scholarly journals Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know

2022 ◽  
Vol 13 (1) ◽  
pp. 11-35
Author(s):  
Ihab Kamel ◽  
Muhammad F Ahmed ◽  
Anish Sethi
Keyword(s):  
Regional Anesthesia ◽  
Orthopedic Procedures ◽  
Orthopedic Surgeons

Posterior Shoulder Instability After Infraclavicular Block for Outpatient Hand Surgery

Hand ◽  
2021 ◽  
pp. 155894472110650
Author(s):  
Ajay C. Kanakamedala ◽  
Jared S. Bookman ◽  
David L. Furgiuele ◽  
Jacques H. Hacquebord
Keyword(s):  
Regional Anesthesia ◽  
Shoulder Instability ◽  
Case Reports ◽  
Hand Surgery ◽  
Orthopedic Procedures ◽  
Postanesthesia Care Unit ◽  
Posterior Shoulder Instability ◽  
Posterior Shoulder Dislocation ◽  
Posterior Shoulder ◽  
Increased Risk

Regional blocks are being increasingly utilized for anesthesia for various orthopedic procedures. Several studies have shown that regional anesthesia has fewer side effects and improved postoperative pain relief compared to general anesthesia, but regional blocks are not without risks. We present case reports of 2 patients who experienced posterior shoulder instability, one of whom had a posterior shoulder dislocation, immediately in the postanesthesia care unit after undergoing hand surgery with regional anesthesia. This paper highlights the importance of being aware that patients might be at increased risk of shoulder instability after upper extremity regional anesthesia, and appropriate perioperative precautions should be taken.

scholarly journals Regional Anesthesia for Pain Management After Orthopedic Procedures for Treatment of Lower Extremity Length Discrepancy

2020 ◽  
Vol Volume 13 ◽  
pp. 547-552
Author(s):  
Mauricio Arce Villalobos ◽  
Giorgio Veneziano ◽  
Christopher Iobst ◽  
Rebecca Miller ◽  
Ana Gabriela Walch ◽  
...  
Keyword(s):  
Pain Management ◽  
Lower Extremity ◽  
Regional Anesthesia ◽  
Orthopedic Procedures ◽  
Length Discrepancy

Anticoagulation in Regional Anesthesia

2018 ◽  
Author(s):  
Issam A. Mardini ◽  
Jiabin Liu ◽  
Nabil Elkassabany
Keyword(s):  
Elderly Patient ◽  
Regional Anesthesia ◽  
The Elderly ◽  
Orthopedic Procedures ◽  
Pain Medicine ◽  
Cardiovascular Risks ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Risks And Benefits ◽  
American Society

Regional anesthesia and analgesia provide attractive options for patients undergoing major orthopedic procedures. The use of anticoagulation medications in the elderly patient population and in patients with cardiovascular risks is very common. The guidelines from the American Society of Regional Anesthesia and Pain Medicine (ASRA) and other societies have been adopted widely over many years. The guidelines provide a basis for adequate delay intervals between dosing of medications and performing neuraxial or peripheral nerve blocks (PNBs), thus allowing for safer practice of regional anesthesia. Following guidelines never eliminates risk, but it allows balanced clinical practice by physicians in regard to the risks and benefits for individual patients.

scholarly journals Study Of Nutrient Foramina In Adult Human Femur Bones

2018 ◽  
Vol 14 (2) ◽  
pp. 44-49 ◽  
Author(s):  
Anil Kumar Gupta ◽  
M. N. Ambekar
Keyword(s):  
Clinical Importance ◽  
Orthopedic Procedures ◽  
Nutrient Foramen ◽  
The Past ◽  
Nutrient Artery ◽  
Orthopedic Surgeons ◽  
Common Location ◽  
Nutrient Foramina ◽  
Proper Diagnosis

 Background: The role of nutrient foramen (NF) in nutrition and growth of the bones is evident from term Nutrient itself. The nutrient foramen is opening of nutrient canal on the surface of shaft of the bone which conducts the nutrient artery and the peripheral nerves to bones. Long bones receive most of the interosseous blood supply (70% to 80%) from the nutrient arteries and remaning (20% to 30%) through the periosteal vessels. Nutrient arteries play an important role in nutrition and growth of the bones particularly during early phases of ossification and growth. The present study is of great importance to orthopedic surgeons in planning repair of fracture, amputation and bone grafting procedures.Aim and objective of study: A study regarding nutrient foramina in femur was not conducted in the past in Nepal. Its importance in orthopedic procedures has inspired us to undertake this study.Materials and methods: This study was conducted on 100 adult dry femur bones (50 right and 50 left). All the important parameters were studied using osteometric board, vernier calipers, and needles of different gauges.Results: Mean distance of nutrient foramen from upper end was 18.09 cms. The most common location of NF was on lateral surface 58.8%. In 71% femur only one NF was seen, while 25% had two NF, 1% femur had three NF and 3% femur had no NFs. In 64.5% femur big size or dominant NFs were seen in present study.Conclusions: The findings of this study on nutrient foramen adds to the information from studies in the past by other authors. The fact that maximum number of the nutrient foramina are present in the middle third of the shaft of the femur is of clinical importance for proper diagnosis, planning of surgery and predict the prognosis. JNGMC,  Vol. 14 No. 2 December 2016, Page: 44-49

scholarly journals Malpractice claims associated with foot surgery

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Davis A. Hartnett ◽  
Steven F. DeFroda ◽  
Shaan A. Ahmed ◽  
Adam E.M. Eltorai ◽  
Brad Blankenhorn ◽  
...  
Keyword(s):  
Orthopedic Procedures ◽  
Medical Outcome ◽  
Substantial Portion ◽  
Physician Specialty ◽  
Foot Surgery ◽  
Malpractice Litigation ◽  
Factors Associated ◽  
Orthopedic Surgeons ◽  
Malpractice Claims ◽  
Legal Outcomes

Surgery of the foot constitutes a substantial portion of orthopedic procedures, performed by both orthopedic surgeons and doctors of podiatric medicine. Little research exists on the medicolegal implications of foot surgery amongst these specialties. This study seeks to investigate the different medical and legal factors associated with foot surgery-based malpractice litigation. Malpractice data between 2004 and 2017 was collected using the VerdictSearch legal database. Cases involving foot surgery were identified, and case information including physician specialty, procedure, medical outcome, verdict, and payment amount were obtained. A total of 72 cases were analyzed. A majority of lawsuits involved podiatrists (76.4%), with orthopedic surgeons accounting for 15.3%. Lawsuits against podiatrists primarily occurred over elective procedures (94.5%) and most frequently involved plaintiff complaints of persistent pain (41.8%) or deformation (27.3%). Podiatrist cases most often involved allegations of failure to treat (45.5%) or inappropriate surgical procedure (27.3%). Orthopedic surgeons saw higher rates of urgent cases (45.5%), with surgical complications (27.3%) occurring at higher rates than podiatrists. Despite different trends in case types, similar rates of plaintiff victories, and mean payments were seen between podiatrists (25.5%, $911,884 ± 1,145,345) and orthopedic surgeons (27.3%, $975,555 ± 448,795). This investigation is the first to analyze malpractice trends amongst podiatrists and orthopedic surgeons. Differing factors related to medical and legal outcomes can suggest quality improvement targets for both specialties. This data may assist in reducing malpractice risk and refining patient care, particularly with regards to outlining risks, benefits, and alternatives during pre-operative counselling.

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.

scholarly journals The effects of different anesthesia techniques on free radical production after tourniquet-induced ischemia-reperfusion injury at children's age

2010 ◽  
Vol 67 (8) ◽  
pp. 659-664 ◽  
Author(s):  
Ivana Budic ◽  
Dusica Pavlovic ◽  
Tatjana Cvetkovic ◽  
Nina Djordjevic ◽  
Dusica Simic ◽  
...  
Keyword(s):  
Reperfusion Injury ◽  
Regional Anesthesia ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Venous Blood ◽  
Orthopedic Procedures ◽  
Time Points ◽  
Significant Difference ◽  
Tourniquet Release ◽  
American Society

Background/Aim. Reperfusion of previously ischemic tissue leads to injuries mediated by reactive oxygen species. The aim of the study was to investigate the effects of different anesthesia techniques on oxidative stress caused by tourniquetinduced ischemia-reperfusion (IR) injury during extremity operations at children's age. Methods. The study included 45 patients American Society of Anesthesiologists (ASA) classification I or II, 8 to 17 years of age, undergoing orthopedic procedures that required bloodless limb surgery. The children were randomized into three groups of 15 patients each: general inhalational anesthesia with sevoflurane (group S), total intravenous anesthesia with propofol (group T) and regional anesthesia (group R). Venous blood samples were obtained at four time points: before peripheral nerve block and induction of general anesthesia (baseline), 1 min before tourniquet release (BTR), 5 and 20 min after tourniquet release (ATR). Postischemic reperfusion injury was estimated by measurement of concentration of malondialdehyde (MDA) in plasma and erythrocytes as well as catalase (CAT) activity. Results. Plasma MDA concentration in the group S was significantly higher at 20 min ATR in comparison with the groups T and R (6.78 ? 0.33 ?molL-1-1 vs 4.07 ? 1.53 and 3.22 ? 0.9. ?molL-1-1, respectively). There was a significant difference in MDA concentration in erytrocythes between the groups S and T after 5 min of reperfusion (5.88 ? 0.88 vs 4.27 ? 1.04 nmol/mlEr, p < 0.05). Although not statistically significant, CAT activity was slightly increased as compared to baseline in both groups S and R. In the group T, CAT activity decreased at all time points when compared with baseline, but the observed decrease was only statistically significant at BTR (34.70 ? 9.27 vs 39.69 ? 12.91 UL-1, p < 0.05). Conclusion. Continuous propofol infusion and regional anesthesia techniques attenuate lipid peroxidation and IR injury connected with tourniquet application in pediatric extremity surgery.

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