Spinal Myoclonus after Sub-Arachnoid Block

Spinal myoclonus is a rare and less known sequel e after central neuraxial blocks and hereby we present a case of 68 yrs old lady undergoing removal of infected femur implant under sub-arachnoid block (SAB), developing myoclonus after the procedure ended but before regression of block. It was treated successfully with an infusion of lignocaine and magnesium sulphate. The patient was called in for follow-up after one week and had no any complains thereafter. Keywords: Spinal myoclonus, sub-arachnoid block, neuraxial block

Integrating ultrasound with the combined spinal-epidural kit as a rescue technique during difficult spinal anaesthesia

Conducting spinal anaesthesia in patients with elevated body mass index is commonly difficult, yet there are no guidelines to direct best practice. Landmark techniques are sometimes insufficient, leading to increased failure rates and suboptimal patient outcomes. Although ultrasound-guided techniques are now considered standard care for central venous access and regional anaesthesia, there has been relatively sparse uptake of this widely available resource for central neuraxial block, despite evidence of its efficacy.This article outlines a successful case of ultrasound-assisted spinal anaesthesia, after landmark techniques failed, in conjunction with a combined spinal-epidural kit. This unique combination of techniques has not been published as an amalgamated rescue strategy for difficult spinal anaesthesia. This article adds to current evidence by highlighting the potential benefits of combining these techniques into a novel approach either when difficulties are expected or as a rescue technique after failed landmark-based attempts.

Perineural versus Systemic Dexamethasone to Prolong Analgesia after ultrasound guided Inter-Scalene Brachial Plexsus Block in Arthroscopic Shoulder Surgeries

Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuraxial block is used for postoperative pain management and decrease analgesic use. Objective To compare the analgesic duration of intravenous and perineural administration of Dexamethasone in interscalene block during arthroscopic shoulder surgery. Patients and Methods Interventional randomized Double-Blind Study. This study was conducted in Ain Shams University Hospitals’ operating rooms throughout six months. In our study, 60 patients were randomly divided into two equal groups: Group A (30 patients) Block with 20 ml Bupivacaine 0.5% (+ 2 ml Dexamethasone ‘8 mg’) & 5 ml normal saline was injected IV. Group B (30 patients) Block with 20 ml Bupivacaine 0.5% (+ 2 ml normal saline) & 5 ml Dexamethasone ‘8 mg’ was injected IV. Results Our study showed that addition of 8 mg dexamethasone to bupivacaine in interscalene brachial plexus nerve block prolongs post-operative analgesia & reduced numbers of rescue analgesia doses more than injecting dexamethasone intravenously. Conclusion Addition of perineural dexamethasone to bupivacaine in interscalene brachial nerve block prolongs post-operative analgesia & reduced numbers of rescue analgesia doses more than injecting dexamethasone intravenously. Dexamethasone was seen to be a potent adjunct to local anaesthetic to prolong post-operative analgesia with negligible side effects.

EVALUATION OF PREDICTORS FOR DIFFICULT LUMBAR NEUROAXIAL BLOCK BY USING ULTRASONOGRAPHY

Introduction: The neuraxial block, whether spinal or epidural, is commonly used as an anesthetic technique for the performance of surgeries or the treatment of chronic pain. In studies carried out, described by authors such as Kallidaikurichi et al and Grau et al, it has been shown that even experienced anesthesiologists are able to find the adequate intervertebral space in only 29% of patients who undergo this type of anesthetic procedure. Objectives: To determine the association of ultrasonographic parameters with the technical difficulty of lumbar neuraxial block, in patients undergoing elective surgery. Take ultrasound measurements that include the distance between the skin and the spinous process of L1, L2, L3, L4 and L5. To determine whether the presence of the yellow ligament and / or the posterior longitudinal ligament could be visualized by ultrasound. Assess whether there was concordance between the level determined by the palpation technique of anatomical landmarks and the ultrasound examination. Classify the level of difficulty of the neuraxial block based on the number of punctures, as well as the number of redirections of the needle during blocking. Method: This study included 45 electronic records of patients who underwent elective surgery at the Naval Medical Center in a period from May 2019 to May 2020 and whose anesthesia technique included Lumbar Neuroaxial Block and who also underwent a ultrasonographic tracking for the collection of anatomical data. Results: The results obtained in the analysis of these were not significant for the general objective of our study, however they helped us to conclude that the space referred by anesthesiologists and the one actually approached agrees only in 68.9%. Conclusions: Performing ultrasonography prior to performing BNA can improve its performance.

Lower Segment Cesarean Section for Guillain- Barre Syndrome - A Novel Anaesthetic Technique

Introduction: Guillain Barre Syndrome in pregnant ladies, undergoing cesarean section, has not yet reported in Nepal. Anaesthetic management of 15 patients with Guillain Barre Syndrome who underwent lower segment cesarean section at Nobel Medical College Teaching Hospital is reported here. Objective: The purpose of this study is to assess the benefits of Rectus sheath nerve block along with infiltration of retropubic space of Retzius in Guillain Barre syndrome patients planned for lower segment cesarean section (LSCS). Methodology: During the period from 1st August 2015 to 31st April 2020 at NMCTH, a retrospective descriptive analysis of 15 pregnant ladies with Guillain Barre Syndrome who underwent lower segment cesarean section under Rectus sheath nerve block along with Retro pubic space of Retzius, infiltration and visceral peritoneum infiltration is discussed. Result: Considering Surgeons opinion about the operating conditions like Relaxation, Straining, Coughing, Bucking, Satisfactory to good operative conditions were reported. Excellent to good satisfaction was expressed by 39.9% of patients, 60% patients reported satisfactory. Hypotension and Arrhythmias was seen in 2 patients. Diaphoresis was seen in 1 patient. Fetomaternal outcome was good. There was no mortality. Conclusion: Rectus sheath block along with infiltration of retro pubic space of Retzius block can be considered as a good alternative to general anaesthesia or neuraxial block incase where general anesthesia & neuraxial block is risky or contraindicated for lower segment cesarean section in patients with Guillain Barre Syndrome.

Bilateral Simultaneous Anterior Ischemic Optic Neuropathy following Total Knee Arthroplasty with Epidural Block

Ischemic optic neuropathy (ION) resulting in perioperative vision loss (POVL) is a rare occurrence following nonocular procedures. Bilateral simultaneous anterior ION (AION) is even rarer, and no cases have been reported after central neuraxial block. We report a case of bilateral simultaneous AION, confirmed by multimodal imaging, in a 66-year-old male patient who underwent total knee arthroplasty under epidural anesthesia in which episodes of hypotension—one intraoperatively and one late postoperatively—had occurred. Hypotension is the most common adverse effect to epidural block, and counseling about POVL should extend beyond general anesthesia to include those undergoing procedures with central neuraxial block.