scholarly journals Regional Anesthesia For Postdural Puncture Headache (PDPH): A New Solution For An Old Problem? A Systemic Review.

2020 ◽  
Author(s):  
Luca Gregorio Giaccari ◽  
Francesco Coppolino ◽  
Caterina Aurilio ◽  
Valentina Esposito ◽  
Maria Caterina Pace ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Conservative Management ◽  
Systemic Review ◽  
Postdural Puncture Headache ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Occipital Nerve ◽  
Occipital Nerve Block

Abstract Background: Postdural puncture headache (PDPH) is one of the earliest recognized complications of regional anesthesia. It is a common complication after inadvertent dural puncture. When conservative management is ineffective, the Epidural Blood Patch (EBP) is the “gold standard” for the treatment of PDPH. Due to the potential complications of EBP, several alternatives have been promoted as peripheral nerve blocks.A systematic review of the use of regional anesthesia for PDPH is needed to identify an alternative method of pain management.Objectives: To systematically review literature to establish the efficacy and applicability of regional anesthesia used in the treatment of PDPH in the hospital setting.Methods: Embase, MEDLINE, Google Scholar and Cochrane Central Trials Register were systematically searched in May 2020 for studies examining regional anesthesia for PDPH. The methodological quality of the studies and their results were appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and specific measurement properties criteria, respectively.Results: Nineteen studies evaluating peripheral nerve blocks for PDPH were included for a total of 221 patients. Sphenopalatine ganglion block (SPGB), greater occipital nerve block (GONB) and lesser occipital nerve block (LONB) were performed. All participants reported NRS lower than 4 after peripheral nerve blocks at 1, 24 and 48 hours. Only patients who experienced PDPH after diagnostic lumbar puncture reported NRS ≥ 4 after 48 hours. No adverse event was reported after the execution of nerve blocks, except an occasionally discomfort related to the insertion of cotton-tip applicators intranasally for SPGB. 17% of patients underwent a second or more peripheral nerve block due to uncontrolled pain. In 30 participants, EBP was required; none of cases followed spinal anesthesia.Conclusion: Peripheral nerve blocks can be considered as analgesic options in the management of PDPH, as not all cases require EBP for successful treatment. Treatment of PDPH with peripheral nerve blocks seems to be a minimal invasive, easy and effective method, which can offer to patients when conservative management is ineffective.

scholarly journals Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost

2015 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Brendan Carvalho ◽  
Romy D. Yun ◽  
Edward R. Mariano
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Single Injection ◽  
Clinical Care ◽  
Personnel Cost ◽  
Additional Time ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Physician Time

Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a “block room” model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p<0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusion: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.

scholarly journals Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review

2019 ◽  
Vol 16 (18) ◽  
pp. 3257 ◽  
Author(s):  
Olufunke Dada ◽  
Alicia Gonzalez Zacarias ◽  
Corinna Ongaigui ◽  
Marco Echeverria-Villalobos ◽  
Michael Kushelev ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Opioid Consumption ◽  
Orthopedic Procedures ◽  
Negative Consequences ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
The Impact

Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions may reduce the burden of rebound pain. Additionally, patient education regarding the possibility of rebound pain is paramount to ensure appropriate use of prescribed pre-emptive analgesics and establish appropriate expectations of minimized opioid requirements. Understanding the impact of rebound pain and strategies to prevent it is integral to effective utilization of regional anesthesia to reduce negative consequences associated with long-term opioid consumption.

Peripheral Nerve Blocks for the Lower Extremity

2017 ◽  
Author(s):  
Candace Shavit ◽  
Monica W. Harbell
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Improve Patient Care ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Peripheral Nerve Catheter

Lower extremity peripheral nerve blocks (PNBs) are often used for surgical anesthesia and postoperative pain management. The use of PNB provides improved analgesia, reduced opioid consumption, and improved patient satisfaction and can facilitate earlier rehabilitation and discharge. As the number of lower extremity total joint arthroplasties is projected to increase significantly, the role of peripheral nerve blocks can be expected to grow in similar fashion. With the growing number of procedures and the increasing focus on patient experience and expeditious hospital discharge, PNBs are increasingly recognized as a powerful tool to improve patient care and facilitate recovery after lower extremity surgery. We provide a basic review of regional anesthesia for lower extremity surgical procedures. The widespread availability of ultrasonography has improved the performance and efficacy of PNBs; thus, we focus on ultrasonography-guided procedures. In this review, we discuss pertinent lower extremity anatomy and sonoanatomy, indications, patient outcome measures, techniques, and complications of the most commonly used blocks. This review contains 35 figures, 11 tables, 5 videos, and 103 references.  Key words: adductor canal block, analgesia, ankle block, clinical applications of peripheral nerve blocks, complications of peripheral nerve blocks, continuous peripheral nerve catheter, early ambulation, fascia iliaca compartment block, femoral nerve block, lower extremity nerve blocks, lower extremity regional anesthesia, lumbar plexus block, obturator nerve block, peripheral nerve block, peripheral nerve catheter, popliteal block, psoas compartment block, regional anesthesia, regional anesthesia techniques, saphenous nerve block, sciatic nerve block, ultrasonography guided

Continuous Peripheral Nerve Blocks

2019 ◽  
pp. 555-567
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

This chapter reviews the use of peripheral nerve block catheters in regional anesthesia.

Peripheral Nerve Blocks for the Lower Extremity

2017 ◽  
Author(s):  
Candace Shavit ◽  
Monica W. Harbell
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Improve Patient Care ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Peripheral Nerve Catheter

Lower extremity peripheral nerve blocks (PNBs) are often used for surgical anesthesia and postoperative pain management. The use of PNB provides improved analgesia, reduced opioid consumption, and improved patient satisfaction and can facilitate earlier rehabilitation and discharge. As the number of lower extremity total joint arthroplasties is projected to increase significantly, the role of peripheral nerve blocks can be expected to grow in similar fashion. With the growing number of procedures and the increasing focus on patient experience and expeditious hospital discharge, PNBs are increasingly recognized as a powerful tool to improve patient care and facilitate recovery after lower extremity surgery. We provide a basic review of regional anesthesia for lower extremity surgical procedures. The widespread availability of ultrasonography has improved the performance and efficacy of PNBs; thus, we focus on ultrasonography-guided procedures. In this review, we discuss pertinent lower extremity anatomy and sonoanatomy, indications, patient outcome measures, techniques, and complications of the most commonly used blocks. This review contains 35 figures, 11 tables, 5 videos, and 103 references.  Key words: adductor canal block, analgesia, ankle block, clinical applications of peripheral nerve blocks, complications of peripheral nerve blocks, continuous peripheral nerve catheter, early ambulation, fascia iliaca compartment block, femoral nerve block, lower extremity nerve blocks, lower extremity regional anesthesia, lumbar plexus block, obturator nerve block, peripheral nerve block, peripheral nerve catheter, popliteal block, psoas compartment block, regional anesthesia, regional anesthesia techniques, saphenous nerve block, sciatic nerve block, ultrasonography guided

Greater occipital nerve block in migraine prophylaxis: Narrative review

Cephalalgia ◽  
2019 ◽  
Vol 39 (7) ◽  
pp. 908-920 ◽  
Author(s):  
Levent Ertugrul Inan ◽  
Nurten Inan ◽  
Hanzade Aybuke Unal-Artık ◽  
Ceyla Atac ◽  
Gulcin Babaoglu
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Case Reports ◽  
Migraine Treatment ◽  
Occipital Nerve ◽  
Randomized Controlled ◽  
Greater Occipital Nerve Block ◽  
Greater Occipital Nerve ◽  
Occipital Nerve Block

Objectives The importance and popularity of peripheral nerve block procedures have increased in the treatment of migraine. Greater occipital nerve (GON) block is a commonly used peripheral nerve block method, and there are numerous researches on its use in migraine treatment. Materials and methods A search of PubMed for English-language randomized controlled trials (RCT) and open studies on greater occipital nerve block between 1995 and 2018 was performed using greater occipital nerve, headache, and migraine as keywords. Results In total, 242 potentially relevant PubMed studies were found. A sum of 228 of them which were non-English articles and reviews, case reports, letters and meta-analyses were excluded. The remaining articles were reviewed, and 14 clinical trials, seven of which were randomized-controlled on greater occipital nerve block in migraine patients, were identified and reviewed. Conclusions Although clinicians commonly use greater occipital nerve block in migraine patients, the procedure has yet to be standardized. The present study reviewed the techniques, drugs and dosages, the frequency of administration, side effects, and efficacy of greater occipital nerve block in migraine patients.

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