in small boluses or by patient-controlled sedation, which is titrated to effect, according to sedation and pain scales. Patient-controlled infusion with propofol has also been used. However, we must bear in mind that burn patients often show an altered pharmacokinetic and pharmacodynamic response to drugs as a result of altered haemodynamics, protein binding and/or increased extracellular fluid volume, and possible changes in glomerular filtration. Because sedation and analgesia can range from minimal sedation (anxiolysis) to general anaesthesia, sedative and analgesic agents should always be administered by designated trained practitioners and not by the person performing the procedure. At least one individual who is capable of establishing a patent airway and positive pressure ventilation, as well as someone who can call for additional assistance, should always be present whenever analgo-sedation is administered. Oxygen should be routinely delivered during sedation. Blood pressure and continuous ECG monitoring should be carried out whenever possible, even if a patient is undergoing bathing or other procedures that may limit monitoring of vital pulse-oximetry parameters.
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Affiliation(s)
- Cesare Gregoretti
- Intensive Care Unit, Azienda Ospedaliera CTO-CRF-ICORMA, Turin, Italy
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Navarro R, Guasch E, Parodi E, Gilsanz F. [Assessment of agreement between anesthesiologists' location of anatomical landmarks]. ACTA ACUST UNITED AC 2008; 55:144-50. [PMID: 18401988 DOI: 10.1016/s0034-9356(08)70532-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The main objective of this study was to evaluate agreement between anesthesiologists' location of specific anatomical landmarks in regional anesthesia. MATERIAL AND METHODS We administered an anonymous written questionnaire asking for the location of the T5 and T10 dermatomes, Tuffier's line (L3-L4 space), and the T7-T8 and C6-C7 spaces on an anatomical drawing. We asked about each anesthesiologist's number of years of experience and type of block most commonly performed and in what type of surgery, number of blocks performed per year, whether or not levels of sensory and motor blocks were assessed, and whether training had been received. Relative frequencies were then calculated. The relationships between years of experience and number of blocks performed and number of correct identifications of anatomical points were analyzed using the chi2 test. RESULTS We studied 100 doctors (66 residents and 24 staff anesthesiologists). The landmark for which agreement was highest was T10 (91.8%); agreement was lowest for T5 (38.1%). Forty-five percent of anesthesiologists performed between 100 and 250 neuraxial blocks per year. The most commonly performed procedure was a lumbar block (98% of the anesthesiologists). Level of sensory block was evaluated by 95% of the respondents and level of motor block by 83%. Response to heat and cold was used by 94.8%; the Bromage scale was used by 81%. The number of years of experience and the number of correctly located points appeared to be unrelated (P=.76). Nor was there a correlation between the number of blocks performed and number of correctly located points (P=.2). CONCLUSIONS T10 was the landmark correctly identified by the largest number of respondents; T5 was correctly identified by the fewest respondents, with answers differing by as much as 4 dermatomes.
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Affiliation(s)
- R Navarro
- Servicio de Anestesiología y Reanimación, Hospital Universitario de la Princesa,. Madrid
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