Journal of anesthesiology and pain therapy最新文献

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Three Cases of Local Anesthetic Systemic Toxicity following regional infiltration analgesia: The need for prompt recognition and treatment 局部浸润镇痛致局麻全身毒性3例:需及时识别和治疗

Journal of anesthesiology and pain therapy Pub Date : 2023-09-25 DOI: 10.29245/2768-5365/2023/2.1144

Kevin A. S. Carroll, Jonathan Henglein, Paul Boland, Paul Gallagher, Kermaan Mehta, Sabatino A. Leffe, Oktay Shuminov, Alejandro Betancourt-Ramirez, Shannon F. R. Small

{"title":"Three Cases of Local Anesthetic Systemic Toxicity following regional infiltration analgesia: The need for prompt recognition and treatment","authors":"Kevin A. S. Carroll, Jonathan Henglein, Paul Boland, Paul Gallagher, Kermaan Mehta, Sabatino A. Leffe, Oktay Shuminov, Alejandro Betancourt-Ramirez, Shannon F. R. Small","doi":"10.29245/2768-5365/2023/2.1144","DOIUrl":"https://doi.org/10.29245/2768-5365/2023/2.1144","url":null,"abstract":"Introduction: The diagnosis and management of systemic toxicity in patients following regional infiltration analgesia is of paramount importance. While the mechanism and risk factors have been elucidated in previous studies, we believe that due to the potentially life-threatening nature of this rare occurrence, a greater focus on diagnostic precision and management enhancements is warranted. Cases: Here, we describe three cases of LAST, the first in a 59 year old female following elective L4-L5 laminectomy and L5-S1 fusion, who suffered a cardiac arrest after receiving local Exparel and Marcaine at the time of closure; the second in a 69 year old woman following a rib block using local Exparel and Marcaine for the management of multiple rib fractures, who had a witnessed tonic-clonic seizure requiring intubation. The third patient is an 80-year-old male, who after an elective L4-L5 laminectomy and fusion, suffered a cardiac arrest after receiving local anesthetic (Exparel and Marcaine) at the time of closure. All patients were treated with intralipids and eventually recovered with no lasting deficits. Conclusion: LAST events most commonly occur in the first minutes after injection, and are characterized by CNS and cardiovascular toxicities, as seen in these patients. Delayed presentations up to several days post exposure have been described. These cases exposed the opportunity for education in early recognition and most important, the need to improve the availability of intralipids. Prompt recognition and access to intralipid is critical to the treatment of LAST, and education regarding this rare but life-threatening condition is needed in surgical and trauma centers.","PeriodicalId":496788,"journal":{"name":"Journal of anesthesiology and pain therapy","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135867673","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

Treatment of Pain Revisited ‐ The argument against too rapid resort to narcotic analgesics in Emergency Departments in Australia 重新审视疼痛治疗——澳大利亚急诊科反对过快使用麻醉性镇痛药的争论

Journal of anesthesiology and pain therapy Pub Date : 2023-09-12 DOI: 10.29245/2768-5365/2023/2.1142

Roy G. Beran

{"title":"Treatment of Pain Revisited ‐ The argument against too rapid resort to narcotic analgesics in Emergency Departments in Australia","authors":"Roy G. Beran","doi":"10.29245/2768-5365/2023/2.1142","DOIUrl":"https://doi.org/10.29245/2768-5365/2023/2.1142","url":null,"abstract":"Introduction: Pain is a common neurological complaint with many patients already taking narcotic analgesics at presentation to the neurologist. This paper examines an approach to pain management aimed to avoid narcotic analgesics. Clinical Practice: Pain is subjective and may be considered as either acute or chronic pain, differentiated between pain provoking avoidance or pain without benefit. Pain management is determined by the underlying diagnosis and clinical status. Use of Narcotic Analgesics: Narcotic analgesics have the potential for abuse and pose public health risks. Abuse has increased among street and recreational drug users. The Australian Government restricted access to combination codeine containing medications, requiring a prescription and medical supervision. Discussion: While there exist specific pain syndromes, the use of narcotic analgesics should be judicious. Their use should be restricted to refractory pain but should not exclude their legitimate use, once alternative remediation has been exhausted and entails medical supervision. Conclusion: Narcotic analgesics should not be the first line treatment for pain, with initial approach directed towards diagnosis and treating the underlying cause. Once refractory chronic pain has been established, narcotic analgesics should be available under medical supervision, acknowledging the risk of overuse and addiction.","PeriodicalId":496788,"journal":{"name":"Journal of anesthesiology and pain therapy","volume":"154-155 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135887168","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