Local and Regional Anesthesia最新文献

{"title":"Large Hematoma Following Ultrasound-Guided Rectus Sheath Block.","authors":"Toshie Shiraishi","doi":"10.2147/LRA.S511201","DOIUrl":"10.2147/LRA.S511201","url":null,"abstract":"<p><strong>Purpose: </strong>Rectus sheath block is a commonly used nerve block to reduce pain from abdominal surgery. Although hematoma complications due to vascular injury during nerve block is rare, it remains an important consideration, particularly in cases requiring the use of antithrombogenic agents. In rectus sheath block, anesthesiologists are aware that major vessels subject to needle puncture injury during the procedure include the inferior epigastric artery (IEA) and inferior epigastric vein (IEV). However, increasing use of ultrasound-guided block has resulted in a decrease in significant bleeding risk, including in patients taking antithrombogenic agents. We recently experienced a large subcutaneous hematoma (430 mL) after rectus sheath block. In this case report, we describe the clinical course of the hematoma and discuss its cause and the possible vessels involved, including the IEA and IEV, and branches such as the superior epigastric arteries and veins.</p><p><strong>Case presentation: </strong>A 40-year-old female underwent bilateral ultrasound-guided rectus sheath block and transversus abdominis block following laparoscopic cholecystectomy. After the operation, a large, painful hematoma was identified with a volume estimated at 430 mL. Investigation of the bleeding site by CT scan showed that the hematoma was subcutaneous and in an area with multiple venous and arterial branches. Identification of the responsible vessel appeared difficult; however, on discussion with the radiologist, bleeding from a cutaneous (or deeper) vessel from the block or surgical (trocar or needle) injury was included in the different diagnosis. The superficial epigastric artery was considered the most probable source because it was the closest to the hematoma.</p><p><strong>Conclusion: </strong>Although the IEA and IEV are the major candidates for vascular injury in rectus sheath block, clinicians should recognize that the SEA can also be injured during rectus sheath block procedures.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"39-44"},"PeriodicalIF":1.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perineural Dexamethasone is More Efficient Than Perineural Dexmedetomidine in Prolonging Popliteal Sciatic and Saphenous Nerve Blocks: A Single-Center, Prospective, Double-Blinded, Randomized Controlled Trial.","authors":"Guiyu Lei, Lili Wu, Yue Yin, Shu Zhang, Guyan Wang","doi":"10.2147/LRA.S515510","DOIUrl":"https://doi.org/10.2147/LRA.S515510","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to assess and compare the effectiveness of perineural dexamethasone (DEX) and perineural dexmedetomidine (DEM) as adjuvant in popliteal sciatic and saphenous nerve blocks, focusing on the duration of analgesia and side effects following major foot and ankle surgeries.</p><p><strong>Patients and methods: </strong>Ninety patients scheduled for major foot and ankle surgeries under general anesthesia, who received popliteal sciatic and saphenous nerve blocks, were randomly assigned to one of three groups: (1) control group receiving 0.375% ropivacaine; (2) DEX group receiving 0.375% ropivacaine combined with 10 mg perineural dexamethasone; (3) DEM group receiving 0.375% ropivacaine combined with 0.75 μg/kg perineural dexmedetomidine. The primary outcome measured was the duration of analgesia, defined as the time from the administration of the nerve block to the onset of the first pain sensation in the surgical area. Secondary outcomes included opioid consumption within the first 48 hours post-surgery and the incidence of side effects such as hypotension and bradycardia. (Clinical trial registration number: ChiCTR2100048127).</p><p><strong>Results: </strong>The time until the first perception of pain was significantly extended in the DEX group (28.0 (3.3) hours) compared to the DEM group (24.1 (1.3) hours) and the control group (17.5 (3.5) hours, P<0.001). Additionally, opioid consumption within the first 24 hours was markedly reduced in both the DEX and DEM groups compared to the control group (P<0.001). However, opioid usage between 0 to 48 hours post-surgery showed no significant differences among the three groups. The DEM group experienced a higher incidence of hypotension and bradycardia compared to both the DEX and control group (P<0.001).</p><p><strong>Conclusion: </strong>Both 10 mg dexamethasone and 0.75 µg/kg dexmedetomidine effectively prolonged analgesia in patients undergoing major foot and ankle surgery with a popliteal sciatic and saphenous nerve block. However, dexamethasone (10 mg) provided a significantly longer duration of analgesia compared to dexmedetomidine (0.75 µg/kg).</p><p><strong>Trial registration: </strong>Chictr.org.cn identifier: ChiCTR2100048127.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"27-38"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Combining Lidocaine and Ropivacaine on the Duration of Analgesia and Anesthesia of an Infraclavicular Brachial Plexus Block.","authors":"Mathias T Steensbæk, Jens L Temberg, Sina Yousef, Sanja Pisljagic, Christian Steen-Hansen, Anders K Nørskov, Kai H W Lange, Christian Rothe, Lars H Lundstrøm","doi":"10.2147/LRA.S505536","DOIUrl":"https://doi.org/10.2147/LRA.S505536","url":null,"abstract":"<p><strong>Background: </strong>Combining local anesthetics for peripheral nerve blocks may change block characteristics, resulting in altered onset and block duration. We aimed to investigate the block characteristics of an infraclavicular brachial plexus block regarding block duration, pain after block cessation, and patient satisfaction by using a combination of lidocaine-epinephrine and ropivacaine.</p><p><strong>Methods: </strong>In this retrospective cohort study, 103 patients undergoing ambulatory hand or wrist surgery received an infraclavicular brachial plexus block with either a combination of ropivacaine 5 mg/mL combined with lidocaine 20 mg/mL and epinephrine 5 µg/mL (COMBI group) or only ropivacaine 5 mg/mL (ROPI group). The primary outcome was \"Total block duration\". Secondary outcomes were \"Time until block begins to subside\", \"Pain after complete block cessation (Numerical Rating Scale 0-10)\", and \"Patient experience of nerve block\". All outcomes were patient-reported. Multivariable regression analyses were used to adjust for predefined potential confounders.</p><p><strong>Results: </strong>\"Total block duration\" (mean ± SD) was 655±215 minutes in the COMBI group and 961±195 in the ROPI group; mean difference of 309 minutes; <i>P</i><0.001. \"Time until block begins to subside\" was 396±120 minutes in the COMBI group and 642±214 minutes in the ROPI group; <i>P</i><0.001. The median \"Pain after block cessation\" on a Numeric rank scale (NRS) was 5.0 (IQR 3.0-8.0) in the COMBI group and 6.0 (IQR 4.0-7.0) in the ROPI group; <i>P</i>=0.80. In the COMBI group, 60% were satisfied with block quality versus 38% in the ROPI group; <i>P</i>=0.042. Multivariable adjusted analyses confirmed the results regarding block duration and pain after block cessation but not satisfaction.</p><p><strong>Conclusion: </strong>Combining lidocaine-epinephrine and ropivacaine reduced the duration of analgesia by approximately 5 hours. Pain after block cessation was moderately high in both groups.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"17-25"},"PeriodicalIF":1.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative \"Three-in-One\" Method for Intervention of Lower Limb Neuropathic Pain: Retrospective Case Series Study.","authors":"Jinyu Lai, Yan Lai, Yijun Wu, Yong Xiang, Fengqin Zhang","doi":"10.2147/LRA.S511488","DOIUrl":"10.2147/LRA.S511488","url":null,"abstract":"<p><strong>Purpose: </strong>Minimally invasive intervention therapy anterior cutaneous branch of the femoral nerve for refractory neuropathic pain in the inner thigh area typically requires punctures at multiple sites to target the three nerves of the obturator nerve cutaneous branch, anterior cutaneous branch of the femoral nerve, and infrapatellar branch of the saphenous nerve. Clinical practice has demonstrated that the innovative \"three-in-one\" technique allows for simultaneous targeting of the three cutaneous nerves from a single entry point, effectively treating inner thigh pain. Moreover, this approach can also be used for local anaesthesia in shallow surgical procedures in the inner thigh area. We hope to promote this puncture technique among pain physicians.</p><p><strong>Patients and methods: </strong>Clinical data of 8 patients with localized pain in the inner thigh from the Pain Department of Taihe Hospital, Shiyan City, Hubei Medical College, from April 2023 to September 2024 were collected. All the patients experienced pain in the cutaneous branch of the obturator nerve, the anterior branch of medial femoral cutaneous nerve, and the infrapatellar branch of the saphenous nerve. The \"three-in-one\" approach was used for nerve block and radiofrequency puncture.</p><p><strong>Results: </strong>After the \"three-in-one\" approach, the 8 patients showed varying degrees of improvement in their Numeric Rating Scale (NRS) scores. The patients were satisfied with the treatment method and efficacy, and no complications, such as nerve damage, occurred during the operation.</p><p><strong>Conclusion: </strong>The \"three-in-one\" approach is a potentially effective method for treating pain in the inner lower limb area, significantly reducing the damage caused by multiple puncture and providing ideas for more minimally invasive treatment of other areas; this approach meets expectations for more minimally invasive treatment.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"9-15"},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Intravenous Chloroprocaine in Gastrointestinal Endoscopy: A Randomized Controlled Trial.","authors":"Peng Zhang, Jin Zhang, Ying Zhao, Jun Chen, Shaolin Wang","doi":"10.2147/LRA.S505804","DOIUrl":"10.2147/LRA.S505804","url":null,"abstract":"<p><strong>Background: </strong>While propofol is a commonly utilized medication for sedation during gastrointestinal endoscopy, it is associated with adverse effects such as hypotension and injection pain. This trial was conducted to test the hypothesis that chloroprocaine can reduce the requirement for propofol and alleviate injection pain during gastrointestinal endoscopy.</p><p><strong>Methods: </strong>Sixty patients undergoing gastrointestinal endoscopy were enrolled and randomly divided into study group (Group CP) and control group (Group C). Patients in Group CP received intravenous chloroprocaine 2 mg/kg, followed by continuous infusion at 6 mg·kg^-1·h^-1 until the end of examination. Patients in Group C received the same volume of saline. Subsequently, all patients were intravenously administered sufentanil at a dose of 0.05 μg/kg. Thirty seconds later, propofol was uniformly infused intravenously at a rate of 60 mL/min using an infusion pump. The primary outcome was the consumption of propofol. Secondary outcomes included the incidence of hypoxemia, hypotension, bradycardia, injection pain, and coughing/body movement during examination. The recovery time, PACU stay time, postoperative pain score, and endoscopists' satisfaction score were also recorded.</p><p><strong>Results: </strong>Group CP demonstrated a significantly lower total requirement for propofol compared to Group C, with means of (119±14) mg and (148±18) mg respectively, P<0.001. This trend was also observed for both the first and supplemental doses. There were no significant differences between the two groups regarding intraoperative adverse events. The incidence of injection pain in Group CP was lower than that in Group C (P=0.007). The recovery time [(4.7±1.4) vs (6.6±1.3), P<0.001], PACU stay time [(13.0±2.9) vs (16.7±3.0), P<0.001] and postoperative pain score [(1.9±0.7) vs (2.5±0.7), P=0.002] in Group CP were lower than those in Group C.</p><p><strong>Conclusion: </strong>Intravenous chloroprocaine reduces the requirement for propofol, alleviates propofol injection pain, and improves recovery in patients undergoing gastrointestinal endoscopy.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"1-8"},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Maternal and Neonatal Glycemic Stress Response in Normal Vaginal Delivery: A Comparative Study Between Epidural and Parenteral Opioids Analgesia.","authors":"Ala A Alhowary, Omar Altal, Diab Bani Hani, Anas Alrusan, Yaser Saleh Ba Jusair, Rania Al-Bataineh, Ahmed Al Sharie, Abdelwahab Aleshawi","doi":"10.2147/LRA.S499370","DOIUrl":"https://doi.org/10.2147/LRA.S499370","url":null,"abstract":"<p><strong>Background: </strong>It has been recognized that the type of anesthetic and analgesic technique and the relative pain degree may have an influence on hyperglycemic-stress response to surgery. This comparative study aimed to assess glucose levels in both mothers and infants during normal vaginal delivery. This study aimed to investigate this stress response between mothers who received parenteral analgesia versus epidural analgesia (EA) as an objective reflection for pain response.</p><p><strong>Methods: </strong>One hundred and seventeen patients participated in this prospective comparative study. They were categorized into two groups: parenteral analgesia group (who received subcutaneous morphine) and EA group. The primary outcome was to measure the difference in blood glucose level before delivery (at 3 cm cervical dilation), at full dilation, and at the third stage of labor and compare these values between both groups. The secondary outcome was to assess the factors affecting the glycemic stress response in mothers and neonates.</p><p><strong>Results: </strong>The change in maternal glucose level at full dilation and after delivery were significantly lower in the EA group. Neonatal glucose levels were not significantly different between the two groups. The change in maternal glucose level was influenced by the number of gravity and miscarriages. Neonatal glucose levels were associated with the gestational age of delivery, birth weight, and maternal glucose level at full cervical dilation.</p><p><strong>Conclusion: </strong>EA appears superior to parenteral opioids analgesia, providing better pain management and subsequent lower stress response levels for mothers during vaginal delivery. These findings highlight the importance of the choice of analgesia during labor to optimize maternal well-being. Optimizing maternal factors (such as glycemic response) and neonatal factors (such as prematurity and birth weight) may influence the stress response of the neonates.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"117-127"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the Ultrasound-Guided Interscalene and Supraclavicular Blocks on the C4 Dermatome.","authors":"Yue Qiu, Chelsea Cady, Bedda L Rosario, Steven Orebaugh","doi":"10.2147/LRA.S495105","DOIUrl":"10.2147/LRA.S495105","url":null,"abstract":"<p><strong>Purpose: </strong>The C4 dermatome anesthesia holds significance for arthroscopic shoulder surgery. However, the reliability of achieving C4 dermatome anesthesia with the current low-dose ultrasound-guided interscalene block (ISB) and supraclavicular block (SCB) remains uncertain. This prospective, single-center study examined the effects of ultrasound-guided interscalene block (ISB) and supraclavicular block (SCB) on the C4 sensory dermatome in patients undergoing shoulder, hand, or wrist surgery.</p><p><strong>Patients and methods: </strong>Patients undergoing outpatient shoulder, hand, or wrist surgeries received ultrasound-guided ISB (for shoulder surgeries) with 12-15 mL of 0.5% bupivacaine or ultrasound-guided SCB (for hand and wrist surgeries) with 20-24 mL of 0.5% bupivacaine. The primary objective of the study was to investigate the sensory effect on the C4 dermatome after ISB and SCB. The secondary outcomes included the sensory effect on the C5 dermatome after performing ISB and SCB, pain scores upon arrival at the post-anesthesia care unit (PACU), and the incidence of adverse effects.</p><p><strong>Results: </strong>Sixty-one patients were recruited: 30 for ISB and 31 for SCB. C4 dermatome coverage was achieved in 53% and 29% of patients in the ISB and SCB groups, respectively (p=0.0268). Additionally, C5 dermatome coverage was achieved in 97% and 68% of patients in the ISB and SCB groups, respectively (p=0.0034). A moderate correlation coefficient (r=0.47) was observed between C4 sensory scores and postoperative pain scores.</p><p><strong>Conclusion: </strong>Ultrasound-guided ISB successfully provided C4 coverage in 53% of cases, suggesting that performing an additional C4 block alongside ISB could be advantageous when aiming for complete surgical anesthesia. SCB may not be the primary choice for shoulder surgeries as it often fails to achieve satisfactory sensory blocks at the C4 and C5 levels.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"107-115"},"PeriodicalIF":1.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adding Dexmedetomidine to Methylene Blue in Thoracic Paravertebral Block for Video-Assisted Lobectomy: A Case Series Study.","authors":"Francesco Coppolino, Simona Brunetti, Leonardo Maria Bottazzo, Gianluigi Cosenza, Pasquale Sansone, Marco Fiore, Maria Beatrice Passavanti, Vincenzo Pota, Maria Caterina Pace","doi":"10.2147/LRA.S487981","DOIUrl":"10.2147/LRA.S487981","url":null,"abstract":"<p><strong>Purpose: </strong>Thoracic surgery often results in severe chronic postoperative pain. Current evidence favors two locoregional techniques. Thoracic Epidural Anesthesia (TEA), the gold standard, and Thoracic Paravertebral Block (TPVB), which is associated with fewer side effects but is limited by short duration of action of local anesthetics (LA) and potential failure due to improper drug distribution. This study investigates the use of dexmedetomidine (DEX) as adjuvant to prolong the effects of LA in TPVB, with methylene blue used for visual confirmation of accurate injectate spread.</p><p><strong>Patients and methods: </strong>We observed 6 patients undergoing Video-Assisted Thoracoscopy (VATS) lobectomy who received TPVB with ropivacaine, DEX and methylene blue. The primary endpoint was postoperative pain recorded at 1, 12, 24, 48 hours using Numeric Rating Scale (NRS); the secondary endpoints were cumulative opioid consumption in the first 24 hours in Milligram Morphine Equivalents (MME); adverse events: occurrence of bradycardia, hypotension, Postoperative Nausea and Vomiting (PONV); length of hospital stay. All patients completed the study.</p><p><strong>Results: </strong>Our results showed optimal pain scores, with NRS scores always below 4, decreased need for opioids, and prolonged analgesia. None of the patients had bradycardia nor PONV, but two patients experienced acute and self-limited hypotension following TPVB.</p><p><strong>Conclusion: </strong>Thoracic Paravertebral Block with Dexmedetomidine and methylene blue was effective and safe in controlling postoperative pain. Methylene blue could help improving knowledge on anesthetics distribution to reduce failure rates.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"99-105"},"PeriodicalIF":1.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-Guided Bilateral Modified-Thoracoabdominal Nerve Block Through a Perichondral Approach in a Patient Undergoing Bilateral Laparoscopic Inguinal Hernia Repair: A Case Report.","authors":"Jassim Rauf, Mohammad Mohsin A M Haji","doi":"10.2147/LRA.S482038","DOIUrl":"10.2147/LRA.S482038","url":null,"abstract":"<p><strong>Background: </strong>Modified thoracoabdominal nerve block through the perichondrial approach (M TAPA), described by Tulgar et al in 2019, is a relatively new block. The block is relatively superficial and easy to perform. It has been successfully used in various laparoscopic surgeries and has been shown to reduce the perioperative opioid requirements.</p><p><strong>Case presentation: </strong>We report the case of a 41-year-old male with ASA grade 2, who was scheduled to undergo laparoscopic unilateral inguinal hernia repair. The patient had General Anaesthesia with bilateral M TAPA using 30 mL of 0.25% levobupivacaine on each side before the incision. Intraoperatively, the surgeon decided that the patient would require bilateral inguinal hernia repair. The patient received 100 µg fentanyl at induction, and intravenous paracetamol and ketorolac intraoperatively. The surgery was uneventful, and the patient was transferred to a post anaesthesia care unit. In the postoperative period, the patient did not require opioids and received only two doses each of paracetamol and ketorolac. The patient was discharged the following day, without any further sequelae.</p><p><strong>Conclusion: </strong>When administered bilaterally, MTAPA can provide adequate analgesia and has opioid-sparing effects in both the intra and postoperative periods.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"93-97"},"PeriodicalIF":1.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foot Drop Following a Popliteal Sciatic Nerve Block with Ropivacaine, A Case Report and Literature Review.","authors":"Andreas Clipet-Jensen, Hans Fjeldsøe-Nielsen, Peter Roy Kirkegaard","doi":"10.2147/LRA.S470574","DOIUrl":"10.2147/LRA.S470574","url":null,"abstract":"<p><p>Although peripheral nerve blocks are deemed very safe, a significant number of patients for whom this anesthetic technique may be particularly appealing to apply may present with preexisting peripheral neuropathies, putting them at risk for further nerve damage. We present a case with a 74-year-old male with several risk factors for peripheral neuropathy who developed a foot drop following a popliteal sciatic nerve block with ropivacaine. We suggest that the vasoconstrictive properties of ropivacaine may have contributed to a preexisting neuronal ischemia, thus further damaging an already compromised nerve.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"17 ","pages":"87-91"},"PeriodicalIF":1.5,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}