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Regional anesthesia analgesia

Jacob M Drew, Jonathan Neilio, Lisa Kunze
Perioperative care of the total knee arthroplasty (TKA) patient has evolved considerably over the past decade. Among the changes driving this evolution toward shorter hospitalization and accelerated rehabilitation have been regional anesthesia, peripheral nerve blockade, and multimodal analgesia protocols. These complementary techniques are increasingly supported by scientific evidence, though considerable uncertainty persists regarding the optimal combination of strategies. Continued refinement of technique and critical evaluation is trending toward greater characterization of the comparative effectiveness of myriad options...
March 7, 2018: Journal of Knee Surgery
Kaori Takahashi, Daisuke Nishizawa, Shinya Kasai, Yoshihiko Koukita, Ken-Ichi Fukuda, Tatsuya Ichinohe, Kazutaka Ikeda
Opioid analgesics are widely used for the treatment of moderate to severe pain. The analgesic effects of opioids are well known to vary among individuals. The present study focused on the genetic factors that are associated with interindividual differences in pain and opioid sensitivity. We conducted a multistage genome-wide association study in subjects who were scheduled to undergo mandibular sagittal split ramus osteotomy and were not medicated until they received fentanyl for the induction of anesthesia...
February 16, 2018: Journal of Pharmacological Sciences
Andrea Droghetti, Erika Basso Ricci, Paolo Scimia, Fabiola Harizai, Massimiliano Marini
BACKGROUND: The standard technique for implanting a subcutaneous defibrillator (S-ICD) requires three incisions and the pocket of the device is created in the subcutaneous tissue of the left lateral thoracic wall. However, a two-incision technique may be adopted, in which the cranial parasternal region is avoided and the device is positioned more deeply, completely under the latissimus dorsi muscle. This can also be combined with Ultrasound-Guided Serratus Anterior Plane Block (US-SAPB) for intraoperative anesthesia and perioperative analgesia...
March 1, 2018: Pacing and Clinical Electrophysiology: PACE
Allana Munro, Ana Sjaus, Ronald B George
PURPOSE OF REVIEW: High-quality analgesia has been linked to improved patient satisfaction as well as improved short-term and long-term postoperative outcomes. Acute surgical pain is a modifiable risk factor for development of chronic postoperative pain, which is reported by up to 26% of gynecologic surgical patients. In other surgical populations, multimodal analgesia has shown improved pain control and decreased reliance on opioids. This review examines recent evidence for various analgesic modalities applied specifically to the gynecologic surgical population...
February 22, 2018: Current Opinion in Anaesthesiology
Shankar Vallapu, Nidhi Bidyut Panda, Navneh Samagh, Neerja Bharti
Context: Scalp infiltration and scalp block are being used to manage postcraniotomy pain. Dexmedetomidine has been successfully used as an adjuvant in regional anesthesia. The study was intended to compare whether addition of dexmedetomidine prolonged the duration of analgesia as well as to compare the two techniques. Aims: The primary objective was to assess whether addition of dexmedetomidine to bupivacaine prolonged the duration of analgesia. The secondary objective was to compare between scalp nerve block and scalp infiltration as techniques for pain relief...
January 2018: Journal of Neurosciences in Rural Practice
Qing Zhao Ruan, Shawn Diamond, Scott Zimmer, Matthew L Iorio
BACKGROUND: Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. METHODS: A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed...
February 16, 2018: Journal of Reconstructive Microsurgery
Marija Damjanovska, Tatjana Stopar Pintaric, Erika Cvetko, Kamen Vlassakov
Purpose: The ultrasound-guided retrolaminar block is one of the newer and simpler alternatives to the traditional, often technically challenging, paravertebral (PV) block. Its feasibility, safety, and efficacy have already been clinically demonstrated in patients with multiple rib fractures using higher volumes of local anesthetic, when compared with the traditional approach. The primary aim of this observational anatomical study was to assess the spread of local anesthetic from the retrolaminar injection point to the PV space and its volume dependence...
2018: Journal of Pain Research
Change Zhu, Saiji Zhang, Zhiqing Gu, Yiru Tong, Rong Wei
BACKGROUND: Dexamethasone has become a popular additive for regional anesthesia. The aim of this meta-analysis was to assess the effectiveness of this additive on the duration of postoperative analgesia, postoperative vomiting, and possible adverse events in pediatrics. METHODS: We searched databases, conference records, and registered trials for randomized controlled trials. The databases included the Cochrane Library, JBI Database of Systematic Reviews, PubMed, ISI Web of Knowledge, Science-Direct, and Embase...
March 2018: Paediatric Anaesthesia
Jonathan W Cheah, David C Sing, Erik N Hansen, Pedram Aleshi, Thomas P Vail
BACKGROUND: Intrathecal morphine (ITM) combined with bupivacaine spinal anesthesia can improve postoperative pain, but has potential side effects of postoperative nausea/vomiting (PONV) and pruritus. With the use of multimodal analgesia and regional anesthetic techniques, postoperative pain control has improved significantly to a point where ITM may be avoided in total joint arthroplasty (TJA). METHODS: We performed a retrospective study of primary TJA patients who underwent a standardized multimodal recovery pathway and received bupivacaine neuraxial anesthesia with ITM vs bupivacaine neuraxial anesthesia alone (control)...
January 31, 2018: Journal of Arthroplasty
Jessica Shao-Yeung Lim, Cherry E Koh, Hannah Liu, Michael J Solomon, Charlotte S H Johnstone
BACKGROUND: Pelvic exenterations are extensive surgical procedures for locally advanced or recurrent malignancies of the pelvis. However, this is often at the cost of significant morbidity due to perioperative pain, which has been poorly studied. OBJECTIVE: This study aims to review perioperative pain management in patients undergoing pelvic exenteration. DESIGN: This is a retrospective review of patients undergoing pelvic exenteration between January 2013 and December 2014...
March 2018: Diseases of the Colon and Rectum
Harsha Shanthanna, Peter Moisuik, Turlough O'Hare, Sadeesh Srinathan, Christian Finley, James Paul, Peter Slinger
OBJECTIVES: To determine the preferences and perceptions regarding analgesic options for video-assisted thoracic surgery (VATS) among thoracic anesthesiologists in Canada. DESIGN: A cross-sectional survey of thoracic anesthesiologists with 30 multiple choice questions was e-mailed through an online survey tool called FluidSurveys was performed to members of the Canadian Anesthesiologists' Society. SETTING: A nationwide survey. PARTICIPANTS: Members of Canadian Anesthesiologists' Society who provide thoracic anesthesia INTERVENTIONS: None...
January 5, 2018: Journal of Cardiothoracic and Vascular Anesthesia
K O Rove, M A Brockel, A F Saltzman, M I Dönmez, K E Brodie, D J Chalmers, B T Caldwell, V M Vemulakonda, D T Wilcox
BACKGROUND: Enhanced recovery after surgery (ERAS) protocol is a set of peri-operative strategies to increase speed of recovery. ERAS is well established in adults but has not been well studied in children. OBJECTIVE: The purpose of the current study was to establish the safety and efficacy of an ERAS protocol in pediatric urology patients undergoing reconstructive operations. It was hypothesized that ERAS would reduce length of stay and decrease complications when compared with historical controls...
February 1, 2018: Journal of Pediatric Urology
Shahram Seyfi, Nadia Banihashem, Ali Bijani, Karimollah Hajian-Taliki, Mohsen Daghmehchi
Background: Intravenous regional anesthesia is a simple and reliable method for upper extremity surgery. In order to increase the quality of blocks and reduce the amount of pain, many drugs are used with lidocaine. In this study, the effect of ketorolac-lidocaine in intravenous regional anesthesia was investigated. Methods: 40 patients undergoing elective upper limb with America Society of Anesthesiologists class I and II were selected and randomly divided into two groups...
2018: Caspian Journal of Internal Medicine
Michel Galinski, Laure Hoffman, Delphine Bregeaud, Mounir Kamboua, François-Xavier Ageron, Catherine Rouanet, Jean-Christophe Hubert, Jacques Istria, Mirko Ruscev, Karim Tazarourte, Florence Pevirieri, Frédéric Lapostolle, Frédéric Adnet
BACKGROUND: The quality of procedural analgesia and sedation among trauma patients has not been studied much in the prehospital setting. The main objective of this study was to characterize the quality of procedural analgesia sedation practices in prehospital settings in trauma patients. METHODS: This was an open-label observational prospective multicenter study (January 01, 2012-December 31, 2013). We included all consecutive trauma victims undergoing a potentially painful procedure on the accident scene...
January 31, 2018: Prehospital Emergency Care
C Gaio-Lima, C C Costa, J B Moreira, T S Lemos, H L Trindade
Erector spinae plane block has been recently described and it appears as a very promising regional analgesia technique. We report the first continuous erector spinae plane block performed in a pediatric patient for thoracic surgery. A 15-month-old boy, diagnosed with a paracardiac teratoma was scheduled for a tumor resection with a thoracotomy approach. After general anesthesia induction, a continuous erector spinae plane block at T5 level was performed with ropivacaine 0.2%. After surgery, a continuous thoracic interfascial infusion of ropivacaine 0...
January 19, 2018: Revista Española de Anestesiología y Reanimación
Eralp Çevikkalp, Koray Erbüyün, Serpil Erbüyün, Gülay Ok
Pediatric regional anesthesia is widely used to relieve postoperative pain after abdominal surgery. Commonly used techniques of regional anesthesia include lumbar epidural and caudal block. However, the use of central neuraxial blockade has limitations. It is contraindicated in patients with clotting abnormalities, spinal dysraphism with tethered cord syndrome, meningomyelocele, and following spinal surgery with instrumentation. Ultrasound guided transversus abdominis plane block is a new method of regional anesthesia that can be used in settings where central neuraxial blockade is contraindicated...
January 2018: Saudi Medical Journal
Aaron B Parrish, Sean M O'Neill, Steven R Crain, Tara A Russell, Deepak K Sonthalia, Vu T Nguyen, Armen Aboulian
BACKGROUND: Ambulatory surgery for anorectal procedures has been proven to be safe and effective. Specific perioperative pathways combining multiple interventions have been shown to optimize recovery and outcomes associated with inpatient colorectal surgery. However, there are no major studies describing and evaluating a standardized protocol for ambulatory anorectal surgery. The purpose of this study was to evaluate the outcomes of a modified enhanced recovery after surgery (ERAS) protocol for ambulatory anorectal surgery...
January 9, 2018: World Journal of Surgery
M D Herrick, H Liu, M Davis, J-E Bell, B D Sites
BACKGROUND: Regional anesthesia can be used as part of the anesthetic to optimize anesthesia and analgesia during shoulder arthroplasty, but little is known about the overall effect that regional anesthesia has on perioperative outcomes and resource utilization. We hypothesized that regional anesthesia may decrease complication rates and resource utilization in shoulder arthroplasty patients. METHODS: We examined administrative data from 588 US hospitals from 2010 to 2015...
January 7, 2018: Acta Anaesthesiologica Scandinavica
Dell C McLaughlin, Jonathan W Cheah, Pedram Aleshi, Alan L Zhang, C Benjamin Ma, Brian T Feeley
BACKGROUND: Studies on perioperative pain control in shoulder arthroplasty focus on regional anesthesia, with little research on other approaches. Perioperative multimodal analgesia regimens decrease opioid intake and opioid-related side effects in lower-extremity arthroplasty. In this study we compare pain scores, opioid consumption, length of stay, and readmission rates in postoperative shoulder arthroplasty patients treated with a standard or multimodal analgesia regimen. METHODS: A prospective cohort analysis was performed at a single institution...
January 3, 2018: Journal of Shoulder and Elbow Surgery
Josh Luftig, Daniel Mantuani, Andrew A Herring, Brittany Dixon, Eben Clattenburg, Arun Nagdev
The Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society Guidelines recommend prompt and effective multimodal analgesia for rib fractures that combines regional anesthesia (RA) techniques with pharmacotherapy to treat pain, optimize pulmonary function, and reduce opioid related complications. However, RA techniques such as epidurals and paravertebral blocks, are generally underutilized or unavailable for emergency department (ED) patients. The recently described serratus anterior plane block (SAPB) is a promising technique, but failures with posterior rib fractures have been observed...
December 28, 2017: American Journal of Emergency Medicine
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