1
|
Paśnicki M, Król A, Kosson D, Kołacz M. The Safety of Peripheral Nerve Blocks: The Role of Triple Monitoring in Regional Anaesthesia, a Comprehensive Review. Healthcare (Basel) 2024; 12:769. [PMID: 38610191 PMCID: PMC11011500 DOI: 10.3390/healthcare12070769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Regional anaesthesia, referred to as regional blocks, is one of the most frequently used methods of anaesthesia for surgery and for pain management. Local anaesthetic drug should be administered as close to the nerve as possible. If administered too far away, this may result in insufficient block. If it is administrated too close, severe nerve damage can occur. Neurostimulation techniques and ultrasound imaging have improved the effectiveness and safety of blockade, but the risk of nerve injury with permanent nerve disfunction has not been eliminated. Intraneural administration of a local anaesthetic damages the nerve mechanically by the needle and the high pressure generated by the drug inside the nerve. In many studies, injection pressure is described as significantly higher for unintended intraneural injections than for perineural ones. In recent years, the concept of combining techniques (neurostimulation + USG imaging + injection pressure monitoring) has emerged as a method increasing safety and efficiency in regional anaesthesia. This study focuses on the contribution of nerve identification methods to improve the safety of peripheral nerve blocks by reducing the risk of neural damage.
Collapse
Affiliation(s)
- Marek Paśnicki
- Department of Anaesthesiology and Intensive Care Education, Medical University of Warsaw, 4 Oczki Str., 02-005 Warsaw, Poland; (M.P.); (D.K.)
| | - Andrzej Król
- Department of Anaesthesia and Chronic Pain Service, St George’s University Hospital, Blackshaw Road Tooting, London SW17 0QT, UK
| | - Dariusz Kosson
- Department of Anaesthesiology and Intensive Care Education, Medical University of Warsaw, 4 Oczki Str., 02-005 Warsaw, Poland; (M.P.); (D.K.)
| | - Marcin Kołacz
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, 4 Lindleya Str., 02-005 Warsaw, Poland;
| |
Collapse
|
2
|
Merz-Herrala J, Leu N, Anderson E, Lambeck A, Jefferson J, Sobrero M, Mantuani D, Mudda G, Nagdev A. Safety and Pain Reduction in Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study. Ann Emerg Med 2024; 83:14-21. [PMID: 37747384 DOI: 10.1016/j.annemergmed.2023.08.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023]
Abstract
STUDY OBJECTIVE Emergency practitioners use ultrasound-guided nerve blocks to alleviate pain. This study represents the largest registry of single-injection ultrasound-guided nerve blocks performed in an emergency department (ED) to date. We wished to assess the safety and pain score reductions associated with ED-performed ultrasound-guided nerve blocks. The main outcomes of interest were ultrasound-guided nerve block complication rates and change in patient-reported pain (0 to 10 on the VAS) pre and post ultrasound-guided nerve blocks. Other variables of interest were ultrasound-guided nerve block types and indications during the study period. METHODS This is a retrospective analysis of 420 emergency practitioner-performed ultrasound-guided nerve blocks through chart review over 1 year in the Highland ED. Four emergency physician abstractors reviewed all templated ultrasound-guided nerve block notes and nursing records over the study period. Inter-rater reliability was assessed using 10 randomly selected charts with 100% agreement for 70 key variables (Kappa=1, P<.001). RESULTS Seventy-five unique emergency practitioners performed 420 ultrasound-guided nerve blocks. Ultrasound-guided nerve blocks were most often performed by emergency residents (61.9%), advanced practice practitioners (21.2%), ultrasound fellowship-trained faculty (8.3%), interns (3.6%), nonultrasound fellowship-trained faculty (3.3%), and not recorded (1.7%). One complication occurred during the study (arterial puncture recognized through syringe aspiration without further sequelae). Among the 261 ultrasound-guided nerve blocks with preblock and postblock pain scores, there was an improvement in postblock pain scores. The mean pain scores decreased from 7.4 to 2.8 after an ultrasound-guided nerve block (difference 4.6, 95% confidence interval 3.9 to 5.2). CONCLUSIONS This 1-year retrospective study supports that emergency practitioner-performed ultrasound-guided nerve blocks have a low complication rate and are associated with reduced pain.
Collapse
Affiliation(s)
- Jeffrey Merz-Herrala
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA.
| | - Nathaniel Leu
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA
| | - Erik Anderson
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA
| | - Alexandra Lambeck
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA
| | - Jamal Jefferson
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA
| | - Max Sobrero
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA
| | - Daniel Mantuani
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA
| | - Galaxy Mudda
- Department of Anesthesia, Highland Hospital-Alameda Health System, Oakland, CA
| | - Arun Nagdev
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA
| |
Collapse
|
3
|
Pentsou J, Hoey S, Vagias M, Guy B, Huuskonen V. Comparison of Ultrasound-Guided Versus Anatomical Landmark-Guided Thoracolumbar Retrolaminar Techniques in Canine Cadavers. Animals (Basel) 2023; 13:3045. [PMID: 37835651 PMCID: PMC10571554 DOI: 10.3390/ani13193045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
The retrolaminar block was developed in humans as an easier and safer alternative to the thoracic paravertebral block. This study aims to describe an ultrasound-guided thoracolumbar retrolaminar injection in canine cadavers and compare the injectate distribution between a landmark-guided and an ultrasound-guided thoracolumbar retrolaminar technique using computed tomography. Ten canine cadavers were randomised to receive two injections each of 0.6 mL/kg of iodinated contrast at the level of the twelfth thoracic vertebra (T12): a landmark-guided retrolaminar injection was performed on one hemithorax (group B, n = 10) and an ultrasound-guided on the other hemithorax (group U, n = 10). Groups were compared using the Mann-Whitney U test. The median (range) spread of the contrast in the paravertebral space was 0 (0-3) and 1 (0-5) vertebrae in groups B and U, respectively (p = 0.038). The median (range) extent of the spread surrounding the interverbal foramina was 4 (0-5) in group B and 4 (3-5) in group U. The median (range) spread along the retrolaminar space cranial and caudal to T12 was 3 (0-6) retrolaminar segments in group B and 3 (3-4) in group U. The potential of the ultrasound-guided retrolaminar injection to provide analgesia for dogs suffering from thoracolumbar pain should be further investigated.
Collapse
Affiliation(s)
- Julia Pentsou
- Department of Veterinary Anaesthesia and Analgesia, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK
| | - Séamus Hoey
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, UCD School of Veterinary Medicine, University College Dublin, D04W6F6 Dublin, Ireland; (S.H.); (V.H.)
| | - Michail Vagias
- Department of Small Animal Surgery, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK;
| | - Bethany Guy
- Department of Veterinary Medicine, Queen’s Veterinary School Hospital, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK;
| | - Vilhelmiina Huuskonen
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, UCD School of Veterinary Medicine, University College Dublin, D04W6F6 Dublin, Ireland; (S.H.); (V.H.)
| |
Collapse
|
4
|
Continuous Lumbar Plexus Block vs Continuous Lumbar Erector Spinae Plane Block for Postoperative Pain Control After Revision Total Hip Arthroplasty. Arthroplast Today 2021; 9:29-34. [PMID: 33997205 PMCID: PMC8099915 DOI: 10.1016/j.artd.2021.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background Optimal pain management is key to successful recovery in revision total hip arthroplasty. Lumbar plexus blocks (LPBs) have traditionally been used for postoperative pain management. Recently, the lumbar erector spinae plane block (LESPB) has emerged as a promising regional anesthesia technique and is relatively simple to perform. Our study aimed to evaluate whether continuous LESPB provided better analgesia and clinical outcomes than continuous LPB in revision hip arthroplasty. Material and methods We compared 25 LPBs with 25 LESPBs performed from October 2017 to November 2018 for revision hip arthroplasty. The primary outcome of this study was difference in opioid consumption between the groups at 24 hours postoperatively. Secondary outcomes include pain scores, hospital lengths of stay, pain adjunct consumption, and incidence of postoperative nausea and vomiting. Results There was no significant difference in average opioid consumption between the LPB and LESPB groups during the first 24 hours postoperatively (73.8 ± 68.1 mg vs 85.1 ± 69.7 mg, respectively, P = .57). Similarly, there was no significant difference in average pain scores (3.3 ± 2.1 vs 3.7 ± 1.8, respectively, P = .42). Conclusions There was no significant difference in opioid consumption and pain scores in patients with continuous LESPB compared with those with continuous LPB. While our study did not show a difference in these outcomes, the LESPB is a straightforward regional block that avoids many of the risks of LPBs and may be as effective for pain control.
Collapse
|
5
|
Nair A, Diwan S, Gawai N, Sancheti P. Flow dynamics of ultrasound-guided lumbar plexus block in adults. J Anaesthesiol Clin Pharmacol 2021; 37:565-568. [PMID: 35340966 PMCID: PMC8944356 DOI: 10.4103/joacp.joacp_584_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/02/2020] [Accepted: 02/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: The outcomes of plexus and peripheral nerve blocks depend on needle-nerve contact and the spread of local anesthetic (LA) around the plexus or nerve. Needle-nerve distance and spread of LA could be visualized during US-guided lumbar plexus block (LPB). Material and Methods: After Institutional Ethics Committee approval and after obtaining informed consent, 24 American Society of Anesthesiologists’-physical status I–III patients who underwent surgical fixation of fractures of proximal femur were enrolled. Spinal anesthesia was a primary anesthetic in all patients. At the end of the surgery, all patients received US and neurostimulation-aided LPB at the third lumbar nerve root (LNr). The primary aim was to determine the spread of LA in the lumbar plexus area with the relation of the needle tip and LNr contact. The secondary aim was to understand block efficacy in terms of pain scores monitored at regular intervals and 100 mg intravenous tramadol was administered as a rescue analgesic if VAS >4. Results: In all 24 patients, we observed an oval and antegrade LA spread after lumbar plexus was identified with neurostimulation at L3. With the needle closer to intervertebral foramina (IVF), a retrograde spread was visualized. Only 2/24 patients received rescue analgesia in the first 24 h. Conclusion: The type of spread after the US-guided LPB could predict block success of block and a possible epidural spread.
Collapse
|
6
|
Saranteas T, Kostroglou A, Efstathiou G, Giannoulis D, Moschovaki N, Mavrogenis AF, Perisanidis C. Peripheral nerve blocks in the cervical region: from anatomy to ultrasound-guided techniques. Dentomaxillofac Radiol 2020; 49:20190400. [PMID: 32176537 DOI: 10.1259/dmfr.20190400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cervical plexus nerve blocks have been employed in various head and neck operations. Both adequate anaesthesia and analgesia are attained in clinical practice. Nowadays, ultrasound imaging in regional anaesthesia is driven towards a certain objective that dictates high accuracy and safety during the implementation of peripheral nerve blocks. In the cervical region, ultrasound-guided nerve blocks have routinely been conducted only for the past few years and thus only a small number of publications pervade the current literature. Moreover, the sonoanatomy of the neck, the foundation stone of interventional techniques, is very challenging; multiple muscles and fascial layers compose a complex of compartments in a narrow anatomic region, in which local anaesthetics are injected. Therefore, this review intends to deliver new insights into ultrasound-guided peripheral nerve block techniques in the neck. The sonoanatomy of the cervical region, in addition to the cervical plexus, cervical ganglia, superior and recurrent laryngeal nerve blocks are comprehensively discussed.
Collapse
Affiliation(s)
- Theodosios Saranteas
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Andreas Kostroglou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgia Efstathiou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Giannoulis
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nefeli Moschovaki
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, University Medical School, Athens, Greece
| | - Christos Perisanidis
- Department of Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
7
|
Akhondzadeh R, Rashidi M, Gousheh M, Olapour A, Tasbihi B. Comparison of the Ketamine-Lidocaine and Fentanyl-Lidocaine in Postoperative Analgesia in Axillary Block in Upper Limb Fractures By Ultrasound Guidance. Anesth Pain Med 2020; 9:e92695. [PMID: 32280613 PMCID: PMC7118445 DOI: 10.5812/aapm.92695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/12/2019] [Accepted: 10/25/2019] [Indexed: 01/06/2023] Open
Abstract
Background Regional anesthesia provides safe anesthesia for upper extremity surgery. Axillary plexus block approach for hand and forearm surgery is commonly used. The use of adjuvants in combination with local anesthetics for peripheral nerve blocks enhances the quality and duration of anesthesia and postoperative analgesia. Methods This double-blind clinical trial was performed on 60 patients who were candidates for the surgery of upper extremity fractures with ASA I and II classes. The patients were randomly divided into two equal groups (n = 30). The intervention group 1 received 4 mg/kg lidocaine 1% and 50 µg fentanyl and the intervention group 2 received 4 mg/kg lidocaine 1% and 30 mg ketamine during the axillary block. After the necessary monitoring, a pinprick test was performed to evaluate sensory block, and a three-point scale test for the motor block was performed for median, ulnar, radial and musculocutaneous nerves. The duration of postoperative analgesia, the time of the first request for a painkiller, and the amount of opioid received were compared in the two groups. Results Onset of sensory and motor block was shorter in the fentanyl group but did not differ significantly. The sensory and motor block length was slightly higher in the fentanyl group, but no significant difference was observed. The severity of pain (VAS) and the mean of received opioid (pethidine) were significantly lower in the fentanyl group 24 hours after the surgery (P < 0.0001). The duration of postoperative analgesia and the time of the first request for painkiller were longer in the fentanyl group, but there was no significant difference. Conclusions The severity of pain and analgesic intake in the fentanyl group decreased significantly. Therefore, fentanyl is a better drug than ketamine for using as an adjuvant in the axillary block.
Collapse
Affiliation(s)
- Reza Akhondzadeh
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahboobe Rashidi
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mohammadreza Gousheh
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Olapour
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahrammohamad Tasbihi
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
8
|
Lo JCC, Nguyen D, Matthews TK. Usefulness of stellate ganglion block for refractory angina pectoris. Proc (Bayl Univ Med Cent) 2018; 31:370-371. [PMID: 29904316 DOI: 10.1080/08998280.2018.1463040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 10/16/2022] Open
Abstract
Chronic refractory angina pectoris (AP) affects 600,000 to 1,800,000 Americans, with approximately 50,000 new cases annually. A recent study revealed long-term mortality of refractory AP to be lower than previously reported, with >70% of patients living >9 years. Treating AP can improve quality of life. We describe a patient with refractory AP who underwent a successful stellate ganglion block for symptom control.
Collapse
Affiliation(s)
| | - David Nguyen
- Department of Anesthesiology, Texas A&M Health Science Center, Temple, Texas
| | - T Keller Matthews
- Department of Anesthesiology, Baylor Scott and White Health, Temple, Texas
| |
Collapse
|
9
|
Abstract
Total joint arthroplasty is one of the most common surgical procedures performed for end-stage osteoarthritis. The increasing demand for knee and hip arthroplasties along with the improvement in life expectancy has created a substantial medical and economic impact on the society. Effective planning of health care for these individuals is vital. The best method for providing anesthesia and analgesia for total joint arthroplasty has not been defined. Yet, emerging evidence suggests that the type of anesthesia can affect morbidity and mortality of patients undergoing these procedures.
Collapse
Affiliation(s)
- Dalia H Elmofty
- Department of Anesthesia & Critical Care, The University of Chicago, Chicago, Illinois
| | - Asokumar Buvanendran
- Department of Anesthesia & Critical Care, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
10
|
Martins LES, Ferraro LHC, Takeda A, Munechika M, Tardelli MA. Bloqueios de nervos periféricos guiados por ultrassom em pacientes anticoagulados – série de casos. Braz J Anesthesiol 2017; 67:100-106. [DOI: 10.1016/j.bjan.2016.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/15/2015] [Indexed: 11/25/2022] Open
|
11
|
Ultrasound-guided peripheral nerve blocks in anticoagulated patients - case series. Braz J Anesthesiol 2016; 67:100-106. [PMID: 28017161 DOI: 10.1016/j.bjane.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/15/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The advent of ultrasound has brought many benefits to peripheral nerve blocks. It includes both safety and effectiveness, given the possibility of visualizing the neurovascular structures and the needle during the procedure. Despite these benefits, there is no consensus in the literature on the use of this technique in anticoagulated patients or with other coagulation disorders. Moreover, peripheral blocks vary in depth, spreadability, and possibility of local compression. However, few societies take it into account when drawing up its recommendations, establishing a single recommendation for performing peripheral blocks, regardless of the route used. The objective of this series is to expand the discussion on peripheral nerve block in anticoagulated patients. CASE REPORTS This series reports 9 cases of superficial peripheral nerve blocks guided by ultrasound in patients with primary or secondary dyscrasias. All blocks were performed by experienced anesthesiologists in the management of ultrasound, and there was no bruising or neurological injuries in the cases. CONCLUSIONS This case series support the discussion on conducting surface peripheral nerve blocks and easy local knowledge as the axillary, interscalene, femoral, saphenous or popliteal in anticoagulated patients, on dual antiaggregation therapy and/or with other coagulation disorders, provided that guided by ultrasound and performed by an anesthesiologist with extensive experience in guided nerve blocks. However, larger series should be performed to prove the safety of the technique for these patients.
Collapse
|
12
|
Moreno-Martínez DA, Perea-Bello AH, Díaz-Bohada JL, García-Rodriguez DM, Echeverri-Mallarino V, Valencia-Peña MJ, Osorio-Cardona W, Silva-Enríquez PN. Factores asociados con anestesia regional fallida de plexo braquial para cirugía de extremidad superior. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rca.2016.06.007] [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] Open
|
13
|
Factors associated with failed brachial plexus regional anesthesia for upper limb surgery. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
14
|
Kim YD, Park SJ, Shim J, Kim H. Clinical usefulness of pectoral nerve block for the management of zoster-associated pain: case reports and technical description. J Anesth 2016; 30:1074-1077. [PMID: 27650294 DOI: 10.1007/s00540-016-2248-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/31/2016] [Indexed: 11/25/2022]
Abstract
The recently introduced pectoral nerve (Pecs) block is a simple alterative to the conventional thoracic paravertebral block or epidural block for breast surgery. It produces excellent analgesia and can be used to provide balanced anesthesia and as a rescue block in cases where performing a neuraxial blockade is not possible. In the thoracic region, a neuraxial blockade is often used to manage zoster-associated pain. However, this can be challenging for physicians due to the increased risk of hemodynamic instability in the upper thoracic level, and comorbid and contraindicated medical conditions such as coagulopathy. Here, we introduce an ultrasound-guided Pecs block for the management of herpes zoster-associated pain, which could be an effective alternative to other interventional options in the thoracic region.
Collapse
Affiliation(s)
- Yeon-Dong Kim
- Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Wonkwang Institute of Science, Iksan, Republic of Korea
| | - Seon-Jeong Park
- Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Wonkwang Institute of Science, Iksan, Republic of Korea
| | - Junho Shim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Seonam University College of Medicine, Jeonju, Republic of Korea
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Seonam University College of Medicine, Jeonju, Republic of Korea.
| |
Collapse
|
15
|
Factors associated with failed brachial plexus regional anesthesia for upper limb surgery☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644040-00006] [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] Open
|
16
|
Abstract
Pediatric acute femur fractures are a relatively common major orthopedic injury seen in emergency departments. Providing adequate and safe analgesia is essential while patients await definitive management of these fractures. Opioid medications are typically used to treat fracture-associated pain but have well-known adverse effects including respiratory and central nervous system depression, pruritus, nausea, and allergic reactions. Dose titration of opioids in pediatric patients may be difficult and requires frequent nursing and physician reassessments. Regional anesthesia using ultrasound guidance has been proposed as a reliable and safe method to provide pain relief for this population and to decrease reliance on opioid medications. There is a growing body of literature on the utility and safety of ultrasound-guided femoral nerve blocks for pediatric patients in the acute care setting. This review article covers recent literature on point-of-care ultrasound-guided femoral nerve blocks for pediatric patients, with a discussion of the indications, sonographic anatomy, selection of anesthetics, nerve block technique, and complications. This review supplements the expert supervision and practice required to gain competency.
Collapse
|
17
|
De Pinto M, Dagal A, O'Donnell B, Stogicza A, Chiu S, Edwards WT. Regional anesthesia for management of acute pain in the intensive care unit. Int J Crit Illn Inj Sci 2015; 5:138-43. [PMID: 26557482 PMCID: PMC4613411 DOI: 10.4103/2229-5151.164917] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids’ side effects. Minimizing nausea, vomiting, urinary retention, and sedation may indeed facilitate patient recovery and it is likely to shorten the ICU and hospital stay. Adequate postoperative and post-trauma pain management is also crucial for the achievement of effective rehabilitation. Furthermore, recent studies suggest that effective acute pain management may be helpful in reducing the development of chronic pain. When used appropriately, and in combination with other treatment modalities, regional analgesia techniques (neuraxial and peripheral nerve blocks) have the potential to reduce or eliminate the physiological stress response to surgery and trauma, decreasing the possibility of surgical complications and improving the outcomes. Also they may reduce the total amount of opioid analgesics necessary to achieve adequate pain control and the development of potentially dangerous side effects.
Collapse
Affiliation(s)
- Mario De Pinto
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - Armagan Dagal
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - Brendan O'Donnell
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - Agnes Stogicza
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - Sheila Chiu
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| | - William Thomas Edwards
- Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center - 325 9 Ave., Seattle, WA 98104, Box 359724, USA
| |
Collapse
|
18
|
Denby C, Groves DG, Eleuteri A, Tsang HK, Leach A, Hammond C, Bridson JD, Fisher M, Elt M, Laflin R, Fisher AC. Temporary sympathectomy in chronic refractory angina: a randomised, double-blind, placebo-controlled trial. Br J Pain 2015; 9:142-8. [PMID: 26516570 DOI: 10.1177/2049463714549775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Temporary sympathectomy by injection of bupivacaine at the site of the left stellate ganglion is used in the management of refractory angina at several UK centres. Although patients frequently report significant reduction in symptoms, efficacy has not been established by double-blind, randomised placebo-controlled trial (RCT). OBJECTIVE To investigate the efficacy of the procedure for the first time by a double-blind RCT. METHODS Consecutive patients referred to the authors' National Health Service (NHS) angina centre who were candidates for temporary sympathectomy were invited to participate in a trial. A total of 65 patients were randomised to receive either bupivacaine or saline injections. Identical syringes were prepared remotely, blinding patients and staff from randomisation. Cardiac autonomic function was measured 3 hours pre- and post-injection using new heart rate variability (HRV) analyses. Angina episodes were recorded contemporaneously by patients in study diaries in the 7-day periods pre- and post-injection. RESULTS In 51 patients suitable for analysis, no significant differences between the active and placebo groups were found in patient-recorded frequency or intensity of angina episodes pre- and post-injection. However, across both groups combined, a significant difference was found in the frequency of angina episodes pre- and post-injection. CONCLUSION The reduction in frequency of angina episodes produced by this procedure may not be due to drug pharmacology. It may be a placebo response or due to the mechanical effects of the injection of fluid. There is a need for further work using a larger patient cohort considering both mechanical and psychological factors.
Collapse
Affiliation(s)
- Christine Denby
- Department of Medical Physics and Clinical Engineering, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK
| | - David G Groves
- Department of Medical Physics and Clinical Engineering, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK
| | - Antonio Eleuteri
- Department of Medical Physics and Clinical Engineering, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK
| | - Hoo Kee Tsang
- Liverpool Angina Management Programme, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK ; Department of Anaesthesia, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK
| | - Austin Leach
- Liverpool Angina Management Programme, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK ; Department of Anaesthesia, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK
| | - Clare Hammond
- Liverpool Angina Management Programme, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK ; Department of Cardiology, Whiston Hospital, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | - John D Bridson
- Liverpool Angina Management Programme, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK
| | - Michael Fisher
- Liverpool Angina Management Programme, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK
| | - Matthew Elt
- Department of Medical Physics and Clinical Engineering, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK
| | - Robert Laflin
- Department of Medical Physics and Clinical Engineering, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK
| | - Anthony C Fisher
- Department of Medical Physics and Clinical Engineering, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), Liverpool, UK ; Department of Physics, University of Liverpool, Liverpool, UK
| |
Collapse
|
19
|
Aksoy M, Dostbil A, Ince I, Ahiskalioglu A, Alici HA, Aydin A, Kilinc OO. Continuous spinal anaesthesia versus ultrasound-guided combined psoas compartment-sciatic nerve block for hip replacement surgery in elderly high-risk patients: a prospective randomised study. BMC Anesthesiol 2014; 14:99. [PMID: 25414593 PMCID: PMC4237736 DOI: 10.1186/1471-2253-14-99] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 10/27/2014] [Indexed: 11/23/2022] Open
Abstract
Background Our aim is to compare the hemodynamic effects of combined psoas compartment-sciatic nerve block (PCSNB) with continuous spinal anaesthesia (CSA) in elderly high-risk patients undergoing hip replacement surgery. Methods Seventy patients over the age of 60 with ASA III or IV physical status were randomly allocated to two groups: In the PCSNB group, ultrasound-guided psoas compartment block was performed with modified Winnie technique using 30 mL of 0.25% bupivacaine with 1:200.000 epinephrine (5 μgr/mL) and iliac crest block was performed using the same local anaesthetic solution (5 mL). All patients in the PCSNB group needed continuing infusion of propofol (2 mg/kg/h) during operation. In the CSA group, CSA was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 2.5 mg of isobaric bupivacaine 0.5%. When sensory block was not reached to the level of T12 within 10 minutes in the CSA group, additional 2.5 mg of isobaric bupivacaine 0.5% was administered through the catheter at 5-min intervals by limiting the total dose of 15 mg until a T12 level of the sensory block was achieved. Results The PCSNB group had significantly higher mean arterial blood pressure values at the beginning of surgery and at 5th, 10th and 20th minutes of surgery compared to the CSA group (P =0.038, P =0.029, P =0.012, P =0.009 respectively). There were no significant differences between groups in terms of heart rate and peripheral oxygen saturation values during surgery and the postoperative period (P >0.05). Arterial hypotension required ephedrine was observed in 13 patients in the CSA and 4 patients in the PCSNB group (P =0.012). Conclusions CSA and PCSNB produce satisfactory quality of anaesthesia in elderly high-risk patients with fewer hemodynamic changes in PCSNB cases compared with CSA cases. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12614000658617, Registered 24 June 2014.
Collapse
Affiliation(s)
- Mehmet Aksoy
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Aysenur Dostbil
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ilker Ince
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Hacı Ahmet Alici
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ali Aydin
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Osman Ozgur Kilinc
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| |
Collapse
|
20
|
Curt Nuño F, López Álvarez S, Juncal Díaz J, Domínguez Chaos A, Llorca González F, Pensado Castiñeiras A. [Peroneal nerve injury: anesthesia is not always to blame]. ACTA ACUST UNITED AC 2014; 62:104-7. [PMID: 25048997 DOI: 10.1016/j.redar.2014.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/12/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
We introduce a case report of a woman that was operated of foot surgery under locoregional anesthesia with an echo-guided peripheral sciatic-popliteal nerve block. As post operatory complication a peroneal nerve injury was noticed. We revised differential diagnosis of peripheral nerve block and therapeutic strategy we should take. In our case the finding was a high degree axonotmesis secondary to extrinsic compressure due to pneumatic tourniquet placed in the ankle used during surgery. There was no relationship with the anesthetic technique.
Collapse
Affiliation(s)
- F Curt Nuño
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
| | - S López Álvarez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - J Juncal Díaz
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - A Domínguez Chaos
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - F Llorca González
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - A Pensado Castiñeiras
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| |
Collapse
|
21
|
Kumar A, Wilson GAM, Engelhardt TE. Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy. Saudi J Anaesth 2014; 8:229-32. [PMID: 24843338 PMCID: PMC4024682 DOI: 10.4103/1658-354x.130725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Provision of appropriate analgesia for supraumbilical pyloromyotomy in infants is limited by concerns about sensitivity to opioids and other medication groups, due to immature metabolism. Local anesthetic infiltration and ultrasound guided rectus sheath blockade are two techniques commonly employed to provide perioperative analgesia. The aim of this review was to compare the quality of post-operative analgesia afforded by these two techniques. Materials and Methods: A retrospective chart analysis of hospital records of all patients who underwent supraumbilical pyloromyotomy at a tertiary pediatric hospital between March 2009 and February 2011. Analysis of the anesthetic technique employed and post-operative acetaminophen requirements were performed. Additional information as to time to first post-operative feed, any complications and time of discharge from the hospital were collected by reviewing the post-operative nursing notes. Results: A total of 30 patients underwent supraumbilical pyloromyotomy during this period. A total of 18 received local anesthetic infiltration at the end of the procedure and 12 patients underwent ultrasound guided pre-incisional rectus sheath block for post-operative analgesia. Patients who had post-operative local anesthetic infiltration had a median (range) of 2 (1-3) doses of acetaminophen in the first 24 h. In the group of patients who received a rectus sheath block, the median (range) number of doses of acetaminophen in the first 24 h was also 2 (1-3). There were no differences in time to first feed and time to hospital discharge between the groups. The volume of local anesthetic administered was significantly smaller in the group receiving analgesia via rectus sheath block. Conclusion: Local anesthetic infiltration and pre-incisional ultrasound guided rectus sheath block provide similar degrees of post-operative analgesia. There were no differences between the two groups in time for first post-operative feed and time to hospital discharge.
Collapse
Affiliation(s)
- Anoop Kumar
- Department of Anesthesia, Aberdeen Royal Infirmary, Scotland, UK
| | - Graham A M Wilson
- Royal Aberdeen Children's Hospital, Aberdeeen, AB25 2ZN, Scotland, UK
| | | |
Collapse
|
22
|
Olea E, Fondarella A, Sánchez C, Iriarte I, Almeida MV, Martínez de Salinas A. [Ultrasound-guided peripheral nerve block at wrist level for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin]. ACTA ACUST UNITED AC 2013; 60:571-5. [PMID: 24210213 DOI: 10.1016/j.redar.2013.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Evaluation of pain and degree of satisfaction in patients undergoing ultrasound-assisted peripheral regional block for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin. PATIENTS AND METHODS A descriptive, observational study of patients with palmar hyperhidrosis treated with botulinum toxin A, who underwent ultrasound-guided peripheral regional block of the median and ulnar nerves with 3 ml of mepivacaine 1% in each one. The radial nerve block was injected in the anatomical snuffbox. After establishing blocking, the dermatologist performed a mapping and injected around 100 IU of botulinum toxin across the whole palm. The pain experienced during the injection of botulinum toxin was evaluated by verbal numerical scale (from 0 to 10), along with the degree of satisfaction with the anesthetic technique, and the post-anesthetic complications. RESULTS A total of 40 patients were enrolled in the study, 11 men and 29 women with no significant differences. The pain intensity assessed with verbal numerical scale was 1.03 (standard deviation of 1.37). No patients had a value greater than 5. The degree of patient satisfaction with the anesthetic technique was very good for 85% of the patients, and good for 7.5%. There were no complications related to type of anesthesia. CONCLUSIONS The ultrasound-assisted peripheral regional block could be a simple, effective and safe technique for patients undergoing palmar injection of botulinum toxin. Pain intensity was very low, and it provided a very good level of satisfaction in most patients.
Collapse
Affiliation(s)
- E Olea
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Álava, Vitoria-Gasteiz, Álava, España.
| | | | | | | | | | | |
Collapse
|
23
|
Morillas-Sendin P, Ortega-Romero A, del-Olmo C. Basic considerations before injections and scanning techniques. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.trap.2014.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
24
|
VASSILIOU T, EIDER J, NIMPHIUS W, WIESMANN T, ANDRES J, MÜLLER HH, WULF H, STEINFELDT T. Dual guidance improves needle tip placement for peripheral nerve blocks in a porcine model. Acta Anaesthesiol Scand 2012; 56:1156-62. [PMID: 22834779 DOI: 10.1111/j.1399-6576.2012.02740.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of the study was to evaluate whether the use of ultrasound (US) together with nerve stimulation (USNST) provides a better needle tip position for performing peripheral regional anaesthesia than the use of US or nerve stimulation (NST) alone. METHODS Needle placements were applied at the brachial plexus and sciatic nerves in 32 anaesthetised pigs. Following needle placement near the target nerve, using either the USNST or the US or NST, a volume of 0.3 ml synthetic resin was injected mimicking a 'test-dose' injection. The primary outcome was the incidence of close needle-to-nerve placement assessed by injectate localisation in direct contact with the nerve epineurium. Secondary endpoints were the incidences of intraneural injection and haematoma formation in direct contact with the target nerve. RESULTS A total of 611 punctures were performed. The evaluation for the criterion 'close needle placement' revealed significant differences in favour of the USNST group (98.5%) compared with the NST (90.1%) and the US group (81.6%) (P = 0.001). Significant differences were observed regarding 'intraneural needle placement' between the groups as well (USNST, 0.5%; US, 4%; NST, 2.5%; P = 0.034). The incidence of haematoma formation was significantly higher in the NST group (10.8%) than in the US group (2.5%) and in the USNST group (1.5%) (P = 0.001). CONCLUSION These findings suggest that the USNST approach combines the benefits of the US and the NST techniques in terms of a higher rate of close needle tip placements and a lower incidence of haematoma formation.
Collapse
Affiliation(s)
- T. VASSILIOU
- Department of Anaesthesiology and Critical Care; University Hospital Giessen-Marburg, Philipps-University Marburg; Marburg; Germany
| | - J. EIDER
- Department of Anaesthesiology and Critical Care; University Hospital Giessen-Marburg, Philipps-University Marburg; Marburg; Germany
| | - W. NIMPHIUS
- Institute of Pathology; University Hospital Giessen-Marburg, Philipps-University Marburg; Marburg; Germany
| | - T. WIESMANN
- Department of Anaesthesiology and Critical Care; University Hospital Giessen-Marburg, Philipps-University Marburg; Marburg; Germany
| | - J. ANDRES
- Department of Anaesthesiology and Critical Care; University General Hospital Valencia; Valencia; Spain
| | - H.-H. MÜLLER
- Institute of Medical Informatics, Biometry and Epidemiology; Ludwig-Maximilians-University; Munich; Germany
| | - H. WULF
- Department of Anaesthesiology and Critical Care; University Hospital Giessen-Marburg, Philipps-University Marburg; Marburg; Germany
| | - T. STEINFELDT
- Department of Anaesthesiology and Critical Care; University Hospital Giessen-Marburg, Philipps-University Marburg; Marburg; Germany
| |
Collapse
|
25
|
Pang HN, Lim W, Chua WC, Seet B. Management of musculoskeletal injuries after the 2009 western Sumatra earthquake. J Orthop Surg (Hong Kong) 2011; 19:3-7. [PMID: 21519067 DOI: 10.1177/230949901101900102] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To report injury patterns and management of musculoskeletal injuries after an earthquake. METHODS 94 male and 161 female patients aged 17 to 90 (mean, 53) years underwent surgery for musculoskeletal injuries. Their injury patterns, anaesthesia administered, surgeries undertaken, and development of postoperative complications were reviewed. RESULTS Of the 255 patients, 155 sustained superficial lacerations with minor soft-tissue contusion, whereas 100 sustained injuries that necessitated surgery under anaesthesia. The injuries involved the tibia/ankle (n=90), the hand (n=48), the pelvis/femur (n=41), the radius/ulnar (n=36), the foot (n=20), the humerus (n=10), and the spine (n=10). 30 (12%) of the patients had multiple injuries. The most common procedure performed was debridement (n=58), followed by open reduction and internal fixation with plates and screws for closed fractures (n=20), Kirschner wiring (n=11), external fixation (n=8), and general surgery and others (n=6). Repeated debridements were performed for 19 open fractures; 10 involved the distal tibia. 63 procedures were carried out under anaesthesia or sedation. General anaesthesia involved 2 patients; one had a right hemi-colectomy for an ischaemic bowel and another had an appendicectomy. Regional anaesthesia included sub-arachnoid block for lowerlimb surgeries (n=21), axillary brachial plexus block for upper-limb surgeries (n=11), and femoral and sciatic nerve blocks for a lower-limb surgery (n=1). The remaining 28 procedures involved conscious sedation. The mean number of debridements for open fractures was 2.8 (range, 2-5). The mean followup duration was 10.4 (range, 7-14) days. Only one patient developed a postoperative wound infection. CONCLUSION Our team was effective in managing orthopaedic injuries after an earthquake. The postoperative complication rate was low. Regional and spinal anaesthesia are relatively safe alternatives to general anaesthesia when carried out under such austere circumstances. The success of the mission depended on collaboration with the local health care workers and external agencies.
Collapse
Affiliation(s)
- Hee-Nee Pang
- Singapore Armed Forces Medical Corps, Singapore.
| | | | | | | |
Collapse
|
26
|
Is ultrasound guidance mandatory when performing paediatric regional anaesthesia? Curr Opin Anaesthesiol 2010; 23:337-41. [PMID: 20404721 DOI: 10.1097/aco.0b013e328339276f] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Since Kapral in 1994 first described the use of real-time ultrasound-guided regional anaesthesia, this novel technique has gained widespread recognition in adult practice and has been shown to be associated with clinically relevant advantages. The aim of this manuscript is to review the currently published paediatric data associated with the use of ultrasound-guided regional anaesthesia. RECENT FINDINGS Compared with alternative techniques ultrasound guidance is associated with an increased success rate, reduced onset time, moderately prolonged duration, reduced need for local anaesthetics and lower costs, and may also be considered to reduce the risk for complications. SUMMARY Based on current data the use of ultrasound guidance is strongly recommended when performing peripheral nerve blocks in infants and children. Concerning ultrasound assistance in relation to paediatric neuroaxial blocks there is currently not enough supporting evidence to issue a general recommendation regarding its routine use.
Collapse
|
27
|
Ultrasound-Guided Femoral and Sciatic Nerve Blocks in an Anticoagulated Patient. Case Reports. Braz J Anesthesiol 2010; 60:422-8. [DOI: 10.1016/s0034-7094(10)70052-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 04/05/2010] [Indexed: 11/22/2022] Open
|