Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block

Background Continuous peripheral nerve catheters (PNCs) have been shown to provide superior postoperative analgesia, decrease opioid consumption, and improve patient satisfaction compared with single injection techniques. In order to achieve success and reliability, accurate catheter positioning is an essential element of PNC placement. An agitated solution of normal saline, D5W, or a local anesthetic solution can be produced by the introduction of air to the injectate, creating air bubbles that can enhance ultrasonographic visualization and possibly improve block success. Methods Eighty-three patients were enrolled. Ultrasound-guided continuous popliteal sciatic nerve blocks were performed by positioning the tip of a Tuohy needle between the tibial and common peroneal branches of the sciatic nerve and threading a catheter. An agitated local anesthetic solution was injected through the catheter, viewed with color Doppler ultrasound and video recorded. A peripheral block score (lower score = greater blockade, range 0-14) was calculated based upon the motor and sensory testing at 10, 20, and 30 min after block completion. The color Doppler agitation coverage pattern for the branches of the sciatic nerve was graded as follows: complete (> 50%), partial (> 0%, ≤ 50%), or none (0%). Results The degree of nerve blockade at 30 min as judged by median (10th, 90th percentile) peripheral block score was significant for partial or complete color Doppler coverage of the sciatic nerve injectate compared to no coverage [3 (0, 7) vs 8 (4, 14); p < 0.01] and block onset was faster (p = 0.03). The block success was higher in groups with partial or complete coverage of the branches of the sciatic nerve vs no coverage (96% vs 70%; p = 0.02). Conclusions Injection of an agitated solution through a popliteal sciatic perineural catheter is predictive of accurate catheter placement when partial or complete coverage of the sciatic nerve branches is visualized with color Doppler ultrasound. Trial registration NCT01591603

Color Doppler Ultrasonography of an Agitated Solution is Predictive of Accurate Catheter Placement for a Continuous Popliteal Sciatic Nerve Block

Background: Continuous peripheral nerve catheters (PNCs) have been shown to provide superior postoperative analgesia, decrease opioid consumption, and improve patient satisfaction compared with single injection techniques. In order to achieve success and reliability, accurate catheter positioning is an essential element of PNC placement. An agitated solution of normal saline, D5W, or a local anesthetic solution can be produced by the introduction of air to the injectate, creating air bubbles that can enhance ultrasonographic visualization and possibly improve block success.Methods: Eighty-three patients were enrolled. Ultrasound-guided continuous popliteal sciatic nerve blocks were performed by positioning the tip of a Tuohy needle between the tibial and common peroneal branches of the sciatic nerve and threading a catheter. An agitated local anesthetic solution was injected through the catheter, viewed with color Doppler ultrasound and video recorded. A peripheral block score (lower score = greater blockade, range 0-14) was calculated based upon the motor and sensory testing at 10, 20, and 30 minutes after block completion. The color Doppler agitation coverage pattern for the branches of the sciatic nerve was graded as follows: complete (> 50%), partial (> 0%, ≤ 50%), or none (0%).Results: The degree of nerve blockade at 30 minutes as judged by median (10 th, 90 th percentile) peripheral block score was significant for partial or complete color Doppler coverage of the sciatic nerve injectate compared to no coverage [3 (0, 7) vs 8 (4, 14); p < 0.01] and block onset was faster (p = 0.03). The block success was higher in groups with partial or complete coverage of the branches of the sciatic nerve vs no coverage (96% vs 70%; p = 0.02).Conclusions: Injection of an agitated solution through a popliteal sciatic perineural catheter is predictive of accurate catheter placement when partial or complete coverage of the sciatic nerve branches is visualized with color Doppler ultrasound.Trial Registration: NCT01591603

Amount of Local Anesthetic Solution Used in Mandibular Third Molar Surgery- A Retrospective Analysis

Mandibular third molar is the most commonly impacted teeth and surgical removal of them is the most common minor oral surgical procedure done under local anesthesia in the outpatient department. For a comfortable patient experience and best surgical results, emphasis should be made on a pain-free procedure. In this study, we aim to analyse retrospectively the amount of local anesthetic solution used during surgical removal of impacted mandibular third molar and to find if any association between the amount of local anesthesia used and Pederson's difficulty Index (PDI) of the impacted teeth. Retrospective observational study conducted among patients reporting to the Department of Oral and Maxillofacial Surgery, Chennai for the surgical removal of impacted mandibular third molar between the study period June 2019 to March 2020. 658 patients who fulfilled the inclusion and exclusion criteria were included in the study. Data regarding patients demography, site of impaction, Pederson Difficulty Index of impacted teeth, amount of local anesthesia used were rewarded. The data were statistically analysed using descriptive statistics in IBM SPSS version 20 software. Study population included 58.4% males and 41.6% females, majority of them in the 3rd decade of life. (53.6%) with mean age 29.1 years. Of 658 impacted teeth analysed 54.4% were moderately difficult followed by minimally difficult 38.4% and very difficult 7.1% according to PDI. A significant association was found between the amount of local anesthesia used and PDI score of impacted teeth. In 64.7% cases 2ml of local anesthesia was sufficient to achieve anesthesia during the procedure. 2ml of local anesthesia is sufficient to achieve adequate anesthetic effect in surgical removal of impacted molar. As PDI increased, the amount of local anesthesia used also increased.

Comparative area of desensitiztion by three different volumes of local anesthetic solution for paravertebral block

Aim and objectives: Ropivacaine is the drug of choice when we need more sensory block and less motor block. It also has a good safety margin. The anesthesiologists have been using rough formulas to determine the volume of the drug for the desired spread. We conducted this study to determine the area distribution of paravertebral block (PVB) using three different volumes of ropivacaine.

Anesthetic challenges in a large multinodular thyroidectomy at a peripheral hospital

We present a case of large multinodular goiter with retrosternal extension scheduled for thyroidectomy under general anesthesia (GA). We anticipated difficult airway due to tracheal compression as well as perioperative hemodynamic instability. She had had hyperthyroidism previously, which had been treated successfully. We planned and prepared to encounter airway problems in the light of Difficult Airway Society guidelines. After counselling and consent, her upper airways were sprayed with local anesthetic solution. Awake, flexible fiberoptic nasal intubation was performed and GA was induced. She had two episodes of bradycardia and hypotension peri-operatively, which were treated with inj atropine. Tracheostomy was performed in anticipation of tracheomalacia, which was de-cannulated on 3rd postoperative day. She was discharged on 4th post-operative day.Citation: Ikram M, Mahboob S. Anesthetic challenges in a large multinodular thyroidectomy at a peripheral hospital. Anaesth pain & intensive care 2019;23(3):311- 313

Role of Caudal Blockade in the Modulation of Stress Response in the Surgical Correction of Congenital Malformations of the Lower Parts of the Urogenital System in Children

Objective: to assess the efficiency and safety of an anesthetic technique during the surgical correction of congenital malformations of the lower departments of the urogenital system in children by means of the comparative analysis of laboratory and hemodynamic indices, as well as the course of the early postoperative period, development of adverse effects during the anesthesia.Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with a local anesthetic solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of a local anesthetic solution and adjuvant (group 3, n = 45).Results. The performed analysis of the parameters of hemodynamics, levels of cortisol, glucose, lactate and interleukin-6 (IL-6), as well as the quality, duration, depth of anesthesia and the necessity for an inhalation anesthetic, the assessment of complications and the adverse effects have revealed statistically significant differences indicative of a more effective blockade of the pain sensitivity in the combined application of general and regional anesthesia.Conclusion. The technique of combined anesthesia with the application of the combination of 0.25 % bupivacaine solution and adjuvant to 0.1 % morphine has shown the best efficiency and safety during the surgical correction of congenital malformations of the lower departments of the urogenital system in the children.

ACCIDENTAL INTRA-ORAL INJECTION OF XYLENE INSTEAD OF LOCAL ANESTHETIC AGENT IN ENDODONTIC RETREATMENT

There have been quite a few case reports of organic solvents accidentally being injected into the oral cavity during dental procedures. These solvents,which should be used with caution mostly are clear liquids which gets confused with local anesthetic solutions when not kept in proper container and thus accidents happen.There have been reports of sodium hypochlorite,chloroform being pushed as local anesthetic solution in the oral cavity.In a first of its kind report,here we discuss the accidental intra-oral injection of xylene being used for guttapercha solvent instead of local anesthetic agent and its management.