Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies.
Authors: De Hert S Abstract Approximately, one in three physicians is experiencing burnout at any given time. This may not only interfere with own wellbeing but also with the quality of delivered care. This narrative review discusses several aspects of the burnout syndrome: prevalence, symptoms, etiopathogenesis, diagnosis, impact, and strategies on how to deal with the problem. PMID: 33149664 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - November 7, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings.
Authors: Dohlman LE, Kwikiriza A, Ehie O Abstract Safe and accessible surgical and anesthetic care is critically limited for over half of the world's population, particularly in Sub-Saharan African and Southeast Asian countries. Increasing the use of regional anesthesia in these areas has potential benefits regarding access, safety, and cost-effectiveness. Perioperative anesthesia-related mortality is significantly higher in resource-limited countries and every effort should be made to encourage the use of anesthetic techniques in these countries that are safest under the present conditions. Studies from Sub-Sahara...
Source: Local and Regional Anesthesia - November 1, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Interfascial Plane Blocks and Laparoscopic Abdominal Surgery: A Narrative Review.
Authors: Jones JH, Aldwinckle R Abstract Laparoscopic abdominal surgery has become a mainstay of modern surgical practice. Postoperative analgesia is an integral component of recovery following laparoscopic abdominal surgery and may be improved by regional anesthesia or intravenous lidocaine infusion. There is inconsistent evidence supporting the use of interfascial plane blocks, such as transversus abdominis plane (TAP) blocks, for patients undergoing laparoscopic abdominal surgery as evidenced by variable patterns of local anesthetic spread and conflicting results from studies comparing TAP blocks to local anesth...
Source: Local and Regional Anesthesia - November 1, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Selective Spinal Anesthesia in a Patient with Low Ejection Fraction Who Underwent Emergent Below-Knee Amputation in a Resource-Constrained Setting.
This report will hopefully show the contextual challenges of the perioperative care of critically ill patients in resource-constrained settings. PMID: 33116811 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - October 31, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Enlarged Brachial Plexus Nerve Found During Ultrasound-Guided Peripheral Nerve Block Diagnosed as Charcot-Marie-Tooth Disease: A Case Report.
We report a case of an enlarged brachial plexus nerve noted on ultrasonographic images, as part of PNB, which was diagnosed postoperatively as Charcot-Marie-Tooth disease (CMTD), an inherited neurological disorder of the peripheral nerves. Although nerve enlargement is characteristic of demyelinating diseases such as CMTD, the use of ultrasonography in the diagnosis of neurological disorders is a developing area for neurologists and anesthesiologists can lack knowledge in this emerging field. Unusual nerve presentation on ultrasonographic images during PNB anesthetic procedures should be recognized as being indicative of u...
Source: Local and Regional Anesthesia - October 31, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block.
The objective of this review is to analyze the case reports, clinical and cadaveric studies about lumbar ESPB that have been published to date. We performed a search in "Pubmed" and "Google Scholar" database. After a selection of the relevant studies, 59 articles were found eligible and were included in this review. While we believe that lumbar ESPB is reliable and easy, we suggest that its efficacy and indications should be verified with anatomical and clinical studies, and its safety should be confirmed with pharmacokinetic studies. Moreover, the possibility of complications must be considered. PM...
Source: Local and Regional Anesthesia - October 21, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients.
Conclusion: Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique. PMID: 32982397 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - September 29, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Novice and Expert Anesthesiologists' Eye-Tracking Metrics During Simulated Epidural Block: A Preliminary, Brief Observational Report.
Authors: Capogna E, Salvi F, Delvino L, Di Giacinto A, Velardo M Abstract Introduction: Eye tracking is the process of measuring an individual's eye movements to register their attentional behavior by using a device called an eye-tracker. Studies conducted using eye-tracking techniques have demonstrated a number of differences in eye movement parameters and patterns between experts and novices. The aim of this preliminary study was to evaluate if there are any differences in eye-tracking metrics between novice and expert anesthesiologists during the performance of an epidural block using an epidural simulator. ...
Source: Local and Regional Anesthesia - September 16, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Successful Dental Treatments Using Procaine Hydrochloride in a Patient Afraid of Local Anesthesia but Consenting for Allergic Testing with Lidocaine: A Case Report.
Conclusion: The success of dental treatment using procaine hydrochloride may have relieved the patient's fear of local anesthesia. We discuss an important aspect of treatment planning for patients with a history of complications during local anesthesia. PMID: 32903881 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - September 11, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Postoperative "Rescue" Use of Erector Spinae Plane Block After Lumbar Spine Fusion: A Report of 2 Cases.
We present a report of two cases that highlight the efficacy of the ESP block as an early postoperative "rescue" regional anesthetic technique in lumbar spine surgery. These cases demonstrate the potential effectiveness of a "rescue" use of the ESP block in patients having uncontrolled or poorly controlled pain in the early postoperative period with no evidence of significant side effects. PMID: 32884335 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - September 5, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Establishing a Technique for Pectoral II-Block Catheter Insertion with Ultrasound Guidance: A Randomized Controlled Trial.
Conclusion: The modified technique facilitated the procedure, shortened the catheter-insertion time, and showed higher patient satisfaction. However, it was associated with lower catheter visibility on ultrasonography. Further studies are required to confirm the present findings and assess the safety of the modified technique. PMID: 32848451 [PubMed] (Source: Local and Regional Anesthesia)
Source: Local and Regional Anesthesia - August 29, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Emergence Agitation and Delirium: Considerations for Epidemiology and Routine Monitoring in Pediatric Patients.
Authors: Menser C, Smith H Abstract Emergence from anesthesia can be associated with a wide spectrum of cognitive and behavioral dysregulation in children, including delirium or acute brain dysfunction. This period of neurobehavioral recovery can be further confounded by pain, anxiety, and fear. The implementation of monitoring for level of consciousness, pain, and delirium using valid pediatric tools is necessary to avoid misdiagnosis due to overlapping symptomatology and support appropriate management. Understanding the epidemiology of delirium in the postoperative setting will require consistent use of accurate ...
Source: Local and Regional Anesthesia - August 19, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

Anesthesia Options and the Recurrence of Cancer: What We Know so Far?
Authors: Cata JP, Guerra C, Soto G, Ramirez MF Abstract Surgery is a critical period in the survival of patients with cancer. While resective surgery of primary tumors has shown to prolong the life of these patients, it can also promote mechanisms associated with metastatic progression. During surgery, patients require general and sometimes local anesthetics that also modulate mechanisms that can favor or reduce metastasis. In this narrative review, we summarized the evidence about the impact of local, regional and general anesthesia on metastatic mechanisms and the survival of patients. The available evidence sugg...
Source: Local and Regional Anesthesia - August 13, 2020 Category: Anesthesiology Tags: Local Reg Anesth Source Type: research

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 4, 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