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Catheter nerve analgesia

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https://www.readbyqxmd.com/read/27871587/peripheral-nerve-blocks-in-the-management-of-postoperative-pain-challenges-and-opportunities
#1
REVIEW
Girish Joshi, Kishor Gandhi, Nishant Shah, Jeff Gadsden, Shelby L Corman
Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27870742/thoracic-paravertebral-nerve-blocks-in-pediatric-patients-safety-and-clinical-experience
#2
Tricia Vecchione, David Zurakowski, Karen Boretsky
Thoracic paravertebral nerve blocks (PVNBs) provide excellent analgesia for many surgeries. The primary aim was to estimate the complication rate, and secondary aims were to provide information on the potential clinical application of PVNBs. Data on 2390 PVNBs were collected. A total of 625 catheters were performed on 468 patients, and 1765 single-injection PVNBs were performed on 403 patients. There was 1 case of local anesthetic systemic toxicity for a major complication rate of 1 per 2390 PVNBs. The minor complication rate was 13...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27847703/treatment-of-post-latissimus-dorsi-flap-breast-reconstruction-pain-with-continuous-paravertebral-nerve-blocks-a-retrospective-review
#3
Jonathan T Unkart, Jennifer A Padwal, Brian M Ilfeld, Anne M Wallace
OBJECTIVES: The addition of a perioperative continuous paravertebral nerve block (cPVB) to a single-injection thoracic paravertebral nerve block (tPVB) has demonstrated improved analgesia in breast surgery. However, its use following isolated post-mastectomy reconstruction using a latissimus dorsi flap (LDF) has not previously been examined. METHODS: We performed a retrospective review of patients who underwent salvage breast reconstruction with a unilateral LDF by a single surgeon...
October 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/27749354/continuous-peripheral-nerve-blocks-an-update-of-the-published-evidence-and-comparison-with-novel-alternative-analgesic-modalities
#4
Brian M Ilfeld
A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered, providing a prolonged block that may be titrated to the desired effect. In the decades after its first report in 1946, a plethora of data relating to CPNB was published, much of which was examined in a 2011 Anesthesia & Analgesia article. The current update is an evidence-based review of the CPNB literature published in the interim...
October 3, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27749351/optimizing-pain-and-rehabilitation-after-knee-arthroplasty-a-two-center-randomized-trial
#5
Stephen Choi, Turlough O'Hare, Jeffrey Gollish, James E Paul, Hans Kreder, Kevin E Thorpe, Joel D Katz, Muhammad Mamdani, Peter Moisiuk, Colin J McCartney
BACKGROUND: This randomized trial compared (1) continuous femoral nerve block (cFNB), (2) single femoral nerve block (sFNB), and (3) local infiltration analgesia (LIA) with respect to analgesic and functional outcomes after primary tricompartmental knee arthroplasty (TKA). METHODS: One hundred twenty patients undergoing primary tricompartmental knee arthroplasty were randomly assigned to 1 of 3 interventions for postoperative analgesia: (1) cFNB-preoperative bolus of ropivacaine 0...
November 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27745867/intercostal-nerve-cryoablation-versus-thoracic-epidural-catheters-for-postoperative-analgesia-following-pectus-excavatum-repair-preliminary-outcomes-in-twenty-six-cryoablation-patients
#6
Benjamin A Keller, Sandra K Kabagambe, James C Becker, Y Julia Chen, Laura F Goodman, Julianna M Clark-Wronski, Kenneth Furukawa, Rebecca A Stark, Amy L Rahm, Shinjiro Hirose, Gary W Raff
BACKGROUND: Multimodal pain management strategies are used for analgesia following pectus excavatum repair. However, the optimal regimen has not been identified. We describe our early experience with intercostal cryoablation for pain management in children undergoing the Nuss procedure and compare early cryoablation outcomes to our prior outcomes using thoracic epidural analgesia. METHODS: A multi-institutional, retrospective review of fifty-two patients undergoing Nuss bar placement with either intercostal cryoablation (n=26) or thoracic epidural analgesia (n=26) from March 2013 to January 2016 was conducted...
September 28, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27734492/a-randomised-controlled-trial-comparing-two-popliteal-nerve-catheter-tip-positions-for-postoperative-analgesia-after-day-case-hallux-valgus-repair
#7
A L Ambrosoli, L Guzzetti, M Chiaranda, S Cuffari, M Gemma, G Cappelleri
We compared the effect of two different positions of a sciatic nerve catheter within the popliteal fossa on local anaesthetic consumption and postoperative analgesia in patients undergoing day-case hallux valgus repair. Eighty-four patients were randomly allocated to receive a sciatic nerve catheter either between the tibial and peroneal components (sciatic group) or medial to the tibial nerve (tibial group). The primary endpoint was postoperative local anaesthetic consumption, while secondary endpoints were pain scores, number of occasions where sleep was disturbed by pain and incidence of insensate limb and foot drop at 24 h and 48 h postoperatively...
November 2016: Anaesthesia
https://www.readbyqxmd.com/read/27703632/a-comparison-of-strength-for-two-continuous-peripheral-nerve-block-catheter-dressings
#8
Lindsay Borg, Steven K Howard, T Edward Kim, Lauren Steffel, Cynthia Shum, Edward R Mariano
BACKGROUND: Despite the benefits of continuous peripheral nerve blocks, catheter dislodgment remains a major problem, especially in the ambulatory setting. However, catheter dressing techniques to prevent such dislodgment have not been studied rigorously. We designed this simulation study to test the strength of two commercially available catheter dressings. METHODS: Using a cadaver model, we randomly assigned 20 trials to one of two dressing techniques applied to the lateral thigh: 1) clear adhesive dressing alone, or 2) clear adhesive dressing with an anchoring device...
October 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27673545/systematic-review-of-liposomal-bupivacaine-exparel-for-postoperative-analgesia
#9
Krishna S Vyas, Sibi Rajendran, Shane D Morrison, Afaaf Shakir, Samir Mardini, Valerie Lemaine, Maurice Y Nahabedian, Stephen B Baker, Brian D Rinker, Henry C Vasconez
BACKGROUND: Management of postoperative pain often requires multimodal approaches. Suboptimal dosages of current therapies can leave patients experiencing periods of insufficient analgesia, often requiring rescue therapy. With absence of a validated and standardized approach to pain management, further refinement of treatment protocols and targeted therapeutics is needed. Liposomal bupivacaine (Exparel) is a longer acting form of traditional bupivacaine that delivers the drug by means of a multivesicular liposomal system...
October 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27631270/a-prospective-randomized-and-controlled-study-of-interscalene-brachial-plexus-block-for-arthroscopic-shoulder-surgery-a-comparison-of-c5-and-conventional-approach-a-consort-compliant-article
#10
Hyun-Jung Shin, Hyo-Seok Na, Ah-Young Oh, Jung-Won Hwang, Byung-Gun Kim, Hee-Pyoung Park, Young-Tae Jeon, Seong-Won Min, Jung-Hee Ryu
BACKGROUND: The shoulder area is mainly innervated with the C5 and C6 nerve roots, and interscalene brachial plexus block (ISB) is widely used for postoperative analgesia after shoulder surgery. However, it is associated with adverse effects, such as numbness and weakness in the blocked arm due to an unwanted block of the lower brachial plexus (C7-T1). We hypothesized that the C5 approach during ISB would provide postoperative analgesia while minimizing adverse events after arthroscopic shoulder surgery...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27603376/femoral-nerve-block-for-patient-undergoing-total-knee-arthroplasty-prospective-randomized-double-blinded-study-evaluating-analgesic-effect-of-perineural-fentanyl-additive-to-local-anesthetics
#11
Bong Ha Heo, Hyeon Jung Lee, Hyung Gon Lee, Man Young Kim, Keun Suk Park, Jeong Il Choi, Myung Ha Yoon, Woong Mo Kim
BACKGROUND: The existence of peripheral opioid receptors and its effectiveness in peripheral nerve block remain controversial. The aim of this prospective, randomized, double-blinded study was to examine the analgesic effects of adding fentanyl to ropivacaine for continuous femoral nerve block (CFNB) using patient-controlled analgesia after total knee arthroplasty (TKA). METHODS: The patients were divided into 2 groups, each with n = 40 in ropivacaine (R) group and n = 42 in R with fentanyl (R + F) group...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27597428/comparison-of-lumbar-epidurals-and-lumbar-plexus-nerve-blocks-for-analgesia-following-primary-total-hip-arthroplasty-a-retrospective-analysis
#12
Sylvia H Wilson, Bethany J Wolf, Abdalrahman A Algendy, Clark Sealy, Harry A Demos, Julie R McSwain
BACKGROUND: Total hip arthroplasty (THA) is associated with significant postoperative pain. Both lumbar epidurals and lumbar plexus nerve blocks have been described for postoperative pain control, but it is unclear if one technique is more beneficial. METHODS: Using electronic medical records, a randomly selected, cohort of 58 patients with lumbar epidurals were compared with 58 patients with lumbar plexus nerve blocks following primary THA. The primary end point was 48-hour postoperative opiate consumption...
August 10, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27513969/bilateral-continuous-suprascapular-nerve-blocks-for-bilateral-shoulder-hemiarthroplasty
#13
James M Flaherty, David B Auyong, Neil A Hanson
We report a novel case of a patient undergoing a bilateral shoulder hemiarthroplasty for chronic bilateral shoulder dislocations with proximal humeral fractures. Bilateral selective suprascapular nerve catheters were placed preoperatively with the intent to provide continuous local anesthetic-based analgesia while sparing diaphragmatic function. Postoperative respiratory mechanics were relatively spared while numerical rating scale pain scores were suggestive of analgesic benefit.
September 15, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27510834/a-review-of-anesthetic-techniques-and-outcomes-following-minimally-invasive-repair-of-pectus-excavatum-nuss-procedure
#14
Geoff Frawley, Jacinta Frawley, Joe Crameri
BACKGROUND: Pectus excavatum (PE) is the most common congenital chest wall deformity, occurring in 1 : 1000 children with a male to female ratio of 4 : 1. Several procedures have been described to manage this deformity, including cartilage resection with sternal osteotomy (the Ravitch procedure) and a minimally invasive repair technique (the Nuss procedure). While initially described as a nonthoracoscopic technique, the current surgical approach of the Royal Childrens Hospital involves thoracoscopic assistance...
November 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27482314/an-ultrasound-guided-fascia-iliaca-catheter-technique-does-not-impair-ambulatory-ability-within-a-clinical-pathway-for-total-hip-arthroplasty
#15
Seshadri C Mudumbai, T Edward Kim, Steven K Howard, Nicholas J Giori, Steven Woolson, Toni Ganaway, Alex Kou, Robert King, Edward R Mariano
BACKGROUND: Both neuraxial and peripheral regional analgesic techniques offer postoperative analgesia for total hip arthroplasty (THA) patients. While no single technique is preferred, quadriceps muscle weakness from peripheral nerve blocks may impede rehabilitation. We designed this study to compare postoperative ambulation outcome in THA patients who were treated with a new ultrasound-guided fascia iliaca catheter (FIC) technique or intrathecal morphine (ITM). METHODS: We reviewed the electronic health records of a sequential series of primary unilateral THA patients who were part of a standardized clinical pathway; apart from differences in regional analgesic technique, all other aspects of the pathway were the same...
August 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27464944/a-novel-approach-to-brachial-plexus-catheter-management-a-brachial-plexus-test-dose-for-phrenic-nerve-paralysis-and-patient-controlled-demand-only-dosing-for-a-patient-with-extreme-obesity
#16
Adam W Meier, Shin-E Lin, Neil A Hanson, David B Auyong
A 53-year-old woman with extreme obesity (body mass index = 82 kg/m) presented for an open reduction and internal fixation of the proximal humerus. This report describes the novel management of her continuous brachial plexus catheter in the setting of her comorbidities. Phrenic nerve paralysis from brachial plexus blocks can cause clinically significant dyspnea in obese patients. Brachial plexus catheters can be used effectively for these patients with some modification to routine management. We detail our use of a short-acting chloroprocaine test dose for phrenic paralysis and demand-only dosing to provide effective analgesia while avoiding respiratory complications associated with these blocks...
September 15, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27430605/postoperative-pain-control-by-preventive-intercostal-nerve-block-under-direct-vision-followed-by-catheter-based-infusion-of-local-analgesics-in-rib-cartilage-harvest-for-auricular-reconstruction-in-children-with-microtia-a-randomized-controlled-trial
#17
Kyong-Je Woo, Bo Young Kang, Jeong Jin Min, Jin-Woo Park, Ara Kim, Kap Sung Oh
BACKGROUND: Children with microtia complain of severe postoperative pain during early postoperative days after rib cartilage harvest for auricular reconstruction. The purpose of this study was to evaluate the effects of preventive donor site wound analgesia by intercostal nerve block (ICNB) and catheter-based infusion of local analgesics on postoperative pain after rib cartilage graft for auricular reconstruction in children with microtia. METHODS: In this prospective randomized study, 66 children underwent postoperative pain control using either preventive ICNB followed by catheter-based infusion (33 patients, study group) or intravenous (IV) analgesia alone (33 patients, control group)...
September 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/27322898/chronic-cancer-related-pain-continuous-perineural-infusion-of-local-anesthetics-as-alternative-to-systemic-analgesic-drugs
#18
Regis Fuzier, Philippe Izard, Claire Cabos, Brigitte Chaminade, Jacques Pouymayou
Pain is a major concern for patients suffering from cancer. Although opioid drugs remain the gold standard for treatment of pain, little is known about the interest of continuous analgesia techniques as alternative. The aim of the present article is to detail the feasibility and to present the diversity of continuous perineural infusion of local anesthetic. A series of five patients suffering from different cancer-related pain is presented. A continuous perineural block was proposed to patients presenting with unbearable pain in an area innervated by a plexus or a nerve despite parenteral analgesic pharmacotherapy...
September 2016: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/27311845/suprazygomatic-access-for-continuous-bilateral-mandibular-nerve-block-for-pain-and-trismus-relief-in-the-tetraplegic-patient
#19
Mikhail A Dziadzko, Fabrice Heritier
PURPOSE: Extraoral mandibular nerve block (MNB) is used in oropharyngeal surgery for analgesia and anesthesia. Repeated or continuous MNB has been used successfully as treatment for uncontrollable pain, masseter spasticity, and airway assessment. The usual technique involves transcutaneous infrazygomatic access. However, in some specific settings, this approach is not always feasible. MATERIALS AND METHODS: A continuous bilateral MNB with a suprazygomatic approach to the pterygomandibular space was used to resolve a case of refractory and painful trismus in a patient with tetraplegia...
October 2016: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/27293824/management-of-post-operative-pain-by-placement-of-an-intraoperative-intercostal-catheter-after-single-port-video-assisted-thoracoscopic-surgery-a-propensity-score-matched-study
#20
Ching-Feng Wu, Ming-Ju Hsieh, Hung-Pin Liu, Diego Gonzalez-Rivas, Yun-Hen Liu, Yi-Cheng Wu, Yin-Kai Chao, Ching-Yang Wu
BACKGROUND: The establishment of a golden standard for post-operative analgesia after thoracic surgery remains an unresolved issue. Benefiting from the rapid development of single port video-assisted thoracoscopic surgery (VATS), a good candidate for the alleviation of patients' pain is the placement of an intercostal catheter (ICC) safely after uniport VATS. We hypothesized that continual infusion through ICC could provide effective analgesia for patients with only one wound and we evaluate its postoperative analgesic function in uniport VATS patients with or without intercostal nerve blockade...
June 2016: Journal of Thoracic Disease
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