Delayed Neurological Recovery After Ultrasound-Guided Brachial Plexus Block: A Case Report [Response to Letter].
Authors: Shrestha N, Karki B, Koirala M, Acharya S, Shrestha PS, Acharya SP PMID: 32606917 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - July 3, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Relief of Secondary Headaches with High Thoracic Erector Spinae Plane Block.
We report four cases of effective analgesia for intractable secondary headache resistant to medical management with high thoracic ESP blocks. In each case, the ESP block provided instant pain relief. We suggest that the findings of this case series indicate that the ESP block may be a useful intervention in patients with severe secondary headache or posterior cervical pain where conventional therapies have limited success, though more studies are necessary. PMID: 32606918 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - July 3, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Delayed Neurological Recovery After Ultrasound-Guided Brachial Plexus Block: A Case Report [Letter].
Authors: Mangla C, Yarmush J PMID: 32581576 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - June 27, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Control of Spinal Anesthesia-Induced Hypotension in Adults.
Authors: Ferré F, Martin C, Bosch L, Kurrek M, Lairez O, Minville V Abstract Spinal anesthesia-induced hypotension (SAIH) occurs frequently, particularly in the elderly and in patients undergoing caesarean section. SAIH is caused by arterial and venous vasodilatation resulting from the sympathetic block along with a paradoxical activation of cardioinhibitory receptors. Bradycardia after spinal anesthesia (SA) must always be treated as a warning sign of an important hemodynamic compromise. Fluid preloading (before initiation of the SA) with colloids such as hydroxyethyl starch (HES) effectively reduces the in...
Source: Local and Regional Anesthesia - June 27, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Delayed Neurological Recovery After Ultrasound -Guided Brachial Plexus Block: A Case Report.
Conclusion: Although peripheral neuropathies are known complications of peripheral nerve blocks, such a prolonged brachial plexus block is a rare event. The only plausible cause for the patient's condition could have been the prolonged drug effect; however, it has been rarely documented. PMID: 32425591 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - May 21, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Ankle Surgery in a Patient with Acute Subdural Hematoma Under Combined Lumbar Plexus and Proximal Sciatic Nerve Block - A Case Report.
Authors: Acharya U, Lamsal R Abstract Acute subdural hematoma (aSDH) is commonly encountered in the emergency department in patients with traumatic injuries. If the hematoma is small, non-expanding and asymptomatic, it is managed conservatively. However, other injuries sustained during trauma may warrant surgical intervention, during which anesthetic management becomes challenging. There have been reports of rebleeding in patients with aSDH after undergoing surgery under either general or spinal anesthesia. Here we present a case where ankle surgery for tri-malleolar fracture was successfully performed in a patient...
Source: Local and Regional Anesthesia - May 1, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Peripheral Neuropathic Pain and Pain Related to Complex Regional Pain Syndrome with and without Fixed Dystonia - Efficient Therapeutic Approach with Local Anesthetics.
Authors: Michels T Abstract Peripheral Neuropathic Pain (PNP) as well as the Complex Regional Pain Syndrome (CRPS), also known as "Reflex Sympathetic Dystrophy", or "Sudeck Dystrophy", all of them have a poor prognosis. The numerous therapeutic offers are rarely accompanied by convincing success over a long duration of time. Even worse is the prognosis of a fixed dystonia which may develop in the extremities of PNP or CRPS patients. In literature a few cases are reported in which the often unbearable pain of those patients with or without a disabling dystonia disappeared immediately after the in...
Source: Local and Regional Anesthesia - February 28, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Opioid-Free Cesarean Section with Bilateral Quadratus Lumborum Catheters.
We describe the case of an elective CD with narcotic-free pain control using continuous bilateral posterior quadratus lumborum (QL) blockade as the primary mode of analgesia. Case Report: The patient is a 36-year-old female, G3P1, who presented at 37 weeks of gestation in active labor scheduled for elective primary CD. A spinal anesthetic was performed at L4-L5 with hyperbaric 0.75% bupivacaine, without intrathecal morphine. Bilateral posterior QL catheters were placed under sterile conditions with 20 mL of 0.25% bupivacaine per side. Continuous infusion of 0.2% ropivacaine was then started at 10 mL/hour per side. The ...
Source: Local and Regional Anesthesia - February 28, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Long-term placement of continuous popliteal nerve block catheter for management of a wounded patient in a combat field environment: a case report.
Authors: Fontana C, Rocco M, Vetrugno L, Bignami E Abstract Continuous peripheral nerve block is a relevant part of multimodal treatment of postoperative pain. In this context the continuous popliteal nerve block is described as an option for postoperative pain management for surgical procedures on the leg, and particularly on the ankle and foot. We applied continuous popliteal nerve block for different types of anesthesia and postoperative pain management via the same catheter. No clear evidence of this specific use has been described in the literature. A 38 year-old patient wounded in combat with a displaced frac...
Source: Local and Regional Anesthesia - February 7, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Non-Operating Room Anesthesia: Patient Selection and Special Considerations.
Authors: Wong T, Georgiadis PL, Urman RD, Tsai MH Abstract Non-operating room anesthesia (NORA) represents a growing field of medicine with an increasing trend in the number of cases performed over the previous decade. As a result, anesthesia providers will need to enhance their familiarity with the resources, personnel, and environment outside of the operating room. Anesthesia delivery in NORA settings should be held with the same high-quality standards as that within the operating room. This review looks at special considerations in patient selection and the preoperative, intraoperative, and postoperative periods...
Source: Local and Regional Anesthesia - February 7, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Anesthesia for Percutaneous Radiofrequency Tumor Ablation (PRFA): A Review of Current Practice and Techniques.
Authors: Piccioni F, Poli A, Templeton LC, Templeton TW, Rispoli M, Vetrugno L, Santonastaso D, Valenza F Abstract Percutaneous radiofrequency ablation (PRFA) of solid tumors is a minimally invasive procedure used to treat primary or metastatic cancer lesions via needle targeted thermal energy transfer. Some of the most common tumor lesions treated using PRFA include those within the liver, lungs and kidneys. Additionally, bone, thyroid, and breast lesions can also be treated. In most cases, this procedure is performed outside of the operating room in a specialized radiology suite. As a result, the clinician must a...
Source: Local and Regional Anesthesia - December 13, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Obesity And Obstetric Anesthesia: Current Insights.
Authors: Taylor CR, Dominguez JE, Habib AS Abstract Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population...
Source: Local and Regional Anesthesia - December 12, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures [Response To Letter].
Authors: Mangla C, Kamath HS, Yarmush J PMID: 31819610 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - December 12, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures [Letter].
Authors: Hendriksen E, Slagt C PMID: 31807062 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - December 8, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Case Report Of Cryoneurolysis For The Treatment Of Refractory Intercostobrachial Neuralgia With Postherpetic Neuralgia.
We present a case of a gentleman with refractory postherpetic neuralgia in the intercostobrachial nerve distribution that was successfully treated with cryoneurolysis/cryoanalgesia therapy. PMID: 31802935 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - December 6, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Effect of bupivacaine and adjuvant drugs on skeletal muscle tissue oximetry and blood flow: an experimental study.
Conclusion: Bupivacaine alone results in a significant decrease of tissue oximetry in skeletal muscle which is not increased by the addition of epinephrine or clonidine despite further reductions of microcirculatory perfusion. Overall, bupivacaine alone or with adjuvants does produce local muscle ischemia for which pathological consequences need to be addressed in further studies. PMID: 31695484 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - November 8, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Erratum: Evaluation Of The Attitudes Of Surgeons About Regional Anesthesia: A Survey Study [Corrigendum].
Authors: Abstract [This corrects the article DOI: 10.2147/LRA.S211469.]. PMID: 31632133 [PubMed - in process] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - October 23, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures.
We report a case of a 41-year-old male with anticipated difficult airway undergoing a repair of a bilateral radial fracture under bilateral sequential brachial plexus block. Anesthesiologists are reluctant to perform bilateral blocks because of the fear of complications like diaphragmatic paralysis, local anesthetic (LA) toxicity, and pneumothorax. We advise that with the correct application of LA pharmacokinetics, careful patient selection and usage of ultrasound, bilateral blocks can be done safely. We used chloroprocaine as an LA in one of the blocks to reduce the dose required for the more toxic LAs. chloroprocaine's f...
Source: Local and Regional Anesthesia - October 5, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Evaluation of the attitudes of surgeons about regional anesthesia: a survey study.
Conclusion: We conclude that programmes for informing surgeons and educating patients about the advantages of RA may increase the preference ratio among surgeons and decrease patients' refusals to choose this procedure. PMID: 31571980 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - October 3, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks.
Authors: Mallan D, Sharan S, Saxena S, Singh TK, Faisal Abstract Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24-48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose...
Source: Local and Regional Anesthesia - October 2, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Impact of serratus plane block on pain scores and incentive spirometry volumes after chest trauma.
Authors: Hernandez N, de Haan J, Clendeninn D, Meyer DE, Ghebremichael S, Artime C, Williams G, Eltzschig H, Sen S Abstract Background: Adequate pain control is difficult to achieve in patients with multiple rib fractures (MRF). Serratus plane block (SPB) is a novel technique for alleviating rib fracture pain. Several published case reports support this hypothesis. Purpose: The purpose of this study was to evaluate the use of SPB in MRF at our level 1 trauma center. Methods: Our hospital's Regional Anesthesia Registry was queried for all trauma patients with MRF who underwent SPB between August 2014 and January 201...
Source: Local and Regional Anesthesia - August 27, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Effect of hypotensive hypovolemia and thoracic epidural anesthesia on plasma pro-atrial natriuretic peptide to indicate deviations in central blood volume in pigs: a blinded, randomized controlled trial.
Authors: Strandby RB, Ambrus R, Achiam MP, Henriksen A, Goetze JP, Secher NH, Svendsen LB Abstract Purpose: Changes in plasma pro-atrial natriuretic peptide (proANP) may indicate deviations in the central blood volume (CBV). We evaluated the plasma proANP response to hypotensive hypovolemia under the influence of thoracic epidural anesthesia (TEA) in pigs. We hypothesized that plasma proANP would decrease in response to hypotensive hypovolemia and that TEA would aggravate the proANP response, reflecting a further decrease in CBV. Design: Randomized, blinded, controlled trial. Setting: A university-affiliate...
Source: Local and Regional Anesthesia - August 17, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist [Corrigendum].
Authors: PMID: 31303786 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - July 17, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist.
Authors: Dexter F, Osman BM, Epstein RH Abstract Permanent transitions of care from one anesthesia provider to another are associated with adverse events and mortality. There are currently no available data on how to mitigate these poor patient outcomes other than to reduce the occurrence of such handoffs. We used data from an ambulatory surgery center to demonstrate the steps that can be taken to achieve this goal. First, perform statistical forecasting using many months of historical data to create optimal, as opposed to arbitrary shift durations. Second, consider assigning the anesthesia providers designated to ...
Source: Local and Regional Anesthesia - June 21, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Comparison of subcutaneous dexmedetomidine versus clonidine as an adjuvant to spinal anesthesia: a randomized double blind control trial.
Conclusion: Both subcutaneous clonidine and dexmedetomidine prolonged the duration of postoperative analgesia and reduced analgesic requirements when used as adjuvants to SAB with stable hemodynamics, hence both of these drugs can be used effectively as adjuvants to SAB. PMID: 31114312 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - May 23, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Celiac plexus block as a diagnostic tool in suspected pediatric median arcuate ligament syndrome.
We report the use of celiac plexus block (CPB) as a diagnostic aid in the evaluation of median arcuate ligament syndrome (MALS) in a pediatric patient. MALS is a rare cause of severe, debilitating, abdominal postprandial pain associated with nausea, vomiting, occasional diarrhea, unintentional weight loss, and abdominal bruit. MALS is a diagnosis of exclusion, after multiple investigations. This is the first case report where CPB was used to confirm candidacy for corrective surgery in the pediatric population and has served as the cornerstone in diagnosis of MALS. PMID: 30881107 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - March 20, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients.
This study investigated the hemodynamic effect of SA in elderly patients by studying the effect of two different dosages of intrathecal bupivacaine. Methods: This prospective cohort study included 64 patients aged>65 years scheduled for procedures under SA; the patients received either 15 mg bupivacaine (the medium dose [MD] group) or 10 mg bupivacaine and 5 μg sufentanil (the low dose [LD] group). Blood pressure and CO were monitored throughout the procedure using Nexfin™, a noninvasive continuous monitoring device using a finger cuff. Results: Thirty-three patients received MD and 31 received LD and t...
Source: Local and Regional Anesthesia - March 20, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

A clearer view on postoperative cognitive dysfunction? [Letter].
Authors: van der Veen GJ, Slagt C PMID: 30881109 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - March 20, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

The addition of intrathecal morphine to a transversus abdominis plane block with liposome bupivacaine provides more effective analgesia than transversus abdominis plane block with liposome bupivacaine alone: a retrospective study.
Authors: Hutchins JL, Renfro L, Orza F, Honl C, Navare S, Berg AA Abstract Objective: The purpose of this study was to determine if the standardization of using liposomal bupivacaine in transversus abdominis plane (LB TAP) blocks eliminated the benefit of intrathecal morphine (ITM) in patients after undergoing a cesarean section. Methods: This was a retrospective review of 358 patients who underwent cesarean section over an 11-month period. Patients were divided into two groups: those who received only an LB TAP (67 patients) vs those who received an LB TAP and ITM (291 patients). All blocks were placed bilater...
Source: Local and Regional Anesthesia - March 15, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Effect of local anesthesia (with lidocaine vs bupivacaine) on cognitive function in patients undergoing elective cataract surgery.
Conclusion: Both lidocaine and bupivacaine caused postoperative cognitive impairment. Lidocaine was found to have a worse effect on cognitive function than bupivacaine, but the difference was not statistically significant. PMID: 30643450 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - January 17, 2019 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Treatment of peripheral pain with low-dose local anesthetics by epidermal, epithelial and periosteal application.
Conclusion: LAs in low concentration and small quantities proved to be highly efficient in the treatment of peripheral pain. An almost complete remission could be obtained in a majority of patients. Given the extent of pain reduction achieved, the method of application seems to be of major importance. PMID: 30588085 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - December 29, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Real-time ultrasound-guided retrobulbar block vs blind technique for cataract surgery (pilot study).
Conclusion: There were no statistically significant difference between real-time ultrasound-guided and blind retrobulbar regional eye blocks concerning the onset of action, total volume of injected local anesthetic solution, supplemental injection required, pain scores, and degree of patient satisfaction. PMID: 30584353 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - December 26, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Broken needle during spinal anesthesia: an avoidable complication.
We report a case of a broken spinal needle occurring in a morbid obese pregnant woman during SA indicated for an emergent cesarean section. Multiple puncture attempts due to difficult identification of lumbar spine, associated with an inadequate use of the introducer, contributed to this complication. The recognition of predictive factors for difficult neuraxial anesthesia, the use of ultrasound in obese patients, and a properly executed technique may have allowed avoiding this complication. PMID: 30538540 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - December 14, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Patient-controlled paravertebral analgesia for video-assisted thoracoscopic surgery lobectomy.
This study aimed to compare patient-controlled paravertebral analgesia (PCPA) and intravenous patient-controlled analgesia (IVPCA) in terms of analgesic efficiency, respiratory function, and adverse effects after video-assisted thoracoscopic surgery (VATS) lobectomy. Patients and methods: The prospective randomized trial study was carried out on 60 patients who underwent VATS lobectomy (randomly allocated 30 patients in each group). In the PCPA group, an initial dose of 0.3 mL/kg of 0.125% bupivacaine with fentanyl 2 µg/mL was administered, followed by a 3 mL/h continuous infusion with patient-controlled analgesi...
Source: Local and Regional Anesthesia - December 14, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Erector spinae block for postoperative analgesia following axillary hidradenitis suppurativa resection: a case report.
Authors: de Haan JB, Hernandez N, Sen S Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the terminal hair follicle of the apocrine gland-bearing skin, presenting with inflamed nodules, abscesses, and sinus tracts. Autoimmune, genetic, and infectious factors have been implicated in its pathogenesis. HS can be managed medically using topical and systemic antibiotics and with tumor necrosis factor antibody therapy in severe cases. Surgical treatment can range from local excision, deroofing or excision of sinus tracts, or wide radical excision of severe lesions. Lesions can be severely painf...
Source: Local and Regional Anesthesia - December 12, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials.
Authors: Kendall MC, Alves LJC, Suh EI, McCormick ZL, De Oliveira GS Abstract Regional anesthesia is becoming increasingly popular among anesthesiologists in the management of postoperative analgesia following pediatric surgery. The main objective of this review was to systematically evaluate the last 5 years of randomized controlled trials on the role of regional anesthesia techniques in alleviating postoperative pain associated with various pediatric surgical procedures. Forty studies on 2,408 pediatric patients were evaluated. The majority of the articles published from 2013 to 2017 reported that the use of regi...
Source: Local and Regional Anesthesia - December 12, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Caudal epidural block instead of general anesthesia in an adult with Duchenne muscular dystrophy.
We present a 36-year-old adult with DMD, who required anesthetic care during surgical debridement of an ischial pressure sore. Given his significant respiratory muscle involvement, ultrasound-guided caudal epidural anesthesia was used instead of general during the surgical procedure. The technique and its applications are discussed, with particular emphasis on the feasibility and safety of using regional anesthetic techniques in patients with DMD. PMID: 30410390 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - November 11, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Impact of thoracic epidural sympathetic block on cardiac repolarization.
Authors: Komatsuzaki M, Takasusuki T, Yamaguchi S Abstract Purpose: The interval from the peak to the end of the T wave (Tp-Te) on electrocardiography is considered a marker of ventricular arrhythmias. A previous study suggested that right stellate ganglion block prolonged QT and QT dispersion (QTD). We investigated the effect of thoracic epidural sympathetic block with 1% mepivacaine on QT, QTD, Tp-Te, and Tp-Te/QT by using computerized measurement. Patients and methods: After obtaining the approval of the ethics committee of Dokkyo Medical University Hospital, 23 patients with American Society of Anesthesiolo...
Source: Local and Regional Anesthesia - November 11, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Frailty and anesthesia - risks during and post-surgery.
Authors: Lin HS, McBride RL, Hubbard RE Abstract Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications ...
Source: Local and Regional Anesthesia - October 18, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Plasma ropivacaine concentration after TAP block in a patient with cardiac and renal failure.
We report a successful ultrasound-guided transversus abdominis plane (TAP) block as an analgesic option for minor abdominal surgery in a 66-year-old patient with cardiac, respiratory, and renal dysfunction caused by primary systemic amyloidosis. Bilateral TAP blocks with 120 mg (1.8 mg/kg) of ropivacaine provided sufficient intra- and postoperative analgesia for insertion of a continuous ambulatory peritoneal dialysis catheter. However, the plasma concentration of ropivacaine reached a maximum of 2.5 µg/mL at 15 minutes after the TAP block, a concentration that was potentially neurotoxic. Although apparent signs of l...
Source: Local and Regional Anesthesia - October 6, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

The impact of fluoroscopic confirmation of thoracic imaging on accuracy of thoracic epidural catheter placement on postoperative pain control.
Conclusion: Improvement in assuring success in the technique for TEA catheter placement following major thoracic or upper abdominal surgery exists, for which contrast-enhanced fluoroscopy might be a promising solution. PMID: 30214281 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - September 16, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Foot drop after spinal anesthesia for cesarean section: a case report.
Conclusion: Foot drop is a neurological disorder, which occurs following natural childbirth and spinal anesthesia due to direct needle trauma or local anesthetic toxicity. This complication is transient and usually resolves within a few days. In our patient, the neurological complication appeared after labor and anesthesia recovery, which was treated by corticosteroids and anti-inflammatory drugs, with no particular side effects. PMID: 30127636 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - August 23, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Local anesthetic systemic toxicity: current perspectives.
Authors: El-Boghdadly K, Pawa A, Chin KJ Abstract Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes. Increasing use of local anesthetic techniques in various healthcare settings makes contemporary understanding of LAST highly relevant. Recent data have demonstrated that the underlying mechanisms of LAST are multifactorial, with diverse cellular effects in the central nervous system and cardiovascular system. Although neurological presentation is most common, LAST often presents atypically, and o...
Source: Local and Regional Anesthesia - August 22, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Optimizing the securement of epidural catheters: an in vitro trial.
Conclusion: Our study demonstrates the advantage of the Suresite Window Clear Dressing in securing the epidural catheter. Future clinical trials are needed to validate these findings. PMID: 30046251 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - July 31, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Spinal anesthesia instead of general anesthesia for infants undergoing tendon Achilles lengthening.
We present the use of SA for 6 infants undergoing tendon Achilles lengthening, review the use of SA in orthopedic surgery, describe our protocols and dosing regimens, and discuss the potential adverse effects related to this technique. PMID: 29760560 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - May 17, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Remifentanil-induced postoperative hyperalgesia: current perspectives on mechanisms and therapeutic strategies.
Authors: Santonocito C, Noto A, Crimi C, Sanfilippo F Abstract The use of remifentanil in clinical practice offers several advantages and it is used for a wide range of procedures, ranging from day-surgery anesthesia to more complex procedures. Nonetheless, remifentanil has been consistently linked with development of opioid-induced hyperalgesia (OIH), which is described as a paradoxical increase in sensitivity to painful stimuli that develops after exposure to opioid treatment. The development of OIH may cause several issues, delaying recovery after surgery and preventing timely patient's discharge. Moreover, it c...
Source: Local and Regional Anesthesia - April 21, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Effect of warming anesthetic on pain perception during dental injection: a split-mouth randomized clinical trial.
Authors: Aravena PC, Barrientos C, Troncoso C, Coronado C, Sotelo-Hitschfeld P Abstract Background: The purpose of this study is to determine the effectiveness of warming anesthesia on the control of the pain produced during the administration of dental anesthesia injection and to analyze the role of Transient Receptor Potential Vanilloid-1 nociceptor channels in this effect. Patients and methods: A double-blind, split-mouth randomized clinical trial was designed. Seventy-two volunteer students (22.1±2.45 years old; 51 men) from the School of Dentistry at the Universidad Austral de Chile (Valdivia, Chile...
Source: Local and Regional Anesthesia - March 6, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Local anesthetics for brain tumor resection: current perspectives.
Authors: Potters JW, Klimek M Abstract This review summarizes the added value of local anesthetics in patients undergoing craniotomy for brain tumor resection, which is a procedure that is carried out frequently in neurosurgical practice. The procedure can be carried out under general anesthesia, sedation with local anesthesia or under local anesthesia only. Literature shows a large variation in the postoperative pain intensity ranging from no postoperative analgesia requirement in two-thirds of the patients up to a rate of 96% of the patients suffering from severe postoperative pain. The only identified causative ...
Source: Local and Regional Anesthesia - February 16, 2018 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Administration of epidural labor analgesia is not associated with a decreased risk of postpartum depression in an urban Canadian population of mothers: a secondary analysis of prospective cohort data.
Conclusion: We did not observe a significant association between epidural use and PPD. While the CIs are wide, we do not believe that this masks a clinically relevant association, and as such, the risks and benefits of epidural analgesia communicated to women during labor and delivery should not be modified. PMID: 29184440 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - December 3, 2017 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients.
CONCLUSION: SA is effective for use in patients undergoing elective lumbar laminectomy and/or diskectomy spinal surgery, and was shown to be the more expedient anesthetic choice in the perioperative setting. PMID: 29066932 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - October 27, 2017 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research