Regional Anesthetic Approaches for Postoperative Analgesia Following Vertebral Body Tethering: A Case Series

Abstract Postoperative pain management is of major importance and the existence of a device that ensures a good analgesia in the immediate postoperative period and also removes the side effects of the systemic drugs, is becoming a necessity. Objectives: The goal was to obtain a good quality anaesthesia and also a good postoperative analgesia by inserting a perineural catheter at the brachial plexus site. Material and method: This study included adult patients who underwent brachial plexus anaesthesia through a perineural catheter inserted at the brachial plexus site. The perineural catheter was introduced by ultrasound guidance with neurostimulation control. After insertion, a quantity of a an-aesthetic admixture of 0.4mg/kg is administered. The anaesthetic admixture contained Ropivacaine and Lidocaine, equimolar concentration of 0.5% In the postoperative period, the analgesia was ensured trough the already installed catheter. The analgesic mixture contained Ropivacaine and Lidocaine, equivalent concentrations of 0.25%. The administration rate was 5 ml every 4 hours, starting 6 hours postoperatively. Results: The anaesthesia, obtained through the perineural catheter, was a good quality anaesthesia ensuring both, good sensory and motor block. The feedback regarding postoperative analgesia was positive, this type of pain management being efficient and without the systemic drug side effects. This approach of brachial plexus block was accepted easily by the patients and was rated as a very satisfactory method. Conclusions: The insertion of a perineural catheter for anaesthesia and postoperative analgesia represents a safe and efficient method of achieving both analgesia and anaesthesia.

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Lumbosacral paraspinal interfascial plane blocks for pain control after feminizing genital gender affirmation surgery

Pain Management ◽

10.2217/pmt-2020-0062 ◽

2021 ◽

Author(s):

Sudipta Sen ◽

Johanna B de Haan ◽

Grace Guvernator ◽

Andrzej P Kwater ◽

Xuan T Langridge ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Case Series ◽

Erector Spinae ◽

Anesthetic Techniques ◽

Pain Scores ◽

Gender Affirmation ◽

The Usa ◽

Gender Affirmation Surgery ◽

Regional Anesthetic

Aim: Feminizing genital gender affirmation surgery (fgGAS) is increasing in prevalence in the USA. Management of postoperative pain following fgGAS is challenging. We report a series of patients where post-fgGAS pain was adequately controlled with paraspinal blocks. Materials & methods: This is a case series of three patients who received bilateral lumbar and sacral erector spinae plane blocks after fgGAS. Block techniques, medications administered, opioid requirements and pain scores were reviewed. Results: Erector spinae plane blocks provided adequate analgesia for 24–48 h following the block. Conclusion: Currently, there are two regional anesthetic techniques described for the treatment of postoperative pain after fgGAS. We describe two additional approaches as options for improved pain management in this patient population.

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Transesophageal endoscopic ultrasound fine needle aspiration of vertebral body osteolytic tumors – a novel diagnostic approach. Case series.

Medical Ultrasonography ◽

10.11152/mu-2618 ◽

2020 ◽

Author(s):

Romeo Ioan Chira ◽

Alina Florea ◽

Vlad Ichim ◽

Liliana Rogojan ◽

Alexandra Chira ◽

...

Keyword(s):

Vertebral Body ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Histopathological Examination ◽

Traditional Approach ◽

Case Series ◽

Lumbar Vertebrae ◽

Needle Aspiration ◽

Ct Guided ◽

Fine Needle

Aims: Vertebral lesions, either primary or more frequently metastasis, are difficult targets for percutaneous guided biopsies and surgical biopsies and are associated with greater risks of complications. We investigated the feasibility of endoscopic ultrasound (EUS) fine needle aspiration (FNA) biopsy in the assessment of vertebral osteolytic tumors as an alternative to CT guided biopsy which is the technique currently used.Material and methods: Four patients with osteolytic tumors of the vertebral bodies identified by imaging methods (CT or MRI) – 3 patients, and one with a tumor detected primarily during EUS procedure were included in order to evaluate the feasibility of the procedure. The lesions were located either at the dorsal or lumbar vertebrae. In all cases we performed EUS FNA of the osteolytic vertebral body lesions with 22G needles using the transesophageal or transgastric approach.Results: In all cases EUS FNA provided enough tissue for an accurate histopathological report, with no procedural complication. We diagnosed lung adenocarcinoma, hepatocarcinoma and a pancreatic adenocarcinoma vertebral metastasis and one case of lymphoma.Conclusions: EUS FNA is a valuable technique which should be considered in selected cases, when a “traditional approach” is not applicable or associated with a higher risk. Treatment guidelines are based on the histology of the tumor, histopathological examination being nowadays mandatory. Therefore, we propose for selected cases a feasible technique, with significantly lower procedural risks, as an alternative for open surgical biopsies or computed tomography guided biopsies

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Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series

CardioVascular and Interventional Radiology ◽

10.1007/s00270-015-1216-y ◽

2015 ◽

Vol 39 (2) ◽

pp. 290-295 ◽

Cited By ~ 4

Author(s):

Adam N. Wallace ◽

Rafael A. Pacheco ◽

Anderanik Tomasian ◽

Andy C. Hsi ◽

Jeremiah Long ◽

...

Keyword(s):

Vertebral Body ◽

Case Series

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An analysis of the causes of transient paraplegia during percutaneous vertebral augmentation under local anesthesia: A case series of 12 patients

Journal of Orthopaedic Surgery ◽

10.1177/2309499019861879 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901986187

Author(s):

Guan Shi ◽

Fei Feng ◽

Chen Hao ◽

Jia Pu ◽

Bao Li ◽

...

Keyword(s):

Spinal Cord ◽

Local Anesthesia ◽

Vertebral Body ◽

Case Series ◽

Operation Time ◽

Complete Recovery ◽

Vertebral Compression Fractures ◽

Vertebral Augmentation ◽

Anesthetic Drugs

Background: Percutaneous vertebral augmentation (PVA) under local anesthesia has been widely used to treat osteoporotic vertebral compression fractures and vertebral body tumors. However, the occurrence of spinal cord or nerve root dysfunction may result in poor prognosis for patients. The aim of this study was to analyze the causes of transient paraplegia in 12 patients undergoing PVA. Methods: The medical records of 12 patients with transient paraplegia during PVA in our hospital were analyzed. Data, including operation, vertebral, anesthetic dose, operation time, recovery time, and follow-up, were extracted. Results: Among the 12 patients, ranging in age from 62 years to 83 years, with a mean age of 74 years, 8 were females and 4 were males. The average anesthetic dose injected per vertebral body was 6.38 ml. Patients required an average of 218.75 min to recover sensation and movement completely. However, the amount of anesthetic injected into each vertebral body was not related to the time required for complete recovery. Follow-up showed that all patients had regained normal bilateral sensation and motor function. Postoperative visual analog scale and Oswestry Disability Index values of the 12 patients were significantly improved compared with preoperative values. Conclusion: The complication of transient paraplegia was caused by local anesthetic drugs infiltrating into the spinal canal and inhibiting nerve conduction in the spinal cord.

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