Peripheral Nerve Block Catheter for Extremity Surgery

2013 ◽  
Author(s):  
Elizabeth Prentice
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Postoperative Analgesia ◽  
Lower Limb ◽  
Club Foot ◽  
Peripheral Nerve Block ◽  
Pediatric Population ◽  
Severe Postoperative Pain ◽  
Peripheral Nerve Blockade ◽  
Lower Limb Surgery

Continuous peripheral nerve blockade (CPNB) can provide excellent postoperative analgesia. Many adult studies report the effectiveness of CPNB. Although not as widely adopted in pediatrics, several studies support its use. Its niche lies in provision of analgesia after major unilateral limb surgery with severe postoperative pain expected for 48 to 72 hours. Lower limb surgery of this type is more common than upper limb in the pediatric population. Examples include club foot repair, osteotomy, or resection of sarcoma. This chapter presents two cases where CPNB is a good option for postoperative analgesia.

scholarly journals Successful use of ultrasound-guided peripheral nerve block for lower limb surgery in a patient with heart failure with reduced ejection fraction: a case report

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110452
Author(s):  
Jaewoong Jung ◽  
Misoon Lee ◽  
Yang-Hoon Chung ◽  
Sung-Hwan Cho
Keyword(s):  
Heart Failure ◽  
Sciatic Nerve ◽  
Ejection Fraction ◽  
Peripheral Nerve ◽  
Lower Limb ◽  
Peripheral Nerve Block ◽  
Ultrasound Guided ◽  
Reduced Ejection Fraction ◽  
Lower Limb Surgery ◽  
Fascia Iliaca Compartment Block

The number of patients with heart failure with reduced ejection fraction (HFrEF) is increasing. These patients have a reduced cardiorespiratory reserve. Therefore, preoperative evaluation is essential to determine the best type of anaesthesia to use in patients with HFrEF. A 70-year-old man with HFrEF was scheduled to undergo debridement of skin necrosis due to thrombotic occlusion of the right common iliac artery. He had undergone wound dressing changes under local anaesthesia every other day for several months, and treatment for heart failure was on-going. A sciatic nerve and fascia iliaca compartment block was performed under ultrasound guidance because of the patient’s cardiopulmonary function. After confirming adequate sensory blockage, surgery was performed without any haemodynamic instability or complications. Thereafter, debridement was performed twice more using the same block technique, and a skin autograft was also successfully performed. We successfully performed an ultrasound-guided sciatic nerve and fascia iliaca compartment block in a patient with HFrEF who was scheduled to undergo lower limb surgery. Peripheral nerve block is an alternative option for patients with HFrEF.

scholarly journals Comparison of Analgesic Efficacy of Caudal Dexamethasone versus Intravenous Dexamethasone as an Adjuvant to Caudal Block in Pediatric Patients Undergoing Lower limb orthopedic Surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
G S Mohamed ◽  
A A Abdelatif ◽  
M Menshawey ◽  
A A S Mansour
Keyword(s):  
Postoperative Pain ◽  
Surgical Procedures ◽  
Postoperative Analgesia ◽  
Lower Limb ◽  
Pediatric Population ◽  
Anesthetic Techniques ◽  
Caudal Block ◽  
Caudal Anesthesia ◽  
Analgesic Regimen ◽  
Better Than

Abstract Background Lower limb orthopedic surguries are one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics is caudal block. Aim of the Work This study is conducted to evaluate the analgesic effect of dexamethasone when given systemically versus caudally as an adjuvant to caudal block for children undergoing lower limb orthopedic surgeries. Patients and Methods The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 25 patients. Results The results of the study revealed that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain. Conclusion From our study, we can conclude that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain.

Postoperative Pain Management for Peripheral Nerve Block Patients

2011 ◽  
Vol 26 (3) ◽  
pp. 188
Author(s):  
Pamela Windle ◽  
Agnes Hsu ◽  
Thomas Prodan ◽  
Videlyn Ilacio-Uy ◽  
Herminia Robles
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Postoperative Pain Management

Epipleural surgical block and ultrasound-guided erector spinae plane block for analgesia in VATS

2021 ◽  
Keyword(s):  
Postoperative Pain ◽  
Thoracic Surgery ◽  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Additional Method ◽  
Video Tutorial ◽  
Erector Spinae Plane Block ◽  
Severe Postoperative Pain

Thoracic surgery is still associated with severe postoperative pain. In this video tutorial, we present 2 techniques that could be used as an additional method in a multimodal postoperative analgesia strategy for video-assisted thoracic surgery. We present the combination of an epipleural surgical infiltration of a local anesthetic with an ultrasound-guided erector spinae plane block.

scholarly journals Az ultrahang-képalkotás alkalmazása biotechnikai előrelépés a perioperatív fájdalomcsillapításban

2019 ◽  
Vol 160 (15) ◽  
pp. 573-584
Author(s):  
Róbert Gyula Almási
Keyword(s):  
Nervous System ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Peripheral Nerve ◽  
General Anaesthesia ◽  
Central Sensitization ◽  
Regional Anaesthesia ◽  
Nerve Blockade ◽  
Peripheral Nerve Blockade

Abstract: The perioperative pain management – instead of the efforts, guidelines and protocols – is underestimated and undertreated. Even in the case of general anaesthesia, the nervous system is overwhelmed by copious quantities of nociceptive stimuli at surgical incision. Stress and pain-modulation processes are triggered which can have significant influence on the outcome. Often the pain-management is discontinued, so a notable part of patients complain about pain in the ward after surgery. Regional anaesthesia conceptually prevents noxious inputs to enter the central nervous system, beyond surgical anaesthesia it is pertinent to achieve excellent analgesia in the immediate postoperative period as well. Based on current literature, this paper provides an overview of the history and role of regional anaesthesia in the multidimensional model of pain. Besides the sensitization caused by nociceptive stimuli – peripheral and central sensitization, descending modulation – there are several biopsychosocial factors involved in pain pathophysiology. Preventing the side effects of general anaesthesia, the ultrasound-guided peripheral nerve blockade is a safe technique with high success rate, rare side effects, achieving long-lasting, excellent analgesia. Continuous perineural catheter placed under ultrasound provides extended pain control. As a part of multimodal analgesia, peripheral nerve blockade prevents central sensitization. After surgery, the pain intensity of patients under peripheral nerve blockade is less, the chronification tendency is decreased, the quality of life and patients’ comfort are improved, and the stress-response is attenuated. The greater part of patients are protected from the undesirable side effects of general anaesthesia. Nowadays, it is an unequivocal evidence that the increasingly used peripheral nerve blockades prior to incision are efficient tools in the prevention of chronic postoperative pain. Ultrasound guidance is suitable not only for surgical anaesthesia, but for postoperative pain management as well, however, besides economic factors, the main goal of this technique is to match the best interest of the patients. Orv Hetil. 2019; 160(15): 573–584.

scholarly journals Postoperative analgesia with the use of peripheral nerve block of the foot and ankle

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Kelly Stéfani ◽  
Gabriel Ferraz
Keyword(s):  
Peripheral Nerve ◽  
Pain Intensity ◽  
Nerve Block ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Peripheral Nerve Block ◽  
Control Group ◽  
Study Group ◽  
Foot And Ankle ◽  
The Mean

Category: Basic Sciences/Biologics Introduction/Purpose: Peripheral nerve block in the foot and ankle is usually used for anesthesia in forefoot and midfoot surgeries. However, since the postoperative analgesia obtained is prolonged, we can expand its use, as an adjuvant after the end of the spinal or general anesthesia. The aim of this study was to evaluate the use of peripheral nerve block of the foot and ankle as a method of postoperative analgesia. Methods: A prospective, randomized, blinding study was performed. The study group included 30 patients (32 feet) submitted to peripheral anesthetic block after surgery with spinal anesthesia and the control group (30 patients, 31 feet) were patients not submitted to nerve block. The inclusion criterion was: patients submitted to foot and ankle surgery at our institution. Patients answered the questionnaire postoperatively, with the measurement of pain intensity by the Visual Analog Scale (VAS) and the time of onset of pain. All local peripheral block was performed by the same orthopedic team with 20 mL of Ropivacaine at a concentration of 7.5 mg / mL (0.75%). Results: The mean patient age was 52,5 years, and the majority of patients were women (66%). The results showed a statistically significant difference between the control group and the study group, with a longer time of postoperative analgesia (p <0.001) and lower pain intensity in the immediate postoperative period (p <0.001) in patients submitted to blockade anesthetic. There was no statistical difference between the two groups regarding pain intensity on the first and second postoperative day. Conclusion: In the study group, the mean postoperative pain (six hours after surgery) was lower when compared to the control group, with statistical significance. This result showed that the ankle block helped to control pain, in a safe and effective mode. The use of ropivacaine presents a sensitive block similar to bupivacaine, but with shorter motor block, allowing early initiation of rehabilitation. The study demonstrated that peripheral nerve block in the foot and ankle region can be used effectively in postoperative analgesia, reducing pain intensity in the immediate postoperative period and also prolonging analgesia and thus maximizing physiotherapy postoperative period.

scholarly journals Liposomal bupivacaine peripheral nerve block for the management of postoperative pain

2015 ◽  
Author(s):  
Thomas W Hamilton ◽  
Vassilis Athanassoglou ◽  
Marialena Trivella ◽  
Stephen Mellon ◽  
David Murray ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Liposomal Bupivacaine

scholarly journals Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: A Pragmatic Effectiveness Trial of a Nonpharmacologic Alternative for the Treatment of Postoperative Pain

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_2) ◽  
pp. S53-S61
Author(s):  
Brian M Ilfeld ◽  
Harold Gelfand ◽  
Sandeep Dhanjal ◽  
Robert Hackworth ◽  
Anthony Plunkett ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Postoperative Analgesia ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Past Century ◽  
Effectiveness Trial ◽  
Small Series ◽  
Surgical Pain ◽  
Introducer Needle

Abstract Background Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducer needle followed by the delivery of electric current after needle withdrawal. This modality has been used extensively to treat chronic pain, but only small series have been published involving postoperative pain. The ultimate objective of this study is to determine the postoperative effects of percutaneous PNS following moderately to severely painful ambulatory surgery within a real-world clinical practice setting. The primary hypothesis is that surgical pain and opioid consumption during the initial 7 days after surgery will be reduced by percutaneous PNS compared with usual and customary analgesia (dual primary outcome measures). Design A multicenter pragmatic effectiveness trial. We are randomizing participants having painful orthopedic surgical procedures of the upper and lower extremity to receive 14 days of either 1) electrical stimulation or 2) sham in a double-masked fashion. End points are being assessed at various time points over 12 postoperative months. Summary The postoperative experience will be much improved if percutaneous PNS provides potent analgesia while concurrently decreasing opioid requirements following painful surgery. Because this modality can be administered for up to 60 days at home, it may provide postoperative analgesia that outlasts surgical pain yet has relatively few risks and, unlike opioids, has no systemic side effects or potential for abuse, addiction, and overdose. Percutaneous PNS has the potential to revolutionize postoperative analgesia as it has been practiced for the past century. This study will inform key stakeholders regarding an evidence-based nonpharmacologic approach to the management of postoperative pain.

scholarly journals Protocol of DEXPED trial: efficacy of intravenous dexamethasone, administered at the time of analgesic blocking of the lower limb, on postoperative pain in children: a randomised, placebo-controlled, double-blind trial

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036863
Author(s):  
Nicolas Vautrin ◽  
Nathalie Thilly ◽  
Yohann Bernard ◽  
François Wurtz ◽  
Claude Meistelman
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
General Anaesthesia ◽  
Lower Limb ◽  
Postoperative Nausea And Vomiting ◽  
Primary Objective ◽  
University Hospital ◽  
Anaesthetic Induction ◽  
Double Blind ◽  
Peripheral Block

IntroductionDexamethasone is a drug used to prolong the postoperative analgesia in children after peripheral nerve blockade, although the dose usually used (0.2 mg/kg) has not been studied yet. This study is a monocentric, prospective, randomised, placebo-controlled, double-blinded study in a university hospital in France. The primary objective of the study is to evaluate the efficacy of 0.2 mg/kg intravenous dexamethasone on early postoperative pain in children aged 6–15 years, who require a lower limb peripheral nerve block following general anaesthesia.Methods and analysisEighty children, aged 6–15 years, undergoing surgery for which peripheral nerve lower limb blockade with ropivacaine following general anaesthesia are included. The inclusion criteria are: children aged 6–15 years, with American Society of Anaesthesiologists physical status I or II and scheduled for surgery requiring a peripheral block of the lower limb for analgesic purposes, with a preoperative anaesthetic evaluation between 90 and 2 days before the surgery, with informed consent from legal representatives. General anaesthesia is performed. The patient receives, according to his group, either 0.2 mg/kg of dexamethasone intravenously at the start of anaesthetic induction or the same volume of placebo. Then, the peripheral block of the lower limb is performed with ropivacaine. The primary outcome is the total doses of opioid administered (in mg/kg of morphine equivalent) within 24 hours postoperatively. The secondary objectives are the evaluation of the effect of a single-dose intravenous dexamethasone at the time of anaesthetic induction, on the following parameters: onset of postoperative pain, duration of motor block, postoperative nausea and vomiting within 24 hours.Ethics and disseminationThis study is conducted according to the principles of the Declaration of Helsinki and has been approved by the French national ethics committee and the National Drug Safety Agency. Findings of this study will be widely disseminated through conference presentations, reports, factsheets and academic publications.Trial registration numberNCT03618173.

scholarly journals Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

2019 ◽  
Vol 24 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Katherine Lemming ◽  
Gary Fang ◽  
Marcia L. Buck
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Dose Reduction ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Postoperative Pain Management ◽  
Nuss Procedure ◽  
The Mean

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

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