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Grinman L, Elmore B, Ardon AE, Hussain A, Malik MF, Hernandez N, Jacoby MJ. Use of Peripheral Nerve Blocks for Total hip Arthroplasty. Curr Pain Headache Rep 2024:10.1007/s11916-024-01287-7. [PMID: 38907794 DOI: 10.1007/s11916-024-01287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the recent literature regarding regional anesthesia (RA) techniques and outcomes for total hip arthroplasty (THA) in the face of changing surgical techniques and perioperative considerations. RECENT FINDINGS Based on large meta-analyses, peripheral nerve blocks are indicated for THA. Each block has its own risks and benefits and data for outcomes for particular techniques are limited. New surgical techniques, improved use of multimodal analgesia, and improved ultrasound guided regional anesthetics lead to better pain control for patients undergoing THA with less associated risks. Block selection continues to be influenced by provider comfort, surgical approach, patient anatomy, and postoperative goals. Head-to-head studies of particular nerve blocks are warranted.
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Affiliation(s)
- Leon Grinman
- Department of Anesthesiology and Perioperative Medicine, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA.
| | - Brett Elmore
- Department of Anesthesiology and Perioperative Medicine, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Alberto E Ardon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, India
| | - Adnan Hussain
- Department of Anesthesiology and Perioperative Medicine, Henry Ford Health, Detroit, USA
| | - Mohammed Faysal Malik
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, India
| | - Nadia Hernandez
- Department of Anesthesiology and Perioperative Medicine, University of Texas McGovern Medical School, Austin, USA
| | - Mackenzie Janice Jacoby
- Department of Anesthesiology and Perioperative Medicine, University of Texas McGovern Medical School, Austin, USA
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Hasegawa M, Singh D, Urits I, Pi M, Nakasone C, Viswanath O, Kaye AD. Review on Nerve Blocks Utilized for Perioperative Total Knee Arthroplasty Analgesia. Orthop Rev (Pavia) 2022; 14:37405. [PMID: 35936803 PMCID: PMC9353705 DOI: 10.52965/001c.37405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Total Knee Arthroplasty (TKA) is an increasingly common procedure performed for advanced osteoarthritis. Optimal perioperative pain management strategies are critical for early mobilization and shorter hospital stays in TKA. Peripheral nerve blocks commonly used in TKA perioperative analgesia including individual and combined femoral, obturator, sciatic, lumbar plexus, and adductor canal nerve blocks. Overall, the safety profile varies depending on which block is utilized, but the current evidence suggests when optimally chosen and delivered, peripheral nerve blocks may provide a safe, effective option for perioperative analgesia. Determining optimal analgesic regimens for total knee arthroplasty is critical to improve postoperative pain, patient satisfaction, decreasing opioid usage, recovery times and functional outcomes, and as such, peripheral nerve blocks may represent a viable option to supplement analgesic requirements in the perioperative period.
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Affiliation(s)
- Morgan Hasegawa
- Surgery- Division of Orthopaedics, University of Hawai'i Department of Sugery-Division of Orthopaedics
| | - Dylan Singh
- John A. Burns School of Medicine, University of Hawai'i- John A . Burns School of Medicine
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School; Southcoast health, southcoast health physicians group, pain medicine; Department of Anesthesiology, Louisiana State University Health Shreveport, Department of Anesthesiology
| | - Michael Pi
- University of Hawai'i, Department of Surgery; Pediatric Anesthesia Division Lead, Department of Anesthesiology; American Society of Anesthesiology; Pediatric Anesthesia Division Lead, Pacific Anesthesia Corporation, Inc
| | - Cass Nakasone
- The Bone and Joint Center at Straub, Straub Clinic and Hospital, Honolulu, Hawaii; University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawaii
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Department of Anesthesiology; Valley Pain Consultants e Envision Physician Services; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology; Creighton University School of Medicine, Department of Anesthesiology
| | - Alan D Kaye
- Department of Anesthesia, Louisiana State University Health Shreveport
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Maniar A, Macachor J, Chiew WLA, Kumar CM, Imani F, Rokhtabnak F. Nuts and Bolts of Peripheral Nerve Blocks for Pain After Hip Fracture for Everyday Anesthetist. Anesth Pain Med 2021; 11:e116099. [PMID: 34692438 PMCID: PMC8520681 DOI: 10.5812/aapm.116099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
A range of peripheral nerve blocks is available to treat hip fracture pain, leaving clinicians confused on choice. No single block appears to be outstanding. The article described the relevant anatomy, technical approach, risk associated, and practicability to facilitate a better understanding of the various approaches available. The clinician should be able to make an informed decision based on local requirements and logistics.
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Affiliation(s)
- Amjad Maniar
- Department of Anaesthesia, Satya Sai Orthopaedic and Multispecialty Hospital, Bengaluru, India
| | - Joselo Macachor
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
| | | | - Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
- Corresponding Author: Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore.
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faranak Rokhtabnak
- Department of Anesthesiology, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Romanenko A, Кучин Ю, Бєлка К, Токар І. Perioperative pain management in elderly patients with а proximal femoral fracture: evidence review. PAIN MEDICINE 2020. [DOI: 10.31636/pmjua.v4i4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this article is to compare different methods of analgesia during perioperative period in elderly patients with а proximal femoral fracture. The incidence of hip fracture is high and also rises with the age, for example, In Great Britain, number of patients with a hip fracture will be approximately 100 000 in 2033, and it’s also associated with significant healthcare financing. Nevertheless, effective pain management is a big challenge for clinicians because of considerable problems in geriatric patients, including age, physiological changes in the elderly, preexisting comorbidities, cognitive impairment, high risk of delirium, problems with rehabilitation and probability of an independent life [12]. Opioids are still the main option for hip fracture pain management, despite differences in pharmacokinetics and pharmacodynamics in elderly patients, which are correlated with high frequency of side effects. Opioid-related adverse drug events are associated with worse patient outcomes such as morbidity, mortality and length of stay increase. Therefore, peripheral nerve blocks as part of multimodal analgesic technique can provide more effective pain control after hip fracture. Comprehensive literature searches focus on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anesthesia for hip fracture surgery.
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Zhang XH, Li YJ, He WQ, Yang CY, Gu JT, Lu KZ, Yi B. Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial. BMC Anesthesiol 2019; 19:103. [PMID: 31185905 PMCID: PMC6560859 DOI: 10.1186/s12871-019-0750-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 05/08/2019] [Indexed: 02/03/2023] Open
Abstract
Background Ultrasound guidance might decrease the incidence of local anesthetics systemic toxicity (LAST) for many peripheral nerve blocks compared with nerve stimulator guidance. However, it remains uncertain whether ultrasound guidance is superior to nerve stimulator guidance for deep nerve block of the lower extremity. This study was designed to investigate whether deep nerve block with ultrasound guidance would decrease the incidence of LAST compared with that with nerve stimulator guidance, and to identify associated risk factors of LAST. Methods Three hundred patients undergoing elective lower limb surgery and desiring lumbar plexus blocks (LPBs) and sciatic nerve blocks (SNBs) were enrolled in this study. The patients were randomly assigned to receive LPBs and SNBs with ultrasound guidance (group U), nerve stimulator guidance (group N) or dual guidance (group M). The primary outcome was the incidence of LAST. The secondary outcomes were the number of needle redirection, motor and sensory block onset and nerve distribution restoration time, as well as associated risk factors. Results There were 18 patients with LAST, including 12 in group U, 4 in group N and 2 in group M. By multiple comparisons among the three groups, we found that the incidence of LAST in group U (12%) was significantly higher than that in group N (4%)(P = 0.037) and group M(2%)(P = 0.006). The OR of LAST with hepatitis B (HBV) infection and the female sex was 3.352 (95% CI,1.233–9.108, P = 0.013) and 9.488 (95% CI,2.142–42.093, P = 0.0004), respectively. Conclusions Ultrasound guidance, HBV infection and the female sex were risk factors of LAST with LPBs and SNBs. For patients infected with HBV or female patients receiving LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator guidance should be used to improve the safety. Trial registration This study was approved by the Ethical Committee of the First Affiliated Hospital of Army Medical University. The protocol was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15, 2016.
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Affiliation(s)
- Xu-Hao Zhang
- Department of Anesthesia, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Yu-Jie Li
- Department of Anesthesia, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Wen-Quan He
- Department of Anesthesia, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Chun-Yong Yang
- Department of Anesthesia, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Jian-Teng Gu
- Department of Anesthesia, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Kai-Zhi Lu
- Department of Anesthesia, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Bin Yi
- Department of Anesthesia, Southwest Hospital, Army Medical University, Chongqing, 400038, China.
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Bugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin 2018; 36:403-415. [PMID: 30092937 DOI: 10.1016/j.anclin.2018.04.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In hip surgery, regional anesthesia offers benefits in pain management and recovery. There are a wide range of regional analgesic options; none have shown to be superior. Lumbar plexus block, femoral nerve block, and fascia iliaca block are the most supported by published literature. Other techniques, such as selective obturator and/or lateral femoral cutaneous nerve blocks, represent alternatives. Newer approaches, such as quadratus lumborum block and local infiltration analgesia, require rigorous studies. To realize long-term outcome benefits, postoperative regional analgesia must be tailored to the individual patient and last longer.
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Affiliation(s)
- Dario Bugada
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, Bergamo 24127, Italy.
| | - Valentina Bellini
- Department of Anesthesia and Pain Therapy, Parma University Hospital, Via Gramsci, 14, Parma 43126, Italy
| | - Luca F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, Bergamo 24127, Italy
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 3801 Miranda Avenue, MC 112A, Palo Alto, CA 94304, USA; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, MC 112A, Palo Alto, CA 94304, USA
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Chandran R, Beh ZY, Tsai FC, Kuruppu SD, Lim JY. Peripheral nerve blocks for above knee amputation in high-risk patients. J Anaesthesiol Clin Pharmacol 2018; 34:458-464. [PMID: 30774226 PMCID: PMC6360901 DOI: 10.4103/joacp.joacp_346_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: Above knee amputation (AKA) is associated with considerable mortality and morbidity. There is paucity of data describing the use of peripheral nerve blocks (PNB) as the sole anesthetic technique in high-risk patients undergoing AKA. Our objectives were to evaluate the use of PNB as sole anesthetic technique in the above-mentioned population and its clinical outcomes. Material and Methods: This was a retrospective descriptive study conducted in a tertiary hospital. For this study, patients with American Society of Anesthesiologist [ASA] IV physical status underwent AKA using PNB between January 2010 and December 2016, were identified. The primary outcome measured was the success of the operation. The secondary outcomes were block details, intraoperative hemodynamics, usage of sedation and analgesia, patients’ comorbidities, mortality rates at 30 days and one year. Results: Out of fifty-seven patients, the median age (interquartile range) was 74 (57 – 81) years and 60% were males. The results show 91% successfully underwent surgery with PNB (95% CI 81% to 96%). 95% required intraoperative sedation and analgesia. 67% received combined femoral, obturator and sciatic nerve blocks, in which nine cases had an additional lateral femoral cutaneous nerve block. Interestingly, 33% only received combined femoral and sciatic nerve blocks, and they required higher sedation analgesia (p = 0.013). The 30-day and one-year mortality were 12.3% & 47.4%. Majority had stable hemodynamics during the surgery. Conclusion: This study shows that PNB is a viable option for reliable anesthesia for AKA in high-risk patients. Combined FOS nerve block would reduce the dose for sedation–analgesia during the operation.
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Affiliation(s)
- Rajkumar Chandran
- Department of Anesthesia and Intensive Care, Changi General Hospital, Singapore
| | - Zhi Yuen Beh
- Department of Anesthesia and Intensive Care, Changi General Hospital, Singapore
| | - Fung Chen Tsai
- Department of Anesthesia and Intensive Care, Changi General Hospital, Singapore
| | | | - Jia Yin Lim
- Department of Anesthesia and Intensive Care, Changi General Hospital, Singapore
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Almeida CR, Francisco EM, Pinho-Oliveira V, Assunção JP. Fascia iliaca block associated only with deep sedation in high-risk patients, taking P2Y12 receptor inhibitors, for intramedullary femoral fixation in intertrochanteric hip fracture: a series of 3 cases. J Clin Anesth 2016; 35:339-345. [DOI: 10.1016/j.jclinane.2016.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/09/2016] [Accepted: 08/14/2016] [Indexed: 10/20/2022]
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Cappelleri G, Ghisi D, Ceravola E, Guzzetti L, Ambrosoli AL, Gemma M, Cornaggia G. A randomised controlled comparison between stimulating and standard catheters for lumbar plexus block. Anaesthesia 2015; 70:948-55. [DOI: 10.1111/anae.13077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- G. Cappelleri
- Department of Anaesthesia; Istituto Ortopedico G. Pini; Milan Italy
| | - D. Ghisi
- Department of Anaesthesia; Istituti Ospidalieri di Cremona; Cremona Italy
| | - E. Ceravola
- Department of Anaesthesia; Università degli studi di Milano; Milan Italy
| | - L. Guzzetti
- Department of Anaesthesia; Università degli Studi Insubria di Varese; Varese Italy
| | - A. L. Ambrosoli
- Department of Anaesthesia; Ospedale di Circolo Varese; Varese Italy
| | - M. Gemma
- Department of Anaesthesia; IRCCS Ospedale San Raffaele; Milan Italy
| | - G. Cornaggia
- Department of Anaesthesia; Istituto Ortopedico G. Pini; Milan Italy
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Local anesthetic systemic toxicity after combined psoas compartment-sciatic nerve block: analysis of decision factors and diagnostic delay. Anesthesiology 2014; 120:987-96. [PMID: 24694849 DOI: 10.1097/aln.0000000000000154] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mokini Z, Vitale G, Buccino C, Mauri T, Fumagalli R, Pesenti A. L1-2 roots block with psoas compartment block: reply from the authors? Br J Anaesth 2014; 112:591-3. [PMID: 24535528 DOI: 10.1093/bja/aeu027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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de Leeuw MA, Perez RSGM. Psoas compartment block for surgical repair of inguinal hernias. Br J Anaesth 2014; 112:591-2. [PMID: 24535527 DOI: 10.1093/bja/aeu026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kim HY, Park JW, Park SY, Moon JY, Shin JH, Park SH. Psoas compartment blockade in a laterally herniated disc compressing the psoas muscle -a case report-. Korean J Pain 2012; 25:116-20. [PMID: 22514781 PMCID: PMC3324737 DOI: 10.3344/kjp.2012.25.2.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 12/14/2011] [Accepted: 12/26/2011] [Indexed: 11/05/2022] Open
Abstract
A psoas compartment block has been used to provide anesthesia for orthopedic surgical procedures and analgesia for post-operative pain. Currently, this block is advocated for relieving pain in the lower extremity and pelvic area resulting from various origins. We report a case of a 69-year-old male patient who had gait abnormality with posterior pelvic and hip pain, which were both aggravated by hip extension. From the magnetic resonance image, the patient was found to have a laterally herniated intervertebral disc at the L2/3 level, which compressed the right psoas muscle. This was thought to be the origin of the pain, so a psoas compartment block was performed using 0.25% chirocaine with triamcinolone 5mg, and the pain in both the pelvis and hip were relieved.
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Affiliation(s)
- Hye Young Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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de Leeuw MA, Zuurmond WWA, Perez RSGM. The psoas compartment block for hip surgery: the past, present, and future. Anesthesiol Res Pract 2011; 2011:159541. [PMID: 21716721 PMCID: PMC3119414 DOI: 10.1155/2011/159541] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/10/2011] [Accepted: 03/24/2011] [Indexed: 01/01/2023] Open
Abstract
A posterior lumbar plexus block or psoas compartment block (PCB) is an effective locoregional anesthetic technique for analgesia and anesthesia of the entire lower extremity including the hip. Since the first description in the early seventies, this technique has been modified based on advanced knowledge of the anatomical localization of the lumbar plexus and the improvement of technical equipment. This paper provides an overview of the history, clinical efficacy, and risk profile of the PCB focused on hip surgery. Current status and future expectations are discussed.
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Affiliation(s)
- M. A. de Leeuw
- Department of Anesthesia, Intensive Care and Pain Medicine, Zaans Medical Centre, Koningin Julianaplein 58, 1502 DV Zaandam, The Netherlands
| | - W. W. A. Zuurmond
- Department of Anesthesia, VU Medical Centre, 1502 DV Amsterdam, The Netherlands
| | - R. S. G. M. Perez
- Department of Anesthesia, VU Medical Centre, 1502 DV Amsterdam, The Netherlands
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