scholarly journals Regional anesthetic techniques for hip surgery in children with cerebral palsy

2020 ◽  
Vol 26 (4) ◽  
pp. 521-526
Author(s):  
V.V. Evreinov ◽  
◽  
T.A. Zhirova ◽  
Keyword(s):  
Cerebral Palsy ◽  
Sciatic Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Lower Limb ◽  
Anesthetic Techniques ◽  
Single Shot ◽  
Sedation Scale ◽  
Multi Level ◽  
Regional Anesthetic

Patients with cerebral palsy (CP) experience pain through the lifespan. The hip joint is the main source of nociceptive input. Use of nonopioid adjuvant medication and regional anesthesia for hip surgeries can be an integral part of a perioperative strategy to decrease opioid use. Regional anesthesia can be delivered efficiently and safely for pediatric orthopedic patients. Objective To compare different regional anesthetic techniques used for multi-level lower limb orthopedic surgeries in children with moderate and severe CP. Material and methods A prospective randomized comparative clinical trial enrolled 101 CP patients who underwent unilateral multi-level lower limb surgery for spastic hip displacement or subluxation. According to a type of anesthesia used, patients were allocated into 3 groups: patients receiving prolonged epidural analgesia (PEA) and fentanyl for sedation (PEAF, n = 32); patients receiving PEA and benzodiazepine for sedation (PEAB, n = 37), and patients receiving a continuous femoral plus single-shot sciatic nerve block and benzodiazepines for sedation (FSNBB, n = 32). Hemodynamic findings, pain intensity, a need for opioids and additives (NSAIDs), the level of sedation and complication rate were evaluated. Results The use of NSAIDs (paracetamol) was significantly higher in PEAB and FSNBB groups as compared to PEAF patients with fentanyl administered, and there were no statistically significant differences in the level of pain recorded with the r-FLACC score among the study groups. There were no statistically significant differences in the level of sedation and agitation measured with the Ramsay Sedation Scale and Richmond Agitation-Sedation Scale (RASS) among the groups at early postoperative period. Apnoea as a complication was observed in a PEAF patient. Conclusion A continuous femoral plus single-shot sciatic nerve block and PEA added with NSAIDs (paracetamol) and benzodiazepines for sedation have shown the comparative effectiveness and safety for a perioperative analgesia of CP patients undergoing multi-level lower limb surgeries as compared to the use of PEA and fentanyl for sedation.

scholarly journals Dexmedetomidine as an Adjuvant in Sciatic Nerve Block for Lower Limb Surgeries: An Observational Study

2020 ◽  
Vol 5 (1) ◽  
pp. 114-119
Author(s):  
Krishna Prasad GV ◽  
Vipin Sharma Jaishree
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Lower Limb ◽  
Intraoperative Complications ◽  
Randomized Study ◽  
Sciatic Nerve Block ◽  
Anesthetic Techniques ◽  
Peripheral Oxygen Saturation ◽  
Nerve Blocks ◽  
Rescue Analgesia

Background: In recent anesthetic practice, peripheral nerve blocks (PNB) are used extensively for surgical anesthesia and non-surgical postop analgesia. PNBs offer many benefits over other anesthetic techniques in a certain population of patients and in some specific clinical setting that may contribute to faster and safer pain relief, increased patient satisfaction, reduced hospital stay, and decreased overall healthcare cost. However, the use of a single PNB is not sufficient enough to block the pain for longer durations. Hence, to prolong the effect of anesthesia without causing any adverse event, adjuvants are injected perineurally along with local anesthetic agents. Aim: The present study was aimed to evaluate the anesthetic efficacy of dexmedetomidine as an adjuvant in sciatic nerve block in lower limb surgery patients.Subjects and Methods:This observational non-randomized study involved 50 patients who were undergoing lower limb surgeries in the study period. The heart rate, blood pressure (both SBP and DBP), and peripheral oxygen saturation were recorded. A VAS score of more than 5 was considered significant and these patients received tramadol injection (75 mg) i.v. As rescue analgesia in the postop period. To prolong the effect of sciatic nerve block, dexmedetomidine (0.5 mcg/kg) was used.Results:In the maximum number of the patient,the complete block was achieved. Only 6 patients required tramadol injection as the rescue analgesia. No significant post and intraoperative complications were reported after the procedure.Conclusion:It is concluded from the study that the inclusion of dexmedetomidine (0.5 mcg/kg) in lower limb surgeries was associated with a prolonged duration of analgesia.

Novel compound LL-a produces long and nociceptive-selective regional anesthesia via TRPV1 channels in rodents sciatic nerve block model

2020 ◽  
Vol 45 (6) ◽  
pp. 412-418
Author(s):  
Cheng Zhou ◽  
Lei Tang ◽  
Qinqin Yin ◽  
Linghui Yang ◽  
Deying Gong ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Motor Block ◽  
Sensory Block ◽  
Sciatic Nerve Block ◽  
Block Model ◽  
Voltage Gated ◽  
Trpv1 Channels ◽  
Channel Currents

Background and objectiveLong-acting nociceptive-selective regional anesthesia has remained an elusive clinical goal. We aspired to identify a novel compound that would produce nociceptive-selective regional anesthesia through the transient receptor potential vanilloid 1 (TRPV1) channels.MethodsWe designed and synthesized a novel compound (LL-a) that penetrates the cell membrane through TRPV1 channels and binds to voltage-gated sodium channels. The regional anesthetic effect of LL-a was evaluated in a rodent sciatic nerve block model. Electrophysiological recording was applied to test the inhibition of LL-a on voltage-gated sodium channel currents.ResultsLL-a inhibited sodium channel currents on the dorsal root ganglion neurons of mice and this action was diminished by TRPV1 channel knockout. In a sciatic nerve block model of a rat, 0.2% and 0.4% (w/v) LL-a produced selective sensory block with median (IQR) durations of 42.0 (24.0, 48.0) and 72.0 (69.0, 78.0) hours, respectively. No motor block was found for 0.2% LL-a. 0.4% LL-a produced a motor block with a median (IQR) duration of 3.0 (0.0, 6.0) hours. This selective sensory block was not observed on TRPV1 knockout mice. As a positive control, 0.5% and 0.75% levobupivacaine produced a non-selective sciatic nerve block with median (IQR) durations of 2.8 (2.6, 2.8) and 3.8 (3.8, 4.8) hours, respectively. No systemic or local irritation was observed during injection of LL-a and sensory and motor function completely recovered for all the animals.ConclusionsLL-a is a potential novel local anesthetic for long-lasting nociceptive-selective analgesia.

Continuous or single shot sciatic nerve block to improve postoperative analgesia after total knee arthroplasty

2006 ◽  
Vol 23 (Supplement 37) ◽  
pp. 232
Author(s):  
A. Martínez ◽  
T. Vázquez ◽  
R. Ortiz de la Tabla ◽  
M. Reina ◽  
M. Echevarría
Keyword(s):  
Total Knee Arthroplasty ◽  
Sciatic Nerve ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Postoperative Analgesia ◽  
Sciatic Nerve Block ◽  
Single Shot ◽  
Total Knee

scholarly journals Liposomal Bupivacaine versus Continuous Popliteal Nerve Block in Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ryan Mulligan ◽  
Joel Morash ◽  
James DeOrio ◽  
Selene Parekh
Keyword(s):  
Postoperative Pain ◽  
Sciatic Nerve ◽  
Pain Score ◽  
Nerve Block ◽  
Total Ankle Arthroplasty ◽  
Sciatic Nerve Block ◽  
Foot And Ankle ◽  
Ankle Arthroplasty ◽  
Ankle Surgery ◽  
Regional Anesthetic

Category: Ankle, Ankle Arthritis Introduction/Purpose: The use of liposomal bupivacaine (LB) has recently gained popularity in joint arthroplasty. Despite it’s proven safety and efficacy, there is little reported on the use of LB in foot and ankle surgery. Catheter placement for a continuous popliteal sciatic nerve block (CPSNB) has an excellent track record for pain relief, and is commonly used by our group for major foot and ankle reconstructions. The purpose of this study was to compare the use of intraoperative LB injection to CPSNB as a regional anesthetic for total ankle arthroplasty (TAA), with attention to postoperative pain scores, narcotic use, and complications. Methods: Retrospective review of TAA patients treated by two fellowship-trained orthopedic foot and ankle surgeons was performed. Patient demographic data, operative, and postoperative details were collected, including type of regional anesthetic used. Patient’s received either preoperative single-shot popliteal sciatic nerve block with 0.25% bupivacaine followed by intraoperative injection of LB, or preoperative CPSNB alone. Outcomes examined were VAS pain score at 8 hours, 24 hours, 1 week, and 3 weeks following surgery, need for opioid pain medication refill, physician office notification for pain issues or other adverse events, and complications within the first 90 days following surgery. Standard statistical analysis was performed and p < 0.05 was considered significant. Results: 75 patients were identified who underwent TAA and met inclusion criteria. 41 received LB and 34 received CPSNB. No statistical difference was seen between groups with regard to complications, emergency department visits, readmissions, reoperations, VAS pain score at any time point, physician office contacts, and narcotic refills. Mean VAS with LB use was 1.8, 3.5, 2.6, and 2.2 at 8 hours, 24 hours, 1 week, and 3 weeks respectively, compared with mean VAS 2.1, 3.2, 2.2, and 1.9 at similar time points for CPSNB (p=0.59, 0.65, 0.27, and 0.40, respectively). 16 of 41 LB patients needed narcotic refills, versus 12 of 34 CPSNB patients (p=0.81). 3 of 41 LB patients had a complication postoperatively, versus 4 of 34 CPSNB patients. Conclusion: This is the first study evaluating the use of LB for total ankle arthroplasty. LB was both safe and effective for postoperative pain control, with comparable results to CPSNB. As LB gains more widespread use in foot and ankle surgery, further investigation is warranted to determine potential unseen complications and cost-effectiveness.

scholarly journals Combined femoral and sciatic nerve block with Levobupivacaine in Brugada syndrome patient: A case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Diego Tavoletti ◽  
Elisabetta Rosanò ◽  
Elisabetta Cerutti ◽  
Luca Pecora
Keyword(s):  
Case Report ◽  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Brugada Syndrome ◽  
Peripheral Nerve Block ◽  
Case Reports ◽  
Anesthetic Techniques ◽  
Syndrome Patient

Introduction: Brugada syndrome is a rare arrhythmic disorder associated to ventricular fibrillation and sudden cardiac death. General recommendations in Brugada syndrome patient are focused on avoiding increases in vagal tone and precipitating agents such as electrolyte disorders, hypo/hyperthermia and drugs. Anesthetic management in Brugada syndrome patient has been described in many case reports, however it is still unknown which anesthesia is the safest. Local anesthetic may have a theoretical arrhythmogenic risk, but currently there is no clear evidence and their risk is still debated. Peripheral nerve block avoids autonomic nervous system changes that occur with other anesthetic techniques and it is associated to a lower level in the plasma concentration of the local anesthetic compared with neuraxial anesthesia. Case Report: We report a case of a 38-year-old man patient with Brugada syndrome who underwent urgent orthopedic surgery which was managed with a combined femoral and sciatic nerve blocks using levobupivacaine without any complications. Conclusions: Peripheral nerve block with levobupivacaine provided good analgesia, hemodynamic and cardiac stability in Brugada syndrome patient. Keywords: Brugada syndrome, Anesthesia, Levobupivacaine, Peripheral nerve block, Regional anesthesia

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