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Pain managment , ultrasound guided nerve blockade.

Yeon-Dong Kim, Seon-Jeong Park, Junho Shim, Hyungtae Kim
The recently introduced pectoral nerve (Pecs) block is a simple alterative to the conventional thoracic paravertebral block or epidural block for breast surgery. It produces excellent analgesia and can be used to provide balanced anesthesia and as a rescue block in cases where performing a neuraxial blockade is not possible. In the thoracic region, a neuraxial blockade is often used to manage zoster-associated pain. However, this can be challenging for physicians due to the increased risk of hemodynamic instability in the upper thoracic level, and comorbid and contraindicated medical conditions such as coagulopathy...
September 20, 2016: Journal of Anesthesia
Devender Kumar, Sarla Hooda, Shashi Kiran, Jyoti Devi
INTRODUCTION: Hip fractures are often encountered in the elderly and present special problems to the anaesthesiologist. Fascia iliaca compartment block is another technique with the intent to block all the three nerves like 3-in-1 nerve block. AIM: To evaluate the analgesic efficacy of ultrasound guided fascia iliaca compartment block to facilitate positioning of patients with hip fracture for spinal anaesthesia. MATERIALS AND METHODS: This prospective study was conducted in 50 patients aged between 40-80 years, belonging to American Society of Anesthesiologists (ASA) physical status I-III undergoing surgery for hip fracture...
July 2016: Journal of Clinical and Diagnostic Research: JCDR
Sung Hye Byun, Jonghoon Lee, Jong Hae Kim
BACKGROUND: Patients on antiplatelet therapy following percutaneous coronary intervention can become coagulopathic due to infection. Performing regional anesthesia for bilateral surgery in such cases is challenging. We report a case of successful combined inguinal femoral and subgluteal sciatic nerve blocks (CFSNBs) for simultaneous bilateral below-knee amputations in a coagulopathic patient on antiplatelet therapy. METHODS: A 70-year-old male patient presented with pain in both feet due to diabetic foot syndrome...
July 2016: Medicine (Baltimore)
Maddalena Zampi, Carmine Iacovazzo, Tommaso Pagano, Pasquale Buonanno, Mariella Carlomagno, Flavia Cianciulli, Giuseppe Servillo
Pain management is extremely important in day surgery, and it is one of the limiting factors for this type of procedures. Locoregional anesthesia is strongly recommended for day surgery; nevertheless, it could be very difficult to localize nerve position especially in obese patients. Furthermore, a complete nerve blockade could result in a delayed discharge. We present a case of analgesic ultrasound-guided block of tibial and common peroneal nerves in the popliteal fossa without any motor function involvement in an obese patient undergoing debridement of an infected lower limb ulcer; all previous attempts of surgical debridement in day surgery with topical anesthetics had failed because of discomfort due to pain...
June 2016: International Journal of Lower Extremity Wounds
Nelun Wijayasinghe, Helle M Duriaud, Henrik Kehlet, Kenneth Geving Andersen, Kenneth G Anderson
BACKGROUND: Persistent pain after breast cancer surgery (PPBCS) affects 25 - 60% of breast cancer survivors and damage to the intercostobrachial nerve (ICBN) has been implicated as the cause of this predominantly neuropathic pain. Local anesthetic blockade of the ICBN could provide clues to pathophysiological mechanisms as well as aiding diagnosis and treatment of PPBCS but has never been attempted. OBJECTIVES: To assess the feasibility of ICBN blockade and assess its effects on pain and sensory function in patients with PPBCS...
February 2016: Pain Physician
Joni Maga, Andres Missair, Alex Visan, Lee Kaplan, Juan F Gutierrez, Annika R Jain, Ralf E Gebhard
OBJECTIVES: Ultrasound-guided interscalene brachial plexus blocks are commonly used to provide anesthesia for the shoulder and proximal upper extremity. Some reviews identify a sheath that envelops the brachial plexus as a potential tissue plane target, and current editorials in the literature highlight the need to establish precise and reproducible injection targets under ultrasound guidance. We hypothesize that an injection of a local anesthetic inside the brachial plexus sheath during ultrasound-guided interscalene nerve blocks will result in enhanced procedure success and provide a consistent tissue plane target for this approach with a reproducible and characteristic local anesthetic spread pattern...
February 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Harsha Shanthanna
We report the anaesthetic management of two cases involving surgeries on the clavicle, performed under superficial cervical plexus block and selective C5 nerve root block under ultrasound (US) guidance, along with general anaesthesia. Regional analgesia for clavicular surgeries is challenging. Our patients also had significant comorbidities necessitating individualised approach. The first patient had a history of emphysema, obesity, and was allergic to morphine and hydromorphone. The second patient had clavicular arthritis and pain due to previous surgeries...
May 2014: Indian Journal of Anaesthesia
Nicolas Dufeu, Florence Marchand-Maillet, Arthur Atchabahian, Nicolas Robert, Yasmine Ait Yahia, Didier Milan, Cyrille Robert, Marine Coroir, Marc Beaussier
PURPOSE: To assess the suitability of ultrasound-guided (USG), single-injection distal block(s) for pain management after outpatient hand and wrist bone surgery. METHODS: We conducted a retrospective review of 125 of 198 consecutive ambulatory surgery patients who underwent hand and wrist bone surgery between June 2010 and January 2012. All patients received a USG axillary block using a short-acting local anesthetic (lidocaine) and secondary 1, 2, or 3 (median, radial, or ulnar) USG distal analgesic block(s) using a long-acting local anesthetic (ropivacaine)...
April 2014: Journal of Hand Surgery
Michael Gofeld, Michael N Brown, Laurent Bollag, John G Hanlon, Brian R Theodore
BACKGROUND AND OBJECTIVES: Chronic low back pain related to degenerative spondylosis is commonly managed by the radiofrequency ablation of sensory nerves. Fluoroscopic guidance has been considered mandatory to ensure placement of the active tip of the cannula parallel to the nerve to provide adequate neurolysis. Conversely, analgesic (or diagnostic) blockade is usually accomplished by placing the needle perpendicular to the nerve using either fluoroscopy or ultrasound (US) guidance. The recently introduced disposable equipment of internally cooled radiofrequency allows the denervation procedure to be performed similarly to the routine diagnostic block...
January 2014: Regional Anesthesia and Pain Medicine
Aaron J Krych, Sean Baran, Scott A Kuzma, Hugh M Smith, Rebecca L Johnson, Bruce A Levy
PURPOSE: The purpose of this study was to evaluate the utility of multimodal analgesia with fascia iliaca blockade and for acute pain control in patients undergoing hip arthroscopy. METHODS: Thirty consecutive patients undergoing primary hip arthroscopy were prospectively studied. All patients were treated preoperatively with ultrasound-guided single injection fascia iliaca blockade and multimodal analgesia. Data collected included post-operative nausea, numeric rating scale (NRS) pain scores during rest and activity, opioid consumption during the first five days (recorded as tablets of 5 mg hydrocodone/500 mg acetaminophen) and overall patient satisfaction with analgesia...
April 2014: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Henning Lykke Andersen, Jens Gyrn, Lars Møller, Bodil Christensen, Dusanka Zaric
BACKGROUND AND OBJECTIVES: Local infiltration analgesia (LIA) reduces pain after total knee arthroplasty without the motor blockade associated with epidural analgesia or femoral nerve block. However, the duration and efficacy of LIA are not sufficient. A saphenous nerve block, in addition to single-dose LIA, may improve analgesia without interfering with early mobilization. METHODS: Forty patients were included in this double-blind randomized controlled trial. All patients received spinal anesthesia for surgery and single-dose LIA during the operation...
March 2013: Regional Anesthesia and Pain Medicine
Maged N Guirguis, Alaa A Abd-Elsayed, Girgis Girgis, Loran Mounir Soliman
BACKGROUND AND OBJECTIVES: Neural blockade of the thoracolumbar nerves supplying the anterior abdominal wall through transversus abdominis plane (TAP) has been investigated for different applications mainly for the acute pain management following abdominal surgical procedures. The role of this block for chronic pain syndromes is still to be discovered, and its value in chronic abdominal pain needs to be studied. We are presenting new application of the TAP technique for management of chronic abdominal pain syndrome using the continuous infusion...
March 2013: Pain Practice: the Official Journal of World Institute of Pain
Lawrence Haines, Eitan Dickman, Sergey Ayvazyan, Michelle Pearl, Stanley Wu, David Rosenblum, Antonios Likourezos
BACKGROUND: Hip fracture (HFx) is a painful injury that is commonly seen in the emergency department (ED). Patients who experience pain from HFx are often treated with intravenous opiates, which may cause deleterious side effects, particularly in elderly patients. An alternative to systemic opioid analgesia involves peripheral nerve blockade. This approach may be ideally suited for the ED environment, where one injection could control pain for many hours. OBJECTIVES: We hypothesized that an ultrasound-guided fascia iliaca compartment block (UFIB) would provide analgesia for patients presenting to the ED with pain from HFx and that this procedure could be performed safely by emergency physicians (EP) after a brief training...
October 2012: Journal of Emergency Medicine
Andrew A Herring, Michael B Stone, Oron Frenkel, Annie Chipman, Arun D Nagdev
The ultrasound-guided superficial cervical plexus (SCP) block may be useful for providers in emergency care settings who care for patients with injuries to the ear, neck, and clavicular region, including clavicle fractures and acromioclavicular dislocations. The SCP originates from the anterior rami of the C1-C4 spinal nerves and gives rise to 4 terminal branches--greater auricular, lesser occipital, transverse cervical, and suprascapular nerves--that provide sensory innervation to the skin and superficial structures of the anterolateral neck and sections of the ear and shoulder...
September 2012: American Journal of Emergency Medicine
Chin-wern Chan, Philip W H Peng
Suprascapular nerve blockade (SSNB) is a simple and safe technique for providing relief from various types of shoulder pain, including rheumatologic disorders, cancer, and trauma pain, and postoperative pain due to shoulder arthroscopy. Posterior, superior, and anterior approaches may be used, the most common being the posterior. Recently, an ultrasound-guided approach has been described. In this review, the basic anatomy of the suprascapular nerve will be described. The different techniques of SSNB and indications for SSNB will be discussed...
July 2011: Regional Anesthesia and Pain Medicine
Stephen Choi, Richard Brull
BACKGROUND: Ultrasound (US) guidance for peripheral nerve blockade has gained popularity worldwide. The reported benefits of real-time sonographic visualization compared with traditional nerve localization techniques generally apply to procedural and technical block-related outcomes whereas acute pain-related outcomes are featured less prominently. In this review, we evaluated the effect of US guidance compared with traditional nerve localization techniques for interventional management of acute pain and acute pain-related outcomes...
September 2011: Anesthesia and Analgesia
P Townsley, A Ravenscroft, N Bedforth
We report the first description of ultrasound-guided spinal accessory nerve blockade using single-shot and subsequently continuous infusion (via a perineural catheter) local anaesthetic techniques, for the diagnosis and treatment of myofascial pain affecting the trapezius muscle. A 38-year-old man presented with a two-year history of incapacitating left suprascapular pain after a fall onto his outstretched hand. The history and clinical examination was suggestive of myofascial pain affecting the trapezius muscle...
May 2011: Anaesthesia
Mihaela Visoiu, Charles Yang
Regional anesthesia techniques commonly utilized in post-operative pain management are often considered contraindicated in coagulopathic patients. We report on successful postoperative pain control utilizing peripheral nerve blockade after exploratory laparotomy with small bowel resection in a mildly coagulopathic patient. In our case, complicated by abnormal PT, PTT and INR, a thromboelastogram (TEG) was performed before the procedure and found to be normal. An ultrasound-guided bilateral paravertebral blockade with continuous paravertebral catheters was then performed in this pediatric patient without complications...
April 2011: Paediatric Anaesthesia
Phil B Tsai, Abhishek Karnwal, Clinton Kakazu, Vadim Tokhner, Inderjeet S Julka
PURPOSE: The saphenous nerve, a branch of the femoral nerve, is a pure sensory nerve that supplies the anteromedial aspect of the lower leg from the knee to the foot. There is limited evidence of the effectiveness of ultrasound-guided techniques to block the saphenous nerve. We therefore undertook a retrospective case series to investigate the efficacy of an ultrasound-guided subsartorial approach to saphenous nerve block. METHODS: During a four-month period, all patients receiving a subsartorial saphenous nerve block for lower extremity surgery at our institution had their medical records reviewed...
July 2010: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
J M Asensio-Samper, J De Andrés-Ibáñez, G Fabregat Cid, V Villanueva Pérez, López Alarcón
OBJECTIVE: This case report describes an ultrasound approach to the transversus abdominis plane (TAP) local anesthetic block. This block induces sensory blockade in the lower half of the abdomen where the pulse generator or the infusion pump is to be housed in a subcutaneous pocket, and therefore provides an alternate to general anesthesia or administration of high-dose local anesthetics. CASE REPORT: We report two cases of neuromodulation procedures-implantation of an internal morphine pump for severe somatic pain refractory to other therapies and placement of a double-stimulator generator for dorsal column stimulation in a patient diagnosed with postoperative failed-back syndrome...
March 2010: Pain Practice: the Official Journal of World Institute of Pain
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