197 Dynamic hip screw surgery under peripheral nerve blockade only

Chapter 5 contains a basic review of terminology used to describe body planes, surface orientation, and movements. The anatomy of major nerve plexuses are also examined: brachial plexus, lumbar plexus, lumbosacral plexus. The chapter concludes with a discussion of peripheral nerve anatomy and sensory and motor innervation, including dermatomes, osteotomes, and myotomes.

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Az ultrahang-képalkotás alkalmazása biotechnikai előrelépés a perioperatív fájdalomcsillapításban

Orvosi Hetilap ◽

10.1556/650.2019.31374 ◽

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.

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First Year Specialist Anaesthesia Training in Ireland: A Logbook Analysis

International Journal of Higher Education ◽

10.5430/ijhe.v6n6p106 ◽

2017 ◽

Vol 6 (6) ◽

pp. 106

Author(s):

SM O’Shaughnessy ◽

CJ Skerritt ◽

CW Fitzgerald ◽

R Irwin ◽

F Walsh

Keyword(s):

Peripheral Nerve ◽

Retrospective Analysis ◽

Central Line ◽

First Year ◽

Arterial Line ◽

Direct Supervision ◽

Central Lines ◽

Nerve Blockade ◽

Spinal Anaesthetic ◽

Peripheral Nerve Blockade

Objective:Acquisition of a new range of skills occurs during first year anaesthesia training. At present, no defined logbook targets exist for the Irish anaesthesia trainee.The aim of this study was to quantify the number of practical procedures performed and supervision required during first year anaesthesia training.Methods:A retrospective analysis of prospectively maintained logbooks of three first year anaesthesia trainees was performed.Results:In the first three months, mean numbers of cases were 224, enodotrachael tube (ETT) 64, laryngael mask airway (LMA) 55, spinal anaesthetic 12, arterial lines 9.5, central lines 0.5, peripheral nerve blockade (PNB) 2, epidurals 0. There was 91.5% direct supervision and 8.5% indirect supervision.In the final three months, mean numbers of cases were 205.5, ETT 28, LMA 35, spinals 50, arterial line insertions 4.5, central line insertions 1.5, PNB 3.5, epidurals 80. There was 68.5% direct supervision and 31.5% indirect supervision.Conclusions:Defined logbook targets are needed to quantify trainee progress.

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Lower-Extremity Sclerotomes

Journal of the American Podiatric Medical Association ◽

10.7547/0980232 ◽

2009 ◽

Vol 99 (3) ◽

pp. 232-235 ◽

Cited By ~ 3

Author(s):

Andrew J. Meyr ◽

Raymond DiPrimio

Keyword(s):

Lower Extremity ◽

Peripheral Nerve ◽

Spinal Nerve ◽

Sensory Innervation ◽

Diagnosis And Treatment ◽

Deep Fascia ◽

Nerve Blockade ◽

Anatomical Knowledge ◽

Peripheral Nerve Blockade

A sclerotome is an anatomical concept that defines an area of bone supplied by a single spinal nerve. Similar to the familiar dermatomes, sclerotomes provide an element of depth to the sensory innervation of the lower extremity based on the deep fascia as an embryologic boundary. Anatomical knowledge of sclerotomes can be used clinically in the diagnosis and treatment of pain and in the perioperative setting. Specifically, a modified version of the classic Mayo block is presented to highlight an active anatomical approach to peripheral nerve blockade. (J Am Podiatr Med Assoc 99(3): 232–235, 2009)

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