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Sun G, Atary J, Raju AV, Pozek JPJ, Schwenk ES. Sometimes less is more when it comes to peripheral nerve blocks. J Clin Anesth 2024; 94:111376. [PMID: 38306829 DOI: 10.1016/j.jclinane.2024.111376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/04/2024]
Affiliation(s)
- George Sun
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jordan Atary
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Abhinav V Raju
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66103, USA
| | - John-Paul J Pozek
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66103, USA
| | - Eric S Schwenk
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Lee YC, Brake T, Zhao E, Dumitrescu A, Lee W, Tassie B, Khor KE, Wang AYY. The use of interventional procedures for cancer pain. A brief review. Support Care Cancer 2024; 32:285. [PMID: 38607568 PMCID: PMC11009760 DOI: 10.1007/s00520-024-08467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
CONTEXT Pain is a common experience in people living with cancer. Concerns around opioid prescribing have seen a move toward a multi-modality management approach, which includes interventional pain procedures. PURPOSE In this paper we discuss the interventional pain procedures used to treat cancer pain at two major tertiary centers in Australia. METHODS AND RESULTS This expert review provides practical insights on cancer pain management from healthcare providers in different specialties. These insights can be used to guide the management of a wide range of cancer pain types. CONCLUSIONS Furthermore, this review identifies the need for a systematic and comprehensive approach to the management of cancer pain that is broader than that of a single specialty. With recent advances in pain management procedures, an interdisciplinary approach is essential in order to provide an up to date, patient tailored approach to pain management. This review will help inform the development of a cancer pain intervention registry.
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Affiliation(s)
- Yi-Ching Lee
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia.
- Department of Anaesthetics and Pain Service, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
- School of Medicine, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Timothy Brake
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia
- School of Medicine, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - Emma Zhao
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia
- Department of Anaesthetics and Pain Service, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Nursing School, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - Alix Dumitrescu
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia
- School of Medicine, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
- Department of Palliative Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wei Lee
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- HammondCare, Royal North Shore Hospital, Sydney, NSW, Australia
- Northern Clinical School, University of Sydney, St Leonards, Australia
| | - Benjamin Tassie
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia
| | - Kok-Eng Khor
- Pain Management Department, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Andy Yi-Yang Wang
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia.
- Department of Anaesthetics and Pain Service, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
- School of Medicine, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
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Luebbert E, Rosenblatt MA. Postoperative Rebound Pain: Our Current Understanding About the Role of Regional Anesthesia and Multimodal Approaches in Prevention and Treatment. Curr Pain Headache Rep 2023; 27:449-454. [PMID: 37389683 DOI: 10.1007/s11916-023-01136-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE OF REVIEW Rebound pain (RP) is a common occurrence after peripheral nerve block placement, especially when blocks are used for orthopedic surgery. This literature review focuses on the incidence and risk factors for RP as well as preventative and treatment strategies. RECENT FINDINGS The addition of adjuvants to a block, when appropriate, and starting patients on oral analgesics prior to sensory resolution are reasonable approaches. Using continuous nerve block techniques can provide extended analgesia through the immediate postoperative phase when pain is the most intense. Peripheral nerve blocks (PNBs) are associated with RP, a frequent phenomenon that must be recognized and addressed to prevent short-term pain and patient dissatisfaction, as well as long-term complications and avoidable hospital resource utilization. Knowledge about the advantages and limitations of PNBs allows the anesthesiologists to anticipate, intervene, and hopefully mitigate or avoid the phenomenon of RP.
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Affiliation(s)
- Elizabeth Luebbert
- Department of Anesthesiology, Perioperative, and Pain Medicine, Mount Sinai Morningside and West Hospitals, New York, NY, USA
| | - Meg A Rosenblatt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Mount Sinai Morningside and West Hospitals, New York, NY, USA.
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Abstract
Variation in care is associated with variation in outcomes after total joint arthroplasty (TJA). Accordingly, much research into enhanced recovery efficacy for TJA has been devoted to linking standardization with better outcomes. This article focuses on recent advances suggesting that variation within a set of core protocol elements may be less important than providing the core elements within enhanced recovery pathways for TJA. Provided the core elements are associated with benefits for patients and health care system outcomes, variation in the details of their provision may contribute to a pathway's success. This article provides an updated review of the literature.
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Affiliation(s)
- Ellen M Soffin
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, 89 Holdenhurst Road, Bournemouth, Dorset BH8 8FT, UK
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Oliver JA, Oliver LA, Aggarwal N, Baldev K, Wood M, Makusha L, Vadivelu N, Lichtor L. Ambulatory Pain Management in the Pediatric Patient Population. Curr Pain Headache Rep 2022; 26:15-23. [PMID: 35129824 DOI: 10.1007/s11916-022-00999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Outpatient surgery in the pediatric population has become increasingly common. However, many patients still experience moderate to severe postoperative pain. A poor understanding of the extent of pain after pediatric ambulatory surgery and the lack of randomized control studies of pain management of the outpatient necessitate this review of scientific evidence and multimodal analgesia. RECENT FINDINGS A multimodal approach to pain management should be applied to the ambulatory setting to decrease postoperative pain. These include non-pharmacological techniques, multimodal pharmacologics, and neuraxial and peripheral nerve blocks. Postoperative pain management in pediatric ambulatory surgical patients remains suboptimal at most centers due to limited evidence-based approach to postoperative pain control. Pediatric ambulatory pain management requires a multipronged approach to address this inadequacy.
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Affiliation(s)
- Jodi-Ann Oliver
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Lori-Ann Oliver
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Nitish Aggarwal
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA.
| | - Khushboo Baldev
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Melanie Wood
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Lovemore Makusha
- Department of Anesthesiology, Stanford University, Pao Alto, CA, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
| | - Lance Lichtor
- Department of Anesthesiology, Yale University, New Haven, CT, 06520, USA
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Kamel I, Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthop 2022; 13:11-35. [PMID: 35096534 PMCID: PMC8771411 DOI: 10.5312/wjo.v13.i1.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/20/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.
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Affiliation(s)
- Ihab Kamel
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Muhammad F Ahmed
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Anish Sethi
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
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Denomme J, McCarroll K, Prabhakar C, Petrar S. Videoconferencing as a tool to improve access to regional anesthesia in remote community hospitals. Can J Anaesth 2021; 68:1836-1837. [PMID: 34498232 DOI: 10.1007/s12630-021-02097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Justine Denomme
- Department of Anesthesia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada.
| | - Kirk McCarroll
- Department of Anesthesia, Queen Victoria Hospital, Revelstoke, BC, Canada
| | - Chris Prabhakar
- Department of Anesthesia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada
| | - Steven Petrar
- Department of Anesthesia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada
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Zheng FY, Liu YB, Huang H, Xu S, Ma XJ, Liu YZ, Chu HC. The impact of IPACK combined with adductor canal block under ultrasound guidance on early motor function after total knee arthroplasty. Braz J Anesthesiol 2021; 72:110-114. [PMID: 33915199 PMCID: PMC9373452 DOI: 10.1016/j.bjane.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to evaluate the impact of Infiltration between the Popliteal Artery and Capsule of the posterior Knee (IPACK) combined with an adductor canal block under the guidance of ultrasound on early motor function after Total Knee Arthroplasty (TKA). Methods A sample of 60 cases who were scheduled for elective unilateral TKA were divided into two groups using random number table method: a group with IPACK combined with an adductor canal block (I group, n = 30), and a group with femoral nerve block combined with superior popliteal sciatic nerve block (FS group, n = 30). Before anesthesia induction was completed, the patients in I group received an ultrasound-guided adductor canal block with 15 mL of 0.375% ropivacaine and an IPACK block with 25 mL of ropivacaine, and the patients in FS group received a femoral nerve block and a superior popliteal sciatic nerve block with 20 mL of 0.375% ropivacaine under ultrasound guidance. Post-operation, all the patients received patient-controlled intravenous analgesia combined with an oral celecoxib capsule to relieve pain and maintain a visual analogue scale score of ≤ 3. Results The quadriceps femoris muscle strength score was significantly higher in Ⅰ group than in FS group (p = 0.001), while the modified Bromage score were significantly lower and walking distance results were significantly higher in Ⅰ group than in FS group (both p = 0.000). Conclusion Compared with femoral nerve block combined with superior popliteal sciatic nerve block, IPACK combined with adductor canal block had a mild impact on early motor functions after TKA.
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Affiliation(s)
- Fang-Yu Zheng
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China; Women and Children's Hospital, Qingdao University, Department of Anesthesiology, Qingdao, China
| | - Yong-Bo Liu
- The Affiliated Hospital of Qingdao University, Department of Operating Room, Qingdao, China
| | - Hui Huang
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China
| | - Shuai Xu
- The Affiliated Hospital of Qingdao University, Department of Cardiovascular Surgery Intensive Care Unit, Qingdao, China
| | - Xiao-Jun Ma
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China
| | - Ying-Zhi Liu
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China.
| | - Hai-Chen Chu
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China
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Wang Q, Yang Y, Yang Z, Hu Y, Zhao X, Chen C, Kang P. Analgesic Effects of Ultrasound-Guided Iliohypogastric/Ilioinguinal Nerve Block Combined with Lateral Femoral Cutaneous Nerve Block in Total Hip Arthroplasty via Direct Anterior Approach: A Retrospective Cohort Study. Orthop Surg 2021; 13:920-931. [PMID: 33788407 PMCID: PMC8126898 DOI: 10.1111/os.12795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 08/04/2020] [Indexed: 02/05/2023] Open
Abstract
Objective This study aimed to explore the efficacy and safety of the combination of lateral femoral cutaneous nerve blocks (LFCNB) and iliohypogastric/ilioinguinal nerve blocks (IHINB) on postoperative pain and functional outcomes after total hip arthroplasty (THA) via the direct anterior approach (DAA). Methods In this retrospective cohort study, patients undergoing THA via the DAA between January 2019 and November 2019 were stratified into two groups based on their date of admission. Sixty‐seven patients received LFCNB and IHINB along with periarticular infiltration analgesia (PIA) (nerve block group), and 75 patients received PIA alone (control group). The outcomes included postoperative morphine consumption, postoperative pain assessed using the visual analogue scale (VAS), the QoR‐15 score, and functional recovery measured as quadriceps strength, time to first straight leg rise, daily ambulation distance, and duration of hospitalization. The Oxford hip score and the UCLA activity level rating were assessed at 1 and 3 months after surgery. In addition, postoperative complications were recorded. Patients were also compared based on the type of incision used during surgery (traditional longitudinal or “bikini” incision). Results Patients in the nerve block group showed significantly lower postoperative morphine consumption, lower resting VAS scores within 12 h postoperatively, lower VAS scores during motion within 24 h postoperatively, and better QoR‐15 scores on postoperative day 1. These patients also showed significantly better functional recovery during hospitalization. At 1‐month and 3‐month outpatient follow up, the two groups showed no significant differences in Oxford hip score or UCLA activity level rating. There were no significant differences in the incidence of postoperative complications. Similar results were observed when patients were stratified by type of incision, except that the duration of hospitalization was similar. Conclusion Compared to PIA alone, a combination of LFCNB and IHINB along with PIA can improve early pain relief, reduce morphine consumption, and accelerate functional recovery, without increasing complications after THA via the DAA.
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Affiliation(s)
- Qiuru Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Yang
- Department of Orthopaedic Surgery, Karamay Municipal People's Hospital, Karamay, China
| | - Zhouyuan Yang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yunlian Hu
- Department of General Surgery, Yongchuan Hospital of Traditional Chinese Medicine, Yongchuan, China
| | - Xin Zhao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Changjun Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Pengde Kang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Singh N, Ponde V, Jagannathan B, Rao PB, Dixit A, Agarwal G. Development and validation of a Questionnaire to study practices and diversities in Plexus and Peripheral nerve blocks. Indian J Anaesth 2021; 65:197-201. [PMID: 33776109 PMCID: PMC7989482 DOI: 10.4103/ija.ija_1161_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/27/2020] [Accepted: 02/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background and Aims Regional anaesthesia techniques are a part of perioperative medicine that affects both perioperative and long-term outcomes. We have a paucity of the data on the usage and practices of plexus and peripheral nerve blocks (PNBs). To the best of our knowledge, this is the first effort to validate a survey for plexus and PNBs. Subsequently, this questionnaire could be used for the survey to look for the trends and disparities in PNB practices and further to develop a national registry in the future. Methods Thirty questions were prepared after evidence-based search and reviewed by experts for suggestions. Changes were done and the questionnaire with the grading sheet was sent to 19 experts. The responses were analysed to calculate the content validity index (CVI) item-wise (I-CVI), scale-wise (S-CVI), and modified kappa statistics. The I-CVI of 0.78 and an S-CVI/average of 0.90 was taken as acceptable with more than six experts. Results Fourteen experts out of 19 assessed and graded the questions as per the provided sheet and submitted suggestions through the mail. Question reframing, option reconsideration, and change from single to multiple choices were incorporated as per the suggestions of the experts. Mean I-CVI for relevance, simplicity, clarity, and ambiguity was 0.99, 0.98, 0.98, and 0.99, respectively. S-CVI/average was 0.98, 0.97, 0.98, and 0.99 for relevance, simplicity, clarity, and ambiguity, respectively. Conclusion We conclude that this questionnaire has met the content validity criteria and can be used to study plexus and PNBs practices.
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Affiliation(s)
- Neha Singh
- Department of Anaesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | - Vrushali Ponde
- Department of Anaesthesia, Surya Children Hospital, Mumbai, Maharashtra, India
| | | | - Parnandi B Rao
- Department of Anaesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | - Amit Dixit
- Department of Anaesthesia, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Gaurav Agarwal
- Department of Anaesthesia, Care Hospital, Bhubaneswar, Odisha, India
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11
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Shapiro DM, Ye Y, Burnett G, Zerillo J, Chen D, Jeng CL. Broken peripheral nerve block needles with considerations and recommendations. J Clin Anesth 2019; 60:17-18. [PMID: 31437592 DOI: 10.1016/j.jclinane.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/25/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- David M Shapiro
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Ying Ye
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Garrett Burnett
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jeron Zerillo
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Darwin Chen
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Christina L Jeng
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Abstract
Although enhanced recovery pathways were initially implemented in inpatients, their principles are relevant in the ambulatory setting. Opioid minimization and addressing pain and nausea through multimodal analgesia, regional anesthesia, and robust preoperative education programs are integral to the success of ambulatory enhanced recovery programs. Rather than measurements of length of stay as in traditional inpatient programs, the focus of enhanced recovery programs in ambulatory surgery should be on improved quality of recovery, pain management, and early ambulation.
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Affiliation(s)
- Anoushka M Afonso
- Enhanced Recovery Programs (ERP), Department of Anesthesiology & Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M-301, New York, NY 10065, USA.
| | - Hanae K Tokita
- Department of Anesthesiology & Critical Care, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Patrick J McCormick
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Rebecca S Twersky
- Department of Anesthesiology & Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, 1133 York Avenue, Suite 312, New York, NY 10065, USA
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Abstract
Proper pain control is critical for ambulatory surgery. Regional anesthesia can decrease postoperative pain, improve patient satisfaction, and expedite patient discharge. This article discusses the techniques, clinical pearls, and potential pitfalls associated with those blocks, which are most useful in an ambulatory perioperative setting. Interscalene, supraclavicular, infraclavicular, axillary, paravertebral, erector spinae, pectoralis, serratus anterior, transversus abdominis plane, femoral, adductor canal, popliteal, interspace between the popliteal artery and capsule of the knee, and ankle blocks are described.
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Affiliation(s)
- Alberto E Ardon
- Department of Anesthesiology, University of Florida Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA.
| | - Arun Prasad
- Department of Anesthesiology, University of Toronto, Women's College Hospital, Mc L 2-405, 399, Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Robert Lewis McClain
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - M Stephen Melton
- Department of Anesthesiology, Duke University Medical Center, Duke University Medical Center, DUMC Box #3094, Stop #4, Durham, NC 27710, USA
| | - Karen C Nielsen
- Department of Anesthesiology, Duke University Medical Center, Duke University Medical Center, DUMC Box #3094, Stop #4, Durham, NC 27710, USA
| | - Roy Greengrass
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Abstract
PURPOSE OF REVIEW Cancer pain is often incapacitating and discouraging to patients; is demoralizing to family members and care takers; and is taxing and difficult to subdue for the pain specialists. The consequences of implementing suboptimal treatment are far-reaching; therefore, effective treatment methods are in a great demand. The face of cancer pain management has changed in considerable ways, and interventional procedures have become an integral part of providing multimodal analgesia in cancer pain treatment. The goals of this review are to draw attention to the critical role that regional anesthetic nerve blocks and interventional pain management techniques play in treating malignancy-related pain and emphasize the benefits provided by the aforementioned treatment strategies. RECENT FINDINGS A large proportion of cancer patients continues to struggle with an inadequately treated pain despite a strict adherence to the WHO analgesic step ladder. The previous pain treatment algorithm has been modified to include peripheral neural blockade, neuro-destructive techniques, neuromodulatory device use, and intrathecal drug delivery systems. The accumulated evidence highlights the opioid-sparing qualities and other benefits afforded by these modalities: decreasing medication-induced side effects, reducing economic burden of poor analgesia, and overall improvement in quality of life of the patients afflicted with a painful neoplastic disease. The rising prevalence of cancer-related pain syndromes is paralleled by an unmatched growth of innovative treatment strategies. Modified WHO analgesic ladder represents one of the greatest paradigm shifts within the domain of oncologic pain treatment. The cancer patient population requires a prompt and liberal, albeit judicious, delivery of unorthodox pain treatment options freed from the rigid bonds of conventional guidelines and standard practices.
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Abstract
Introduction: Peripheral nerve blocks are gaining popularity for many infraumblical surgeries with the development of new techniques such as ultrasound and peripheral nerve stimulator. It provides stable hemodynamic, better, and prolonged postoperative analgesia. This study was carried out to see the effectiveness of combined femoral and sciatic nerve block with ropivacaine alone and by adding fentanyl. Materials and Methods: The study was carried out on 100 patients scheduled for lower limb surgeries and were randomly divided into two groups of 50 each. In Group A, patients received 20 ml of 0.5% ropivacaine for femoral nerve block and same dose for sciatic nerve block and in Group B, 25 μg fentanyl was added each for femoral nerve and sciatic nerve block along with ropivacaine. All hemodynamic parameters, onset and duration of sensory and motor blocks were noted. The patient characteristics were analyzed using the “Chi-square tests” and the intergroup comparison of the parametric data was carried out using the unpaired t-test using software IBM SPSS 17.0. Results: Combined femoral and sciatic nerve block provide longer duration of postoperative analgesia of about 12–13 h. All the above-mentioned parameters were statistically non-significant. Conclusion: Hence in this study, onset and duration of sensory and motor block was comparable in both groups. However postoperative analgesia was prolonged as compared to neuraxial blockade without any hemodynamic instability.
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Affiliation(s)
- Lipsy Bansal
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Joginder Pal Attri
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Pawan Verma
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
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16
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Hinarejos P, Capurro B, Santiveri X, Ortiz P, Leal J, Pelfort X, Torres-Claramunt R, Sánchez-Soler J, Monllau JC. Local infiltration analgesia adds no clinical benefit in pain control to peripheral nerve blocks after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:3299-305. [PMID: 27299450 DOI: 10.1007/s00167-016-4187-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effect of the local infiltration of analgesics for pain after total knee arthroplasty in patients treated with femoral and sciatic peripheral nerve blocks. The secondary objective was to detect differences in analgesic consumption as well as blood loss after local infiltration of analgesics. METHODS Prospective randomized double-blinded study in patients who underwent a TKA for knee osteoarthritis under spinal anesthesia and treated with femoral and sciatic nerve blocks. This study compared 50 patients treated with local infiltration with ropivacaine, epinephrine, ketorolac and clonidine and 50 patients treated with a placebo with the same technique. The visual analogic score was registered postoperatively at 2, 6, 12, 24, 36, 48 and 72 h after surgery. Analgesic consumption was also registered. Both groups of patients were treated with the same surgical and rehabilitation protocols. RESULTS A significant difference of one point was found in the visual analogic pain scores 12 h after surgery (0.6 ± 1.5 vs. 1.7 ± 2.3). There were no significant differences in the visual analogic pain scores evaluated at any other time between 2 and 72 h after surgery. No significant differences were found in the required doses of tramadol or morphine in the postoperative period. Postoperative hemoglobin and blood loss were also similar in both groups. CONCLUSION Adding local infiltration of analgesics to peripheral nerve blocks after TKA surgery only provides minimal benefit for pain control. This benefit may be considered as non-clinically relevant. Moreover, the need for additional analgesics was the same in both groups. Therefore, the use of local infiltration of analgesics treatment in TKA surgery cannot be recommended if peripheral nerve blocks are used. LEVEL OF EVIDENCE I.
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17
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Corvetto MA, Echevarria GC, Espinoza AM, Altermatt FR. Which types of peripheral nerve blocks should be included in residency training programs? BMC Anesthesiol 2015; 15:32. [PMID: 25798069 PMCID: PMC4369355 DOI: 10.1186/s12871-015-0001-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 01/30/2015] [Indexed: 11/23/2022] Open
Abstract
Background Despite the increasing use of regional anesthesia, specific recommendations regarding the type of procedures to be included in residency training programs are not currently available. We aimed to determine the nerve block techniques that practicing Chilean anesthesiologists perceived as essential to master during residency training. Methods After institutional ethics committee approval, an online survey was sent to 154 anesthesiologists that graduated between 2005–2012, from the two largest university residency programs in Chile. Multiple-choice questions elicited responses concerning the use of regional anesthesia. Results A total of 109 questionnaires were completed, which corresponded to a response rate of 70.8%. Almost all (98.2%) of the respondents used regional anesthesia in their clinical practice, 86.7% regularly performed peripheral nerve blocks (PNBs) and 51% used continuous PNB techniques. Residency programs represented their primary source of training. The most common PNB techniques performed were interscalene (100%), femoral (98%), popliteal sciatic (93%), and Bier block (90%). Respondents indicated that they were most confident performing femoral (98%), Bier block (90%), interscalene (90%), and popliteal sciatic (85%) blocks. The PNBs perceived as essential for their actual clinical practice were femoral (81%), interscalene (80%), popliteal sciatic (76%), and Bier blocks (62%). Conclusions Requesting information from former anesthesiology residents may be a source of information, guiding the specific types of PNBs that should be included in residency training. Other groups can easily replicate this methodology to create their own evidence and clinical practice based guidelines for residency training programs.
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Affiliation(s)
- Marcia A Corvetto
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ghislaine C Echevarria
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile ; Department of Anesthesiology, New York University School of Medicine, New York, USA
| | - Ana M Espinoza
- Departmento de Anestesiología, Escuela de Medicina, Universidad de Chile, Santiago, Chile
| | - Fernando R Altermatt
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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18
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Abstract
Available evidence favoring the use of ultrasound for regional anesthesia is reviewed, updated, and critically assessed. Important outcome advantages include decreased time to block onset; decreased risk of local anesthetic systemic toxicity; and, depending on the outcome definition, increased block success rates. Ultrasound guidance, peripheral nerve blocks, and central neuraxial blocks are discussed.
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Affiliation(s)
- Francis V Salinas
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop B2-AN, Seattle, WA 98101, USA.
| | - Neil A Hanson
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop B2-AN, Seattle, WA 98101, USA
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19
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Abstract
Peripheral nerve blocks (PNBs) provide significant improvement in postoperative analgesia and quality of recovery for ambulatory surgery. Use of continuous PNB techniques extend these benefits beyond the limited duration of single-injection PNBs. The use of ultrasound guidance has significantly improved the overall success, efficiency, and has contributed to the increased use of PNBs in the ambulatory setting. More recently, the use of ultrasound guidance has been demonstrated to decrease the risk of local anesthetic systemic toxicity. This article provides a broad overview of the indications and clinically useful aspects of the most commonly used upper and lower extremity PNBs in the ambulatory setting. Emphasis is placed on approaches that can be used for single-injection PNBs and continuous PNB techniques.
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Affiliation(s)
- Francis V Salinas
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98101-2756, USA.
| | - Raymond S Joseph
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98101-2756, USA
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20
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Abstract
Peripheral nerve block is well suited for distal extremity surgery. Blocking the nerves at the distal extremity is easily done. It does not require ultrasound or stimulators to identify the nerve. Blocking nerves in the distal extremity is safe with low risk of toxicity. The effect of the nerve block is limited to the distribution of the nerve. The distal nerves in the lower extremity are sensory branches of the sciatic nerve. This provides a sensory block only. This has the advantage of allowing the patient to actively contract tendons in the foot and ambulate more quickly after surgery.
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Affiliation(s)
- Chris Offierski
- Orthopedic Surgery, Greater Niagara General Hospital, 6453 Morrison Street, Suite 300, Niagara Falls, Ontario L2E 7H1, Canada.
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