Local and Regional Anesthesia最新文献

{"title":"Delayed Neurological Recovery After Ultrasound-Guided Brachial Plexus Block: A Case Report.","authors":"Ninadini Shrestha,&nbsp;Bipin Karki,&nbsp;Megha Koirala,&nbsp;Santosh Acharya,&nbsp;Pramesh Sunder Shrestha,&nbsp;Subhash Prasad Acharya","doi":"10.2147/LRA.S250989","DOIUrl":"https://doi.org/10.2147/LRA.S250989","url":null,"abstract":"<p><strong>Introduction: </strong>Brachial plexus blocks are frequently practiced and safe mode of anaesthsia. Although minor complications may occur, major complications are a rarity. However, we report a rare case of prolonged supraclavicular brachial plexus block which required almost 4 months to recover without a perceivable cause.</p><p><strong>Case presentation: </strong>A 22-year-old gentleman posted for open reduction and internal fixation of both forearm bones was administered an ultrasound-guided supraclavicular brachial plexus block. The intra-operative period was uneventful. However, the block persisted for a very prolonged period of time. All perceivable causes were ruled out. A total of 19 weeks was required for the entire block to regress with no residual neurological deficits thereafter.</p><p><strong>Conclusion: </strong>Although peripheral neuropathies are known complications of peripheral nerve blocks, such a prolonged brachial plexus block is a rare event. The only plausible cause for the patient's condition could have been the prolonged drug effect; however, it has been rarely documented.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"33-35"},"PeriodicalIF":2.9,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S250989","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37952320","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":"Ankle Surgery in a Patient with Acute Subdural Hematoma Under Combined Lumbar Plexus and Proximal Sciatic Nerve Block - A Case Report.","authors":"Utsav Acharya,&nbsp;Ritesh Lamsal","doi":"10.2147/LRA.S247413","DOIUrl":"https://doi.org/10.2147/LRA.S247413","url":null,"abstract":"<p><p>Acute subdural hematoma (aSDH) is commonly encountered in the emergency department in patients with traumatic injuries. If the hematoma is small, non-expanding and asymptomatic, it is managed conservatively. However, other injuries sustained during trauma may warrant surgical intervention, during which anesthetic management becomes challenging. There have been reports of rebleeding in patients with aSDH after undergoing surgery under either general or spinal anesthesia. Here we present a case where ankle surgery for tri-malleolar fracture was successfully performed in a patient with traumatic aSDH under combined lumbar plexus and proximal (para-sacral) sciatic nerve block.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"29-32"},"PeriodicalIF":2.9,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S247413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37882106","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":"Safety and Efficacy of Oral Melatonin When Combined with Thoracic Epidural Analgesia in Patients with Bilateral Multiple Fracture Ribs.","authors":"Ahmed M Fetouh Abdelrahman, Amany Faheem Abdel Salam Omara, Alaa Ali M Elzohry","doi":"10.2147/LRA.S244510","DOIUrl":"10.2147/LRA.S244510","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study is to evaluate the safety and efficacy of oral melatonin administered with thoracic epidural analgesia in patients with multiple bilateral fractured ribs.</p><p><strong>Patients and methods: </strong>A prospective, double-blind randomized control study was carried out on 80 patients of either sex, American Society of Anesthesiologists (ASA) Grade I and II, aged above 18 years, presenting with multiple bilateral fractured ribs. They were randomly divided into two groups, 40 patients each. Placebo group patients received oral placebo tablets and melatonin group (TEA and melatonin) patients received oral melatonin tablets (5 mg), about 1 hour before epidural infusion of local anesthetics and then every 12 hours till the cessation of bupivacaine infusion.</p><p><strong>Results: </strong>Melatonin administration was associated with a significant decrease in total morphine analgesia consumption, from 31.8 ± 1.41 mg in the TE group to 13.03 ± 0.85 mg in the melatonin group (P < 0.001), with a significant decrease (P < 0.001) in the mean infusion rate of bupivacaine required for controlling the pain, from 0.17 ± 0.014 mL/kg/hour in the TE group to 0.12 ± 0.001 mL/kg/hour in the melatonin group. The duration of bupivacaine infusion in the melatonin group was also significantly shorter than in the TE group (96.48 ± 1.87 and 100.05 ± 3.39 hours, resp., P < 0.001).</p><p><strong>Conclusion: </strong>We conclude that premedication of patients with 5 mg melatonin is associated with significant prolongation of thoracic epidural analgesic effects compared to placebo.</p><p><strong>Registration: </strong>This clinical study was registered at Pan African Clinical Trial Registry with no. \"PACTR 201711002741378\" on 02-11-2017.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"21-28"},"PeriodicalIF":2.9,"publicationDate":"2020-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1a/5a/lra-13-21.PMC7166071.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37877978","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":"Opioid-Free Cesarean Section with Bilateral Quadratus Lumborum Catheters.","authors":"Nadia Hernandez,&nbsp;Semhar J Ghebremichael,&nbsp;Sudipta Sen,&nbsp;Johanna B de Haan","doi":"10.2147/LRA.S238026","DOIUrl":"https://doi.org/10.2147/LRA.S238026","url":null,"abstract":"<p><strong>Introduction: </strong>Post-operative pain control following cesarean section delivery (CD) is an important topic of discussion given the lack of consensus on a narcotic-sparing analgesic regimen. We describe the case of an elective CD with narcotic-free pain control using continuous bilateral posterior quadratus lumborum (QL) blockade as the primary mode of analgesia.</p><p><strong>Case report: </strong>The patient is a 36-year-old female, G3P1, who presented at 37 weeks of gestation in active labor scheduled for elective primary CD. A spinal anesthetic was performed at L4-L5 with hyperbaric 0.75% bupivacaine, without intrathecal morphine. Bilateral posterior QL catheters were placed under sterile conditions with 20 mL of 0.25% bupivacaine per side. Continuous infusion of 0.2% ropivacaine was then started at 10 mL/hour per side. The patient's pain was controlled with QL catheters and a multimodal pain regimen consisting of non-steroidal anti-inflammatory drugs and acetaminophen. The patient reported a resting pain score of 0 with a dynamic pain score of 3 out of 10 throughout her recovery. She was discharged on post-operative (post-op) day 3 and the catheters were removed without any complications.</p><p><strong>Discussion: </strong>The gold standard for pain control following CD is intrathecal morphine; however, its use has many adverse effects. Bilateral single-shot QL blocks following CD have been proven to decrease opioid consumption but its limited duration has minimal advantage over intrathecal morphine and patients continue to require oral narcotics for analgesia. With the use of QL catheters and a multimodal pain regimen, it may be possible to achieve opioid-free CD for the post-op period.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"17-20"},"PeriodicalIF":2.9,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S238026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37682414","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":"Peripheral Neuropathic Pain and Pain Related to Complex Regional Pain Syndrome with and without Fixed Dystonia - Efficient Therapeutic Approach with Local Anesthetics.","authors":"Thomas Michels","doi":"10.2147/LRA.S229315","DOIUrl":"https://doi.org/10.2147/LRA.S229315","url":null,"abstract":"<p><p>Peripheral Neuropathic Pain (PNP) as well as the Complex Regional Pain Syndrome (CRPS), also known as \"Reflex Sympathetic Dystrophy\", or \"Sudeck Dystrophy\", all of them have a poor prognosis. The numerous therapeutic offers are rarely accompanied by convincing success over a long duration of time. Even worse is the prognosis of a fixed dystonia which may develop in the extremities of PNP or CRPS patients. In literature a few cases are reported in which the often unbearable pain of those patients with or without a disabling dystonia disappeared immediately after the injection of local anesthetics (LAs) into the scars of a preceding trauma. This review evaluates publications concerning the neuropathological characteristics of fixed dystonia in PNP/CRPS patients and the electrophysiological processes of scar neuromas. The results of these evaluations support the understanding of the therapeutic successes and their immediate results reported above by the injection of LAs into triggering scars. Therapeutic options are discussed.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"11-16"},"PeriodicalIF":2.9,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S229315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37678621","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":"Non-Operating Room Anesthesia: Patient Selection and Special Considerations.","authors":"Timothy Wong,&nbsp;Paige L Georgiadis,&nbsp;Richard D Urman,&nbsp;Mitchell H Tsai","doi":"10.2147/LRA.S181458","DOIUrl":"https://doi.org/10.2147/LRA.S181458","url":null,"abstract":"<p><p>Non-operating room anesthesia (NORA) represents a growing field of medicine with an increasing trend in the number of cases performed over the previous decade. As a result, anesthesia providers will need to enhance their familiarity with the resources, personnel, and environment outside of the operating room. Anesthesia delivery in NORA settings should be held with the same high-quality standards as that within the operating room. This review looks at special considerations in patient selection and the preoperative, intraoperative, and postoperative periods. In addition, there is a discussion on the unique aspects of specific NORA areas and the considerations that come with them.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2020-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S181458","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37611591","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":"Anesthesia for Percutaneous Radiofrequency Tumor Ablation (PRFA): A Review of Current Practice and Techniques.","authors":"Federico Piccioni,&nbsp;Andrea Poli,&nbsp;Leah Carol Templeton,&nbsp;T Wesley Templeton,&nbsp;Marco Rispoli,&nbsp;Luigi Vetrugno,&nbsp;Domenico Santonastaso,&nbsp;Franco Valenza","doi":"10.2147/LRA.S185765","DOIUrl":"https://doi.org/10.2147/LRA.S185765","url":null,"abstract":"<p><p>Percutaneous radiofrequency ablation (PRFA) of solid tumors is a minimally invasive procedure used to treat primary or metastatic cancer lesions via needle targeted thermal energy transfer. Some of the most common tumor lesions treated using PRFA include those within the liver, lungs and kidneys. Additionally, bone, thyroid, and breast lesions can also be treated. In most cases, this procedure is performed outside of the operating room in a specialized radiology suite. As a result, the clinician must adapt in many cases to the specific environmental issues attendant to providing anesthesia outside the operating room, including the lack of availability of an anesthesia machine in some cases, and frequently a lack of adequate scavenging and other specialized monitoring and equipment. At this time, routine practice and anesthetic prescriptions for PRFA can vary widely, ranging from patients receiving local anesthesia alone, to monitored anesthesia care, to regional anesthesia, to combined regional and general anesthesia. The choice of anesthetic technique will depend on tumor location and practitioner experience. This review aims to summarize the current state of the art in terms of anesthetic techniques for patients undergoing PRFA of solid tumors.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 ","pages":"127-137"},"PeriodicalIF":2.9,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S185765","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37446056","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":"Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures [Letter]","authors":"Eva Hendriksen, C. Slagt","doi":"10.2147/lra.s233411","DOIUrl":"https://doi.org/10.2147/lra.s233411","url":null,"abstract":"Department Anaesthesia, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands Dear editor With great interest we have read the article by Mangla et al recently published in Local and Regional Anaesthesia. In this article, they present the anaesthetic considerations of a trauma patient with bilateral radial fractures. Because of posttraumatic orofacial swelling combined with a sore throat after a previous anaesthesia, they anticipated a possible difficult airway. The patient was motivated for a bilateral brachial plexus anaesthesia combined with midazolam and propofol infusion. A infraclavicular block on the right and a supraclavicular block on the left were performed under ultrasound guidance. We would like to share our thoughts regarding this anaesthetic plan with respect to patient safety. Firstly, combining different local anaesthetics is common but their toxicity is additive. Calculating maximal doses becomes blurred. Blocks become unpredictable due to changes in pKa values and alterations in free fractions of these local anaesthetics. Secondly, when pulmonary complications are a real concern we suggest to perform a bilateral axillary block since there are no concerns regarding pulmonal failure (diaphragm palsy, pneumothorax). In combination with a skin ring block to address the intercostobrachial nerve, patients will have sufficient anaesthesia to tolerate a tourniquet (if needed). Third, Mangla et al performed a bilateral brachial block using bupivacaine 0.5%. Regarding LA toxicity, ropivacaine has largely replaced bupivacaine as the most commonly used long-acting local anaesthetic in peripheral nerve blockade. In equivalent doses, it produces less motor blockade compared to bupivacaine but an equally effective sensory block. Most important ropivacaine is less cardiotoxic compared to bupivacaine. The volume of LA that was given to perform the brachial blocks was 30–40mL. An increased volume will increase the spread of local anaesthetics, increasing the chance of blocking the phrenic nerve. Especially as 20 mL of ropivacaine 0.75% or low dose ropivacaine 0.375% is sufficient in a ultrasound guided supraclavicular block. Determining the anaesthetic plan is always a delicate balance between patient wishes, surgical options, surgical and/or anaesthesia risks. Anaesthesiologists should implement the plan that minimizes the risk to the patient.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"109 - 110"},"PeriodicalIF":2.9,"publicationDate":"2019-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/lra.s233411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45529275","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}

{"title":"Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures [Response To Letter]","authors":"Chanchal Mangla, H. Kamath, J. Yarmush","doi":"10.2147/lra.s238432","DOIUrl":"https://doi.org/10.2147/lra.s238432","url":null,"abstract":"Department of Anesthesiology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA Dear editor We would like to thank Dr Hendrickson et al for their interest in our work and writing about their opinion. We agree with the comment that mixing local anesthetics might make individual safe doses unknown, so maximum recommended doses of each local anesthetic should not be used. There are no human studies but it can be presumed to be additive based on some animal studies. We mixed local anesthetics in our patients so that we could decrease the volume of more toxic local anesthetics (Bupivacaine) by using some less toxic ones (like chloroprocaine). We also used doses of each local anesthetic of well below the recommended toxic doses and did spacing in our blocks to avoid toxicity. Though axillary blocks along with medial brachial cutaneous and intercostobrachial block can be used, we chose not to perform bilateral axillary blocks because it requires individual blockage of the terminal nerves which might lead to inadequate coverage, and also, performance of the block time and onset time is longer. Instead, we did infraclavicular block on one side, which greatly decreases the chances of phrenic nerve palsy. Dr Hendricken made a very good point of using ropivacaine instead of bupivacaine due to less toxicity, but unfortunately we do not have ropivacaine available at our institution. Lastly, smaller volume of local anesthetics can be used with the use of ultrasound for a successful block. We used 30 mL volume for each block, as we wanted to ensure complete coverage of surgical anesthesia and to avoid any supplementation/ deeper sedation or general anesthesia in case of an incomplete block. Also, our second block was more than two hours later, hence we avoided the overlap of peak plasma concentration of the local anesthetics from first and second blocks.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"125 - 126"},"PeriodicalIF":2.9,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/lra.s238432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48507115","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}

{"title":"Obesity And Obstetric Anesthesia: Current Insights","authors":"C. Taylor, J. Dominguez, A. Habib","doi":"10.2147/LRA.S186530","DOIUrl":"https://doi.org/10.2147/LRA.S186530","url":null,"abstract":"Abstract Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial anesthesia can be challenging to place in the obese parturient, but is the preferred anesthetic for cesarean delivery to avoid airway manipulation, minimize aspiration risk, prevent fetal exposure to volatile anesthetic, and decrease risk of post-partum hemorrhage from volatile anesthetic exposure. Monitoring and positioning of these patients for surgery may pose specific challenges. Functional labor epidural catheters can be topped up to provide conditions suitable for surgery. In the absence of a working epidural catheter, a combined spinal epidural anesthetic is often the technique of choice due to relative ease of placement versus a single shot spinal technique as well as the ability to extend the anesthetic through the epidural portion. For cesarean delivery with a vertical supraumbilical skin incision, a two-catheter technique may be beneficial. Concern for thromboembolism necessitates early mobilization and a multimodal analgesic regimen can help accomplish this. In addition, thromboprophylaxis is recommended in this population after delivery—especially cesarean delivery. These patients also need close monitoring in the post-partum period when they are at increased risk for several complications.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"111 - 124"},"PeriodicalIF":2.9,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S186530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46230308","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}