Regional Anaesthesia
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Pratibha Deshmukh ◽  
Parag Sable ◽  
Priyanka Deshmukh ◽  
Vivek Chakole

Currently we are at the peak of the second wave of pandemic.  Availability of beds & oxygen is at nadir. The patients coming to us for surgery are the ones where surgery cannot wait. Mainly the load is obstetric. As a matter of COVID pandemic policy we are using regional anaesthesia unless contraindicated or the surgery demands general anaesthesia. The aim is to avoid/reduce aerosolization which is part & parcel of GA, despite the efforts to minimise it. The policy is to protect the anaesthesiologists, surgeons, OT staff & other patients as well. The present manuscript is to review the role of regional anaesthesia & its safe performance.

Mohd Rahmat Bin Abd Hamid ◽  
Marzida Binti Mansor ◽  
Mohd Fitry Bin Zainalabdin

In this study, the effects of music therapy on anxiety for patients undergoing regional anaesthesia in an operating room was succinctly investigated. This investigation was largely based on the adapted Hospital Anxiety and Depression Score (HADS) and Spielberger State-Trait Anxiety Inventory (STAI-S), of patients undergoing regional anaesthesia in an operating room. A randomized control trial was performed on 90 patients due for surgery. The selected patients for regional anaesthesia were allocated to either the music therapy group who listened to music using headphones for the entire surgery or the no-treatment control group. Based on the findings, it has been conclusively demonstrated that music can decrease the patient's anxiety level. According to the socio-demographic evaluation, elderly patients have the highest stress hormones levels when compared to young patients. Although elderly patients are more likely to choose religious songs to help them relax, cortisol analysis revealed an increase in cortisol levels among the elderly compared with younger patients. As a result, music is especially important to be delivered to elderly patients. Nonetheless, there is no restriction against administering music to elderly patients because evidence from the Hospital Anxiety and Depression Score (HADS) and State-Trait Anxiety Inventory (STAI-S) has shown that music helps to shift their attention away from pain and complications and makes them feel tranquil. Similarly, the HADS and modified Spielberger STAI (STAI-S) analyses demonstrate a substantial outcome for both groups, with respondents responding positively. The study found that listening to music during regional anaesthesia might help people feel less worried.

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047113
Jacques Simon Lee ◽  
Tina Bhandari ◽  
Robert Simard ◽  
Marcel Emond ◽  
Claude Topping ◽  

ObjectivesPoint-of-care ultrasound-guided regional anaesthesia (POCUS-GRA) provides safe, rapid analgesia for older people with hip fractures but is rarely performed in the emergency department (ED). Self-perceived inadequate training and time to perform POCUS-GRA are the two most important barriers. Our objective is to assess the feasibility of a proposed multicentre, stepped-wedge cluster randomised clinical trial (RCT) to assess the impact of a knowledge-to-practice (KTP) intervention on delirium.DesignOpen-label feasibility study.SettingAn academic tertiary care Canadian ED (annual visits 60 000).ParticipantsEmergency physicians working at least one ED shift per week, excluding those already performing POCUS-GRA more than four times per year.InterventionA KTP intervention, including 2-hour structured training sessions with procedure bundle and email reminders.Primary and secondary outcome measuresThe primary feasibility outcome is the proportion of eligible physicians that completed training and subsequently performed POCUS-GRA. Secondary outcome is the time needed to complete POCUS-GRA. We also test the feasibility of the enrolment, consent and randomisation processes for the future stepped-wedge cluster RCT (NCT02892968).ResultsOf 36 emergency physicians, 4 (12%) were excluded or declined participation. All remaining 32 emergency physicians completed training and 31 subsequently treated at least one eligible patient. Collectively, 27/31 (87.1%) performed 102 POCUS-GRA blocks (range 1–20 blocks per physician). The median (IQR) time to perform blocks was 15 (10–20) min, and reduction in pain was 6/10 (3–7) following POCUS-GRA. There were no reported complications.ConclusionOur KTP intervention, consent process and randomisation were feasible. The time to perform POCUS-GRA rarely exceeded 30 min, Our findings reinforce the existing data on the safety and effectiveness of POCUS-GRA, mitigate perceived barriers to more widespread adoption and demonstrate the feasibility of trialling this intervention for the proposed stepped-wedge cluster RCT.Trial registration #02892968

2021 ◽  
Uzodimma Ejike Onwuasoanya

Abstract IntroductionThe diagnosis of bilateral varicocele and sub-acute appendicitis co-existing in the same patient is rare and we report the management of a patient who presented to Lily Hospitals Limited, Warri, Delta State, Nigeria with both recurrent right iliac fossa pain and scrotal pain.Case presentation A 27 year old male who presented with recurrent scrotal pain of 3 years duration and recurrent right iliac fossa pain of 2 years duration. Following evaluation, the diagnosis of bilateral varicocele and sub-acute appendicitis was made and he subsequently had open bilateral inguinal varicocelectomy and open appendicectomy at the same sitting under regional anaesthesia. He had uneventful post-operative recovery and was subsequently discharged.ConclusionA thorough evaluation of patients presenting with scrotal and right iliac fossa pains is invaluable to avoid missing the diagnosis of both bilateral varicocele and appendicitis when they co-exist in the same patient.

2021 ◽  
Vol 46 ◽  
pp. 103132
A. Hassan ◽  
J. Neely ◽  
B. Parizkova ◽  
M.E. Jones ◽  
J.A. Pickett

2021 ◽  
Vol 46 ◽  
pp. 103005
M. Nana ◽  
H. Morgan ◽  
S. Moore ◽  
Z. Lee ◽  
E. Ang ◽  

2021 ◽  
Vol 8 (6) ◽  
pp. 1854
Sumit Kumar Gupta ◽  
Arpit Garg ◽  
Sirisha Anne ◽  
Ajit Bhardwaj

Background: The number of breast cancer surgeries in India are increasing in the recent years. Lifestyle changes and increased awareness are the two important factors contributing to the same. Newer methods of anaesthetic management are also being practised for overall benefit of the patient. Recent advances in the regional anaesthesia techniques especially under the guidance of ultrasonography, dramatically changed not only the operative outcomes but also the post-operative stay in the hospital. The present study was aimed to bring out differences between two popular options of opioid sparing regional anaesthesia techniques for post-operative analgesia for patients who had undergone modified radical mastectomy (MRM) for carcinoma breast at our centre.Methods: A total of 88 patients of ASA II and III grading were enrolled in the study who had received either of erector spinae plane block (ESB) or thoracic paravertebral block (TPVB). Post-op numerical rating scale for pain and analgesic requirements were compared between the two groups. Hemodynamic parameters were recorded for comparing the influence of the blocks on hemodynamics.Results: The demographic profile was similar between the 2 groups. The study showed that TPVB have a higher efficacy of analgesia when compared with that of ESB. However, there is no significant differences in the intra-op and post-op hemodynamics.Conclusions: In view of a higher safety profile of ESB, administration of the same may still be preferred over the TPVB especially in those with less experienced hands in patients undergoing modified radical mastectomy.

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