Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities

The higher incidence of comorbidities in advanced age causes difficulties in anesthesia management. When choosing the anesthesia technique in old aged patients, our target must be to avoid aggravating the existing systemic diseases and avoid disturbing the hemodynamics to ensure their rapid return to routine life. In this case report, we present our choice of infraclavicular nerve block accompanied with spinal anesthesia in a patient with advanced age and several comorbidities, who sustained multiple trauma. The surgery of the patient was successfully performed with minimal effects on the hemodynamics, and he was transferred to the clinic. We stress careful selection of the most appropriate anesthesia technique according to the existing state of the patient, and opting for appropriate nerve blocks even to the patients with respiratory problems. Key words: Advanced age; Trauma; Spinal anesthesia; Infraclavicular block Citation: Sahap M, Gulec H, But A, Gulec S, Ozcan AD. Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities. Anaesth. pain intensive care 2021;25(2):222-224. DOI: 10.35975/apic.v25i2.1475 Received: 1 December 2020, Reviewed: 7 February 2021, Accepted: 23 February 2021

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Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review

Anesthesiology Research and Practice ◽

10.1155/2011/262070 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Anupama Wadhwa ◽

Sunitha Kanchi Kandadai ◽

Sujittra Tongpresert ◽

Detlef Obal ◽

Ralf Erich Gebhard

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Nerve Stimulation ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Sense Of Security ◽

False Sense ◽

Anesthesia Technique ◽

Additional Value

Nerve stimulation and ultrasound have been introduced to the practice of regional anesthesia mostly in the last two decades. Ultrasound did not gain as much popularity as the nerve stimulation until a decade ago because of the simplicity, accuracy and portability of the nerve stimulator. Ultrasound is now available in most academic centers practicing regional anesthesia and is a popular tool amongst trainees for performance of nerve blocks. This review article specifically discusses the role of ultrasonography for deeply situated nerves or plexuses such as the infraclavicular block for the upper extremity and lumbar plexus and sciatic nerve blocks for the lower extremity. Transitioning from nerve stimulation to ultrasound-guided blocks alone or in combination is beneficial in certain scenarios. However, not every patient undergoing regional anesthesia technique benefits from the use of ultrasound, especially when circumstances resulting in difficult visualization such as deep nerve blocks and/or block performed by inexperienced ultrasonographers. The use of ultrasound does not replace experience and knowledge of relevant anatomy, especially for visualization of deep structures. In certain scenarios, ultrasound may not offer additional value and substantial amount of time may be spent trying to find relevant structures or even provide a false sense of security, especially to an inexperienced operator. We look at available literature on the role of ultrasound for the performance of deep peripheral nerve blocks and its benefits.

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Major Complications of Regional Anesthesia in France

Anesthesiology ◽

10.1097/00000542-200211000-00034 ◽

2002 ◽

Vol 97 (5) ◽

pp. 1274-1280 ◽

Cited By ~ 630

Author(s):

Yves Auroy ◽

Dan Benhamou ◽

Laurent Bargues ◽

Claude Ecoffey ◽

Bruno Falissard ◽

...

Keyword(s):

Spinal Anesthesia ◽

Regional Anesthesia ◽

Neurologic Complications ◽

Nerve Blocks ◽

Voluntary Reporting ◽

Prospective Survey ◽

Major Complications ◽

Lumbar Plexus Block ◽

Telephone Hotline ◽

Plexus Block

Background Several previous surveys have estimated the rate of major complications that occur after regional anesthesia. However, because of the increase in the use of regional anesthesia in recent years and because of the introduction of new techniques, reappraisal of the incidence and the characteristics of major complications is useful. Methods All French anesthesiologists were invited to participate in this 10-month prospective survey based on (1) voluntary reporting of major complications related to regional anesthesia occurring during the study period using a telephone hotline service available 24 h a day and managed by three experts, and (2) voluntary reporting of the number and type of regional anesthesia procedures performed using pocket booklets. The service was free of charge for participants. Results The participants (n = 487) reported 56 major complications in 158,083 regional anesthesia procedures performed (3.5/10,000). Four deaths were reported. Cardiac arrest occurred after spinal anesthesia (n = 10; 2.7/10,000) and posterior lumbar plexus block (n = 1; 80/10,000). Systemic local anesthetic toxicity consisted of seizures only, without cardiac toxicity. Lidocaine spinal anesthesia was associated with more neurologic complications than bupivacaine spinal anesthesia (14.4/10,000 vs. 2.2/10,000). Most neurologic complications were transient. Among 12 that occurred after peripheral nerve blocks, 9 occurred in patients in whom a nerve stimulator had been used. Conclusion This prospective survey based on a free hotline permanent telephone service allowed us to estimate the incidence of major complications related to regional anesthesia and to provide a detailed analysis of these complications.

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Ultrasound and Regional Anesthesia Technique: Are There Really Ultrasound Guidance Technical Limits in Sciatic Nerve Blocks?

Regional Anesthesia and Pain Medicine ◽

10.1016/j.rapm.2008.01.008 ◽

2008 ◽

Vol 33 (3) ◽

pp. 281-282 ◽

Cited By ~ 1

Author(s):

G DANELLI ◽

D GHISI ◽

A ORTU

Keyword(s):

Sciatic Nerve ◽

Regional Anesthesia ◽

Ultrasound Guidance ◽

Nerve Blocks ◽

Anesthesia Technique

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Lower extremity regional anesthesia: essentials of our current understanding

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-000019 ◽

2019 ◽

Vol 44 (2) ◽

pp. 143-180 ◽

Cited By ~ 7

Author(s):

De Q Tran ◽

Francis V Salinas ◽

Honorio T Benzon ◽

Joseph M Neal

Keyword(s):

Lower Extremity ◽

Regional Anesthesia ◽

Lower Limb ◽

Ultrasound Guidance ◽

Evidence Based ◽

Nerve Blocks ◽

Pharmacological Agents ◽

Current Review ◽

American Society ◽

Selection Of

The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine’s ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.

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Automated text messaging follow-up for patients who receive peripheral nerve blocks

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-102472 ◽

2021 ◽

pp. rapm-2021-102472

Author(s):

Daniel Gessner ◽

Oluwatobi O Hunter ◽

Alex Kou ◽

Edward R Mariano

Keyword(s):

Regional Anesthesia ◽

Nerve Block ◽

Text Messaging ◽

Low Cost ◽

Automated System ◽

Phone Call ◽

Nerve Blocks ◽

Patient Response ◽

Patient Reported

BackgroundRoutine follow-up of patients who receive a nerve block for ambulatory surgery typically consists of a phone call from a regional anesthesia clinician. This process can be burdensome for both patients and clinicians but is necessary to assess the efficacy and complication rate of nerve blocks.MethodsWe present our experience developing an automated system for completing follow-up via short message service text messaging and our preliminary results using it at three clinical sites. The system is built on REDCap, a secure online research data capture platform developed by Vanderbilt University and currently available worldwide.ResultsOur automated system queried patients who received a variety of nerve block techniques, assessed patient-reported nerve block duration, and surveyed patients for potential complications. Patient response rate to text messaging averaged 91% (higher than our rates of daily phone contact reported previously) for patients aged 18 to 90 years.ConclusionsGiven the wide availability of REDCap, we believe this automated text messaging system can be implemented in a variety of health systems at low cost with minimal technical expertise and will improve both the consistency of patient follow-up and the service efficiency of regional anesthesia practices.

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Spinal Versus General Anesthesia for Laparoscopic Cholecystectomy

TAJ Journal of Teachers Association ◽

10.3329/taj.v25i0.37559 ◽

2018 ◽

Vol 25 ◽

pp. 55-58

Author(s):

SMA Taher ◽

Jamil Raihan ◽

M Abu Zahid ◽

AK Azad ◽

MI Alam ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Regional Anesthesia ◽

Gold Standard ◽

Randomised Trial ◽

Gall Stone ◽

Chronic Obstructive ◽

First Time ◽

Symptomatic Gall Stone

Laparascopic Cholecystectomy under regional anesthesia alone has been reported only with severe chronic obstructive airway disease1,2. In a randomised trial, epidural with general anesthesia have been found to be more effective in lessening postoperative pain compare with general anesthesia alone3. Regional anesthesia has been successfully used for laparascopic cholecystectomy in patient. Hamad and Ibrahim El-Khatter4 used spinal anesthesia for laparoscopic for the first time. We performing Laparascopic Cholecystectomy with carbondioxide pneumoperitoneum under spinal anesthesia alone of healthy patients with symptomatic gall stone disease5. We design a control randomized trial to compare spinal anesthesthesia with the Gold standard general anesthesia for elective Laparascopic Cholecystectomy in healty patients.TAJ 2012; 25: 55-58

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Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-102132 ◽

2021 ◽

pp. rapm-2020-102132

Author(s):

Graeme McLeod ◽

Shengli Zihang ◽

Amy Sadler ◽

Anu Chandra ◽

Panpan Qiao ◽

...

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Simulation Training ◽

Historical Data ◽

Injection Pressure ◽

Opening Pressure ◽

Nerve Blocks ◽

Geometric Ratio ◽

Fresh Frozen ◽

Training Opportunities

IntroductionAlthough administration of regional anesthesia nerve blocks has increased during the COVID-19 pandemic, training opportunities in regional anesthesia have reduced. Simulation training may enhance skills, but simulators must be accurate enough for trainees to engage in a realistic way—for example, detection of excessive injection pressure. The soft-embalmed Thiel cadaver is a life-like, durable simulator that is used for dedicated practice and mastery learning training in regional anesthesia. We hypothesized that injection opening pressure in perineural tissue, at epineurium and in subepineurium were similar to opening pressures measured in experimental animals, fresh frozen cadavers, glycol soft-fix cadavers and patients.MethodsWe systematically reviewed historical data, then conducted three validation studies delivering a 0.5 mL hydrolocation bolus of embalming fluid and recording injection pressure. First, we delivered the bolus at 12 mL/min at epimysium, perineural tissue, epineurium and in subepineurium at 48 peripheral nerve sites on three cadavers. Second, we delivered the bolus at using three infusion rates: 1 mL/min, 6 mL/min and 12 mL/min on epineurium at 70 peripheral nerve sites on five cadavers. Third, we repeated three injections (12 mL/min) at 24 epineural sites over the median and sciatic nerves of three cadavers.ResultsMean (95%) injection pressure was greater at epineurium compared with subepineurium (geometric ratio 1.2 (95% CI: 0.9 to 1.6)), p=0.04, and perineural tissue (geometric ratio 5.1 (95% CI: 3.7 to 7.0)), p<0.0001. Mean (95%) injection pressure was greater at 12 mL/min compared with 1 mL/min (geometric ratio 1.6 (95% CI: 1.2 to 2.1), p=0.005). Pressure measurements were similar in study 3 (p>0.05 for all comparisons).DiscussionWe conclude that the soft-embalmed Thiel cadaver is a realistic simulator of injection opening pressure.

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THE CENTRAL HEMODYNAMIC STATE IN DIABETES PATIENTS DURING LOW LIMB SURGERY

Regional Anesthesia and Acute Pain Management ◽

10.18821/1993-6508-2018-12-1-47-54 ◽

2018 ◽

Vol 12 (1) ◽

pp. 47-54

Author(s):

S. V Sokologorskiy ◽

M. A Sheina ◽

A. A Zvyagin ◽

S. A. Orudzheva

Keyword(s):

Mean Arterial Pressure ◽

Spinal Anesthesia ◽

Nerve Block ◽

Oxygen Delivery ◽

Single Injection ◽

Time Points ◽

Hemodynamic State ◽

Central Hemodynamic ◽

Anesthesia Technique ◽

Diabetes Patients

Background: As diabetes takes on pandemic proportions, more than 1000000 patients undergo some kind of low limb surgery yearly. While peripheral hemodynamic state during such kind of surgery in these patients has been studied quite well in various anesthesia technique, the central hemodynamic state and systemic oxygen delivery remain unclear. Objective: To evaluate a single-injection nerve block vs spinal anesthesia influence on central and peripheral hemodynamics and systemic oxygen delivery during low limb surgery in diabetes patients. Design: A prospective cohort study. Setting: Federal scientific centre. Patients: 31 diabetes patients during elective low limb surgery under single-injection nerve block and spinal anesthesia. Intervention: Patients were randomly allocated to one of the two groups according the anesthesia technique - either a single-injection nerve block or spinal anesthesia. Main outcome measures: Levels of cardiac index mean arterial pressure, oxygen delivery index, glycaemia and VAS scores were evaluated on five time points: 24 hours before surgery, during surgery, before discharging from operating room, 6 and 24 hours after surgery respectively. Results. Levels of cardiac, systemic vascular resistance and oxygen delivery indexes together with mean arterial pressure had no statistically significant differences in time points in group received single-injection nerve block technique. These patients had full pain relief even in 6 hours after surgery and 24 hours after surgery their VAS pain scores were not more than 3. A single-injection nerve block technique shown its prolonged pain-relief effect with minimal systemic side effect. In patients with spinal anesthesia technique statistically significant decreases of mean arterial pressure and systemic vascular resistance with parallel cardiac index increase in time points were observed. In 6 hours after surgery, their VAS pain scores were not more 2 and 24 hours after surgery not more than 4. Spinal anesthesia once more shown to be reliable and effective but not long-acting intraoperative anesthesia technique. Additional postoperative pain relief necessity is a specific spinal technique problem. Conclusion: The results of the study showed that a single-injection nerve block technique due to its low influence on systemic circulation is more preferable in patients with compromised circulation system, while spinal technique may be used in patients with no heart and vascular disturbances. More clinical investigations must be done to evaluate central hemodynamic changes during these types of anesthesia in diabetes patients more precisely.

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Ventricular Assist Device and Its Necessity for Elderly Population

Biomedical Engineering ◽

10.4018/978-1-5225-3158-6.ch023 ◽

2018 ◽

pp. 532-552

Author(s):

Md. Shamsul Arefin ◽

Nasser K. Awad ◽

Chandra Prakash Rathore ◽

Anupam Shukla ◽

Yosry S. Morsi

Keyword(s):

Heart Failure ◽

Ventricular Assist Device ◽

Elderly Population ◽

Future Research ◽

Cardiac Complications ◽

Assist Device ◽

Aged Patients ◽

Ventricular Assist ◽

The Past ◽

Selection Of

Ventricular Assist Device (VAD) is considered to be the part and parcel to those people who have cardiac complications or heart failure especially the aged patients. Although VADs have contributed remarkably for the past few years, yet these devices possess some limitations, mainly the driveline infections. Due to these conditions, researchers are aiming to improve its functionality as well as other necessary/additional features and hence there is a need to develop the ‘next generation' wireless VAD system which could be very effective to reduce the risk of this infection. In this chapter, the necessity of the VAD and different kinds of VADs are presented and discussed. These features incorporate hemodynamic states after receiving the VADs, selection of biomaterials for the VAD system, VAD pumps and its classifications. Finally, a brief discussion is also provided based on the recent advancement of the VAD system and the scope for the future research.

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