Combination Of Regional Anesthesia Research Articles

A Case of Intractable Complex Regional Pain Syndrome Successfully Treated with a Combination of Regional Anesthesia and Physical Therapy

A Case of Intractable Complex Regional Pain Syndrome Successfully Treated with a Combination of Regional Anesthesia and Physical Therapy

Comparative analysis of the impact of selected anesthesia methods on the cognitive function of patients undergoing ophthalmic surgery

Background: Anesthesiologists should not only save patient’s life as a process, but also enable the patient to recover his/her social life after surgery, given increased longevity, high social activity throughout life, and increased use of technical equipment in everyday life. Purpose: To assess central nervous system (CNS) changes in patients undergoing penetrating keratoplasty in order to optimize the choice of anesthesia technique, while taking into account the impact of general anesthesia on postoperative cognitive functions. Material and Methods: We employed neuropsychological tests such as Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Luria’s test to examine the cognitive function of patients before surgery and 6 hours, 24 hours, 7 days and 21 days after surgery. Results: On the basis of comparative analysis of the impact of selected anesthesia methods on cognitive function of patients undergoing surgery (penetrating keratoplasty), we concluded that a combination of regional anesthesia (pterygopalatine fossa blockade), dexmedetomidine infusion (0.3 µg/kg) and general analgesia (maintenance in an oxygen/sevoflurane mixture) with exclusion of Sibazon 0.5% had the shortest and the least profound impact on the cognitive function. Conclusion: On the basis of comparative analysis of the impact of selected anesthesia methods on cognitive function of patients undergoing penetrating keratoplasty, we concluded that a combination of regional anesthesia (pterygopalatine fossa blockade), dexmedetomidine infusion (0.3 µg/kg) and general analgesia (maintenance in an oxygen/sevoflurane mixture) with removal of Sibazon 0.5% from premedication and presence of a reduced amount of fentanyl used during anesthesia had the shortest (with a mean duration of a day) and the least profound impact on cognitive state in patients undergoing ophthalmic surgery.

Analgesic Effects of a Novel Combination of Regional Anesthesia After Pediatric Cardiac Surgery: A Retrospective Cohort Study

The objective of this study was to determine whether the use of regional anesthesia in children undergoing congenital heart surgery was associated with differences in outcomes when compared to surgeon-delivered local anesthetic wound infiltration. A retrospective cohort study. At a single pediatric tertiary care center. Pediatric patients who underwent primary repair of septal defects between January 1, 2018, and March 31, 2022. The patients were grouped by whether they received surgeon-delivered local anesthetic wound infiltration or bilateral pectointercostal fascial blocks (PIFBs) and a unilateral rectus sheath block (RSB) on the side ipsilateral to the chest tube. Using overlap propensity score-weighted models, the authors examined postoperative opioid requirements (morphine milliequivalents per kilogram), pain scores, length of stay, and time under general anesthesia (GA). Eighty-nine patients were eligible for inclusion and underwent analysis. In the first 12 hours postoperatively, the block group used fewer morphine equivalents per kilogram versus the infiltration group, 0.27 ± 0.2 v 0.64 ± 0.42, with a weighted estimated decrease of 0.39 morphine equivalents per kilogram (95% CI -0.52 to -0.25; p < 0.001), and had lower pain scores, 3.2 v 1.6, with a weighted estimated decrease of 1.7 (95% CI -2.3 to -1.1; p < 0.001). The length of stay and time under GA also were shorter in the block group with weighted estimated decreases of 22 hours (95% CI -33 to -11; p=0.001) and 18 minutes (95% CI -34 to -2; p=0.03), respectively. Bilateral PIFBs and a unilateral RSB on the side ipsilateral to the chest tube is a novel analgesic technique for sternotomy in pediatric patients. In this retrospective study, these interventions were associated with decreases in postoperative opioid use, pain scores, and hospital length of stay without prolonging time under GA.

Anaesthetic considerations for high-risk patient kyphoplasty.

Patients with vertebral compression fractures are often indicated for balloon kyphoplasty. Many of them are elderly with severe comorbidities, which puts them at high risk for general anaesthesia. Surgery under infiltration of local anaesthetic with or without mild sedation is therefore the preferred technique used by many surgeons. However, patients reported moderate‑to‑severe pain during the procedure. A combination of regional anaesthesia with analgo-sedation offers an interesting alternative to general anaesthesia as well as infiltration administered by the surgeon. In this article we present, apart from general anaesthesia, various regional anaesthetic techniques suitable for high-risk patients, including neuraxial anaesthesia, paravertebral block as well as a novel "erector spinae plane block" at the level of the fractured vertebra. We explore their effectiveness and safety profile, as well as advantage of supplementation of adequate analgo-sedation (Ref. 40). Keywords: erector spinae plane block, kyphoplasty, regional anaesthesia, paravertebral block, neuraxial anaesthesia.

Total Ankle Arthoplasty as a Day Case Surgery: How Safe and Effective it is?

Category:Ankle ArthritisIntroduction/Purpose:Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. Total ankle arthroplasty (TAA) is a surgical procedure commonly used for patients with painful arthritis. As the number of TAA procedures increase, so does the associated economic burden. The purpose of this study was to evaluate patients undergoing total ankle arthroplasty, who were discharged on the same day as undergoing surgery. These patients have stayed in the hospital for <12 hours, and are referred to as ‘‘outpatients.’’ Outpatients were evaluated with regard to the following outcomes: (1) postoperative pain; (2) perioperative complications and healthcare provider visits (readmission). We also assessed patients’ satisfaction regarding discharge on the same day as surgery.Methods:The medical records of 46 consecutive TAA outpatients from July 2018 to June 2019 with a minimum 1 month post- operative follow-up, were reviewed. All patients received an Integra Cadence TAA. Prior to surgery, all patients received popliteal blocks. Patients were discharged home with a popliteal catheter, which they were to remove themselves after 48 hours. After removal of the catheter, patients were prescribed oral pain medication to help with any pain or discomfort. The following data was collected: demographics, comorbidities, (ASA) class, and perioperative complications, including wound breakdown, infection, revision and non-revision surgeries. At their 1-month post-operative visit, patients completed a questionnaire regarding their satisfaction post-surgery, which consisted of six questions.Results:There were no readmissions for pain control, no signs of wound infection among the 46 outpatients. All patients were ‘very satisfied’ with the surgical procedure and with recommend methods of pain control. The majority of patients were also very satisfied with discharge on the same day as surgery with the exception of patients who would have liked to stay overnight. When asked if they would recommend the care they experienced to a friend with the same condition, 46 patients said that they would definitely recommend this process to a friend. In terms of rating their pain on a scale of 0-10 (0 being no pain, 10 being worst pain imaginable), the average score for the 46 patients was 2.03.Conclusion:Our study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory outpatient experience and no readmissions for pain control.

Clinical Update on Anaesthetic Management of Free Flap Surgery in Cervico Facial Cancer Patients

Intraoperative anaesthesia management in oro-facial cancer surgical patients requiring free flap tissue transfer is evolving. In this paper we updated our intraoperative clinical protocol using our own experience in combination with the latest literature. The main areas of change include videolaryngoscopic awake intubation in case of difficult airway management, combination of regional anaesthesia with peripheral catheter to decrease intraoperative opioid consumption, and postoperative pain and finally opioid free anaesthesia techniques using dexmedetomidine.

Virtual reality as an adjunct to anesthesia in the operating room

BackgroundAdvancements in virtual reality (VR) technology have resulted in its expansion into health care. Preliminary studies have found VR to be effective as an adjunct to anesthesia to reduce pain and anxiety for patients during upper gastrointestinal endoscopies, dental procedures and joint arthroplasties. Current standard care practice for upper extremity surgery includes a combination of regional anesthesia and intraoperative propofol sedation. Commonly, patients receive deep propofol sedation during these cases, leading to potentially avoidable risks of over-sedation, hypotension, upper airway obstruction, and apnea. The objective of this study is to evaluate the effectiveness of VR technology to promote relaxation for patients undergoing upper extremity surgery, thereby reducing intraoperative anesthetic requirements and improving the perioperative patient experience.MethodsIn this single-center, randomized controlled trial, 40 adult patients undergoing upper extremity orthopedic surgery will be randomly allocated to either intraoperative VR immersion or usual care. VR immersion is designed to provide patients with a relaxing virtual environment to alleviate intraoperative anxiety. All patients receive a peripheral nerve block prior to surgery. Patients in the intervention group will select videos or immersive environments which will be played in the VR headset during surgery. An anesthesia provider will perform their usual clinical responsibilities intraoperatively and can administer anesthetic medications if and when clinically necessary. Patients in the control arm will undergo perioperative anesthesia according to standard care practice. The primary outcome is the difference in intraoperative propofol dose between the groups. Secondary outcomes include postoperative analgesia requirements and pain scores, length of stay in the postanesthesia care unit, overall patient satisfaction and postoperative functional outcomes.DiscussionIt is unknown whether the use of VR during upper extremity surgery can reduce intraoperative anesthetic requirements, reduce perioperative complications, or improve the postoperative patient experience. A positive result from this clinical trial would add to the growing body of evidence that demonstrates the effectiveness of VR as an adjunct to anesthesia in reducing intraoperative pain and anxiety for multiple types of procedure. This could lead to a change in practice, with the introduction of a nonpharmacologic intervention potentially reducing the burden of over-sedation while still providing a satisfactory perioperative experience.Trial registrationClinicalTrials.gov, NCT03614325. Registered on 9 July 2018.

A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty.

Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. Outpatient TAA are increasingly common and have been shown to decrease costs compared to inpatient surgery. However, there are very few studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive patients who received outpatient TAA to identify complication rates. The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum 6-month follow-up were reviewed. All patients received popliteal and saphenous blocks prior to surgery and were managed with oral pain medication postoperatively. All received a STAR total ankle. Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and perioperative complications including wound breakdown, infection, revision, and nonrevision surgeries were observed. Mean follow-up was 16.6 ± 9.1 months (range, 6-42 months). There were no readmissions for pain control and 1 patient had a wound infection. The overall complication rate was 15.4%. One ankle (1.5%) had a wound breakdown requiring debridement and flap coverage. This patient thrombosed a popliteal artery stent 1 month postop. The 1 ankle (1.5%) with a wound infection occurred in a patient with diabetes, obesity, hypertension, and rheumatoid arthritis. This study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory experience with no readmissions for pain control and 1 wound infection. The 1 wound breakdown complication (1.5%) was attributed to arterial occlusion and not outpatient management. Level IV, retrospective case series.

Perioperative Complications of Outpatient Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. As the number of TAA increases, so too will the associated economic burden. In the current healthcare environment, savings are in the national spotlight. Studies of total joint arthroplasty (THA and TKA) have demonstrated that outpatient surgery decreases surgical costs.1,2 Additionally, outpatient THA and TKA have not been associated with increased complication or readmission rates.3–6 Outpatient TAA are becoming more common which may lead to decreased costs of care. Despite the potential savings, TAA remains an “inpatient-only procedure” for Medicare patients. Currently, there are no clinical studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive outpatient TAA to identify complication rates and patient risk factors. Methods: The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum of 6-month follow-up were reviewed. All patients received popliteal and saphenous blocks with bupivacaine and epinephrine prior to surgery and were managed with oral NSAID and narcotic pain medication post-operatively. All patients received a STAR total ankle prosthesis. Demographics, comorbidities, ASA and perioperative complications including wound breakdown, infection, revision and non-revision surgeries were compared to historic controls. Mean follow up was 16.6 +/- 9.1 months (range, 6-42 months). Results: The overall complication rate in this series was 21.8%. One ankle (1.5%) had a wound breakdown requiring debridement and flap coverage. This patient had a history of Polycythemia Vera with re-thrombosis of their popliteal artery one month after TAA surgery. Two ankles (3%) had deep infections. Nine ankles (13.8%) required non-revision surgery. Three ankles (4.6%) required posterior capsular release, one ankle (1.5%) required medial malleolar screws for symptomatic stress reaction, and three ankles (4.6%) required arthroscopic or open gutter release. Two ankles (3%) required revision surgery. One for talar component subsidence in a patient with Charcot-Marie-Tooth managed with an arthrodesis at eleven months. The other revision was performed for aseptic tibial component loosening and managed with conversion to an INBONE prosthesis at seven months. Conclusion: This study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory outpatient experience and zero patients required readmission for pain control. The one wound complication (1.5%) was attributed to arterial occlusion and not outpatient management. This compares to the 6.6-28% wound breakdown rate found in the literature.7–10 Our revision surgery rate (3%) was comparable to the 3.1-16.5% rate found in the literature, and was also not attributed to outpatient management.7–10 We feel this demonstrates that outpatient TAA can be performed safely.

Нові підходи до анестезіологічного забезпечення при симультанних операційних втручаннях у жінок із поєднаною гінекологічною та екстрагенітальною хірургічною патологією

&lt;p&gt;Розроблено спосіб анестезіологічного забезпечення виконання симультанних операцій у жінок із поєднаною гінекологічною та екстрагенітальною хірургічною патологією. При проведенні операційних втручань у пацієнток з великим обсягом операції, на двох та більше органах, в основному, використовуються ізольовані методи анестезіологічного забезпечення (наркоз, епідуральна чи спінальна анестезія). Використаний спосіб анестезіологічного забезпечення характеризується комбінуванням регіонарної анестезії з використанням додаткового внутрішньовенного знеболювання в поєднанні з штучною вентиляцією легень на тлі міорелаксації, що дає змогу знизити депресивну дію наркозу на центральну нервову та серцево-судинну системи, проводити корекцію гемодинаміки у межах контрольованої нормо- чи гіпотонії. Проведення подовженої регіонарної анестезії дає змогу зменшити дозу введення наркотичних анельгетиків у післяопераційному періоді, швидше нормалізувати функцію шлунково-кишкового тракту, відновити фізичну активність жінок, знизити можливий ризик післяопераційних ускладнень. При даному методі анестезії збільшення обсягу операційного втручання суттєво не впливає на ступінь травматичності операції. &lt;/p&gt;

Impossible Airway Requiring Venovenous Bypass for Tracheostomy

The elective surgical airway is the definitive management for a tracheal stenotic lesion that is not a candidate for tracheal resection, or who has failed multiple-tracheal dilations. This case report details the management of a patient who has failed an elective awake tracheostomy secondary to the inability to be intubated as well as severe scar tissue at the surgical site. A combination of regional anesthesia and venovenous bypass is used to facilitate the surgical airway management of this patient. Cerebral oximetry and a multidisciplinary team approach aid in early detection of an oxygenation issue, as well as the emergent intervention that preserved this patient's life.

Regional anaesthesia in day‐stay and short‐stay surgery

The goals for ambulatory surgery are rapid recovery with minimal side effects, adequate postoperative pain control, rapid patient discharge and overall cost containment. The addition of regional anaesthetic techniques has been shown to decrease nausea, postoperative pain scores and the need for post-anaesthesia care unit monitoring. The use of regional anaesthesia is increasing as studies confirm the goals for ambulatory anaesthesia can be met with a combination of regional anaesthesia and a multimodal pain management regimen.

Use of continuous positive airway pressure during spinal anaesthesia in a patient with severe chronic obstructive pulmonary disease

We report the case of a patient with severe chronic obstructive pulmonary disease who underwent local resection of a carcinoma of the rectum under spinal anaesthesia. Although the patient was keen to avoid general anaesthesia and to have the operation under a spinal anaesthetic, pre-operative assessment showed that he could not lie flat. As the surgical procedure required the patient to be in the lithotomy position, ideally with a head-down tilt, it was hoped that continuous positive airway pressure with a facemask during spinal anaesthesia might help him to tolerate the position comfortably. Continuous positive airway pressure at 7.5 cmH(2)O was successfully used to facilitate breathing during surgery under spinal anaesthesia. A combination of regional anaesthesia and continuous positive airway pressure via a facemask is easy to use and may be a useful option in the management of these challenging patients.