Local and Regional Anesthesia最新文献_第10页

Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures 氯丙卡因用于双侧臂丛阻滞治疗双侧桡骨骨折

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-09-01 DOI: 10.2147/LRA.S225471

Chanchal Mangla, H. Kamath, J. Yarmush

引用次数: 3

Effect of bupivacaine and adjuvant drugs on skeletal muscle tissue oximetry and blood flow: an experimental study 布比卡因及辅助药物对骨骼肌组织血氧测定和血流量影响的实验研究

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-08-29 DOI: 10.2147/LRA.S203569

A. Schubert, S. Müller, H. Wulf, T. Steinfeldt, T. Wiesmann

{"title":"Effect of bupivacaine and adjuvant drugs on skeletal muscle tissue oximetry and blood flow: an experimental study","authors":"A. Schubert, S. Müller, H. Wulf, T. Steinfeldt, T. Wiesmann","doi":"10.2147/LRA.S203569","DOIUrl":"https://doi.org/10.2147/LRA.S203569","url":null,"abstract":"Background Skeletal muscle microvascular blood flow plays a critical role in many myopathologies. The influence of bupivacaine and adjuvants on skeletal muscle microvascular perfusion and tissue oximetry is poorly understood but might be a relevant risk factor for myopathies after local anesthetic administration. The aim of this experimental study was to determine the effects of bupivacaine alone or in combination with epinephrine or clonidine on skeletal muscle perfusion and tissue oximetry. Methods Combined tissue spectrophotometry and Laser-Doppler flowmetry and tissue oximetry were used to assess local muscle blood flow in anesthetized pigs after topical administration of test solutions (bupivacaine, bupivacaine with epinephrine or clonidine, saline). Measurements were performed for up to 60 mins. Results The application of bupivacaine alone did not alter relative muscle blood flow significantly, whereas the addition of epinephrine or clonidine to bupivacaine resulted in a significant reduction of relative muscle blood flow at T30 and T60. However, bupivacaine resulted in a significant decrease of tissue oximetry values when compared to saline control group at T30 and T60. The application of bupivacaine combined with clonidine or epinephrine resulted in no significant reduction of tissue oximetry when compared to bupivacaine alone. Conclusion Bupivacaine alone results in a significant decrease of tissue oximetry in skeletal muscle which is not increased by the addition of epinephrine or clonidine despite further reductions of microcirculatory perfusion. Overall, bupivacaine alone or with adjuvants does produce local muscle ischemia for which pathological consequences need to be addressed in further studies.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"71 - 80"},"PeriodicalIF":2.9,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S203569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41400627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term placement of continuous popliteal nerve block catheter for management of a wounded patient in a combat field environment: a case report. 长期放置连续腘神经阻滞导管治疗战场环境中受伤患者一例报告。

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-08-29 eCollection Date: 2019-01-01 DOI: 10.2147/LRA.S210462

Costantino Fontana, Monica Rocco, Luigi Vetrugno, Elena Bignami

{"title":"Long-term placement of continuous popliteal nerve block catheter for management of a wounded patient in a combat field environment: a case report.","authors":"Costantino Fontana, Monica Rocco, Luigi Vetrugno, Elena Bignami","doi":"10.2147/LRA.S210462","DOIUrl":"https://doi.org/10.2147/LRA.S210462","url":null,"abstract":"Continuous peripheral nerve block is a relevant part of multimodal treatment of postoperative pain. In this context the continuous popliteal nerve block is described as an option for postoperative pain management for surgical procedures on the leg, and particularly on the ankle and foot. We applied continuous popliteal nerve block for different types of anesthesia and postoperative pain management via the same catheter. No clear evidence of this specific use has been described in the literature. A 38 year-old patient wounded in combat with a displaced fracture of left tibia and extensive loss of substance needed orthopedic surgeries as well as several reconstructive procedures. A continuous popliteal nerve block was applied via ultrasound-guided catheter for anesthesia at different times, and postoperative pain control for all surgical procedures. The continuous popliteal nerve block and its long-term positioning, of non-common evidence in literature, was utilized to treat a poly-traumatized patient, thereby avoiding repeated general anesthesia and opioid use and their adverse effects. This technique, within a complicated combat field environment, was demonstrated to be clinically effective with high patient satisfaction.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 ","pages":"67-70"},"PeriodicalIF":2.9,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S210462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37611589","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}

引用次数: 0

Impact of serratus plane block on pain scores and incentive spirometry volumes after chest trauma 胸外伤后锯肌平面阻滞对疼痛评分和刺激肺活量的影响

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-08-01 DOI: 10.2147/LRA.S207791

Nadia Hernandez, J. D. de Haan, Dallis Clendenin, D. Meyer, Semhar J. Ghebremichael, C. Artime, George Williams, H. Eltzschig, S. Sen

{"title":"Impact of serratus plane block on pain scores and incentive spirometry volumes after chest trauma","authors":"Nadia Hernandez, J. D. de Haan, Dallis Clendenin, D. Meyer, Semhar J. Ghebremichael, C. Artime, George Williams, H. Eltzschig, S. Sen","doi":"10.2147/LRA.S207791","DOIUrl":"https://doi.org/10.2147/LRA.S207791","url":null,"abstract":"Background: Adequate pain control is difficult to achieve in patients with multiple rib fractures (MRF). Serratus plane block (SPB) is a novel technique for alleviating rib fracture pain. Several published case reports support this hypothesis. Purpose: The purpose of this study was to evaluate the use of SPB in MRF at our level 1 trauma center. Methods: Our hospital’s Regional Anesthesia Registry was queried for all trauma patients with MRF who underwent SPB between August 2014 and January 2018. Data were compared in each patient as a matched pair for the time periods before and after undergoing SPB. Thirty-four patients with similar baseline characteristics were enrolled. Results: The median number of rib fractures was 7. Ordinal pain scores were found to be improved 4 hrs after SPB from median 7/10 to 3/10 (P<0.001). Incentive spirometry (IS) volumes recorded 4 and 24 hrs postserratus plane block showed a median increase of 150 and 175 mL from baseline, respectively (P<0.001). IS volumes recorded at 48 hrs showed a median increase of 300 mL from baseline (P<0.001). Respiratory rate decreased from a median value of 24.5 to 16 breaths/min (P<0.001). SpO2 was improved at 24 hrs from median 96% to 99% (P<0.001). Conclusion: SPB improves pain scores and IS volumes in MRF. Because it is not limited by patient positioning or anticoagulation and has a better safety profile, it may offer a viable alternative to neuraxial techniques. Additional studies are necessary to evaluate its efficacy compared to neuraxial techniques.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"59 - 66"},"PeriodicalIF":2.9,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S207791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46002169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 15

Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist [Corrigendum]. 改善门诊麻醉的术中交接:麻醉师的挑战和解决方案[勘误]。

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-07-01 eCollection Date: 2019-01-01 DOI: 10.2147/LRA.S217891

引用次数: 0

Effect of hypotensive hypovolemia and thoracic epidural anesthesia on plasma pro-atrial natriuretic peptide to indicate deviations in central blood volume in pigs: a blinded, randomized controlled trial 低血压低血容量和胸段硬膜外麻醉对血浆心房钠素前肽的影响，以指示猪中心血容量的偏差:一项盲法、随机对照试验

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-06-01 DOI: 10.2147/LRA.S204594

R. Strandby, R. Ambrus, M. Achiam, Amalie Henriksen, J. Goetze, N. Secher, L. Svendsen

{"title":"Effect of hypotensive hypovolemia and thoracic epidural anesthesia on plasma pro-atrial natriuretic peptide to indicate deviations in central blood volume in pigs: a blinded, randomized controlled trial","authors":"R. Strandby, R. Ambrus, M. Achiam, Amalie Henriksen, J. Goetze, N. Secher, L. Svendsen","doi":"10.2147/LRA.S204594","DOIUrl":"https://doi.org/10.2147/LRA.S204594","url":null,"abstract":"Purpose Changes in plasma pro-atrial natriuretic peptide (proANP) may indicate deviations in the central blood volume (CBV). We evaluated the plasma proANP response to hypotensive hypovolemia under the influence of thoracic epidural anesthesia (TEA) in pigs. We hypothesized that plasma proANP would decrease in response to hypotensive hypovolemia and that TEA would aggravate the proANP response, reflecting a further decrease in CBV. Design Randomized, blinded, controlled trial. Setting A university-affiliated experimental facility. Participants Twenty pigs randomized to administration of saline (placebo) or bupivacaine with morphine (TEA) in the epidural space at Th8-Th10. Interventions Relative hypovolemia was established by an inflatable Foley catheter positioned in the inferior caval vein just below the heart (caval obstruction), and hemorrhage-induced hypovolemia was by withdrawal of blood from the femoral artery, both aiming at a mean arterial pressure (MAP) of 50–60 mmHg. Hemodynamic variables and plasma proANP were determined before and after the interventions. Results Caval obstruction and withdrawal of blood reduced MAP to 50–60 mmHg. Accordingly, cardiac output, central venous pressure, and mixed venous oxygen saturation decreased (p<0.05). Yet, plasma proANP was stable after both caval obstruction (TEA: 72 [63–78] to 80 pmol/L [72–85], p=0.09 and placebo: 64 [58–76] to 69 pmol/L [57–81], p=0.06) and withdrawal of blood (TEA: 74 [73–83] to 79 pmol/L [77–87], p=0.07 and placebo: 64 [56–77] to 67 pmol/L [58–78], p=0.15). Conclusion Plasma proANP was stable in response to relative and hemorrhage-induced hypovolemia to a MAP of 50–60 mmHg, and the response was independent of TEA. The findings suggest that alterations in plasma proANP do not follow deviations in CBV during hypotensive hypovolemia in pigs.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"47 - 55"},"PeriodicalIF":2.9,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S204594","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48199316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist. 改善门诊麻醉的术中交接:麻醉师面临的挑战和解决方案。

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-05-24 eCollection Date: 2019-01-01 DOI: 10.2147/LRA.S183188

Franklin Dexter, Brian Mark Osman, Richard H Epstein

{"title":"Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist.","authors":"Franklin Dexter, Brian Mark Osman, Richard H Epstein","doi":"10.2147/LRA.S183188","DOIUrl":"https://doi.org/10.2147/LRA.S183188","url":null,"abstract":"Permanent transitions of care from one anesthesia provider to another are associated with adverse events and mortality. There are currently no available data on how to mitigate these poor patient outcomes other than to reduce the occurrence of such handoffs. We used data from an ambulatory surgery center to demonstrate the steps that can be taken to achieve this goal. First, perform statistical forecasting using many months of historical data to create optimal, as opposed to arbitrary shift durations. Second, consider assigning the anesthesia providers designated to work late, if necessary, to the ORs estimated to finish the earliest, rather than latest. We performed multiple analyses showing the quantitative advantage of this strategy for the ambulatory surgery center with multiple brief cases. Third, sequence the cases in the 1 or 2 ORs with the latest scheduled end times so that the briefest cases are finished last. If a supervising anesthesiologist needs to be relieved early for administrative duties (eg, head of the group to meet with administrators or surgeons), assign the anesthesiologist to an OR that finishes with several brief cases. The rationale for these recommendations is that such strategies provide multiple opportunities for a different anesthesia provider to assume responsibility for the patients between cases, thus avoiding a handoff altogether.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 ","pages":"37-46"},"PeriodicalIF":2.9,"publicationDate":"2019-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S183188","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37068050","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}

引用次数: 4

Comparison of subcutaneous dexmedetomidine versus clonidine as an adjuvant to spinal anesthesia: a randomized double blind control trial. 皮下右美托咪定与可乐定作为脊髓麻醉辅助剂的比较:一项随机双盲对照试验。

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-04-05 eCollection Date: 2019-01-01 DOI: 10.2147/LRA.S197386

Divya B Srinivas, Geetha Lakshminarasimhaiah

{"title":"Comparison of subcutaneous dexmedetomidine versus clonidine as an adjuvant to spinal anesthesia: a randomized double blind control trial.","authors":"Divya B Srinivas, Geetha Lakshminarasimhaiah","doi":"10.2147/LRA.S197386","DOIUrl":"https://doi.org/10.2147/LRA.S197386","url":null,"abstract":"Background: Alpha-2 adrenergic agonists like clonidine and dexmedetomidine prolong the duration of postoperative analgesia and improve the quality of subarachnoid block (SAB) when used as adjuvant in various routes. However, addition of these drugs by IV or intrathecal routes are known to cause hemodynamic instability. The subcutaneous (SC) route provides similar efficacy as IV administration with less hemodynamic instability and prolonged effect. Aims: To compare the efficacy of clonidine and dexmedetomidine as adjuvants to SAB when used subcutaneously. Materials and methods: A total of 90 patients were randomized into one of the three groups: Group P received 1 ml of Normal saline SC, Group D received 0.5 mcg/kg of dexmeditomedine SC and Group C received 1 mcg/kg of clonidine SC respectively after SAB with 3ml of 0.5% hyperbaric bupivacaine (15 mg). Time of onset of sensory and motor block, intraoperative hemodynamics, postoperative VAS scores, Richmond agitation sedation scale, duration of postoperative analgesia and mean paracetamol requirement in 24 hours were recorded. Results: Mean duration of postoperative analgesia was prolonged in group D (838.10±348.22 minutes) and group C (816.67±230.48 minutes) when compared to group P (332.10±110.91 minutes). Total paracetamol consumption was less in group D (1400.00±770.13 mg) and group C (1600.00±674.66 mg), whereas it was 1900.00±758.86 mg in group P. Hemodynamic parameters, maximum sensory level attained, and time to attain maximum sensory levels were comparable among the two groups. Conclusion: Both subcutaneous clonidine and dexmedetomidine prolonged the duration of postoperative analgesia and reduced analgesic requirements when used as adjuvants to SAB with stable hemodynamics, hence both of these drugs can be used effectively as adjuvants to SAB.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 ","pages":"29-36"},"PeriodicalIF":2.9,"publicationDate":"2019-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S197386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36998806","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}

引用次数: 3

A clearer view on postoperative cognitive dysfunction? [Letter]. 对术后认知功能障碍有更清晰的认识?(信)。

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-03-12 eCollection Date: 2019-01-01 DOI: 10.2147/LRA.S201896

Gijsbert J van der Veen, Cornelis Slagt

引用次数: 0

Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients. 脊髓麻醉引起的低血压是由老年患者脑卒中量减少引起的。

IF 2.9

Local and Regional Anesthesia Pub Date : 2019-03-04 eCollection Date: 2019-01-01 DOI: 10.2147/LRA.S193925

Charlotte Hofhuizen, Joris Lemson, Marc Snoeck, Gert-Jan Scheffer

{"title":"Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients.","authors":"Charlotte Hofhuizen, Joris Lemson, Marc Snoeck, Gert-Jan Scheffer","doi":"10.2147/LRA.S193925","DOIUrl":"https://doi.org/10.2147/LRA.S193925","url":null,"abstract":"Background: Hypotension is common during spinal anesthesia (SA) and is caused by a decrease in systemic vascular resistance (SVR) and/or cardiac output (CO). The effect of the dose of bupivacaine administered intrathecally on the changes in CO in elderly patients is largely unknown. This study investigated the hemodynamic effect of SA in elderly patients by studying the effect of two different dosages of intrathecal bupivacaine.Methods: This prospective cohort study included 64 patients aged >65 years scheduled for procedures under SA; the patients received either 15 mg bupivacaine (the medium dose [MD] group) or 10 mg bupivacaine and 5 μg sufentanil (the low dose [LD] group). Blood pressure and CO were monitored throughout the procedure using Nexfin™, a noninvasive continuous monitoring device using a finger cuff.Results: Thirty-three patients received MD and 31 received LD and there was no mean difference in baseline hemodynamics between the groups. On an average, the CO decreased 11.6% in the MD group and 10.0 % in the LD group. There was no significant change in SVR. Incidence of a clinically relevant decrease in stroke volume (SV) (>15% from baseline) was 67% in the MD and 45% in the LD groups (P<0.05).Conclusion: CO and blood pressure decreased significantly after the onset of SA in elderly patients. This is mainly caused by a decrease in SV and not by a decrease in SVR. There was no difference in CO and blood pressure change between dosages of 10 or 15 mg bupivacaine.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 ","pages":"19-26"},"PeriodicalIF":2.9,"publicationDate":"2019-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S193925","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37064189","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}

引用次数: 34