Truncal Regional Nerve Blocks in Clinical Anesthesia Practice

Publication date: Available online 19 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Ivan Urits, Peter S. Ostling, Matthew B. Novitch, James C. Burns, Karina Charipova, Kyle L. Gress, Rachel J. Kaye, Matthew R. Eng, Elyse M. Cornett, Alan David KayeAbstractRegional anesthetic techniques are important components of successful multimodal analgesic strategies. When used successfully, truncal nerve blocks of the chest wall, abdomen, and, paraneuraxial nerves, in combination with other analgesic modalities, may offer similar analgesic efficacy as neuraxial techniques, which are associated with a greater risk profile. Moreover, in comparison to neuraxial techniques, truncal nerve blocks are relatively simple to perform and technically straightforward to learn. The transversus abdominus plane (TAP) block is often incorporated into the multimodal analgesia regimen for surgical patients undergoing various abdominal and gynecological procedures. Rectus sheath blocks (RSB) were originally introduced to help relax the anterior abdominal wall during surgery and as an adjunct pain therapy. With the advancement of technology and the development of ultrasound guided techniques, RSB now have a more ubiquitous role and have been shown to decrease postoperative pain and opioid consumption. Different variations of the quadratus lumborum block may provide visceral and sensory analgesic coverage. Moreover, truncal blocks including ilioinguinal, iliohypogastric, Pec...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research

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Publication date: Available online 26 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Mark R. Jones, Matthew B. Novitch, O. Morgan Hall, Andrew P. Bourgeois, George M. Jeha, Rachel J. Kaye, Vwaire Orhurhu, Mariam Salisu Orhurhu, Matthew Eng, Elyse M. Cornett, Alan David KayeAbstractThe facsia iliaca block (FIB) is a relatively new regional technique where local anesthetic is delivered within the fascia iliaca region. Indications for a FIB include surgical anesthesia to the lower extremity after knee, femoral shaft, hip surgery, management of cancer pain or pain secondary to inflammatory cond...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
This study found a "statistically significant difference during initial hours after fracture reduction and fixation so that pain intensity was less in elderly patients under hematoma block than patients who underwent general anesthesia in one and six hours after surgery." Most importantly, patients in the hematoma block group required less narcotic pain medication compared with the general surgery population.Experienced providers often know exactly where to inject anesthesia for hematoma blocks. Ultrasound-guided injection techniques, however, prove to be more accurate. Using ultrasound to identify the hematoma a...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
ABSTRACT: Split-thickness skin grafting is the most common reconstructive procedure in managing burn injuries. Harvesting split-thickness skin creates a new partial thickness wound referred to as the donor site. Pain at the donor site is reported to be one of the most distressing symptoms during the early postoperative period. Here, we (a) identify strategies for managing donor site pain, (b) assess the quality of individual studies, and (c) formulate evidence-based recommendations based on the amount and consistency of evidence. Our analysis revealed five distinct approaches to minimize donor site pain. These include: con...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - Category: Orthopaedics Tags: Review Articles Source Type: research
ConclusionThese results suggest that HIFU treatment of uterine leiomyomas leads to clinical improvement with few significant clinical complications and adverse events.
Source: Archives of Gynecology and Obstetrics - Category: OBGYN Source Type: research
We report 3 different cases in which ultrasound-guided percutaneous cryoneurolysis was performed to treat acute pain: 1 patient with refractory incisional pain after percutaneous nephrolithotomy; 1 patient with burns to the foot; and 1 patient with pain from iliac crest grafting. Acute pain associated with surgery or injury is a challenge to treat with local anesthetic-based regional anesthesia techniques when the anticipated pain duration exceeds a few days. Cryoneurolysis is an alternative analgesic method that utilizes extremely cold temperatures to reversibly ablate peripheral nerves and is potentially a novel method f...
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research
For Allure, by Katie Becker. Discomfort and beauty are always in tension, so we teach ourselves the algorithm of: Is it worth it? We learn the calculations between ouch and better skin (or flatter abs, or a firmer jawline, or...). But you can't do the math without knowing what kind of pain you're in for. We went to the people who know best—the patients—to find out exactly what it feels like to be on the receiving end of all those needles, blades, and lasers. *Pain Meter runs on a scale of 1-5. Botox: An injectable neurotoxin used to temporarily paralyze facial muscles and smooth wrinkles The Patient Report: &q...
Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
The management of pain after burn injuries is a clinical challenge magnified in patients with significant comorbidities. Presently, burn pain is treated via a wide variety of modalities, including systemic pharmacotherapy and regional analgesia. Although the latter can provide effective pain control in patients with burn injuries, it is relatively underused. Furthermore, the development of ultrasound guidance has allowed for novel approaches and sparing of motor nerve blockade with preference toward sensory-specific analgesia that has not been possible previously.
Source: Journal of Clinical Anesthesia - Category: Anesthesiology Authors: Tags: Case Report Source Type: research
SPECIAL FROM Varicose veins, a vascular disease that causes swollen, twisted veins, affect up to 35 percent of the American population. They are usually found in the legs, but can appear elsewhere on the body. Also known as venous insufficiency, varicose veins occur when damaged veins have trouble sending blood from the legs to the heart. There are a lot of myths out there about this condition. We talked to Kathleen Gibson, MD, vascular surgeon and vein specialist of Lake Washington Vascular, Bellevue, WA, to get the real deal: Myth #1: Varicose veins are harmless. Dr. Gibson: Varicose veins can be just a cosmetic iss...
Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
This study in pediatric burn patients undergoing reconstructive procedures examined the analgesia response to local anesthetic infiltration versus either a single ultrasound-guided regional nerve block of the lateral femoral cutaneous nerve (LFCN) or a fascia iliaca compartment block with catheter placement and continuous infusion. Nineteen patients were randomized to one of three groups (infiltration, single-shot nerve block, or compartment block with catheter) and received intraoperative analgesia intervention. Postoperatively, visual analog scale pain scores were recorded—for pain at the donor site—every 4 h...
Source: Journal of Burn Care and Research - Category: Rehabilitation Tags: Original Articles Source Type: research
The objective of the MAS evidence review was to conduct a systematic review of the available evidence on the safety, effectiveness, durability and cost-effectiveness of endovascular laser therapy (ELT) for the treatment of primary symptomatic varicose veins (VV). BACKGROUND: The Ontario Health Technology Advisory Committee (OHTAC) met on November 27, 2009 to review the safety, effectiveness, durability and cost-effectiveness of ELT for the treatment of primary VV based on an evidence-based review by the Medical Advisory Secretariat (MAS). CLINICAL CONDITION: VV are tortuous, twisted, or elongated veins. This can be due...
Source: Ontario Health Technology Assessment Series - Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research
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