Upper Extremity Regional Anesthesia Techniques: A Comprehensive Review for Clinical Anesthesiologists

Publication date: Available online 20 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Mark R. Jones, Matthew B. Novitch, Sudipta Sen, Nadia Hernandez, Johanna Blair De Haan, Rebecca A. Budish, Christopher Bailey, Joseph Ragusa, Pankaj Thakur, Vwaire Orhurhu, Ivan Urits, Elyse M. Cornett, Alan David KayeAbstractSurgeries and chronic pain states of the upper extremity are quite common and pose unique challenges for the clinical anesthesiology and pain specialists. Most innervation of the upper extremity involves the brachial plexus. The four most common brachial plexus blocks performed in clinical setting include the interscalene, supraclavicular, infraclavicular and axillary brachial plexus blocks. These blocks are most commonly performed with the use of ultrasound guided techniques whereby analgesia is achieved by anesthetizing the brachial plexus at different levels such as the roots, divisions, cords and branches. Additional regional anesthetic techniques for upper extremity surgery include wrist, intercostobrachial, and digital nerve blocks, which are most frequently performed using landmark anatomical techniques. This review provides a comprehensive summary of each of these blocks including anatomy, best practice techniques, and potential complications.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research

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ConclusionThe laparoscopic reverse technique is an alternative approach to face retrocervical or rectovaginal nodules infiltrating the anterior rectal wall. In this technique, the separation of the nodule from the rectal wall is performed at the end of the surgery and not at the beginning as performed within the traditional technique. This enables the surgeon to perform a more precise dissection of the endometriotic nodule from the rectal wall because of the increased mobility of the bowel. The wider range of movements serves as an ergonomic advantage for the subsequent dissection of the lesion from the rectum, allowi...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
ConclusionLaparoscopic reverse technique is an alternative approach to face retrocervical or rectovaginal nodules infiltrating the anterior rectal wall.  In this technique, the separation of the nodule from the rectal wall is performed at the end of the surgery and not at the beginning as performed within the traditional technique. This enables the surgeon to perform a more precise dissection of the endometriotic nodule from the rectal wall because of the increased mobility of the bowel. The wider range of movements serves as an ergonomic advantage for the subsequent dissection of the lesion from the rectum, allowing ...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
Publication date: Available online 25 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Sudipta Sen, Michelle Ge, Amit Prabhakar, Vanessa Moll, Rachel J. Kaye, Elyse M. Cornett, O.Morgan Hall, Ira.W. Padnos, Richard D. Urman, Alan David KayeAbstractJust two decades ago, regional anesthesia was performed blindly with dubious outcomes and little support from surgeons and patients. Technological advances in regional anesthesia have revolutionized techniques and greatly improved outcomes. Ultrasound technology continues to advance and has become more affordable. Improvements have come in the form ...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 19 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Henry Liu, Morgan Brown, Lu Sun, Shukan P. Patel, Jinlei Li, Elyse M. Cornett, Richard D. Urman, Charles J. Fox, Alan David KayeAbstractRegional anesthesia is responsible for approximately one-fifth of professional liability claims. The present investigation evaluated common and rare complications related to regional and neuraxial anesthesia, including postdural puncture headache, backache, transient neurological symptoms, inadvertent intrathecal injection, epidural hematoma and abscess, meningitis, arachno...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 18 July 2019Source: Best Practice &Research Clinical AnaesthesiologyAuthor(s): Alan David Kaye, Mark W. Motejunas, Lauren A. Bonneval, Ken P. Ehrhardt, Dustin R. Latimer, Andrea Trescot, Kyle E. Wilson, Ibraham N. Ibrahim, Elyse M. Cornett, Richard D. Urman, Kenneth D. CandidoAbstractChronic pain management techniques have evolved in recent years. In this regard, ultrasound technology has become a standard for most acute pain procedures and essential for postsurgical pain relief and enhanced recovery after surgery protocols. This manuscript summarizes clinical studies evaluating ultra...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
Conclusions: Ultrasound-guided GON block using botulinum toxin is effective in reducing short-term and long-term pain in patients with chronic headache in occipital area. PMID: 31159537 [PubMed - as supplied by publisher]
Source: Korean Journal of Anesthesiology - Category: Anesthesiology Tags: Korean J Anesthesiol Source Type: research
AbstractPurpose of ReviewThe erector spinae plane (ESP) block is an ultrasound-guided regional anesthesia technique that has enjoyed unprecedented popularity since its description in 2016. This review summarizes the applied anatomy, technical performance, and clinical application of the ESP block.Recent FindingsDissection and imaging studies indicate that paravertebral local anesthetic spread is a primary mechanism of action of the ESP block. A large volume of case report literature supports its efficacy in myriad clinical settings, including thoracic surgery, thoracic trauma, cardiac surgery, abdominal surgery, spine surg...
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research
Caesarean delivery is a very common operation worldwide. The procedure leads to a significant incidence of chronic and persistent pain.1 In labouring women the most common nerve injuries are those of the femoral cutaneous and femoral nerve respectively.2 After major pelvic surgery obturator and ilio-inguinal/iliohypogastric (II/IH) nerve injury is the most common postoperative neuropathy.3 The incidence of these latter neuropathies after gynecological surgery or a Pfannenstiel incision has been reported to be 3 –7%.
Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
Caesarean delivery is a very common operation worldwide. The procedure leads to a significant incidence of chronic and persistent pain.1 In laboring women the most common nerve injuries are those of the femoral cutaneous and femoral nerve respectively.2 After major pelvic surgery obturator and ilio-inguinal / iliohypogastric (II/IH ) nerve injury is the most common postoperative neuropathy.3 The incidence of these latter neuropathies after gynecological surgery or a Pfannenstiel incision has been reported to be 3 –7%.
Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
si RG Abstract The perioperative pain management - instead of the efforts, guidelines and protocols - is underestimated and undertreated. Even in the case of general anaesthesia, the nervous system is overwhelmed by copious quantities of nociceptive stimuli at surgical incision. Stress and pain-modulation processes are triggered which can have significant influence on the outcome. Often the pain-management is discontinued, so a notable part of patients complain about pain in the ward after surgery. Regional anaesthesia conceptually prevents noxious inputs to enter the central nervous system, beyond surgical anaest...
Source: Orvosi Hetilap - Category: General Medicine Authors: Tags: Orv Hetil Source Type: research
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