A Novel Technique to Reduce Reliance on Opioids for Analgesia from Acute Appendicitis: The Ultrasound-guided Erector Spinae Plane Block

Single injection, ultrasound-guided nerve blocks have drastically changed the multimodal approach to pain management of the acutely injured patient in the emergency department (ED). Ultrasound-guided femoral nerve blocks in the ED have become standard aspects of multiple, hospital system pain management protocols, with early evidence demonstrating improved patient outcomes. Developing a multimodal pain management strategy can improve analgesia while reducing reliance on opioids in this era of opioid addiction.1 The single injection, ultrasound-guided erector spinae plane (ESP) block is a technique safely used for pain control for rib fractures that can be easily performed at the bedside and integrated into optimal emergency care. A more inferiorly located ultrasound-guided ESP block has been recently described in the anesthesia literature for perioperative pain control for various abdominal surgeries but has not yet been described for patients with acute appendicitis. Here we describe a single injection, lower ESP block performed by emergency physicians that successfully alleviated pain from acute appendicitis in an ED patient awaiting definitive surgical treatment. Along with allowing clinicians to actively manage pain without reliance on opioids, this novel ED technique may improve patient care outcomes.

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Pain Management After Hip Arthroscopy: Systematic Review of Randomized Controlled Trials and Cohort Studies

The American Journal of Sports Medicine ◽

10.1177/0363546517734518 ◽

2017 ◽

Vol 46 (13) ◽

pp. 3288-3298 ◽

Cited By ~ 18

Author(s):

Jason J. Shin ◽

Chris L. McCrum ◽

Craig S. Mauro ◽

Dharmesh Vyas

Keyword(s):

Systematic Review ◽

Pain Management ◽

Postoperative Pain ◽

Hip Arthroscopy ◽

Pain Control ◽

Femoral Nerve ◽

Lumbar Plexus ◽

Nerve Blocks ◽

Fascia Iliaca Block ◽

Plexus Block

Background: Hip arthroscopy is often associated with significant postoperative pain and opioid-associated side effects. Effective pain management after hip arthroscopy improves patient recovery and satisfaction and decreases opioid-related complications. Purpose: To collect, examine, and provide a comprehensive review of the available evidence from randomized controlled trials and comparative studies on pain control after hip arthroscopy. Study Design: Systematic review. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature for postoperative pain control after hip arthroscopy was performed using electronic databases. Only comparative clinical studies with level 1 to 3 evidence comparing a method of postoperative pain control with other modalities or placebo were included in this review. Case series and studies without a comparative cohort were excluded. Results: Several methods of pain management have been described for hip arthroscopy. A total of 14 studies met our inclusion criteria: 3 on femoral nerve block, 3 on lumbar plexus block, 3 on fascia iliaca block, 4 on intra-articular injections, 2 on soft tissue surrounding surgical site injection, and 2 on celecoxib (4 studies compared 2 or more methods of analgesia). The heterogeneity of the studies did not allow for pooling of data. Single-injection femoral nerve blocks and lumbar plexus blocks provided improved analgesia, but increased fall rates were observed. Fascia iliaca blocks do not provide adequate pain relief when compared with surgical site infiltration with local anesthetic and are associated with increased risk of cutaneous nerve deficits. Patients receiving lumbar plexus block experienced significantly decreased pain compared with fascia iliaca block. Portal site and periacetabular injections provide superior analgesia compared with intra-articular injections alone. Preoperative oral celecoxib, compared with placebo, resulted in earlier time to discharge and provided significant pain relief up to 24 hours. Conclusion: Perioperative nerve blocks provide effective pain management after hip arthroscopy but must be used with caution to decrease risk of falls. Intra-articular and portal site injections with local anesthetics and preoperative celecoxib can decrease opioid consumption. There is a lack of high-quality evidence on this topic, and further research is needed to determine the best approach to manage postoperative pain and optimize patient satisfaction.

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Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations

Minerva Anestesiologica ◽

10.23736/s0375-9393.19.13145-8 ◽

2019 ◽

Vol 85 (7) ◽

Cited By ~ 4

Author(s):

Theodosios Saranteas ◽

Iosifina Koliantzaki ◽

Olga Savvidou ◽

Marina Tsoumpa ◽

Georgia Eustathiou ◽

...

Keyword(s):

Pain Management ◽

Peripheral Nerve ◽

Acute Pain ◽

Ultrasound Guided ◽

Acute Pain Management ◽

Nerve Blocks ◽

Peripheral Nerve Blocks

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Ultrasound-guided thoracic wall nerve blocks for effective pain control in cardiac surgery

Minerva Anestesiologica ◽

10.23736/s0375-9393.20.14368-2 ◽

2020 ◽

Vol 86 (6) ◽

Author(s):

Giuseppe Sepolvere ◽

Mario Tedesco ◽

Pierfrancesco Fusco ◽

Paolo Scimia ◽

Loredana Cristiano

Keyword(s):

Cardiac Surgery ◽

Pain Control ◽

Thoracic Wall ◽

Ultrasound Guided ◽

Nerve Blocks

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Pain management practice patterns after hip arthroscopy: an international survey

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa050 ◽

2020 ◽

Author(s):

Flávio L Garcia ◽

Brady T Williams ◽

Bhargavi Maheshwer ◽

Asheesh Bedi ◽

Ivan H Wong ◽

...

Keyword(s):

Pain Management ◽

Hip Arthroscopy ◽

Pain Control ◽

Sports Medicine ◽

Management Practice ◽

Professional Organizations ◽

International Survey ◽

Nerve Blocks ◽

Optimal Approach ◽

Answer Choice

Abstract Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons’ responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as > 80% of respondents selecting a single answer choice, while general agreement was defined as >60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.

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