scholarly journals Lower extremity regional anesthesia: essentials of our current understanding

2019 ◽  
Vol 44 (2) ◽  
pp. 143-180 ◽  
Author(s):  
De Q Tran ◽  
Francis V Salinas ◽  
Honorio T Benzon ◽  
Joseph M Neal
Keyword(s):  
Lower Extremity ◽  
Regional Anesthesia ◽  
Lower Limb ◽  
Ultrasound Guidance ◽  
Evidence Based ◽  
Nerve Blocks ◽  
Pharmacological Agents ◽  
Current Review ◽  
American Society ◽  
Selection Of

The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine’s ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.

Lower Limb Ultrasound Guided Regional Anesthesia

2016 ◽  
Author(s):  
Stuart A. Grant ◽  
David B Auyong
Keyword(s):  
Lower Extremity ◽  
Regional Anesthesia ◽  
Lower Limb ◽  
Clinical Anatomy ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Adductor Canal ◽  
Risks And Benefits ◽  
Tools And Techniques ◽  
Regional Anesthetic

This chapter describes the clinical anatomy relevant to the lower extremities and outlines the tools and techniques used to perform lower extremity ultrasound-guided nerve blocks. The nerve blocks described here include the femoral, lateral femoral cutaneous, adductor canal (selective femoral), saphenous, obturator, lumbar plexus, sciatic (proximal, anterior, and popliteal approaches), (iPACK) and ankle blocks. For each nerve block, the indications, risks, and benefits of the varying approaches are described in detail. The chapter includes step-by-step instructions with illustrations, including cadaver dissections, to allow the operator to perform clinically effective and safe ultrasound-guided lower extremity regional anesthesia. At the conclusion of each block description, a “Pearls” segment highlights important tips gleaned from our clinical experience. This chapter provides the practitioner with thorough instruction and knowledge allowing optimal delivery of regional anesthetic for any lower extremity surgery or trauma.

Anticoagulation in Regional Anesthesia

2018 ◽  
Author(s):  
Issam A. Mardini ◽  
Jiabin Liu ◽  
Nabil Elkassabany
Keyword(s):  
Elderly Patient ◽  
Regional Anesthesia ◽  
The Elderly ◽  
Orthopedic Procedures ◽  
Pain Medicine ◽  
Cardiovascular Risks ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Risks And Benefits ◽  
American Society

Regional anesthesia and analgesia provide attractive options for patients undergoing major orthopedic procedures. The use of anticoagulation medications in the elderly patient population and in patients with cardiovascular risks is very common. The guidelines from the American Society of Regional Anesthesia and Pain Medicine (ASRA) and other societies have been adopted widely over many years. The guidelines provide a basis for adequate delay intervals between dosing of medications and performing neuraxial or peripheral nerve blocks (PNBs), thus allowing for safer practice of regional anesthesia. Following guidelines never eliminates risk, but it allows balanced clinical practice by physicians in regard to the risks and benefits for individual patients.

scholarly journals A Survey of Regional Anesthesia Use In Greece And The Impact of A Structured Regional Anesthesia Course On Regional Techniques Knowledge And Practice

2021 ◽  
Author(s):  
Kassiani Theodoraki ◽  
Eleni Moka ◽  
Alexandros Makris ◽  
Evmorfia Stavropoulou
Keyword(s):  
Regional Anesthesia ◽  
Ultrasound Guidance ◽  
Electronic Database ◽  
Nerve Blocks ◽  
Training Course ◽  
Hands On ◽  
Lower Limb Surgery ◽  
Knowledge And Attitude ◽  
Ra Training ◽  
The Impact

Abstract Background: Due to the growing interest in regional anesthesia (RA) techniques and the realization of the need for formalized education in them, the Greek Chapter of the European Society of Regional Anesthesia and Pain Therapy (ESRA-Hellas) has established a structured hands-on training Course held annually since 2009, which is quite popular in the community of Greek anesthesiologists. The aim of the current survey was two-fold: first to provide an overview about the current practice of RA in Greece and secondly to evaluate the effect the aforementioned training Course has on participants’ knowledge and attitude towards RA.Methods: An electronic questionnaire was uploaded on SurveyMonkey and a link giving access to the questionnaire was forwarded via email to an electronic database of 825 practicing Greek anesthesiologists held in the electronic database of ESRA Hellas. The survey was totally anonymous and no identifying information was collected throughout. It contained questions relating to the anesthesiologists’ demographic characteristics, their RA practice and information pertaining to the RA training Course.Results: A total of 424 fully completed questionnaires were received, representing an overall response rate of 51.4%. Attendants of the Course are more familiar with the performance of peripheral nerve blocks with neurostimulation and/or ultrasound guidance as compared to non-attendants (p<0.001). Attendants are also less likely to practice exclusively general anesthesia, more likely to use peripheral blocks for lower limb surgery and more likely to consider taking the European Diploma of RA in comparison to non-attendants (p<0.001, p=0.018 and p=0,002, respectively). Both cohorts consider the Course of value and agree that the main reason to use regional techniques is to ensure optimal postoperative analgesia while the main hindrance to RA practice is the lack of relevant education in the techniques, especially those under ultrasound guidance. Regarding improvement of the Course, most participants suggested devoting ampler time in ultrasound hands-on practice and application.Conclusion: Greek anesthesiologists seek educational activities in the field of RA and the Course seems to fulfil the majority of attendants’ expectations. There will be further effort by the organizers to improve weaknesses of the current Course and undertake further educational initiatives in the field of RA according to international recommendations.

scholarly journals HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology

2016 ◽  
Vol 140 (12) ◽  
pp. 1345-1363 ◽  
Author(s):  
Angela N. Bartley ◽  
Mary Kay Washington ◽  
Christina B. Ventura ◽  
Nofisat Ismaila ◽  
Carol Colasacco ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Pathology ◽  
Clinical Decision ◽  
Evidence Based ◽  
Her2 Testing ◽  
Gastroesophageal Adenocarcinoma ◽  
American Society ◽  
Evidence Based Guideline ◽  
Selection Of

Context.— ERBB2 (erb-b2 receptor tyrosine kinase 2 or HER2) is currently the only biomarker established for selection of a specific therapy for patients with advanced gastroesophageal adenocarcinoma (GEA). However, there are no comprehensive guidelines for the assessment of HER2 in patients with GEA. Objectives.— To establish an evidence-based guideline for HER2 testing in patients with GEA, to formalize the algorithms for methods to improve the accuracy of HER2 testing while addressing which patients and tumor specimens are appropriate, and to provide guidance on clinical decision making. Design.— The College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology convened an expert panel to conduct a systematic review of the literature to develop an evidence-based guideline with recommendations for optimal HER2 testing in patients with GEA. Results.— The panel is proposing 11 recommendations with strong agreement from the open-comment participants. Recommendations.— The panel recommends that tumor specimen(s) from all patients with advanced GEA, who are candidates for HER2-targeted therapy, should be assessed for HER2 status before the initiation of HER2-targeted therapy. Clinicians should offer combination chemotherapy and a HER2-targeted agent as initial therapy for all patients with HER2-positive advanced GEA. For pathologists, guidance is provided for morphologic selection of neoplastic tissue, testing algorithms, scoring methods, interpretation and reporting of results, and laboratory quality assurance. Conclusions.— This guideline provides specific recommendations for assessment of HER2 in patients with advanced GEA while addressing pertinent technical issues and clinical implications of the results.

The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia

2016 ◽  
Vol 41 (2) ◽  
pp. 181-194 ◽  
Author(s):  
Joseph M. Neal ◽  
Richard Brull ◽  
Jean-Louis Horn ◽  
Spencer S. Liu ◽  
Colin J. L. McCartney ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Pain Medicine ◽  
Ultrasound Guided ◽  
American Society ◽  
Based Medicine

scholarly journals An update around the evidence base for the lower extremity ultrasound regional block technique

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 104 ◽  
Author(s):  
Andrea Fanelli ◽  
Daniela Ghisi ◽  
Rita Maria Melotti
Keyword(s):  
Lower Extremity ◽  
Randomized Controlled Trials ◽  
Regional Anesthesia ◽  
Current Literature ◽  
Gold Standard ◽  
Ultrasound Guidance ◽  
Evidence Base ◽  
Controlled Trials ◽  
Modest Improvement ◽  
Randomized Controlled

Ultrasound guidance currently represents the gold standard for regional anesthesia. In particular for lower extremity blocks, despite the heterogeneity and the lack of large randomized controlled trials, current literature shows a modest improvement in block onset and quality compared with other localization techniques. This review aims to present the most recent findings on the application of ultrasound guidance for each single lower extremity approach.

Peripheral Nerve Blocks for the Lower Extremity

2017 ◽  
Author(s):  
Candace Shavit ◽  
Monica W. Harbell
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Improve Patient Care ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Peripheral Nerve Catheter

Lower extremity peripheral nerve blocks (PNBs) are often used for surgical anesthesia and postoperative pain management. The use of PNB provides improved analgesia, reduced opioid consumption, and improved patient satisfaction and can facilitate earlier rehabilitation and discharge. As the number of lower extremity total joint arthroplasties is projected to increase significantly, the role of peripheral nerve blocks can be expected to grow in similar fashion. With the growing number of procedures and the increasing focus on patient experience and expeditious hospital discharge, PNBs are increasingly recognized as a powerful tool to improve patient care and facilitate recovery after lower extremity surgery. We provide a basic review of regional anesthesia for lower extremity surgical procedures. The widespread availability of ultrasonography has improved the performance and efficacy of PNBs; thus, we focus on ultrasonography-guided procedures. In this review, we discuss pertinent lower extremity anatomy and sonoanatomy, indications, patient outcome measures, techniques, and complications of the most commonly used blocks. This review contains 35 figures, 11 tables, 5 videos, and 103 references.  Key words: adductor canal block, analgesia, ankle block, clinical applications of peripheral nerve blocks, complications of peripheral nerve blocks, continuous peripheral nerve catheter, early ambulation, fascia iliaca compartment block, femoral nerve block, lower extremity nerve blocks, lower extremity regional anesthesia, lumbar plexus block, obturator nerve block, peripheral nerve block, peripheral nerve catheter, popliteal block, psoas compartment block, regional anesthesia, regional anesthesia techniques, saphenous nerve block, sciatic nerve block, ultrasonography guided

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