scholarly journals The Role of Interfascial Plane Blocks in Paediatric Regional Anaesthesia: A Narrative Review of Current Perspectives and Updates

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Sujana Dontukurthy ◽  
Roshanak Mofidi
Keyword(s):  
Pain Control ◽  
Regional Anaesthesia ◽  
Early Mobilization ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Narrative Review ◽  
Complication Rates ◽  
Early Recovery ◽  
Nerve Blocks ◽  
Anaesthesia Practice

Regional anaesthesia has been increasingly used for analgesia in the perioperative period in paediatric anaesthesia for better pain control and improved patient outcomes. Interfascial plane blocks are considered as a subgroup of peripheral nerve blocks. The advent of ultrasound in modern regional anaesthesia practice has led to the evolution of various interfascial plane blocks. The ease of their performance and the low complication rates, compared with neuraxial anaesthesia, have led to their increased use in the perioperative period. Interfascial plane blocks are often incorporated in the multimodal analgesia regimen in the early recovery and ambulation after surgery protocols for various chest wall and abdominal surgeries. This achieves better pain control and decreases the requirements of opioids in the perioperative period, thereby facilitating early mobilization and discharge. This narrative review focuses on the relevant anatomic considerations, technique for the performance of each block along with its current applications and limitations, and includes a review of the current literature on various interfascial plane blocks in paediatric regional anaesthesia.

scholarly journals Regional Anaesthesia, The Seed of Opportunity In COVID-19 Crisis: The Balance Has Shifted

2020 ◽  
Vol 6 (3) ◽  
Keyword(s):  
Critical Care ◽  
General Anaesthesia ◽  
Regional Anaesthesia ◽  
Albert Einstein ◽  
Multimodal Analgesia ◽  
Nerve Blocks ◽  
Great Opportunity ◽  
Aerosol Generation ◽  
Number Of Patients ◽  
Alternative Drugs

Albert Einstein once said, “in the midst of every crisis, lies great opportunity.” There’s no question that we’re in the midst of a global crisis. There’s no doubt that a crisis creates problems, lots of them, but it also creates opportunities. Something that every anaesthetist does day in day out safely, intubation of trachea, is now become a risk factor for spread of the disease. So where is the opportunity in this crisis? In the west, regional anaesthesia is often used as an adjunct rather than as sole anaesthetic technique, as part of multimodal analgesia in patients who are being operated under general anaesthesia. Unfortunately, general anaesthesia requires airway manipulation that is associated with aerosol generation and risks transmission of corona virus. This is a risk that can be averted with use of regional anaesthesia techniques for procedures that can be done with patient awake rather than asleep. At the beginning of the pandemic with surge of patients requiring endotracheal intubation and ventilation, increased intensive care admissions affected anaesthesia services in many ways. The increased number of patients needing critical care increased the demand for drugs used in both anaesthesia and critical care and this demand led to shortage of anaesthesia drugs and led the Association of Anaesthetists (AOA) and the Royal College of Anaesthetists (RCoA), working closely with the Chief Pharmaceutical Officer at NHS England to produce a guidance which summarised potential mitigations to be used in the management of such demand. Direct alternative drugs and techniques were offered (1). The options identified in the guidelines were not exhaustive but give a way of thinking about this situation we all have landed up in. We were unsure of how long this demand would continue and how we would manage the situation. This is where the opportunity to use regional anaesthesia for procedures that could be done purely under neuraxial or peripheral nerve blocks became

scholarly journals The Impact of Bilateral Suprazygomatic Maxillary Nerve Blocks on Postoperative Pain Control in Patients Undergoing Orthognathic Surgery

FACE ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 58-65
Author(s):  
Gabriela D. Garcia Nores ◽  
Daniel A. Cuzzone ◽  
Stefanie E. Hush ◽  
Kalyani Pandya ◽  
Adam Stuart ◽  
...  
Keyword(s):  
Pain Control ◽  
Complication Rates ◽  
Block Group ◽  
Nerve Blocks ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Nerve Blockade ◽  
Maxillary Nerve ◽  
Pain Scales ◽  
Le Fort I

Aims: The mainstay of analgesia in orthognathic interventions for maxillary hypoplasia is perioperative opioids, however, the side effect profile is broad with the potential for well-described deleterious effects. The suprazygomatic maxillary nerve block has been previously shown to be effective in decreasing pain associated with palatal surgery. To date, there have been no studies detailing the use of maxillary nerve blocks as an adjunctive pain control measure during correction of maxillary hypoplasia. Consequently, we sought to evaluate the efficacy of intra-operative, ultrasound-guided bilateral suprazygomatic maxillary nerve blockade in decreasing postoperative narcotic consumption in patients undergoing Le Fort I level surgical orthognathic correction of cleft-related maxillary hypoplasia. Methods: Between January and December 2019, patients underdoing suprazygomatic maxillary nerve blockade for orthognathic correction of maxillary hypoplasia via either Le Fort I advancement or distraction were prospectively collected and compared to controls. Patient demographics, narcotic use (represented as morphine milligram equivalents per kg; MME/kg), self-reported pain scales, operative times, length of stay (LOS), and complication rates were compared. Results: Over the 12-month interval, 40 patients met inclusion criteria (n = 19 Block; n = 21 Control). Mean ages were 15.6 and 15.9 years, respectively. The block group demonstrated a significant reduction in postoperative narcotic requirements on POD1 and POD2 when compared to controls (POD1: 0.020 mg/kg vs 0.066 mg/kg, P < .005; POD2: 0.030 mg/kg vs 0.080 mg/kg, P < .016), with a trend toward significance thereafter. Corroboratively, self-reported pain scores in the first 24 hours were significantly decreased in the block compared to control groups with a trend toward significance thereafter (POD1: 1.13 vs 2.72, P < .001; POD2: 1.72 vs 2.56, P < .08; POD3: 1.21 vs 2.07, P < .06). LOS was decreased by an average of 1 day in the block group, operative times were unchanged, and neither group evidenced perioperative complication or return to service within 30 days. Conclusion: Administration of bilateral suprazygomatic maxillary nerve blocks in patients undergoing Le Fort I maxillary osteotomy for correction of cleft-related maxillary deficiency demonstrated a significant reduction in post-operative narcotic requirements, self-reported pain scales, and LOS without increased complications, suggesting its utility as a safe and effective analgesic adjunct in this patient population.

scholarly journals Tocilizumab use during Covid-19 should alert an orthopaedic surgeon for the surgical management of arthroplasty patients: A narrative review

2022 ◽  
Vol 7 (2) ◽  
pp. 65-70
Author(s):  
Gaurav Govil ◽  
Lavindra Tomar ◽  
Pawan Dhawan
Keyword(s):  
Side Effects ◽  
Perioperative Period ◽  
Recovery Phase ◽  
Narrative Review ◽  
Orthopaedic Surgeon ◽  
Surgical Patients ◽  
Future Research ◽  
Early Recovery ◽  
Considerable Uncertainty ◽  
Post Surgery

The crisis of Covid-19 has shaken the world healthcare systems. The intensive care resources to manage the medical conditions associated with Covid-19 are consistently found to be inadequate with exploration and implementation of newer treatment avenues for an early recovery. Presently, the use of Tocilizumab (TCZ) in severe to critical affection of Covid-19 is being practiced as an off-label therapy. A narrative review of present knowledge regarding TCZ pharmacology, indications of its use, and potential side effects with clinical implications for an orthopedic surgeon is presented. The article discusses the clinicopathological factors required to be monitored during the perioperative management of an orthopedic patient who may have received TCZ for Covid-19 related illness. The implications of its usage should alert the orthopaedic surgeons for future management of their arthritic surgical patients. The commonly associated side effects and complications in the post-operative phase following an arthroplasty or any orthopaedic surgery are an area of concern and considerable uncertainty. In the post-Covid-19 recovery phase, when surgeons need to plan a surgical intervention then a thorough evaluation of their Covid-19 medical management history may be warranted. Practical guidelines for the management of arthritic surgical patients have been postulated. With an unregulated increased usage of TCZ during Covid-19 management, an orthopaedic surgeon should worry and needs to be aware of the possible consequences in the perioperative period for the post-surgery management. Future research to gain more insights will confirm the implied concerns.

scholarly journals Erector Spinae Plane Block for Elective Laparoscopic Cholecystectomy in the Ambulatory Surgical Setting

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Kjartan Eskjaer Hannig ◽  
Christian Jessen ◽  
Uday Kant Soni ◽  
Jens Børglum ◽  
Thomas Fichtner Bendtsen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Series ◽  
Analgesic Efficacy ◽  
Postoperative Nausea And Vomiting ◽  
Early Mobilization ◽  
Multimodal Analgesia ◽  
Erector Spinae ◽  
Early Recovery ◽  
Paravertebral Space ◽  
Respiratory Impairment

Postoperative pain after laparoscopic cholecystectomy can be severe. Despite multimodal analgesia regimes, administration of high doses of opioids is often necessary. This can further lead to several adverse effects such as drowsiness and respiratory impairment as well as postoperative nausea and vomiting. This will hinder early mobilization and discharge of the patient from the day surgery setting and is suboptimal in an Early Recovery after Surgery setting. The ultrasound-guided Erector Spinae Plane (ESP) block is a novel truncal interfascial block technique providing analgesia of the thoracic or abdominal segmental innervation depending on the level of administration. Local anesthetic penetrates anteriorly presumably through the costotransverse foramina to the paravertebral space. We demonstrate the analgesic efficacy of the ESP block in a case series of three patients scheduled for ambulatory laparoscopic cholecystectomy.

scholarly journals Influence of mobilization and weight bearing on in-hospital outcome in geriatric patients with hip fractures

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 4 ◽  
Author(s):  
Manuel Baer ◽  
Valentin Neuhaus ◽  
Hans Christoph Pape ◽  
Bernhard Ciritsis
Keyword(s):  
Length Of Stay ◽  
Weight Bearing ◽  
Early Mobilization ◽  
Full Weight Bearing ◽  
Complication Rates ◽  
Partial Weight Bearing ◽  
Early Recovery ◽  
Hospital Outcome ◽  
Lower Complication ◽  
Partial Weight

Introduction: Early recovery of mobilization after a fracture of the hip is associated with improved long-term ability to walk, lower complication rates, and mortality. In this context, early mobilization and full weight bearing are favorable. The aim of this study was (1) to analyze the influence of time between operation and first mobilization on in-hospital outcome and (2) the influence of early mobilization, full weight bearing, and ASA on pain, mobility of the hip, and ability to walk during the in-hospital phase of recovery. Methods: This is a retrospective in-hospital study of 219 patients aged 70 years or older who were treated with surgery after a hip fracture. Data were collected by a review of medical records. The outcomes were mortality, complications, length of stay, and the Merle d’Aubigné score which evaluates pain, mobility of the hip, and ability to walk. Factors were sought in bivariate and multivariate analyses. Results: A shorter time between operation and first mobilization was significantly associated with lower in-hospital mortality and complications. Early mobilization (within 24 h after the operation) and full weight bearing had no influence on pain, mobility of the hip, and ability to walk as well as length of stay in our cohort. Fracture type and treatment influenced mobility of the hip, while age as well as physical health status affected the ability to walk. Discussion: Patients with femoral neck fractures, respectively after total hip arthroplasty, had less pain and showed better mobility of the hip and ability to walk during hospitalization than patients with trochanteric fractures; these results were irrespective of early vs. late mobilization and full vs. partial weight bearing. Foremost, a shorter time between operation and first mobilization is associated with lower complication and mortality rates.

Multimodal analgesia combined with intravenous administration of acetaminophen in perioperative management of esophagectomy using modified ERAS protocol.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 94-94 ◽  
Author(s):  
Takashi Ogata ◽  
Tetsushi Nakajima ◽  
Kazuki Kano ◽  
Kenki Segami ◽  
Yukio Maezawa ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Perioperative Management ◽  
Breakthrough Pain ◽  
Early Mobilization ◽  
Multimodal Analgesia ◽  
Analgesic Drug ◽  
Group A ◽  
Group B ◽  
Eras Protocol

94 Background: In perioperative management of esophagectomy, we have performed modified ERAS protocol including preoperative oral rehydration, early enteral nutrition, early mobilization, intestinal peristalsis promotion, pain control, and so on. We think these elements are related closely and useful in reducing complication and early recovery after surgery in case of high invasive surgery such as esophagectomy with 3 field lymph node dissection. And we think pain control is particularly close relationship with early mobilization, so multimodal analgesia is very important for postoperative pain control. Methods: We evaluated whether it is possible to reduce postoperative breakthrough pain by using postoperative pain control combined with acetaminophen IV. 124 patients were treated by esophagectomy with 3-field LN dissection from January 2013 to June 2015. Before May 2014, 49 patients were treated without acetaminophen IV protocol (Group A), and after May 2014, 75 patients were treated with acetaminophen IV protocol (Group B). We compared the number of analgesic drug until postoperative day 7, and compared the ratio of liver dysfunction in both groups. Both groups were used epidural anesthesia as postoperative pain management, and intravenous administration of acetaminophen 1000mg/day has been added between day3 to day 7 in Group B. Results: The number of analgesic drug use due to breakthrough pain(Group A / Group B) were day3:1.12/0.55, day4:1.58/0.83, day5:1.76/0.57, day6:1.24/0.49, and it was reduced significantly in Group B (p < 0.01). And liver damage as a side effect by acetaminophen IV, the rise of ALT(Group A / Group B) were seen 32.7%/66.7% in day6, and seen 20.4%/62.7% in day 8, and it was significantly higher in Group B at day6 and day8 (p < 0.01), but was no significant difference in day 30 between both groups. Conclusions: In perioperative management of esophagectomy, pain control combined with acetaminophen IV was useful as multimodal analgesia. Also was ALT rise is seen by liver damage, but it was the minor change in the acceptable range for natural healing.

Low opioid anesthesia and opioid free anesthesia use in pain control treatment in postoperative period

2019 ◽  
Vol 32 (1) ◽  
Author(s):  
Ewa Komorowska-Wojtunik ◽  
Anna M. Lotowska-Cwiklewska ◽  
Urszula Kosciuczuk ◽  
Andrzej Siemiatkowski
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Pain Control ◽  
Scientific Evidence ◽  
Opioid Analgesics ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Control Treatment ◽  
Anesthetic Techniques ◽  
Post Operative Nausea

Postoperative pain is a complex and multifactorial symptom that requires a well thought approach using different treatments to achieve the optimal outcome after surgery. Contemporary anaesthesiology, looking for an alternative to analgesia with the use of opioids, more often turns to the protocols of low-opioid and opioid free treatment and pain control. By replacing opioids with non-opioid analgesics, koanalgetics, as well as using local and regional anesthetic techniques, we limit or avoid adverse effects of opioids while maintaining a satisfactory level of analgesia for the patient. Methods of general anesthesia without or with the minimum amount of opioid drugs are of particular importance in bariatric surgery due to a reduction in the incidence of post-operative respiratory depression and excessive sedation. They also allow to achieve and maintain cardiovascular stability in the intraoperative and postoperative period, prevent the occurrence of opioid-induced hyperalgesia (the so-called opioid paradox), and improve the comfort of patients in the post-operative period due to the lower incidence of post-operative nausea and vomiting and constipation. The particular significance of regional and local analgesia techniques, which supplement general anesthesia and reduce the need for analgesics in the perioperative period, is emphasized. This analysis presents the theoretical foundations of multimodal analgesia and existing scientific evidence confirming its benefits in improving pain control after surgery.

Ultrasound-guided thoracic wall nerve blocks for effective pain control in cardiac surgery

2020 ◽  
Vol 86 (6) ◽  
Author(s):  
Giuseppe Sepolvere ◽  
Mario Tedesco ◽  
Pierfrancesco Fusco ◽  
Paolo Scimia ◽  
Loredana Cristiano
Keyword(s):  
Cardiac Surgery ◽  
Pain Control ◽  
Thoracic Wall ◽  
Ultrasound Guided ◽  
Nerve Blocks

scholarly journals Pain management practice patterns after hip arthroscopy: an international survey

2020 ◽  
Author(s):  
Flávio L Garcia ◽  
Brady T Williams ◽  
Bhargavi Maheshwer ◽  
Asheesh Bedi ◽  
Ivan H Wong ◽  
...  
Keyword(s):  
Pain Management ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Sports Medicine ◽  
Management Practice ◽  
Professional Organizations ◽  
International Survey ◽  
Nerve Blocks ◽  
Optimal Approach ◽  
Answer Choice

Abstract Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons’ responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as &gt; 80% of respondents selecting a single answer choice, while general agreement was defined as &gt;60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.

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