Local and Regional Anesthesia最新文献

{"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}

{"title":"Successful Dental Treatments Using Procaine Hydrochloride in a Patient Afraid of Local Anesthesia but Consenting for Allergic Testing with Lidocaine: A Case Report.","authors":"Terumi Ayuse,&nbsp;Shinji Kurata,&nbsp;Takao Ayuse","doi":"10.2147/LRA.S268498","DOIUrl":"https://doi.org/10.2147/LRA.S268498","url":null,"abstract":"<p><strong>Background: </strong>We report a case in which effective dental anesthetic management was achieved using procaine hydrochloride for a patient who had an unknown history of allergic reactions to lidocaine.</p><p><strong>Case presentation: </strong>Because the patient refused to undergo screening tests using any of the amide-type local anesthetics because of her extreme fear against local anesthetics that she had been administered previously, procaine hydrochloride, which is an ester-form local anesthetic, was the only agent to be tested on this patient at the department of dermatology. Consequent to a negative allergy test, we performed complete dental treatment using procaine hydrochloride after additional chairside drug challenge tests using minimum test dose under vital sign monitoring.</p><p><strong>Conclusion: </strong>The success of dental treatment using procaine hydrochloride may have relieved the patient's fear of local anesthesia. We discuss an important aspect of treatment planning for patients with a history of complications during local anesthesia.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"99-103"},"PeriodicalIF":2.9,"publicationDate":"2020-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/a6/lra-13-99.PMC7445954.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38358487","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 \"Rescue\" Use of Erector Spinae Plane Block After Lumbar Spine Fusion: A Report of 2 Cases.","authors":"Daniel N Kianpour,&nbsp;Joseph T Gundy,&nbsp;Jacob W Nadler,&nbsp;Danielle M Lindenmuth","doi":"10.2147/LRA.S268973","DOIUrl":"https://doi.org/10.2147/LRA.S268973","url":null,"abstract":"<p><p>Pain after lumbar spine fusion surgery is often difficult to control in the immediate postoperative period. Historically, opioids have been the mainstay of treatment, but are associated with many unwanted side effects as well as increased hospital length of stay. The ultrasound-guided erector spinae plane block (ESP) is a relatively safe and simple regional option for the management of acute postoperative pain after spine surgery without the technical difficulty or complications noted with paravertebral injection (eg, pneumothorax, hematoma). To date, there have been reports of preoperative placement of ESP block prior to spine surgery with some success. We present a report of two cases that highlight the efficacy of the ESP block as an early postoperative \"rescue\" regional anesthetic technique in lumbar spine surgery. These cases demonstrate the potential effectiveness of a \"rescue\" use of the ESP block in patients having uncontrolled or poorly controlled pain in the early postoperative period with no evidence of significant side effects.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"95-98"},"PeriodicalIF":2.9,"publicationDate":"2020-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S268973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38440257","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":"Establishing a Technique for Pectoral II-Block Catheter Insertion with Ultrasound Guidance: A Randomized Controlled Trial.","authors":"Mohamed A Mansour,&nbsp;Ahmed Z Fouad,&nbsp;Sarah M Amin,&nbsp;Nasser M Dobal","doi":"10.2147/LRA.S262138","DOIUrl":"https://doi.org/10.2147/LRA.S262138","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the efficacy and safety of a modified technique for ultrasound-guided pectoral II block for postoperative pain control after mastectomy.</p><p><strong>Methods: </strong>In this randomized controlled trial, patients were randomly allocated into two groups (40 patients each). Group I patients were subjected to ultrasound-guided pectoral II block with injection of 10 mL lidocaine 1% as a dissecting solution before attempting catheter insertion, while group II patients underwent the standard procedure without a dissecting solution. Measured outcomes included catheter visibility, pain, patient satisfaction, performance time, and complications.</p><p><strong>Results: </strong>Compared with group II, group I had significantly lower median catheter-visibility scores, shorter block performance time, and fewer insertion attempts. Group I had a nonsignificantly higher rate of complications than group II.</p><p><strong>Conclusion: </strong>The modified technique facilitated the procedure, shortened the catheter-insertion time, and showed higher patient satisfaction. However, it was associated with lower catheter visibility on ultrasonography. Further studies are required to confirm the present findings and assess the safety of the modified technique.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"85-93"},"PeriodicalIF":2.9,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S262138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38311656","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":"Emergence Agitation and Delirium: Considerations for Epidemiology and Routine Monitoring in Pediatric Patients.","authors":"Carrie Menser,&nbsp;Heidi Smith","doi":"10.2147/LRA.S181459","DOIUrl":"https://doi.org/10.2147/LRA.S181459","url":null,"abstract":"<p><p>Emergence from anesthesia can be associated with a wide spectrum of cognitive and behavioral dysregulation in children, including delirium or acute brain dysfunction. This period of neurobehavioral recovery can be further confounded by pain, anxiety, and fear. The implementation of monitoring for level of consciousness, pain, and delirium using valid pediatric tools is necessary to avoid misdiagnosis due to overlapping symptomatology and support appropriate management. Understanding the epidemiology of delirium in the postoperative setting will require consistent use of accurate terminology in the medical literature. The current interchangeable use of the terms \"emergence agitation\" and \"emergence delirium\" needs to be highlighted and awareness of differences in patient conditions and assessment tools is essential. We discuss epidemiology of emergence agitation and delirium in the pediatric population, and the challenges for future delineation of monitoring and management. Furthermore, we describe the possible impact of long-term consequences of emergence delirium among infants and children, and the necessary areas of future research.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"73-83"},"PeriodicalIF":2.9,"publicationDate":"2020-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S181459","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38269013","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 Options and the Recurrence of Cancer: What We Know so Far?","authors":"Juan P Cata,&nbsp;Carlos Guerra,&nbsp;German Soto,&nbsp;Maria F Ramirez","doi":"10.2147/LRA.S240567","DOIUrl":"https://doi.org/10.2147/LRA.S240567","url":null,"abstract":"<p><p>Surgery is a critical period in the survival of patients with cancer. While resective surgery of primary tumors has shown to prolong the life of these patients, it can also promote mechanisms associated with metastatic progression. During surgery, patients require general and sometimes local anesthetics that also modulate mechanisms that can favor or reduce metastasis. In this narrative review, we summarized the evidence about the impact of local, regional and general anesthesia on metastatic mechanisms and the survival of patients. The available evidence suggests that cancer recurrence is not significantly impacted by neither regional anesthesia nor volatile or total intravenous anesthesia.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"57-72"},"PeriodicalIF":2.9,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S240567","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38240193","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":"Relief of Secondary Headaches with High Thoracic Erector Spinae Plane Block.","authors":"Nadia Hernandez,&nbsp;Grace Guvernator,&nbsp;George Ansoanuur,&nbsp;Michelle Ge,&nbsp;Precious Tabansi,&nbsp;Thanh-Thuy Le,&nbsp;Salameh S Obeidat,&nbsp;Johanna de Haan","doi":"10.2147/LRA.S249250","DOIUrl":"https://doi.org/10.2147/LRA.S249250","url":null,"abstract":"<p><p>Intractable headaches can be debilitating, often leading to significant distress, prolonged medical treatment, and unanticipated hospital admissions. There have been significant advances in the treatment of primary intractable headaches such as migraines, tension headaches, and cluster headaches beyond medical management. Treatments may now include interventional strategies such as trigger-point injections, peripheral nerve stimulators, or peripheral nerve and ganglion blocks. There are few studies, however, describing the use of interventional techniques for the management of intractable secondary headaches, including those attributed to injury or infection. A new regional anesthetic technique, the erector spinae plane (ESP) block, was initially used for neuropathic thoracic pain. ESP block has since been reported to provide acute and chronic pain relief of the shoulder, spine, abdomen, pelvis, thorax, and lower extremity. Additionally, there has been one case report to describe the use of the ESP block in the treatment of refractory tension headache. We report four cases of effective analgesia for intractable secondary headache resistant to medical management with high thoracic ESP blocks. In each case, the ESP block provided instant pain relief. We suggest that the findings of this case series indicate that the ESP block may be a useful intervention in patients with severe secondary headache or posterior cervical pain where conventional therapies have limited success, though more studies are necessary.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"49-55"},"PeriodicalIF":2.9,"publicationDate":"2020-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S249250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38103365","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":"Delayed Neurological Recovery After Ultrasound-Guided Brachial Plexus Block: A Case Report [Response to Letter].","authors":"Ninadini Shrestha,&nbsp;Bipin Karki,&nbsp;Megha Koirala,&nbsp;Santosh Acharya,&nbsp;Pramesh Sunder Shrestha,&nbsp;Subhash Prasad Acharya","doi":"10.2147/LRA.S266326","DOIUrl":"https://doi.org/10.2147/LRA.S266326","url":null,"abstract":"","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"47-48"},"PeriodicalIF":2.9,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S266326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38103364","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":"Control of Spinal Anesthesia-Induced Hypotension in Adults.","authors":"Fabrice Ferré,&nbsp;Charlotte Martin,&nbsp;Laetitia Bosch,&nbsp;Matt Kurrek,&nbsp;Olivier Lairez,&nbsp;Vincent Minville","doi":"10.2147/LRA.S240753","DOIUrl":"https://doi.org/10.2147/LRA.S240753","url":null,"abstract":"<p><p>Spinal anesthesia-induced hypotension (SAIH) occurs frequently, particularly in the elderly and in patients undergoing caesarean section. SAIH is caused by arterial and venous vasodilatation resulting from the sympathetic block along with a paradoxical activation of cardioinhibitory receptors. Bradycardia after spinal anesthesia (SA) must always be treated as a warning sign of an important hemodynamic compromise. Fluid preloading (before initiation of the SA) with colloids such as hydroxyethyl starch (HES) effectively reduces the incidence and severity of arterial hypotension, whereas crystalloid preloading is not indicated. Co-loading with crystalloid or colloid is as equally effective to HES preloading, provided that the speed of administration is adequate (ie, bolus over 5 to 10 minutes). Ephedrine has traditionally been considered the vasoconstrictor of choice, especially for use during SAIH associated with bradycardia. Phenylephrine, a α₁ adrenergic receptor agonist, is increasingly used to treat SAIH and its prophylactic administration (ie, immediately after intrathecal injection of local anesthetics) has been shown to decrease the incidence of arterial hypotension. The role of norepinephrine as a possible alternative to phenylephrine seems promising. Other drugs, such as serotonin receptor antagonists (ondansetron), have been shown to limit the blood pressure drop after SA by inhibiting the Bezold-Jarisch reflex (BJR), but further studies are needed before their widespread use can be recommended.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"39-46"},"PeriodicalIF":2.9,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S240753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38083618","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":"Delayed Neurological Recovery After Ultrasound-Guided Brachial Plexus Block: A Case Report [Letter].","authors":"Chanchal Mangla,&nbsp;Joel Yarmush","doi":"10.2147/LRA.S260021","DOIUrl":"https://doi.org/10.2147/LRA.S260021","url":null,"abstract":"","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"37-38"},"PeriodicalIF":2.9,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S260021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38083617","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}