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Local and Regional Anesthesia

Agnes M Lamon, Ashraf S Habib
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients...
2016: Local and Regional Anesthesia
Mark Vogt, Dennis J van Gerwen, John J van den Dobbelsteen, Martin Hagenaars
Performance of neuraxial blockade using a midline approach can be technically difficult. It is therefore important to optimize factors that are under the influence of the clinician performing the procedure. One of these factors might be the chosen point of insertion of the needle. Surprisingly few data exist on where between the tips of two adjacent spinous processes the needle should be introduced. A geometrical model was adopted to gain more insight into this issue. Spinous processes were represented by parallelograms...
2016: Local and Regional Anesthesia
Thuan Dao, David Amaro-Driedger, Jaideep Mehta
Raynaud's syndrome has been treated medically and invasively, sometimes with regional anesthesia leading up to sympathectomy. We demonstrate that regional anesthesia was in this case a useful technique that can allow some patients to find temporary but significant relief from symptoms of Raynaud's syndrome exacerbation. We present a 43-year-old woman with Raynaud's syndrome secondary to lupus who was treated with bilateral popliteal nerve block catheters for ischemic pain and necrosis of her feet; this led to almost immediate resolution of her pain and return of color and function of her feet...
2016: Local and Regional Anesthesia
Asad Siddiqui, Andrew Tse, James E Paul, Peter Fitzgerald, Bernice Teh
INTRODUCTION: Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure) is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children's hospital, in patients undergoing the Nuss procedure...
2016: Local and Regional Anesthesia
Kris Vermeylen, Joris De Puydt, Stefan Engelen, Eva Roofthooft, Filiep Soetens, Arne Neyrinck, Marc Van de Velde
BACKGROUND AND AIMS: A popliteal block is effective in managing postoperative pain for foot surgery, but since the duration of analgesia is limited following a single-shot popliteal fossa block technique, methods to prolong effective postoperative analgesia are mandatory. The aim of this study was to assess the effect of adjuvants to ropivacaine on the duration of sensory and motor block. METHODS: In this double-blind randomized placebo-controlled study, we evaluated the analgesic effect of clonidine or dexamethasone (DXM) when added to ropivacaine for hallux valgus surgery...
2016: Local and Regional Anesthesia
Cor Slagt
No abstract text is available yet for this article.
2016: Local and Regional Anesthesia
Rajagopalan Venkatraman, Ranganathan Jothi Abhinaya, Ayyanar Sakthivel, Govindarajan Sivarajan
BACKGROUND AND AIM: Transversus abdominis plane block (TAP block) is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our study was to gauge the analgesic efficacy of ultrasound-guided TAP block in patients undergoing unilateral inguinal hernia repair. MATERIALS AND METHODS: Sixty patients scheduled for elective inguinal hernia repair were selected for the study...
2016: Local and Regional Anesthesia
Dennis F Flanagan
Four percent articaine local anesthetic has been successfully used to attain local anesthesia for dental procedures. Mandibular block anesthesia may consume longer time to attain and have a higher failure of local anesthesia compared to infiltration. Mandibular facial infiltration has been reported to successfully attain effective local anesthesia for dental procedures. This study involved only several tooth sites and found that 1.8 cc of 4% articaine facial infiltration in the mandible may be effective when the facial mandibular cortex is <2...
2016: Local and Regional Anesthesia
Corey Amlong, Moltu Guy, Kristopher M Schroeder, Melanie J Donnelly
PURPOSE: Paravertebral blocks (PVBs) are a method of limiting postoperative pain for patients undergoing video-assisted thoracoscopic surgery (VATS). We began providing ultrasound-guided PVBs for patients undergoing VATS in the spring of 2011, using an out-of-plane approach. The aim of this study was to evaluate this practice change. METHODS: Following institutional review board approval, we reviewed the charts of 114 patients undergoing VATS by one surgeon at our institution between January 2011 and July 2012...
2015: Local and Regional Anesthesia
Anshul Jain, Shivali Pandey, Roopesh Kumar, Chavi Sethi, Sanjya Sharma
BACKGROUND: Subarachnoid blockade for cesarean section still poses a threat of profound hypotension and can result in unstable maternal and fetal hemodynamics. The correlation of fetal breech and vertex presentation with the occurrence of hypotension under spinal anesthesia is reviewed in this retrospective, double-blind study. PATIENTS AND METHODS: The study was conducted on pregnant females scheduled for a lower segment cesarean section between January 2014 and December 2014...
2015: Local and Regional Anesthesia
Irma Pérez-Ruvalcaba, Viridiana Sánchez-Hernández, Arieh R Mercado-Sesma
AIM: The aim of this study was to assess the effect of continuous and intermittent electrical transcutaneous nerve stimulation on the perception of pain in patients with burns of different types. MATERIALS AND METHODS: A pilot study was conducted in 14 patients (age 30.9±7.5 years) with second- and third-degree burns of different types. The burn types included electrical, fire/flame, and chemical. All patients received continuous and intermittent electrical transcutaneous nerve stimulation sessions three times per week for 4 weeks...
2015: Local and Regional Anesthesia
Jeffrey Gadsden, Sabry Ayad, Jeffrey J Gonzales, Jaideep Mehta, Jan Boublik, Jacob Hutchins
Transversus abdominis plane (TAP) infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration...
2015: Local and Regional Anesthesia
Admir Hadzic, John A Abikhaled, William J Harmon
Liposome bupivacaine is a prolonged-release liposomal formulation of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia of longer duration than traditional local anesthetics. This review summarizes the available data on how volume expansion may impact the analgesic efficacy of liposome bupivacaine. The Phase II and III clinical studies that involved surgical site administration of liposome bupivacaine at various concentrations in different surgical settings revealed no apparent concentration-efficacy relationship...
2015: Local and Regional Anesthesia
Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar
Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation...
2015: Local and Regional Anesthesia
Davide Giordano, Maria Gabriella Raso, Carmine Pernice, Vanni Agnoletti, Verter Barbieri
In recent years, the popularity of aesthetic and cosmetic procedures, often performed in outpatient settings, has strongly renewed interest in topical anesthetics. A number of different options are widely used, alone or in combination, in order to minimize the pain related to surgery. Moreover, interest in local anesthetics in the treatment of some painful degenerative conditions such as myofascial trigger point pain, shoulder impingement syndrome, or patellar tendinopathy is increasing. Numerous clinical trials have shown that lidocaine-tetracaine combination, recently approved for adults aged 18 or older, is effective and safe in managing pain...
2015: Local and Regional Anesthesia
C Slagt, G J van Geffen
No abstract text is available yet for this article.
2015: Local and Regional Anesthesia
Wallis T Muhly, Harshad G Gurnaney, Arjunan Ganesh
The indications for surgery on the knee in children and adolescents share some similarity to adult practice in that there are an increasing number of sports-related injuries requiring surgical repair. In addition, there are some unique age-related conditions or congenital abnormalities that may present as indications for orthopedic intervention at the level of the knee. The efficacy and safety of peripheral nerve blocks (PNBs) for postoperative analgesia following orthopedic surgery has been well established in adults...
2015: Local and Regional Anesthesia
Todd Britt, Ryan Sturm, Rick Ricardi, Virginia Labond
BACKGROUND: Thoracic trauma accounts for 10%-15% of all trauma admissions. Rib fractures are the most common injury following blunt thoracic trauma. Epidural analgesia improves patient outcomes but is not without problems. The use of continuous intercostal nerve blockade (CINB) may offer superior pain control with fewer side effects. This study's objective was to compare the rate of pulmonary complications when traumatic rib fractures were treated with CINB vs epidurals. METHODS: A hospital trauma registry provided retrospective data from 2008 to 2013 for patients with 2 or more traumatic rib fractures...
2015: Local and Regional Anesthesia
Daniela Ghisi, Andrea Fanelli, Julie Jouguelet-Lacoste, Luca La Colla, Anne-Sophie Auroux, Jacques E Chelly
BACKGROUND AND OBJECTIVES: Lidocaine could provide many advantages in continuous regional anesthesia techniques, including faster onset, greater titratability, and lower cost than long-acting local anesthetics. This prospective, randomized, double-blinded, pilot study is therefore intended to compare lidocaine to ropivacaine in bilateral continuous paravertebral blocks using a multimodal approach for postoperative pain management following laparoscopic bowel surgery. METHODS: Thirty-five ASA I-III consecutive patients undergoing elective laparoscopic bowel surgery and bilateral thoracic paravertebral continuous blocks were analyzed: bilateral thoracic paravertebral infusions of ropivacaine 0...
2015: Local and Regional Anesthesia
Jinlei Li, Thomas Halaszynski
Incidence of hemorrhagic complications from neuraxial blockade is unknown, but classically cited as 1 in 150,000 epidurals and 1 in 220,000 spinals. However, recent literature and epidemiologic data suggest that for certain patient populations the frequency is higher (1 in 3,000). Due to safety concerns of bleeding risk, guidelines and recommendations have been designed to reduce patient morbidity/mortality during regional anesthesia. Data from evidence-based reviews, clinical series and case reports, collaborative experience of experts, and pharmacology used in developing consensus statements are unable to address all patient comorbidities and are not able to guarantee specific outcomes...
2015: Local and Regional Anesthesia
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