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Local and Regional Anesthesia

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https://www.readbyqxmd.com/read/30538541/patient-controlled-paravertebral-analgesia-for-video-assisted-thoracoscopic-surgery-lobectomy
#1
Nguyen Truong Giang, Nguyen Van Nam, Nguyen Ngoc Trung, Le Viet Anh, Nguyen Manh Cuong, Ngo Van Dinh, Dinh Cong Pho, Phillip Geiger, Nguyen Trung Kien
Background: Paravertebral block has been proven to be an efficient method to provide post-thoracotomy pain management. 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)...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30538540/broken-needle-during-spinal-anesthesia-an-avoidable-complication
#2
Rawéléguinbasba Armel Flavien Kaboré, Ibrahim Alain Traore, Salah Idriss Séif Traore, Cheik Tidiane Hafi Wind-Pouiré Bougouma, Pascal Augustin, Aboudoul-Fataou Ouro-Bang'na Maman
The occurrence of a needle breaking is a very rare complication of spinal anesthesia (SA). 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...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30532585/regional-anesthesia-to-ameliorate-postoperative-analgesia-outcomes-in-pediatric-surgical-patients-an-updated-systematic-review-of-randomized-controlled-trials
#3
REVIEW
Mark C Kendall, Lucas J Castro Alves, Edward I Suh, Zachary L McCormick, Gildasio S De Oliveira
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 regional anesthesia minimized postoperative pain and reduced opioid consumption...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30532584/erector-spinae-block-for-postoperative-analgesia-following-axillary-hidradenitis-suppurativa-resection-a-case-report
#4
Johanna Blair de Haan, Nadia Hernandez, Sudipta Sen
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...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30410391/impact-of-thoracic-epidural-sympathetic-block-on-cardiac-repolarization
#5
Makoto Komatsuzaki, Toshifumi Takasusuki, Shigeki Yamaguchi
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 Anesthesiologists physical status I or II who were scheduled to undergo thoracic surgery were enrolled...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30410390/caudal-epidural-block-instead-of-general-anesthesia-in-an-adult-with-duchenne-muscular-dystrophy
#6
Shabana Z Shafy, Mohammed Hakim, Mauricio Arce Villalobos, Gregory D Pearson, Giorgio Veneziano, Joseph D Tobias
Duchenne muscular dystrophy (DMD), first described in 1834, is an X-linked dystrophinopathy, leading to early onset skeletal muscle weakness. Life expectancy is reduced to early adulthood as a result of involvement of voluntary skeletal muscles with respiratory failure, orthopedic deformities, and associated cardiomyopathy. Given its multisystem involvement, surgical intervention may be required to address the sequelae of the disease process. We present a 36-year-old adult with DMD, who required anesthetic care during surgical debridement of an ischial pressure sore...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30323657/frailty-and-anesthesia-risks-during-and-post-surgery
#7
REVIEW
Hui-Shan Lin, Rebecca L McBride, Ruth E Hubbard
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 such as postoperative cognitive dysfunction and delirium are explored...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30288098/plasma-ropivacaine-concentration-after-tap-block-in-a-patient-with-cardiac-and-renal-failure
#8
Takashi Ishida, Satoshi Tanaka, Akiyuki Sakamoto, Takanobu Hirabayashi, Mikito Kawamata
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...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30214281/the-impact-of-fluoroscopic-confirmation-of-thoracic-imaging-on-accuracy-of-thoracic-epidural-catheter-placement-on-postoperative-pain-control
#9
Tabish Aijaz, Kenneth D Candido, Utchariya Anantamongkol, Gleb Gorelick, Nebojsa Nick Knezevic
Background: Thoracic epidural analgesia (TEA) provides superior postoperative pain control compared to parenteral opioids after major thoracic and abdominal surgeries. However, some studies with respect to benefits of continuous TEA have shown mixed results. The purpose of this study was to determine the rate of successful TEA catheter insertion into the epidural space using contrast fluoroscopy and the impact of placement location on postoperative analgesia and opioid use. Patients and methods: After Advocate health care institutional review board approval, we conducted a prospective, open-label, single intervention study on patients undergoing thoracic or upper abdominal surgery...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30127636/foot-drop-after-spinal-anesthesia-for-cesarean-section-a-case-report
#10
Ali Dastkhosh, Majid Razavi, Mehryar Taghavi Gilani
Objective: Spinal anesthesia is the preferred anesthetic technique for cesarean section. Neurological complications are very rare and often transient after spinal anesthesia. Case report: In the present case, a 37-year-old woman was considered eligible for cesarean section due to fetal distress. She underwent spinal anesthesia with a 25-gauge pencil-point spinal needle. In the sitting position, 3 mL of 0.5% bupivacaine was injected following free flow of cerebrospinal fluid...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30122981/local-anesthetic-systemic-toxicity-current-perspectives
#11
REVIEW
Kariem El-Boghdadly, Amit Pawa, Ki Jinn Chin
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 one-fifth of the reported cases present with isolated cardiovascular disturbance...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30046251/optimizing-the-securement-of-epidural-catheters-an-in-vitro-trial
#12
Mohammed Hakim, Alexander B Froyshteter, Hina Walia, Dmitry Tumin, Giorgio Veneziano, Tarun Bhalla, Joseph D Tobias
Introduction: Epidural anesthesia is frequently used to provide postoperative analgesia following major surgical procedures. Secure fixation of the epidural catheter is necessary to prevent premature dislodgment and loss of epidural analgesia. Using an in vitro model, the current prospective study evaluates different types of dressings for securement of an epidural catheter by quantifying the force in Newtons (N) required for dislodgment using a digital force gage. Methods: Four methods of epidural catheter securement were used on a simulator mannequin: 1) Suresite® Window Clear Dressing, 2) Op-Site Post-Op® Visible Dressing, 3) Steri-Strips® and Suresite Window Clear Dressing, and 4) Steri-Strips and Op-Site Post-Op Visible Dressing...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/29760560/spinal-anesthesia-instead-of-general-anesthesia-for-infants-undergoing-tendon-achilles-lengthening
#13
EDITORIAL
Mohammad AlSuhebani, David P Martin, Lance M Relland, Tarun Bhalla, Allan C Beebe, Amanda T Whitaker, Walter Samora, Joseph D Tobias
Spinal anesthesia (SA) has been used relatively sparingly in the pediatric population, as it is typically reserved for patients in whom the perceived risk of general anesthesia is high due to comorbid conditions. Recently, concern has been expressed regarding the potential long-term neurocognitive effects of general anesthesia during the early stages of life. In view of this, our center has developed a program in which SA may be used as the sole agent for applicable surgical procedures. While this approach in children is commonly used for urologic or abdominal surgical procedures, there have been a limited number of reports of its use for orthopedic procedures in this population...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/29670398/remifentanil-induced-postoperative-hyperalgesia-current-perspectives-on-mechanisms-and-therapeutic-strategies
#14
REVIEW
Cristina Santonocito, Alberto Noto, Claudia Crimi, Filippo Sanfilippo
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...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/29503582/effect-of-warming-anesthetic-on-pain-perception-during-dental-injection-a-split-mouth-randomized-clinical-trial
#15
Pedro Christian Aravena, Camila Barrientos, Catalina Troncoso, Cesar Coronado, Pamela Sotelo-Hitschfeld
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) participated...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/29440926/local-anesthetics-for-brain-tumor-resection-current-perspectives
#16
REVIEW
Jan-Willem Potters, Markus Klimek
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...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/29184440/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
#17
Marissa Nahirney, Amy Metcalfe, Katie H Chaput
Background: Postpartum depression (PPD) is a common complication of pregnancy, affecting approximately 13% of mothers internationally. Previous research has examined whether epidural analgesia used for pain control during labor and birth is associated with a lower risk of PPD, but reports conflicting results and may have suffered from methodological shortcomings. Our study aimed to prospectively assess whether epidural analgesia is associated with a lower risk of PPD (at either 6 weeks or 6 months postpartum) after attempting to adequately adjust for selection bias and confounding variables...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/29066932/efficiency-of-spinal-anesthesia-versus-general-anesthesia-for-lumbar-spinal-surgery-a-retrospective-analysis-of-544-patients
#18
John T Pierce, Guy Kositratna, Mark A Attiah, Michael J Kallan, Rebecca Koenigsberg, Peter Syre, David Wyler, Paul J Marcotte, W Andrew Kofke, William C Welch
BACKGROUND: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28860857/preventing-nausea-and-vomiting-in-women-undergoing-regional-anesthesia-for-cesarean-section-challenges-and-solutions
#19
REVIEW
Yvonne Jelting, Christian Klein, Thomas Harlander, Leopold Eberhart, Norbert Roewer, Peter Kranke
BACKGROUND: Intraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28790864/case-report-bilateral-tunneled-epidural-catheters-to-prevent-unilateral-analgesia-for-cancer-related-pain
#20
Raj B Padalia, Corey J Reeves, Neal Shah, Ankur A Patel, Devang M Padalia
OBJECTIVE: Unilateral analgesia often occurs with epidural analgesia. Traditional methods of troubleshooting this problem can be insufficient in obtaining adequate pain relief in a timely manner for terminal cancer patients. This case report demonstrates a safe and effective solution which can be utilized in these circumstances. CASE REPORT: A 55-year-old female with stage IV pancreatic cancer and life expectancy of a few weeks presented to the interventional pain clinic with intractable sacral pain...
2017: Local and Regional Anesthesia
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