scholarly journals ULTRASOUND-ASSISTED NEURAXIAL ANAESTHESIA, KETOFOL AND HIGH-FLOW-NASAL-OXYGEN FOR COMPLEX LOWER LIMB ORTHOPAEDIC SURGERY IN AN ANXIOUS PATIENT WITH ACHONDROPLASIA, SEVERE SLEEP APNOEA AND CHIARI MALFORMATION

2019 ◽  
Author(s):  
Kate Wilson ◽  
Mr Martin McNally ◽  
Svetlana Galitzine ◽  
Dr Vassilis Athanassoglou
Keyword(s):  
Lower Limb ◽  
Chiari Malformation ◽  
Orthopaedic Surgery ◽  
Sleep Apnoea ◽  
High Flow ◽  
Neuraxial Anaesthesia ◽  
Anxious Patient ◽  
Ultrasound Assisted

scholarly journals Erector spinae plane block: A safe, simple and effective alternative for knee surgery

2019 ◽  
Vol 47 (5) ◽  
pp. 469-471 ◽  
Author(s):  
Arshad Ayub ◽  
Praween Talawar ◽  
Santosh K Gupta ◽  
Rakesh Kumar ◽  
Alauddin Alam
Keyword(s):  
Lower Limb ◽  
Orthopaedic Surgery ◽  
Knee Surgery ◽  
Erector Spinae ◽  
Thoracic Pain ◽  
Knee Amputation ◽  
Bilateral Knee ◽  
Erector Spinae Plane Block ◽  
Neuraxial Anaesthesia ◽  
Analgesic Use

Neuraxial anaesthesia techniques are routinely used to manage postoperative pain in patients undergoing lower limb orthopaedic surgery. However, neuraxial anaesthesia is contraindicated in patients with a deformed spine or coagulopathy. Researchers recently described the erector spinae plane block—a safe, easy and effective interfascial plane block for managing chronic thoracic pain. Since then, it has been used for providing analgesia in thoracic, abdominal and hip surgery. We report its analgesic use in two patients undergoing knee surgery: one with lumbar scoliosis undergoing above knee amputation, and the other with haemophilia undergoing bilateral knee arthroplasty.

scholarly journals Low-dose intrathecal meperidine for lower limb orthopaedic surgery

1990 ◽  
Vol 37 (8) ◽  
pp. 947-948 ◽  
Author(s):  
Ketan Shevde
Keyword(s):  
Lower Limb ◽  
Orthopaedic Surgery ◽  
Low Dose

scholarly journals Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine in Lumbar Epidural Anaesthesia for Lower Limb Orthopaedic Surgery

1997 ◽  
Vol 25 (3) ◽  
pp. 262-266 ◽  
Author(s):  
D. P. McGlade ◽  
M. V. Kalpokas ◽  
P. H. Mooney ◽  
M. R. Buckland ◽  
S. K. Vallipuram ◽  
...  
Keyword(s):  
Lower Limb ◽  
Orthopaedic Surgery ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
Pressure Profile ◽  
Technical Failure ◽  
Time Duration ◽  
Double Blind ◽  
Multi Centre Study

The purpose of this study was to compare the epidural use of 0.5% ropivacaine and 0.5% bupivacaine in patients undergoing lower limb orthopaedic surgery. In a double-blind, randomized, multi-centre study involving 67 patients, thirty-two patients received 20 ml of 0.5% ropivacaine and 35 patients received 20 ml of 0.5% bupivacaine at the L2,3 or L3,4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset. Four patients (3 ropivacaine, 1 bupivacaine) were excluded from the study due to technical failure of the block. The onset and duration of analgesia at the T10 dermatome (median, interquartile range) was 10 (5-15) minutes and 3.5 (2.7-4.3) hours respectively for ropivacaine, and was 10 (6-15) minutes and 3.4 (2.5-3.8) hours respectively for bupivacaine. Maximum block height (median, range) was T6 (T2-T12) for ropivacaine and T6 (C7-T10) for bupivacaine. Nine patients receiving ropivacaine and eight patients receiving bupivacaine developed no apparent motor block. The incidence of complete motor block (Bromage grade 3) was low in both groups, being 4/27 for ropivacaine and 6/34 for bupivacaine. In the ropivacaine group, motor and sensory block were judged to be satisfactory in 78% of patients. In the bupivacaine group, motor and sensory block were judged to be satisfactory in 71% and 62% of patients respectively. Cardiovascular changes were similar in both groups. No statistical differences were found between the two groups regarding any of the study parameters.

scholarly journals Association between neuraxial anaesthesia or general anaesthesia for lower limb revascularisation surgery in adults and clinical outcomes: population based comparative effectiveness study

BMJ ◽  
2020 ◽  
pp. m4104
Author(s):  
Derek J Roberts ◽  
Sudhir K Nagpal ◽  
Dalibor Kubelik ◽  
Timothy Brandys ◽  
Henry T Stelfox ◽  
...  
Keyword(s):  
Hospital Stay ◽  
General Anaesthesia ◽  
Lower Limb ◽  
Odds Ratio ◽  
Instrumental Variable ◽  
Length Of Hospital Stay ◽  
Population Based ◽  
Neuraxial Anaesthesia ◽  
Renal Complications ◽  
Comparative Effectiveness Study

Abstract Objective To examine the associations between neuraxial anaesthesia or general anaesthesia and clinical outcomes, length of hospital stay, and readmission in adults undergoing lower limb revascularisation surgery. Design Comparative effectiveness study using linked, validated, population based databases. Setting Ontario, Canada, 1 April 2002 to 31 March 2015. Participants 20 988 patients Ontario residents aged 18 years or older who underwent their first lower limb revascularisation surgery in hospitals performing 50 or more of these surgeries annually. Main outcome measures Primary outcome was 30 day all cause mortality. Secondary outcomes were in-hospital cardiopulmonary and renal complications, length of hospital stay, and 30 day readmissions. Multivariable, mixed effects regression models, adjusting for patient, procedural, and hospital characteristics, were used to estimate associations between anaesthetic technique and outcomes. Robustness of analyses were evaluated by conducting instrumental variable, propensity score matched, and survival sensitivity analyses. Results Of 20 988 patients who underwent lower limb revascularisation surgery, 6453 (30.7%) received neuraxial anaesthesia and 14 535 (69.3%) received general anaesthesia. The percentage of neuraxial anaesthesia use ranged from 0.6% to 90.6% across included hospitals. Furthermore, use of neuraxial anaesthesia declined by 17% over the study period. Death within 30 days occurred in 204 (3.2%) patients who received neuraxial anaesthesia and 646 (4.4%) patients who received general anaesthesia. After multivariable, multilevel adjustment, use of neuraxial anaesthesia compared with use of general anaesthesia was associated with decreased 30 day mortality (absolute risk reduction 0.72%, 95% confidence interval 0.65% to 0.79%; odds ratio 0.68, 95% confidence interval 0.57 to 0.83; number needed to treat to prevent one death=139). A similar direction and magnitude of association was found in instrumental variable, propensity score matched, and survival analyses. Use of neuraxial anaesthesia compared with use of general anaesthesia was also associated with decreased in-hospital cardiopulmonary and renal complications (odds ratio 0.73, 0.63 to 0.85) and a reduced length of hospital stay (−0.5 days, −0.3 to−0.6 days). Conclusions Use of neuraxial anaesthesia compared with general anaesthesia for lower limb revascularisation surgery was associated with decreased 30 day mortality and hospital length of stay. These findings might have been related to reduced cardiopulmonary and renal complications after neuraxial anaesthesia and support the increased use of neuraxial anaesthesia in patients undergoing these surgeries until the results of a large, confirmatory randomised trial become available.

scholarly journals Chiari malformation and central sleep apnoea: successful therapy with adaptive pressure support servo-ventilation following surgical treatment

2012 ◽  
Vol 2012 (oct24 1) ◽  
pp. bcr-2012-007143-bcr-2012-007143 ◽  
Author(s):  
A. Fahim ◽  
A. O. Johnson
Keyword(s):  
Surgical Treatment ◽  
Chiari Malformation ◽  
Pressure Support ◽  
Sleep Apnoea ◽  
Successful Therapy ◽  
Central Sleep Apnoea
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