Comparison of efficacy of lignocaine, ropivacaine, and bupivacaine in pain control during extraction of mandibular posterior teeth

Partial Parotidectomy under Local Anaesthesia without Regional Block Assisted by Electromyographic Facial Nerve Monitoring - A Case Report

The Rationale

This study describes a partial parotidectomy (PP) under local anaesthesia (LA) without regional block (LAwRB) assisted by electromyographic monitoring of the facial nerve, to consolidate the feasibility, efficacy and safety of these procedures without general anaesthesia (GA).

Patient Concerns

An 82-year-old with a lump in the left parotid gland suspected for non-Hodgkin lymphoma (NHL) needed a histological examination to start chemotherapy.

Diagnosis and Treatments

Because of multiple comorbidities, the authors performed a PP under LAwRB electromyographically guided by the NIM Vital (Medtronic)™.

Outcomes

The procedure was quick and did not require conversion to GA. The histopathological examination confirmed the NHL. No haematoma, sialocoele, earlobe numbness and transient or permanent facial palsy were observed.

Take-Away Lessons

The electrophysiologic monitoring of the facial nerve improves the efficacy, safety and feasibility of parotid surgery under LA, avoiding adverse effects of GA, need of regional block and reducing hospital stay.

Enhanced Recovery after Surgery (ERAS) in DIEP-Flap Breast Reconstructions-A Comparison of Two Reconstructive Centers with and without ERAS-Protocol

Enhanced recovery after surgery (ERAS) is established for autologous breast reconstruction. ERAS leads to a shortened hospital stay and improved outcome after elective surgery. In this retrospective, two-center case−control study, we compared two different treatment regimens for patients undergoing a DIEP-flap breast reconstruction from two centers, one with an established ERAS protocol and one without. All patients with DIEP breast reconstructions over the period of 12 months were included. The primary outcome measure was the length of hospital stay (LOS) in days. A total of 79 patients with 95 DIEP-flaps were analyzed. In group A (ERAS) 42 patients were operated with DIEP flaps, in group B (non-ERAS) 37 patients. LOS was significantly reduced in the ERAS group (4.51 days) compared to the non-ERAS group (6.32; p < 0.001). Multivariate analysis showed that, in group A, LOS is significantly affected by surgery duration. BMI in the ERAS group had no effect on LOS. In group B a higher BMI resulted in a significantly higher LOS. In multivariate analysis, neither age nor type for surgery (primary/secondary/after neoadjuvant therapy, etc.) affected LOS. In both groups, no systemic or flap-related complications were observed. Comparing two reconstructive centers with and without implemented ERAS, ERAS led to a significantly decreased LOS for all patients. ERAS implementation does not result in an increased complication rate or flap loss. Postoperative pain can be well managed with basic analgesia using NSAID when intraoperative blocks are applied. The reduced use of opioids was well tolerated. With implementation of ERAS the recovery experience can be enhanced making autologous breast reconstructions more available and attractive for various patients.