Local and Regional Anesthesia最新文献

{"title":"Delayed Emergence from Anesthesia: What We Know and How We Act.","authors":"Marco Cascella,&nbsp;Sabrina Bimonte,&nbsp;Raffaela Di Napoli","doi":"10.2147/LRA.S230728","DOIUrl":"https://doi.org/10.2147/LRA.S230728","url":null,"abstract":"<p><p>The emergence from anesthesia is the stage of general anesthesia featuring the patient's progression from the unconsciousness status to wakefulness and restoration of consciousness. This complex process has precise neurobiology which differs from that of induction. Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy. This paper aimed at presenting an update on the phenomenon, analyzing its causes. Diagnostic and therapeutic strategies are addressed. Finally, therapeutic perspectives on the \"active awakening\" are reported.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"195-206"},"PeriodicalIF":2.9,"publicationDate":"2020-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S230728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38696628","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":"Timing of Transversus Abdominis Plane Block and Postoperative Pain Management.","authors":"Maria Escudero-Fung,&nbsp;Erik B Lehman,&nbsp;Kunal Karamchandani","doi":"10.2147/LRA.S278372","DOIUrl":"https://doi.org/10.2147/LRA.S278372","url":null,"abstract":"<p><strong>Background: </strong>Transversus abdominis plane (TAP) blocks using liposomal bupivacaine can reduce postoperative pain and opioid consumption after surgery. The impact of timing of administration of such blocks has not been determined.</p><p><strong>Materials and methods: </strong>A retrospective cohort study of all adult patients that underwent colorectal procedures between January 2013 and October 2015 and received TAP blocks with liposomal bupivacaine at our institution was conducted. The primary outcomes were postoperative pain scores and opioid consumption. Secondary outcomes included postoperative use of non-opioid analgesics as well as total hospital cost of admission and postoperative hospital length of stay.</p><p><strong>Results: </strong>A total of 287 patients were identified and included in the analysis. A total of 71 patients received blocks prior to induction of general anesthesia (pre-ind), 85 patients received blocks after induction of general anesthesia but prior to surgical incision (post-ind) and 131 patients received blocks after completion of surgery (post-op). No significant differences were observed in the postoperative pain scores (either in the first 4 hours or for the entire duration of hospital stay) or opioid consumption between the pre-ind and the post-ind groups. More ketorolac was used in the post-op group compared to the pre-ind group (or= 3.36, 95% CI (1.08, 10.43); p=0.03).</p><p><strong>Conclusion: </strong>Our findings suggest that there seems to be no difference if tap blocks with liposomal bupivacaine are performed before or after induction of anesthesia. Patient preference as well as operating room efficiency should be considered when deciding on the timing of these blocks.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"185-193"},"PeriodicalIF":2.9,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S278372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38696627","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":"Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies.","authors":"Stefan De Hert","doi":"10.2147/LRA.S240564","DOIUrl":"10.2147/LRA.S240564","url":null,"abstract":"<p><p>Approximately, one in three physicians is experiencing burnout at any given time. This may not only interfere with own wellbeing but also with the quality of delivered care. This narrative review discusses several aspects of the burnout syndrome: prevalence, symptoms, etiopathogenesis, diagnosis, impact, and strategies on how to deal with the problem.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"171-183"},"PeriodicalIF":2.9,"publicationDate":"2020-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/82/39/lra-13-171.PMC7604257.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38575129","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":"Interfascial Plane Blocks and Laparoscopic Abdominal Surgery: A Narrative Review.","authors":"James Harvey Jones,&nbsp;Robin Aldwinckle","doi":"10.2147/LRA.S272694","DOIUrl":"https://doi.org/10.2147/LRA.S272694","url":null,"abstract":"<p><p>Laparoscopic abdominal surgery has become a mainstay of modern surgical practice. Postoperative analgesia is an integral component of recovery following laparoscopic abdominal surgery and may be improved by regional anesthesia or intravenous lidocaine infusion. There is inconsistent evidence supporting the use of interfascial plane blocks, such as transversus abdominis plane (TAP) blocks, for patients undergoing laparoscopic abdominal surgery as evidenced by variable patterns of local anesthetic spread and conflicting results from studies comparing TAP blocks to local anesthetic infiltration of laparoscopic port sites and multimodal analgesia. Quadratus lumborum (QL) and erector spinae plane (ESP) blocks may provide greater areas of somatic analgesia as well as visceral analgesia, which may translate to more significant clinical benefits. Aside from the locations of the surgical incisions, it is unclear what other factors should be considered when choosing one regional technique over another or deciding to infuse lidocaine intravenously. We reviewed the current literature in attempt to clarify the roles of various regional anesthesia techniques for patients undergoing laparoscopic abdominal surgery and present one possible approach to evaluating postoperative pain.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"159-169"},"PeriodicalIF":2.9,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S272694","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38640723","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":"Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings.","authors":"Lena Ebba Dohlman, Andrew Kwikiriza, Odinakachukwu Ehie","doi":"10.2147/LRA.S236550","DOIUrl":"10.2147/LRA.S236550","url":null,"abstract":"<p><p>Safe and accessible surgical and anesthetic care is critically limited for over half of the world's population, particularly in Sub-Saharan African and Southeast Asian countries. Increasing the use of regional anesthesia in these areas has potential benefits regarding access, safety, and cost-effectiveness. Perioperative anesthesia-related mortality is significantly higher in resource-limited countries and every effort should be made to encourage the use of anesthetic techniques in these countries that are safest under the present conditions. Studies from Sub-Saharan Africa, although limited in number, have shown a lower risk of death with regional compared to general anesthesia. Regional anesthesia has the further benefit of decreasing the risk of COVID-19 spread to healthcare providers by avoiding the aerosol-generating procedures that occur during general anesthesia. Neuraxial regional anesthesia is relatively easy to teach and perform and is considered the anesthetic of choice for surgeries below the umbilicus in resource-limited settings due to its safety, efficacy, and low cost. Although regional anesthesia has multiple potential advantages, education and training of anesthetic providers in low-and-middle-income countries (LMIC) are a significant barrier to growth. Anesthesia professionals, especially in Sub-Saharan Africa, are often poorly supported and undervalued, and recruitment and retention of adequate numbers of trained practitioners are a continuing problem. Greater use of regional anesthesia could be one way to safely increase anesthesia access and simultaneously create value and enthusiasm for the field. Deficits in anesthesia infrastructure, equipment, and drugs also limit anesthesia capacity in low-and middle-income countries. Ultrasound-guided regional anesthesia may be helpful in improving access to safe and reliable anesthesia in low-resource countries as it continues to become more user-friendly, durable, and affordable.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"147-158"},"PeriodicalIF":1.5,"publicationDate":"2020-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/22/ff/lra-13-147.PMC7588832.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38640722","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":"Enlarged Brachial Plexus Nerve Found During Ultrasound-Guided Peripheral Nerve Block Diagnosed as Charcot-Marie-Tooth Disease: A Case Report.","authors":"Toshie Shiraishi,&nbsp;Kentaro Masumoto,&nbsp;Mitsuyo Nakamura,&nbsp;Gumi Hidano","doi":"10.2147/LRA.S270189","DOIUrl":"https://doi.org/10.2147/LRA.S270189","url":null,"abstract":"<p><p>Ultrasound-guided peripheral nerve block (PNB) has become a popular anesthetic procedure. We report a case of an enlarged brachial plexus nerve noted on ultrasonographic images, as part of PNB, which was diagnosed postoperatively as Charcot-Marie-Tooth disease (CMTD), an inherited neurological disorder of the peripheral nerves. Although nerve enlargement is characteristic of demyelinating diseases such as CMTD, the use of ultrasonography in the diagnosis of neurological disorders is a developing area for neurologists and anesthesiologists can lack knowledge in this emerging field. Unusual nerve presentation on ultrasonographic images during PNB anesthetic procedures should be recognized as being indicative of underlying neurologic disorders. This case highlights that increased awareness of the diagnosis of underlying neurologic disorders by ultrasonography would assist the general practice of PNB in anesthetic medicine. This is especially important as underlying neurological conditions can have important consequences for patient-appropriate anesthesia and may inform best anesthetic practice. A new category, \"neurological disorder on ultrasound image\", should be introduced to PNB knowledge in anesthetic field.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"141-146"},"PeriodicalIF":2.9,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S270189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38643074","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":"Selective Spinal Anesthesia in a Patient with Low Ejection Fraction Who Underwent Emergent Below-Knee Amputation in a Resource-Constrained Setting.","authors":"Hailemariam Mulugeta,&nbsp;Abebayehu Zemedkun,&nbsp;Hailemariam Getachew","doi":"10.2147/LRA.S277152","DOIUrl":"https://doi.org/10.2147/LRA.S277152","url":null,"abstract":"<p><p>Patients with congestive heart failure have a high risk of perioperative major adverse cardiac events and death. The major perioperative goal of management in patients with low ejection fraction is maintaining hemodynamic stability. Evidence is scarce on the safety of a certain anesthetic technique for patients with heart failure. In this report, we present a 48-year-old man with ischemic dilated cardiomyopathy and low-output congestive heart failure (estimated ejection fraction of 27%) who underwent emergent below-knee amputation under selective spinal anesthesia without any apparent complications. We believe that selective spinal anesthesia can be a useful alternative anesthetic technique in patients with low ejection fraction undergoing emergent lower limb surgery. We showed evidence-based and customized anesthetic management of a high-risk patient with the available equipment and resources. This report will hopefully show the contextual challenges of the perioperative care of critically ill patients in resource-constrained settings.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"135-140"},"PeriodicalIF":2.9,"publicationDate":"2020-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S277152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38643073","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":"Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block.","authors":"Serkan Tulgar,&nbsp;Muhammed Enes Aydin,&nbsp;Ali Ahiskalioglu,&nbsp;Alessandro De Cassai,&nbsp;Yavuz Gurkan","doi":"10.2147/LRA.S233274","DOIUrl":"https://doi.org/10.2147/LRA.S233274","url":null,"abstract":"<p><p>Defined in the last decade, erector spinae plane block (ESPB) is one of the more frequently used interfacial plans, and it has been the most discussed block among the recently defined techniques. Lumbar ESPB administered at lumbar levels is relatively novel and is a new horizon for regional anesthesia and pain practice. In this article, we aim to explain and introduce different approaches and explain the possible mechanism of action of lumbar ESPB. The objective of this review is to analyze the case reports, clinical and cadaveric studies about lumbar ESPB that have been published to date. We performed a search in \"Pubmed\" and \"Google Scholar\" database. After a selection of the relevant studies, 59 articles were found eligible and were included in this review. While we believe that lumbar ESPB is reliable and easy, we suggest that its efficacy and indications should be verified with anatomical and clinical studies, and its safety should be confirmed with pharmacokinetic studies. Moreover, the possibility of complications must be considered.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"121-133"},"PeriodicalIF":2.9,"publicationDate":"2020-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S233274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38595559","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":"Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients.","authors":"Alberto Manassero,&nbsp;Matteo Bossolasco,&nbsp;Mattia Carrega,&nbsp;Giuseppe Coletta","doi":"10.2147/LRA.S272410","DOIUrl":"https://doi.org/10.2147/LRA.S272410","url":null,"abstract":"<p><strong>Purpose: </strong>Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications.</p><p><strong>Patients and methods: </strong>Patients received continuous infusion TEA (0.2% ropivacaine and 2 µg ml^-1 fentanyl) to control postoperative pain. Every 8 hours, the acute pain service recorded the analgesia regimen and occurrence of side effects. The initial infusion rate was tapered daily in response to improvement in pain symptoms or occurrence of side effects.</p><p><strong>Results: </strong>A total of 3126 patients received TEA. The median age was 65 years (range, 18-94) and the duration of catheter placement was 3.5 days (range, 2-8). Three major complications were identified (1:1042): two subarachnoid blocks and one epidural abscess which led to permanent sequela (1:3126). Minor complications were hypotension (4.8%), pruritus (4.4%), accidental catheter removal (3.7%), insertion site inflammation (2.5%), motor weakness (2.0%), postoperative nausea and vomiting (1.8%), catheter disconnection (1.9%), catheter occlusion (0.3%), post-dural puncture headache (0.5%), and catheter fragment retention (0.06%), which were the reasons for a 7.4% rate of early discontinuation of epidural analgesia. No occurrence of epidural hematoma, local anesthetic systemic toxicity, and cardiovascular/respiratory depression was recorded.</p><p><strong>Conclusion: </strong>Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"111-119"},"PeriodicalIF":2.9,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S272410","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38424145","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":"Novice and Expert Anesthesiologists' Eye-Tracking Metrics During Simulated Epidural Block: A Preliminary, Brief Observational Report.","authors":"Emanuele Capogna,&nbsp;Francesco Salvi,&nbsp;Lorena Delvino,&nbsp;Andrea Di Giacinto,&nbsp;Matteo Velardo","doi":"10.2147/LRA.S267879","DOIUrl":"https://doi.org/10.2147/LRA.S267879","url":null,"abstract":"<p><strong>Introduction: </strong>Eye tracking is the process of measuring an individual's eye movements to register their attentional behavior by using a device called an eye-tracker. Studies conducted using eye-tracking techniques have demonstrated a number of differences in eye movement parameters and patterns between experts and novices. The aim of this preliminary study was to evaluate if there are any differences in eye-tracking metrics between novice and expert anesthesiologists during the performance of an epidural block using an epidural simulator.</p><p><strong>Methods: </strong>Seven experts and seven novices who gave their consent to this preliminary study were asked to perform an epidural technique using an epidural simulator while wearing a pair of Tobii Pro glasses. Number of fixations, fixation duration, heat maps and scan-paths were examined by Tobii Pro Lab Software. Duration of the procedure was also recorded.</p><p><strong>Results: </strong>The observation of the attentional heat map and gaze plot showed different gaze dispersion between experts and novices. The mean total duration of fixations during needle insertion and advancement and catheter introduction was lower in experts than trainees (respectively, 0.18 vs 3.56 sec; P<0.05 and 0.73 vs 2.48 sec; P<0.05). The mean fixation count was greater in experts vs trainees (5 vs 2; P<0.05). The mean duration of the epidural procedure was 104.16 (41) (trainees) vs 65.3 (32.6) seconds (experts) (P<0.05). Expert anesthesiologists spent more time fixating a more specific target location (eg, the point of the epidural needle rather than the syringe's barrel) whilst novices split their attention between tracking their tools and the target location.</p><p><strong>Discussion: </strong>Eye tracking may have interesting implications for the creation of assessment programs, which distinguish skill level through the use of gaze behavior, and may be a promising tool for monitoring training progress towards the development of expertise.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"105-109"},"PeriodicalIF":2.9,"publicationDate":"2020-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S267879","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38373452","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}