scholarly journals Regional scalp block – the key analgesic element of anesthesia for supratentorial craniotomy

2021 ◽  
Vol 15 (2) ◽  
pp. 119-126
Author(s):  
Alexander S. Kulikov ◽  
Valentina A. Tere ◽  
Alexander A. Imaev ◽  
Andrey Yu. Lubnin
Keyword(s):  
Regional Anesthesia ◽  
Personal Experience ◽  
Routine Practice ◽  
Block Method ◽  
Perioperative Analgesia ◽  
Supratentorial Craniotomy ◽  
Scalp Block

This paper presents the key data on the effectiveness and safety of the regional anesthesia of the scalp, also known as the scalp block, for providing perioperative analgesia for supratentorial craniotomy. The authors describe the technique and its limitations and also trace the implementation of the scalp block method into the routine practice of the largest Russian neurosurgical clinic based on personal experience, results of the own research, and analysis of literature data.

Comparison of Analgesic Effect of Levobupivacaine with Dexmedetomidine and Levobupivacaine for Scalp Block before Supratentorial Craniotomy: A Randomized Controlled Trial

2020 ◽  
Vol 103 (10) ◽  
pp. 1028-1035
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Control Group ◽  
Study Group ◽  
Analgesic Requirement ◽  
Supratentorial Craniotomy ◽  
Numerical Rating ◽  
Fentanyl Consumption ◽  
Scalp Block

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

scholarly journals Multimodal analgesia in bariatric surgery

2016 ◽  
Vol 10 (4) ◽  
pp. 254-261
Author(s):  
M. I Neimark ◽  
Roman V. Kiselev
Keyword(s):  
Bariatric Surgery ◽  
Regional Anesthesia ◽  
Traditional Approach ◽  
Multimodal Analgesia ◽  
Pharmacological Agents ◽  
Perioperative Analgesia ◽  
High Degree ◽  
Mandatory Use ◽  
Different Levels

This review is devoted to the treatment of postoperative pain in bariatric surgery. At present, the prevalence of patients with a high degree of obesity is an epidemic that leads steadily growing number of bariatric operations. Showing the risk factors in the traditional approach to the use of opioids in these patients, as well as the consequences of inadequate analgesia in these patients. Details are presented modern pharmacological agents acting on different levels nociceptive system. Substantiates the role of a multi-modal approach to perioperative analgesia, mandatory use of regional anesthesia. The attention to the visualization neuroaxial structures using ultrasound in the context of the implementation of the efficacy and safety of regional anesthesia in patients with morbid obesity. Possible prospects for pain control in bariatric surgery.

scholarly journals Sedation and Regional Anesthesia for Deep Brain Stimulation in Parkinson’s Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Onur Ozlu ◽  
Sema Sanalbas ◽  
Dilek Yazicioglu ◽  
Gulten Utebey ◽  
Ilkay Baran
Keyword(s):  
Deep Brain Stimulation ◽  
Regional Anesthesia ◽  
Brain Stimulation ◽  
Conscious Sedation ◽  
Cervical Plexus ◽  
Superficial Cervical Plexus Block ◽  
Cervical Plexus Block ◽  
Scalp Block ◽  
Plexus Block ◽  
Deep Brain

Objective. To present the conscious sedation and the regional anesthesia technique, consisting of scalp block and superficial cervical plexus block, used in our institution for patients undergoing deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD). Methods. The study included 26 consecutive patients. A standardized anesthesia protocol was used and clinical data were collected prospectively. Results. Conscious sedation and regional anesthesia were used in all cases. The dexmedetomidine loading dose was 1 μg kg−1 and mean infusion rate was 0.26 μg kg−1 h−1 (0.21) [mean total dexmedetomidine dose: 154.68 μg (64.65)]. Propofol was used to facilitate regional anesthesia. Mean propofol dose was 1.68 mg kg (0.84) [mean total propofol dose: 117.72 mg (59.11)]. Scalp block and superficial cervical plexus block were used for regional anesthesia. Anesthesia related complications were minor. Postoperative pain was evaluated; mean visual analog scale pain scores were 0 at the postoperative 1st and 6th hours and 4 at the 12th and 24th hours. Values are mean (standard deviation). Conclusions. Dexmedetomidine sedation along with scalp block and SCPB provides good surgical conditions and pain relief and does not interfere with neurophysiologic testing during DBS for PD. During DBS the SCPB may be beneficial for patients with osteoarthritic cervical pain. This trial is registered with Clinical Trials Identifier NCT01789385.

Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery

2017 ◽  
Vol 127 (1) ◽  
pp. 173-191 ◽  
Author(s):  
Kariem El-Boghdadly ◽  
Ki Jinn Chin ◽  
Vincent W. S. Chan
Keyword(s):  
Regional Anesthesia ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Shoulder Surgery ◽  
Phrenic Nerve Palsy ◽  
Perioperative Analgesia ◽  
Brachial Plexus Blockade ◽  
Risk Patients ◽  
Established Role ◽  
Regional Anesthetic

Abstract Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5–C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.

Cellblockistry in serous effusion cytology- A systematic review with recent concepts

2021 ◽  
Vol 6 (3) ◽  
pp. 165-169
Author(s):  
Anandraj Vaithy ◽  
Keerthika Sri ◽  
Uma Devi ◽  
Sowmya
Keyword(s):  
Routine Practice ◽  
Cell Block ◽  
Serous Effusion ◽  
Definite Diagnosis ◽  
Combined Approach ◽  
Block Method ◽  
Effective Diagnosis ◽  
Level Of Experience ◽  
Processing Techniques ◽  
Ancillary Studies

Serous effusion cytology being a minimally invasive, readily accessible and inexpensive diagnostic procedure. Nevertheless, the accuracy of SEC could vary widely due to the multitude factors including the level of experience of the cytologists Conventional smear has its own limitations with varied efficacy and hence warranting ancillary studies. Cell block has emerged as a paramount and robust platform for sample processing techniques in cytology. Research studies have proved that the efficiency of cytological diagnosis increases by significant margin of 15-20 percent when it is done in conjunction with cell block techniques especially in cases of exudative fluids in picking up crucial cases and based on this, we intended with a novel aim to analyse the accuracy of Serous effusion cytology by combining conventional smear and cell block technique with an attempt to assess the effectiveness of the cell block by our indigenous Modified Bouin’s method.Cell block method prepared by our indigenous Modified Bouin’s preparation with formalin fixative proved to show high quality significance and hence it could be followed in routine practice across laboratories. Cell block technique is quantitatively superior both standalone as well as in conjunction with conventional smear by improving the effective diagnosis of SEC. Diligent use of cell block technique eliminates the suspicious of malignant category on CS and thereby giving more definite diagnosis and thus it is mandated that combined approach of CB in conjunction with CS should be practiced as binary protocol which proved to have obvious influence on patient management.

Contemporary Perioperative Analgesia in Total Knee Arthroplasty: Multimodal Protocols, Regional Anesthesia, and Peripheral Nerve Blockade

2018 ◽  
Vol 31 (07) ◽  
pp. 600-604 ◽  
Author(s):  
Jonathan Neilio ◽  
Lisa Kunze ◽  
Jacob Drew
Keyword(s):  
Total Knee Arthroplasty ◽  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Knee Arthroplasty ◽  
Critical Evaluation ◽  
Nerve Blockade ◽  
Considerable Uncertainty ◽  
Perioperative Analgesia ◽  
Peripheral Nerve Blockade ◽  
Total Knee

AbstractPerioperative care of the total knee arthroplasty (TKA) patient has evolved considerably over the past decade. Among the changes driving this evolution toward shorter hospitalization and accelerated rehabilitation have been regional anesthesia, peripheral nerve blockade, and multimodal analgesia protocols. These complementary techniques are increasingly supported by scientific evidence, though considerable uncertainty persists regarding the optimal combination of strategies. Continued refinement of technique and critical evaluation is trending toward greater characterization of the comparative effectiveness of myriad options. Contemporary interdisciplinary arthroplasty care teams have the opportunity to individualize the TKA patient's perioperative pain control to optimize not only the clinical outcome but also patient satisfaction.

Role of Immunohistochemistry in Diagnosing Renal Neoplasms: When Is It Really Useful?

2012 ◽  
Vol 136 (4) ◽  
pp. 410-417 ◽  
Author(s):  
Steven S. Shen ◽  
Luan D. Truong ◽  
Marina Scarpelli ◽  
Antonio Lopez-Beltran
Keyword(s):  
Personal Experience ◽  
Routine Practice ◽  
Renal Neoplasm ◽  
Renal Neoplasms ◽  
Diagnostic Role ◽  
Prognosis And Prediction ◽  
The Common ◽  
Immunohistochemical Techniques ◽  
Diagnostic Setting

Context.—With the refinement of molecular and histologic classifications of renal neoplasms and the availability of more-effective molecular targeted therapy for specific renal neoplasms, immunohistochemical techniques will play an increasingly important role in the diagnosis of renal neoplasm. During the past few decades, many markers have been evaluated for their role in the diagnosis, prognosis, and prediction of treatment for renal neoplasms. The number of useful markers in our routine practice continues to increase. The challenge will be to choose among them and to decide in which situations immunohistochemistry will be truly useful. Objectives.—To review the diagnostic utility of molecular markers for renal neoplasms and common diagnostic scenarios that call for immunohistochemistry in routine practice. Data Sources.—This review is based on published literature and personal experience. Conclusions.—Some of the most important and useful markers for the diagnosis of renal neoplasm include cytokeratins, vimentin, PAX2, PAX8, RCC marker, CD10, E-cadherin, kidney-specific cadherin, parvalbumin, claudin-7, claudin-8, α-methylacyl coenzyme A racemase, CD117, TFE3, thrombomodulin, uroplakin III, p63, CD57, and carbonic anhydrase IX. Each marker has its diagnostic role in a specific diagnostic setting. The common diagnostic situations that call for immunohistochemical staining are differential diagnoses of renal versus nonrenal neoplasms, histologic subtyping of renal cell carcinoma, diagnosis of rare primary renal neoplasms, diagnosis of renal neoplasms in small core-biopsy specimens, diagnosis of possible metastatic renal carcinomas, and less frequently, molecular prognostication.

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