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Rathod PR, Bhoi D, Kumar A, Ray BR, Mohan VK, Kashyap L. Effect of ultrasound-guided quadratus lumborum block on neuroendocrine stress response and postoperative analgesia in paediatric patients undergoing elective open pyeloplasty - A randomised clinical trial. Indian J Anaesth 2024; 68:467-472. [PMID: 38764955 PMCID: PMC11100651 DOI: 10.4103/ija.ija_608_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 05/21/2024] Open
Abstract
Background and Aims Quadratus lumborum block (QLB) is a compartmental block of the anterior abdominal wall. Surgical trauma produces neuroendocrine surgical stress responses, which are modified by anaesthetic blocks. The aim of this study was to evaluate the effect of ultrasound (US)-guided QLB on analgesia and surgical neuroendocrine stress response in paediatric patients undergoing pyeloplasty. Methods A randomised trial was conducted in 60 children aged 1-7 years undergoing elective open pyeloplasty. Patients were randomised into Group QLB [US-guided QLB with 0.5 ml/kg of 0.25% ropivacaine after induction of general anaesthesia (GA)], and Group GA, which received only GA. Perioperative haemodynamic parameters, serum cortisol, blood glucose, analgesic consumption and postoperative FLACC scores were recorded. Unpaired t-test, Wilcoxon rank-sum test or Mann-Whitney U test was used to compare variables between the two groups. Two-way analysis of variance or the Friedmann test was used to compare quantitative variables at various points within a group. Results A decrease in serum cortisol and blood glucose values was observed in Group QLB at 30 min after surgical incision and 24 h after surgery compared to the preoperative value and compared to Group GA (P < 0.05). The quality of analgesia assessed by the FLACC scale was significantly better in group QLB. Dose of fentanyl consumption (µg/kg) was higher in Group GA compared to Group QLB in the intraoperative and postoperative period (P < 0.05). Conclusion QLB is effective as part of multimodal analgesia and attenuates the neuroendocrine stress in paediatric patients undergoing open pyeloplasty.
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Affiliation(s)
- Pyarelal Ramsing Rathod
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ajeet Kumar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash Ranjan Ray
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Virender Kumar Mohan
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Lokesh Kashyap
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Rayyani S, Aljedani H, Kariri R, Alsuhim G, Madkhali M, Oraybi H, Assiri S, Alhayaza R, Madah A. Anesthesia Preferences and Outcomes in Saudi Arabian Healthcare: A Cross-Sectional Study. Cureus 2024; 16:e57340. [PMID: 38690461 PMCID: PMC11060666 DOI: 10.7759/cureus.57340] [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: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Anesthesia choice is critical in ensuring optimal surgical outcomes and patient satisfaction. We aimed to investigate anesthesia preferences, trends, and outcomes in elective surgeries within Saudi Arabian healthcare settings. METHODS A cross-sectional survey-based study was conducted among anesthesia residents and attending anesthesiologists across Saudi Arabia. Participants provided demographic information and responded to questions regarding anesthesia preferences, trends, and outcomes. Descriptive statistics were used to summarize the data, and logistic regression analysis was employed to identify factors associated with anesthesia preference. RESULTS The survey was completed by 572 healthcare professionals in Saudi Arabia. Among participants, 51.7% (n=296) preferred general anesthesia, while 48.3% (n=276) favored regional anesthesia for elective surgeries. Factors influencing anesthesia choice included patient preference, surgical complexity, and resource availability. Over half of the respondents reported an increase in regional anesthesia preference over the past five years, although some perceived inadequate training in this area. Common barriers to regional anesthesia adoption included equipment availability, patient reluctance, and limited training opportunities. Postoperative recovery was perceived as quicker with regional anesthesia by 52.3% (n=299) of participants, with postoperative nausea and vomiting being the most common complication associated with general anesthesia. Multivariable logistic regression analysis revealed that participants above 50 years had lower odds of preferring regional anesthesia, while those perceiving training adequacy in regional anesthesia as adequate had higher odds of preferring it (OR=0.64, 95% CI: 0.41-0.98, p=0.041; OR=1.58, 95% CI: 1.21-2.05, p=0.001, respectively). CONCLUSION This study provides insights into anesthesia practice patterns in Saudi Arabian healthcare settings. Individualized anesthesia care, ongoing training in regional anesthesia, and evidence-based decision-making are essential to optimize perioperative outcomes and patient satisfaction.
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Affiliation(s)
| | - Hind Aljedani
- College of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Razan Kariri
- College of Medicine, Jazan University, Jazan, SAU
| | | | | | | | - Shaima Assiri
- College of Medicine, King Khalid University, Abha, SAU
| | - Rand Alhayaza
- College of Medicine, King Khalid University, Abha, SAU
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AlOmran AK, Alosaimi N, Alshaikhi AA, Bakhurji OM, Alzahrani KJ, Salloot BZ, Alabduladhem TO, AlMulhim AI, Alumran A. Burden of routine orthopedic implant removal a single center retrospective study. World J Orthop 2024; 15:139-146. [PMID: 38464354 PMCID: PMC10921180 DOI: 10.5312/wjo.v15.i2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Open reduction and internal fixation represent prevalent orthopedic procedures, sparking ongoing discourse over whether to retain or remove asymptomatic implants. Achieving consensus on this matter is paramount for orthopedic surgeons. This study aims to quantify the impact of routine implant removal on patients and healthcare facilities. A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University (KFHU) was conducted and subjected to statistical scrutiny. Among these cases, 44% necessitated hospitalization exceeding one day, while 56% required only a single day. Adults exhibited a 55% need for extended hospital stays, contrasting with 22.8% among the pediatric cohort. The complication rate was 6%, with all patients experiencing at least one complication. Notably, 34.1% required sick leave and 4.8% exceeded 14 d. General anesthesia was predominant (88%). Routine implant removal introduces unwarranted complications, particularly in adults, potentially prolonging hospitalization. This procedure strains hospital resources, tying up the operating room that could otherwise accommodate critical surgeries. Clearly defined institutional guidelines are imperative to regulate this practice. AIM To measure the burden of routine implant removal on the patients and hospital. METHODS This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU, a tertiary hospital in Saudi Arabia. Data were collected in the orthopedic department at KFHU from February 2016 to August 2022, which includes routine asymptomatic implant removal cases across all age categories. Nonroutine indications such as infection, pain, implant failure, malunion, nonunion, restricted range of motion, and prominent hardware were excluded. Patients who had external fixators removed or joints replaced were also excluded. RESULTS Between February 2016 and August 2022, 360 implants were retrieved; however, only 167 of those who met the inclusion criteria were included in this study. The remaining implants were rejected due to exclusion criteria. Among the cases, 44% required more than one day in the hospital, whereas 56% required only one day. 55% of adults required more than one day of hospitalization, while 22.8% of pediatric patients required more than one day of inpatient care. The complication rate was 6%, with each patient experiencing at least one complication. Sick leave was required in 34.1% of cases, with 4.8% requiring more than 14 d. The most common type of anesthesia used in the surgeries was general anesthesia (88%), and the mean (SD) surgery duration was 77.1 (54.7) min. CONCLUSION Routine implant removal causes unnecessary complications, prolongs hospital stays, depletes resources and monopolizing operating rooms that could serve more critical procedures.
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Affiliation(s)
- Ammar K AlOmran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Nader Alosaimi
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ahmed A Alshaikhi
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Omar M Bakhurji
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Khalid J Alzahrani
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Basil Ziyad Salloot
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Tamim Omar Alabduladhem
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ahmed I AlMulhim
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology Department, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
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Parthasarathy S, Venkatesh TK, Saravanan B. Evaluation of age-based local anaesthetic dosing of bupivacaine for popliteal sciatic nerve block in children undergoing foot and ankle surgery: A prospective single arm interventional study. Indian J Anaesth 2023; 67:S257-S260. [PMID: 38187980 PMCID: PMC10768899 DOI: 10.4103/ija.ija_171_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Recommendations on paediatric single-injection local anaesthetic (LA) dosing for peripheral nerve blocks (PNBs) are based on the children's weight and limited by weight-based toxicity concerns. In this study, we assessed the extent of circumferential spread and block characteristics following the injection of an age-based volume (age in years = LA volume) of 0.25% bupivacaine following popliteal sciatic nerve block (PSNB). Methods Thirty children aged between 2 and 12 years with the American Society of Anesthesiologists (ASA) physical status I and II and undergoing foot and ankle surgical procedures were given single-injection ultrasound-guided subparaneural PSNB using 0.25% bupivacaine at age-based LA volume after the administration of anaesthesia. The circumferential pattern of LA spread (primary objective) was assessed along the nerve (both cephalad and caudal) using ultrasound from the point of administration and the block characteristics in terms of duration of sensory block. Results The mean [standard deviation (SD)] cephalic circumferential LA spread distance was 2.52 (0.68) [95% confidence interval (CI): 2.27-2.76] cm. The mean (SD) caudal circumferential LA spread distance was 2.27 (0.48) [95% CI: 2.09-2.44] cm. The mean (SD) duration of the sensory block was 9.03 (0.97) [95% CI: 8.67-9.38] h. Conclusion The age-based LA volume of bupivacaine for ultrasound-guided PSNB resulted in a longitudinal circumferential spread of around 4.7 cm (adding both cephalic and caudal spread) and provided adequate analgesia for nine postoperative hours.
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Affiliation(s)
- Srinivasan Parthasarathy
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pillayarkuppam, Pondicherry, India
| | - T. Kumar Venkatesh
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pillayarkuppam, Pondicherry, India
| | - Balachandar Saravanan
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal, Pondicherry, India
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Nabil F, Rashed MS, Takrouney MH, Ibrahim IA, Abdalla E, Osman HM. Peri-anal infiltration versus caudal block for multimodal analgesia in paediatric patients with Hirschsprung's disease undergoing transanal endorectal pull-through procedure: A randomised trial. Indian J Anaesth 2023; 67:979-984. [PMID: 38213680 PMCID: PMC10779970 DOI: 10.4103/ija.ija_471_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 01/13/2024] Open
Abstract
Background and Aims Transanal endorectal pull-through (TERPT) is a standard procedure for managing paediatric patients with Hirschsprung's disease (HD). This study aimed to evaluate peri-anal infiltration versus caudal block as a part of multimodal analgesia for paediatric patients with HD undergoing the TERPT procedure. Methods This randomised trial included 60 patients of both genders, aged 6 to 18 months who underwent the TERPT procedure under general anaesthesia. The patients were randomly assigned into two groups to receive either peri-anal infiltration or caudal block with 1 ml/kg bupivacaine 0.25% and dexmedetomidine 1 µg/kg in 0.5 ml normal saline. The primary outcome was the time to the first rescue analgesia. The secondary outcomes were the total consumption, the frequency of nalbuphine administration as rescue analgesia within 24 hours and the level of postoperative sedation. Results The time to first rescue analgesia was significantly shorter in the peri-anal infiltration group versus the caudal block group (median [interquartile range] 10 [7.5-12.5] h versus 16 [13.5-18.5] h, respectively, P = 0.008). The frequency of administration and the total dose of nalbuphine was significantly higher in the peri-anal infiltration group (P = 0.003 and 0.013, respectively). The sedation score was significantly higher in the caudal block group postoperatively. Conclusion For paediatric patients undergoing the TERPT procedure, peri-anal infiltration was less effective than caudal block in terms of the duration of postoperative analgesia. However, both techniques were comparable during the first 6 hours postoperatively.
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Affiliation(s)
- Fatma Nabil
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed S. Rashed
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed H Takrouney
- Department of General Surgery, Pediatric Surgery Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ibrahim A Ibrahim
- Department of General Surgery, Pediatric Surgery Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esam Abdalla
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hany M Osman
- Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Assiut University, Assiut, Egypt
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Diwan S, Sethi D, Jadhav S, Patil S. Monitored epidural catheter placement-ultrasound-guided neurostimulation-aided thoracic catheter placement via caudal route for perioperative analgesia in neonatal thoracotomies: A technical feasibility study. Indian J Anaesth 2023; 67:930-933. [PMID: 38044913 PMCID: PMC10691615 DOI: 10.4103/ija.ija_850_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 12/05/2023] Open
Abstract
In this case series, we investigated the feasibility of combining ultrasound and neurostimulation for inserting a stimulating epidural catheter in the thoracic epidural space through the caudal route in neonates. Twelve neonates undergoing tracheo-oesophageal fistula repair under general anaesthesia were studied. The catheter was visible on ultrasound as a hyperechoic dot in the epidural space. Inadvertent high placement was identified in two neonates with neurostimulation, in whom the catheter was withdrawn to the thoracic epidural space, and the position was confirmed on ultrasound. A 0.5 ml/kg bolus dose of 0.125% bupivacaine injected through the epidural catheter was imaged in real-time in the epidural space. Block was effective in 10 neonates; two needed an additional local anaesthetic (LA) bolus. To conclude, ultrasound with neurostimulation facilitates accurate positioning of the caudally placed epidural catheter to the mid-thoracic level in neonates.
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Affiliation(s)
- Sandeep Diwan
- Department of Anesthesiology, Sancheti Institute of Orthopedics and Rehabilitation, Pune, Maharashtra, India
| | - Divya Sethi
- Department of Anesthesiology, Employees’ State Insurance Cooperation Postgraduate Institute of Medical Sciences and Research (ESIC–PGIMSR), New Delhi, India
| | - Sudhakar Jadhav
- Department of Anaesthesia, Kinderchirurgie Paediatric Surgical Centre, Pune, Maharashtra, India
| | - Santosh Patil
- Department of Anaesthesia, Kinderchirurgie Paediatric Surgical Centre, Pune, Maharashtra, India
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Adlan S, Abd El-Rahman A, Mohamed SAB, Thabet AM, Hamada EM, Farouk BR, El Sherif FA. Systemic Analgesia versus Continuous Erector Spinae Plane Block (ESPB) Infusion During Paediatric Nephrectomy: A Randomized, Controlled Trial. Local Reg Anesth 2023; 16:59-69. [PMID: 37304230 PMCID: PMC10254591 DOI: 10.2147/lra.s401980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose A subcostal flank incision is required for open radical nephrectomy, which is a surgical procedure used to remove tumors of the kidney that are malignant. The erector spinae plane block (ESPB) and continuous catheter use in children are receiving more and more support by paediatric regional anaesthesiologists. Our objective was to compare systemic analgesic to continuous ESPB for pain relief in paediatric patients undergoing open radical nephrectomy. Methods Sixty children with cancer ASA I or II and undergoing open radical nephrectomy between the ages of two and seven participated in this prospective, randomized, controlled, and open label study. The cases were divided into two equal groups (E and T groups); Group E received ipsilateral continuous ultrasound-guided ESPB at T9 (thoracic vertebrae), with a bolus of 0.4 mL/kg bupivacaine 0.25%. Immediately postoperatively, Group E (ESPB group) received continuous ESPB with a PCA (patient controlled analgesia) pump at a rate of 0.2 mL/kg/hour bupivacaine 0.125%. Group T (Tramadol group), Tramadol hydrochloride was administered intravenously at a dose of 2 mg/kg/8hour, which could be increased to 2 mg/kg/6hours. Then, we followed up on patients' total analgesic consumption for 48 hours following surgery, as well as the time it took for them to request rescue analgesic, their FLACC and sedation scores, and their hemodynamics and side effects immediately following surgery as well as at 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours. Results A highly significant difference in total tramadol consumed in group T 11.97 ± 1.13 mg/kg while group E was 2.07± 1.54 mg/kg (p < 0.001). 100% patients in group T requested analgesia compared to 46.7% patients in group E (p < 0.001). From 2 to 48 hour, FLACC significantly decreased in E compared to T group (p≤ 0.006) at all-time points. Conclusion Ultrasound-guided continuous ESPB significantly provided better postoperative pain relief, reduced postoperative tramadol consumption and reduced pain scores compared with the use of tramadol alone, in paediatric cancer patients undergoing nephrectomy.
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Affiliation(s)
- Suzan Adlan
- National Cancer Institute, Cairo University, Cairo, Egypt
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Ponde VC, Puri KJ, Desai AP, Gursale AA, Zehra SUO, Johari AN. Infraclavicular block in children: Is blocking lateral or posterior cord equally successful? J Anaesthesiol Clin Pharmacol 2023; 39:181-188. [PMID: 37564836 PMCID: PMC10410023 DOI: 10.4103/joacp.joacp_235_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 08/12/2023] Open
Abstract
Background and Aims The most effective approach for infraclavicular brachial plexus block in adults is to target the posterior cord, usually situated posterior to axillary artery. However, we do not know if this can be extrapolated in children. Our primary objective was to compare the clinical success rate of ultrasound guided infraclavicular brachial plexus block in children with local anesthetic injection aimed at two targets. These were posterior to axillary artery (posterior cord) and lateral to axillary artery (lateral cord). The secondary objectives involved need for intraoperative rescue analgesia, evaluation of duration of analgesia, incidence of complications such as pneumothorax and arterial puncture, comparison of postoperative pain scores and fluoroscopic dye spread pattern was also observed. Material and Methods It was a randomized, prospective pilot study. Forty children undergoing forearm and hand surgeries were randomized to two groups, in accordance with the target site of the block. Target sites of Group P (20 patients) and Group L (20 patients) were posterior and lateral to the axillary artery, i.e., posterior and lateral cord respectively. Aforesaid objectives were assessed. SPSS (Version 15.0) statistical package was used. Comparison between Group L and P was by using student's unpaired t test for age and weight. Fisher's exact probability test was applied to compare percentages between groups. Results Blocks of both groups were equally successful. No patient required intraoperative rescue analgesia. Duration of analgesia was comparable. Both groups had no major complications and similar postoperative pain scores. Conclusions The success rate of infraclavicular brachial plexus block by aiming at the lateral and posterior cord was similar.
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Affiliation(s)
- Vrushali C. Ponde
- Department of Anaesthesiology, Surya Children Hospital, Mumbai, India
| | - Kriti J. Puri
- Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Ankit P. Desai
- Department of Anaesthesiology, Surya Children Hospital, Mumbai, India
| | - Anuya A. Gursale
- Department of Anaesthesiology, Surya Children Hospital, Mumbai, India
| | - Serpil U. O. Zehra
- Department of Anaesthesiology and Reanimation, University of MAA Acibadem, Istanbul
| | - Ashok N. Johari
- Department of Paediatric Orthopaedic Surgery, Children Orthopaedic Centre, Maharashtra, India
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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.
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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
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Patil A, Ponde VC, Johari A, Jain M, Kaushik A. The possibilities and challenges in pain management of a child with 26 fingers posted for polydactyly excisions of all 4 limbs! J Anaesthesiol Clin Pharmacol 2022; 38:345-347. [PMID: 36171955 PMCID: PMC9511846 DOI: 10.4103/joacp.joacp_119_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anagha Patil
- Anaesthesiology Clinical Fellow, Paediatric Anaesthesia, Childrens Anaesthesia Services and Surya Hospital
| | - Vrushali C. Ponde
- Consultant, Paediatric Anaesthesia, Childrens Anaesthesia Services and Surya Hospital, Santacruz, Mumbai, Maharashtra, India,Address for correspondence: Dr. Vrushali C. Ponde, Department of Anesthesiology, Surya Children Hospital, SV Road Santacruz, Mumbai - 54, Maharashtra, India. E-mail:
| | - Ashok Johari
- Consultant, Paediatric Orthopaedics, Childrens Orthopaedic Centre and Surya Hospital, Santacruz, Mumbai, Maharashtra, India
| | - Mohit Jain
- Consultant, Paediatric Orthopaedics, Childrens Orthopaedic Centre and Surya Hospital, Santacruz, Mumbai, Maharashtra, India
| | - Aditya Kaushik
- Clinical Fellow, Paediatric Orthopaedics, Childrens Orthopaedic Centre and Surya Hospital, Santacruz, Mumbai, Maharashtra, India
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Singh Bajwa S, Malde A, Prabhu SS, Sundaram S. Paediatric anaesthesia practice: Has it really changed over the times? Indian J Anaesth 2022; 66:621-624. [DOI: 10.4103/ija.ija_776_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2022] Open
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E. Hylton J. Harlequin syndrome as a complication of epidural anaesthesia in an infant: Do adjunct medications play a role? Indian J Anaesth 2022; 66:669-672. [DOI: 10.4103/ija.ija_426_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/04/2022] Open
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Abosamak M, Shama A, Ng K, Shahen M. Effect of adding midazolam to intrathecal bupivacaine in children undergoing lower abdominal surgeries: A randomised controlled trial. Indian J Anaesth 2022; 66:200-206. [PMID: 35497697 PMCID: PMC9053896 DOI: 10.4103/ija.ija_466_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/24/2021] [Accepted: 03/01/2022] [Indexed: 11/04/2022] Open
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Ponde V, Singh N, Chavan D, Nagdev T. Interscalene brachial plexus block in a neonate: Here's how. Indian J Anaesth 2021; 65:700-701. [PMID: 34764506 PMCID: PMC8577716 DOI: 10.4103/ija.ija_394_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/04/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Vrushali Ponde
- Department of Anaesthesiology, Surya Children's Hospital, S.V. Road - Santacruz, West Mumbai, Maharashtra, India
| | - Neha Singh
- Department of Anaesthesia, AIIMS, Bhuwaneshwar, Odisha, India
| | - Dilip Chavan
- Department of Anaesthesiology, Surya Children's Hospital, S.V. Road - Santacruz, West Mumbai, Maharashtra, India
| | - Tripti Nagdev
- Department of Anaesthesiology, Surya Children's Hospital, S.V. Road - Santacruz, West Mumbai, Maharashtra, India
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15
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Karagoz S, Tekin E, Aydin ME, Turgut MC, Yayik AM. Sedoanalgesia Versus Infraclavicular Block for Closed Reduction of Pediatric Forearm Fracture in Emergency Department: Prospective Randomized Study. Pediatr Emerg Care 2021; 37:e324-e328. [PMID: 32665506 DOI: 10.1097/pec.0000000000002190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Procedural sedoanalgesia is commonly used in pediatric patients in the emergency department (ED) for interventional procedures, diagnosis, and treatment. However, this method causes serious systemic complications, such as respiratory and cardiac depression. To minimize these complications, ultrasound-guided regional anesthesia methods have been used in recent years. We aimed to compare the use of procedural sedoanalgesia (PSA) and infraclavicular block (ICB) in the pain management of pediatric patients who underwent closed reductions of forearm fractures. MATERIALS AND METHODS This prospective, randomized, clinical study included patients aged 3 to 15 years who presented to the ED with forearm fractures. The patients were divided into 2 groups: the procedural sedoanalgesia group (group PSA, n = 30) and ultrasound-guided ICB group (group ICB, n = 30). Pain scores of the patients were evaluated using the Wong-Baker FACES Scale before and during the procedure. Pain scores and parental and operator satisfaction were compared between the groups. RESULTS There was no statistical significance in terms of demographic data. The pain scores observed during the procedures were significantly higher in the group PSA than in the group ICB (3.07 ± 1.55 vs 0.47 ± 0.86, respectively; P < 0.001). The parental and operator satisfaction of the ICB group was significantly higher than that of the PSA group (P < 0.001). CONCLUSIONS Ultrasound-guided ICB is a safe and effective method in the management of pain during closed reduction of forearm fracture in pediatric patients in EDs. It can be used safely in emergency rooms and has a high level of both parental and operator satisfaction.
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Affiliation(s)
| | | | - Muhammed Enes Aydin
- Department of Anesthesiology and Reanimation, Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum,Turkey
| | - Mehmet Cenk Turgut
- Department of Orthopedic Surgery, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ahmet Murat Yayik
- Department of Anesthesiology and Reanimation, Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum,Turkey
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16
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Ponde VC, Uemera A, Singh N. Complications in paediatric regional anaesthesia: a narrative review. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.6.s2.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Currently, almost all paediatric patients posted for surgery could and should be given a regional block unless and until contraindicated. This is because the scope, techniques, and their benefits have a wide range and complications are rare. The first report that used regional anaesthesia in children was in 1898, and over the last 120 years it has been developed with many scholars’ wisdom, ideas and publications. Paediatric regional anaesthesia (PRA) has many advantages but requires experience and expertise. For a long-time, exclusively landmark-guided techniques were used and gradually the development of new techniques such as the use of neuro-stimulator and ultrasound-guided (USG) blocks developed into PRA. Especially, the application of ultrasonography (US) has revolutionised the practice of PRA. Few limitations of regional anaesthesia can be tackled by the use of US, leading to shorter time to perform the block, reduced time for block onset and use of a smaller volume of local anaesthetic. Life threatening complications of regional anaesthesia are rare and the riskbenefit ratio is favourable. However, a thorough insight into RA complications, no matter how rare they are, is essential for safe practice. This is because they can be life-threatening, and no matter how small the percentage is, when complications occur, for that individual patient statistics is irrelevant.
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17
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Mehdiratta L, Chakravarthy K, Anand S. Improving the perioperative compliance and quality care in obstetric and paediatric anaesthesia: Challenges and anodynes. Indian J Anaesth 2020; 64:927-930. [PMID: 33487675 PMCID: PMC7815004 DOI: 10.4103/ija.ija_1386_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lalit Mehdiratta
- Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Center, Bhopal, Madhya Pradesh, India E-mail:
| | - Kousalya Chakravarthy
- Department of Anaesthesiology, Modern Government Maternity Hospital, Petlaburj, Osmania Medical College, Hyderabad, Telangana, India
| | - Smriti Anand
- Department of Anaesthesiology and Intensive Care, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India
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18
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Deepa T, Gopalaiah S, Parthasarathy P, Shreyavathi R. A two month male baby with Alagille Syndrome, posted for pyeloplasty: Anaesthesia management. Indian J Anaesth 2020; 64:727-729. [PMID: 32934414 PMCID: PMC7457980 DOI: 10.4103/ija.ija_102_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/18/2020] [Accepted: 06/14/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- T Deepa
- Department of Anaesthesia, Sapthagiri Institute of Medical Sciences And Research Centre, Bengaluru, Karnataka, India
| | - Shwetha Gopalaiah
- Department of Anaesthesia, Sapthagiri Institute of Medical Sciences And Research Centre, Bengaluru, Karnataka, India
| | - Prabha Parthasarathy
- Department of Anaesthesia, Sapthagiri Institute of Medical Sciences And Research Centre, Bengaluru, Karnataka, India
| | - R Shreyavathi
- Department of Anaesthesia, Sapthagiri Institute of Medical Sciences And Research Centre, Bengaluru, Karnataka, India
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19
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D'souza NJ, Mara KP, Patil P, Diwan S. Paediatric lumbar paravertebral sonoanatomy: More like a "Dragon fly" than a "Shamrock". Indian J Anaesth 2020; 64:804-805. [PMID: 33162577 PMCID: PMC7641088 DOI: 10.4103/ija.ija_670_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nita J D'souza
- Department of Anaesthesia, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Kirthi Priya Mara
- Department of Anaesthesia, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Pranita Patil
- Department of Anaesthesia, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sandeep Diwan
- Department of Anaesthesia, Sancheti Hospital, Pune, Maharashtra, India
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20
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Singh S, Jha RK, Sharma M. The analgesic effect of bilateral ultrasound-guided erector spinae plane block in paediatric lower abdominal surgeries: A randomised, prospective trial. Indian J Anaesth 2020; 64:762-767. [PMID: 33162570 PMCID: PMC7641087 DOI: 10.4103/ija.ija_630_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/20/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background and Aims: This study aims to evaluate the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) in paediatric lower abdominal surgeries. Methods: Randomised, prospective trial. Forty patients, aged 2–10 years with the American Society of Anesthesiologists Score of I and II scheduled for elective lower abdominal surgery were included in the study. Interventions: Patients were randomised into two groups as control group and ESPB group. Ultrasound-guided erector spinae plane block at L1 vertebral level was performed preoperatively using 0.5 ml/kg 0.25% bupivacaine (max 20 ml) for the patients in ESPB group. Analgesic requirements and time to first analgesic requirement were recorded and Face, Legs, Activity, Cry and Consolability (FLACC) scores for pain were recorded at 0, 1, 2, 3, 6, 12 and 24 h postoperatively. Results: Forty patients were included in the final analyses. Significant difference was determined between the groups on post-operative morphine requirement and FLACC scores at 3 h and 6 h postoperatively (P < 0.05). Significant difference was also determined in time to first dose of rescue analgesia between the groups (P < 0.05). Conclusions: This study shows that the ESPB provides adequate post-operative analgesia in paediatric patients undergoing lower abdominal surgery.
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Affiliation(s)
- Swati Singh
- Department of Anaesthesia and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Raushan Kumar Jha
- Department of Anaesthesia and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Manisha Sharma
- Department of Anaesthesia and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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21
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Kaushal S, Singh S, Sharma A. A randomised study comparing the extent of block produced by spinal column height and body weight-based formulae for paediatric caudal analgesia. Indian J Anaesth 2020; 64:477-482. [PMID: 32792711 PMCID: PMC7398024 DOI: 10.4103/ija.ija_824_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/19/2020] [Accepted: 05/04/2020] [Indexed: 11/08/2022] Open
Abstract
Background and Aims: Height and weight-based formulae are used for calculation of dose of medications for caudal analgesia but these have not been compared. We compared spinal column height-based Spiegel and weight-based Takasaki and Armitage formulae for achieving maximum height of sensory neuraxial block after caudal epidural analgesia in paediatric patients. Methods: In this double-blind randomised study, children aged between 1 and 6 years and planned for infra-umbilical surgery were randomly allocated to receive caudal epidural block (targeting T10level block) with 0.25% bupivacaine, using a volume calculated by modified Spiegel formula (group I), Takasaki formula (group II), and Armitage formula (group III). The Institute ethics committee reviewed and approved the study protocol. The primary endpoint of the study was the difference in the number of spinal segments blocked as assessed by pinprick method. The secondary endpoint was the difference in volume of 0.25% bupivacaine used among the groups. The groups were compared using one-way ANOVA. Results: Seventy-five patients (25 in each group) completed the study as per protocol. The mean number of spinal segments blocked was significantly different among groups (P < 0.001) with patients in group I (13.8 ± 0.83) showing significantly lower number of spinal segments blocked as compared to that in group II (15.8 ± 1.06; P < 0.001), and group III (16.8 ± 1.28; P < 0.001). The mean volume of 0.25% bupivacaine used in group I was significantly lower (P < 0.001) than that in group II and group III. Conclusion: Dose calculation in caudal epidural analgesia as per spinal column height-based modified Spiegel formula was more precise than bodyweight-based Takasaki and Armitage formulae.
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Affiliation(s)
- Sonali Kaushal
- Department of Anaesthesiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Surinder Singh
- Department of Anaesthesiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Sharma
- Department of Anaesthesiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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22
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Govender S, Mohr D, Bosenberg A, Van Schoor AN. A cadaveric study of the erector spinae plane block in a neonatal sample. Reg Anesth Pain Med 2020; 45:386-388. [DOI: 10.1136/rapm-2019-100985] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/03/2022]
Abstract
BackgroundThe aim of this article was to provide a detailed description of the neonatal anatomy related to the erector spinae plane block and to report the spread of the dye within the fascial planes and potential dermatomal coverage.MethodsUsing ultrasound guidance, the bony landmarks and anatomy of the erector spinae fascial plane space were identified. The erector spinae plane block was then replicated unilaterally in two fresh unembalmed neonatal cadavers. Using methylene blue dye, the block was performed at vertebral levels T5—using 0.5 mL in cadaver 1—and T8—using 0.2 mL in cadaver 2. The craniocaudal spread of dye was tracked within the space on the ultrasound screen and further confirmed on dissection.ResultsCraniocaudal spread was noted from vertebral levels T3 to T6 when the dye was introduced at vertebral level T5 and from vertebral levels T7 to T11 when the dye was introduced at vertebral level T8. Furthermore, the methylene blue spread was found anteriorly in the paravertebral and epidural spaces, staining both the dorsal and ventral rami of the spinal nerves T2 to T12. Small amounts of dye were also found in the intercostal spaces.ConclusionIn two neonatal fresh cadavers, the dye was found to spread to multiple levels and key anatomic locations.
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