1
|
Xie G, Zhao J, Chu L, Song S, Wang Y, Lai D, Cheng B, Fang X. Establishment of Difficult Caudal Epidural Blockade Prediction Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2037904. [PMID: 36387347 PMCID: PMC9652077 DOI: 10.1155/2022/2037904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/12/2022] [Accepted: 07/22/2022] [Indexed: 07/29/2023]
Abstract
Background We aimed to develop a predictive difficult caudal epidural blockade (pDCEB) model when ultrasound was not available and verified the role of ultrasound in difficult caudal epidural blockade (CEB). Methods From October 2018 to March 2019, this study consisted of three phases. First, we prospectively enrolled 202 patients scheduled to undergo caudal epidural anesthesia and assessed risk factors by binary logistic regression to develop the predictive scoring system. Second, we enrolled 87 patients to validate it. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the prediction model. Youden-index was used to determine the cut-off value. Third, we enrolled 68 patients with a high risk of difficult CEB (pDCEB score ≥3) and randomized them into ultrasound and landmark groups to verify the role of ultrasound. Result The rate of difficult CEB was 14.98% overall 289 patients. We found a correlation between unclear palpation of the sacral hiatus (OR 9.688) and cornua (OR 4.725), the number of the sacral hiatus by palpation ≥1 (OR 4.451), and history of difficult CEB (OR 39.282) with a higher possibility of difficult CEB. The area under the receiver operating characteristic curve of the pDCEB model involving the aforementioned factors was 0.889 (95% CI, 0.827-0.952) in the development cohort and 0.862 (95% CI, 0.747-0.977) in the validation cohort. For patients with a pDCEB score ≥3, a preprocedure ultrasound scan could reduce the incidence of difficult CEB (55.56% in the Landmark group vs. 9.38% in the ultrasound group, p < 0.001). Conclusion This novel pDCEB score, which takes into account palpation of the sacral hiatus/cornua, number of the sacral hiatus by palpation ≥1, and history of difficult CEB, showed a good predictive ability of difficult CEB. The findings suggested that performing an ultrasound scan is essential for patients with a pDCEB score ≥3. Trial registration: No: ChiCTR1800018871, Site URL: https://www.chictr.org.cn/edit.aspx?pid=31875&htm=4; Principal investigator: Jialian Zhao, Date of registration: 2018.10.14.
Collapse
Affiliation(s)
- Guohao Xie
- Departments of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jialian Zhao
- Departments of Anesthesiology, The Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lihua Chu
- Departments of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shengwen Song
- Departments of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ya Wang
- Departments of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dengming Lai
- Departments of Neonatal Surgery, The Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Baoli Cheng
- Departments of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiangming Fang
- Departments of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| |
Collapse
|
2
|
Alrayashi W, Cravero J, Brusseau R. Unique Issues Related to Regional Anesthesia in Pediatric Orthopedics. Anesthesiol Clin 2022; 40:481-489. [PMID: 36049876 DOI: 10.1016/j.anclin.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article will narrow its focus largely to notable issues related to regional anesthesia in pediatrics. First, the controversy surrounding awake versus anesthetized block placement will be addressed. There will also be a discussion on the use of regional anesthetics in orthopedics cases and the risk of compartment syndrome. Subsequently, the concern for regional anesthetics in the setting of an instrumented spine (eg, following spine fusion, baclofen pump placement) will be reviewed as such can have significant ramifications for patients. Finally, this article will consider ambulatory regional catheters and their increasing use in pediatric orthopedic anesthesia. Their utilization during the COVD epidemic played a key role in facilitating procedures that would have been canceled due to the protracted hospital bed shortage.
Collapse
Affiliation(s)
- Walid Alrayashi
- Department of Anesthesiology, Harvard Medical School, Home Analgesia Program, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Joseph Cravero
- Department of Anesthesiology, Harvard Medical School, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Roland Brusseau
- Department of Anesthesiology, Harvard Medical School, Pediatric Regional Anesthesia Program, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| |
Collapse
|
3
|
Infraclavicular brachial plexus block in adults: a comprehensive review based on a unified nomenclature system. J Anesth 2019; 33:463-477. [PMID: 31076946 DOI: 10.1007/s00540-019-02638-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 03/28/2019] [Indexed: 12/12/2022]
Abstract
Over the last decade, considerable progress has been made regarding infraclavicular brachial plexus block (ICB) in adults, especially since the introduction of ultrasound guidance. The advancements in ICB have been attributed to the development of various approaches to improve the success rate and reduce complications. This has also necessitated a unified nomenclature system to facilitate comparison among different approaches. This review aimed to propose an anatomical nomenclature system by classifying ICB approaches into proximal and distal ones to aid future research and provide practice advisories according to recent updates. We also comprehensively discuss various aspects of this nomenclature system. Our review suggests that ultrasound-guided ICB should be categorized as an advanced technique that should be performed under supervision and dual guidance. For one-shot block, the conventional distal approach is still preferred but should be modified to follow ergonomic practice, with the arm in the proper position. For continuous ICB, the proximal approach is promising for reducing local anesthetic volume and increasing efficacy. Nevertheless, further studies are warranted in this direction. We provide practice advisories to maximize safety and minimize adverse events, and recommend designing future studies on ICB according to these findings based on the unified nomenclature system.
Collapse
|