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https://www.readbyqxmd.com/read/28796131/beyond-ultrasound-guidance-for-regional-anesthesiology
#1
De Q Tran, André P Boezaart, Joseph M Neal
Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Perhaps the greatest confusion afflicting US-guided regional anesthesiology originates from an intellectual misconception pertaining to its application...
August 8, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28794527/the-effect-of-addition-of-dexamethasone-to-levobupivacaine-in-parturients-receiving-combined-spinal-epidural-for-analgesia-for-vaginal-delivery
#2
Amr Samir Wahdan, Ahmed Ibrahim El-Sakka, Hassan Mostafa Ismail Gaafar
BACKGROUND AND AIMS: Regional analgesia is commonly used for the relief of labour pain, Prolongation of analgesia can be achieved by adjuvant medications. The aim of this randomised controlled trial was to evaluate the efficacy of intrathecal levobupivacaine with dexamethasone for labour analgesia. METHODS: A total of 80 females were included in this study, all were primigravidas undergoing vaginal delivery with cervical dilatation ≥4 cm and 50% or more effacement...
July 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28776222/-surgical-techniques-for-severe-brain-injury-with-special-emphasis-on-polytrauma
#3
REVIEW
Georg C Clarici
CLINICAL ISSUE: In Austria approximately 2000 people suffer from severe brain injury per year. Brain trauma is the most common cause of death under the age of 45 years. In polytrauma patients the treatment and management of severe brain injury is particularly challenging because the life-threatening injuries of other organ systems significantly influence the timing of surgery and the outcome. The sequence of the necessary surgery is an interdisciplinary decision already made in the emergency room...
August 3, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28767472/intrathecal-migration-of-an-epidural-catheter-while-using-a-programmed-intermittent-epidural-bolus-technique-for-labor-analgesia-maintenance-a-case-report
#4
Francesca Betti, Brendan Carvalho, Edward T Riley
We describe a case of intrathecal migration of a wire-reinforced epidural catheter in a parturient who received epidural labor analgesia. Epidural analgesia was initiated with a combined-spinal epidural technique and maintained by programmed intermittent epidural boluses. Epidural catheter aspiration after insertion was negative for cerebrospinal fluid. The patient's response to the first four doses of local anesthetic was consistent with epidural drug delivery. After the fifth dose, she developed a complete lower extremity motor block, hypotension, and high sensory blockade...
August 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28759948/the-role-of-epidural-contrast-distribution-in-predicting-the-effectiveness-of-steroid-and-local-anesthetic-injection-in-patients-with-lumbar-spinal-stenosis
#5
Jong Won Kwon, Sang Jun Kim
STUDY DESIGN: A prospective observational comparative study. BACKGROUND: Because epidural corticosteroids are more effective for pain relief when delivered close to the site of pathology, lumbar spinal stenosis with multilevel stenotic areas can be treated more effectively when medications cover all of the stenotic areas. Distribution of medications to the pathologic sites is considered an important factor in the effectiveness of inter-laminar epidural injection...
July 14, 2017: Journal of Back and Musculoskeletal Rehabilitation
https://www.readbyqxmd.com/read/28742435/the-role-of-transversus-abdominis-plane-blocks-in-eras-pathways-for-open-and-laparoscopic-colorectal-surgery
#6
Alexander J Kim, Robert Jason Yong, Richard D Urman
INTRODUCTION: The concepts of Enhanced Recovery After Surgery (ERAS(®)) have steadily increased in usage, with benefits in patient outcomes and hospital length of stay. One important component of successful implementation of ERAS protocol is optimized pain control, via the multimodal approach, which includes neuraxial or regional anesthesia techniques and reduction of opioid use as the primary analgesic. Transversus abdominis plane (TAP) block is one such regional anesthesia technique, and it has been widely studied in abdominal surgery...
July 25, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28740770/versatility-of-the-latissimus-dorsi-free-flap-during-the-treatment-of-complex-postcraniotomy-surgical-site-infections
#7
Nobutaka Yoshioka
BACKGROUND: Some intractable cases of postcraniotomy infection, which can involve compromised skin, an open frontal air sinus, and residual epidural dead space, have been reported. In such cases, reconstructing the scalp and skull is challenging. METHODS: Between 2009 and 2016, the author treated 12 patients with recalcitrant postcraniotomy surgical site infections with latissimus dorsi (LD) free flaps. The patients' ages ranged from 37 to 79 years (mean, 63.5 years), and their underlying diseases included subarachnoid hemorrhaging (n = 5), brain tumors (n = 4), and cerebral arteriovenous malformations (n = 3)...
June 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28740682/combined-analgesic-treatment-of-epidural-and-paravertebral-block-after-thoracic-surgery
#8
Yujiro Yokoyama, Takahiro Nakagomi, Daichi Shikata, Taichiro Goto
In pulmonary surgical practice, appropriate pain management after thoracotomy is essential for patient recovery and the prevention of complications. Although epidural analgesia (EPI) has been established for chest surgery, it has some limitations and contraindications. Recently, paravertebral block (PVB) was reported as a good alternative method with fewer side effects. Despite the significant effects of these two treatments, postoperative pain remains among the greatest patient burdens. In our institution, we apply a combination of epidural and PVBs after thoracic surgery to reduce pain more effectively...
June 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28727702/subcutaneous-injection-of-triamcinolone-and-lidocaine-to-prevent-postherpetic-neuralgia
#9
Jiaxiang Ni, Xiaoping Wang, Yuanzhang Tang, Liqiang Yang, Yuanjie Zeng, Yuna Guo
BACKGROUND: Herpes zoster (HZ) is associated with inflammation of the peripheral nerves, which is considered to be an important cause of postherpetic neuralgia (PHN). Interventions aimed at reducing this inflammation could prevent PHN. One option is the epidural administration of corticosteroid and local anesthetic. However, several authors have reported a risk of arachnoiditis with epidural corticosteroids. Subcutaneous injection in an outpatient setting is a safer option. However, there is limited evidence of the effectiveness of this alternative for preventing PHN...
July 2017: Pain Physician
https://www.readbyqxmd.com/read/28727597/bilateral-continuous-erector-spinae-plane-block-contributes-to-effective-postoperative-analgesia-after-major-open-abdominal-surgery-a-case-report
#10
Carlos Eduardo Restrepo-Garces, Ki Jinn Chin, Patricia Suarez, Alejandro Diaz
The erector spinae plane (ESP) block is a regional anesthetic technique involving local anesthetic injection in a paraspinal plane deep to the erector spinae muscle. Originally described for thoracic analgesia when performed at the T5 transverse process, the ESP block can provide abdominal analgesia if performed at lower thoracic levels because the erector spinae muscles extend to the lumbar spine. A catheter inserted into this plane can extend analgesic duration and can be an alternative to epidural analgesia...
July 19, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28720990/selective-nerve-root-blocks-vs-caudal-epidural-injection-for-single-level-prolapsed-lumbar-intervertebral-disc-a-prospective-randomized-study
#11
Sudhir Singh, Sanjiv Kumar, Gaurav Chahal, Reetu Verma
BACKGROUND: Chronic lumbar radiculopathy has a lifetime prevalence of 5.3% in men and 3.7% in women. It usually resolves spontaneously, but up to 30% cases will have pronounced symptoms even after one year. AIMS: A prospective randomized single-blind study was conducted to compare the efficacy of caudal epidural steroid injection and selective nerve root block in management of pain and disability in cases of lumbar disc herniation. METHODS: Eighty patients with confirmed single-level lumbar disc herniation were equally divided in two groups: (a) caudal epidural and (b) selective nerve root block group, by a computer-generated random allocation method...
April 2017: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28718323/modern-approaches-to-the-management-of-metastatic-epidural-spinal-cord-compression
#12
Zain A Husain, Arjun Sahgal, Eric L Chang, Pejman Jabehdar Maralani, Charlotte D Kubicky, Kristin J Redmond, Charles Fisher, Ilya Laufer, Simon S Lo
Metastatic epidural spinal cord compression (MESCC) is an oncologic emergency requiring prompt treatment to maximize neurologic function, ambulatory function and local control. Traditionally, options for MESCC included external beam radiation therapy with or without surgery. Surgery has usually been reserved for the patient with optimal performance status, single level MESCC or mechanical instability. Advances in external beam radiation therapy such as the development of stereotactic body radiation therapy have allowed for the delivery of high-dose radiation, allowing for both long-term pain and local control...
July 18, 2017: CNS Oncology
https://www.readbyqxmd.com/read/28691979/perioperative-management-for-abdominal-surgery-in-bilateral-diaphragmatic-paralysis-a-case-report-and-literature-review
#13
Glenio B Mizubuti, Louie Wang, Anthony M-H Ho, Robert C Tanzola, Jordan Leitch
The optimal approach to postoperative analgesia in patients with bilateral diaphragmatic paralysis undergoing abdominal surgery remains unclear. We report a 69-year-old woman with bilateral diaphragmatic paralysis who underwent a laparoscopic hernia repair and an open laparotomy for reversal of a Hartmann procedure under general anesthesia. Postoperative analgesia was provided by intravenous opioid and epidural local anesthetic and opioid, respectively. The patient's trachea was successfully extubated at the end of both surgical procedures...
July 6, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28682439/the-effect-of-percutaneous-endoscopic-lumbar-discectomy-under-different-anesthesia-on-pain-and-immunity-of-patients-with-prolapse-of-lumbar-intervertebral-disc
#14
S-J Wang, B-H Chen, P Wang, C-S Liu, J-M Yu, X-X Ma
OBJECTIVE: To explore the effect of percutaneous transforaminal endoscopic discectomy under different anesthesia on pain and immunity of patients with lumbar disc herniation. PATIENTS AND METHODS: 92 cases of patients with lumbar disc herniation in the Affiliated Hospital of Qingdao University from February 2015 to January 2016 were collected. These patients were randomly divided into control group and observation group (n = 46). Patients in the control group underwent percutaneous transforaminal endoscopic discectomy with the use of local anesthesia, while patients in the observation group used continuous epidural anesthesia...
June 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28681962/systematic-review-of-management-of-chronic-pain-after-surgery
#15
REVIEW
V Wylde, J Dennis, A D Beswick, J Bruce, C Eccleston, N Howells, T J Peters, R Gooberman-Hill
BACKGROUND: Pain present for at least 3 months after a surgical procedure is considered chronic postsurgical pain (CPSP) and affects 10-50 per cent of patients. Interventions for CPSP may focus on the underlying condition that indicated surgery, the aetiology of new-onset pain or be multifactorial in recognition of the diverse causes of this pain. The aim of this systematic review was to identify RCTs of interventions for the management of CPSP, and synthesize data across treatment type to estimate their effectiveness and safety...
September 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28677829/intravenous-lignocaine-in-colorectal-surgery-a-systematic-review
#16
REVIEW
Wiremu S MacFater, Jamie-Lee Rahiri, Melanie Lauti, Bruce Su'a, Andrew G Hill
BACKGROUND: Colorectal surgery leads to morbidity during recovery including pain and fatigue. Intravenous (IV) lignocaine (IVL) has both analgesic and anti-inflammatory effects that may improve post-operative pain and recovery. The aim of this review is to compare the effectiveness of IVL to other perioperative analgesia regimens for reducing pain and opioid consumption following colorectal surgery. METHODS: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, a literature search was conducted to identify randomized clinical trials that compared IVL with IV placebo or epidural anaesthesia in open or laparoscopic colorectal surgery...
July 5, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28663617/comparison-between-epidural-ropivacaine-versus-ropivacaine-with-clonidine-in-patients-undergoing-abdominal-hysterectomy-a-randomized-study
#17
Keshav Govind Rao, Shilpi Misra, Aparna Shukla
CONTEXT: Regional anesthesia has emerged as one of the preferred and convenient modes for intra- and post-operative management owing to its advantage of not interfering with the metabolic functions, better tolerability, and decrease in reflex activity. In recent years, ropivacaine has increasingly replaced bupivacaine as a preferred local anesthetic because of its similar analgesic properties, lesser motor blockade, and decreased propensity of cardiotoxicity. Neuraxial adjuvant such as clonidine used in epidural anesthesia offers advantage by augmenting the local anesthetic effect and reducing the anesthetic and analgesic requirement...
April 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28656055/optimal-dose-of-epidural-dexmedetomidine-added-to-ropivacaine-for-epidural-labor-analgesia-a-pilot-study
#18
Zhang Wangping, Ren Ming
BACKGROUND: Dexmedetomidine combined with local anesthetics can decrease the concentration of epidural ropivacaine. However, the optimal dose of epidural dexmedetomidine combined with ropivacaine for labor analgesia is still uncertain. This study investigated the effect of adding different dose of epidural dexmedetomidine to ropivacaine during epidural labor analgesia. METHODS: One hundred women were randomly assigned to one of the four groups (Groups A, B, C, and D received 0...
2017: Evidence-based Complementary and Alternative Medicine: ECAM
https://www.readbyqxmd.com/read/28655957/comparison-of-analgesic-efficacy-of-caudal-dexmedetomidine-versus-caudal-tramadol-with-ropivacaine-in-paediatric-infraumbilical-surgeries-a-prospective-randomised-double-blinded-clinical-study
#19
Savita Gupta, Rashmi Sharma
BACKGROUND AND AIMS: Caudal epidural analgesia is commonly practised regional block technique in children undergoing infraumbilical surgeries but has a short duration of action after single shot local anaesthetic injection. The aim of this study was to compare ropivacaine 0.25% with dexmedetomidine and tramadol in caudal anaesthesia in paediatric infraumbilical surgeries. METHODS: In a randomised, prospective, double-blinded study, sixty children (1-8 years) belonging to American Society of Anesthesiologists' physical status I or II scheduled for infraumbilical surgeries were included...
June 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28648141/anesthetic-management-of-spontaneous-cervical-epidural-hematoma-during-pregnancy-a-case-report
#20
Mehdi Samali, Abdelghafour Elkoundi, Achraf Tahri, Mustapha Bensghir, Charki Haimeur
BACKGROUND: Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. The potential for difficult airway management with the patient under general anesthesia is one of the major concerns that needs to be addressed to prevent further cord compression...
June 26, 2017: Journal of Medical Case Reports
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