Local Regional Anesthesia Research Articles

CHAPTER 1: THE MANAGEMENT OF ERECTILE DYSFUNCTION: AN AUA UPDATE

approach to develop a guideline for the ED treatment modalities that had become available in the United States after publication of the 1996 Report. Guideline statements from the 1996 Report on previously available therapeutic modalities were either revised or brought forward unchanged depending on the existing evidence. All guideline statements were graded according to the degree of flexibility in clinical application: standard, recommendation, or option, with standard being the least flexible and option being the most flexible (Table 1). Grading is based on two characteristics: knowledge of the health outcomes of the alternative intervention and preference for the intervention. The Panel believed that the patient, with physician guidance, must make his own decision in selecting treatment. Outcome estimates derived from review and meta-analysis of evidence provide physicians and patients with scientifically based information to assist them in making appropriate treatment decisions. Thus, a second Panel objective was to determine whether or not there was sufficient evidence for outcomes (both benefits and risks) to be estimated.

Alberto Gutierrez: Beyond the Hanging Drop

It is not surprising that many of the earlier contributions to regional anesthesia were made by surgeons, as they had operated under less than ideal conditions with the general anesthetics of the time. Bier, Cushing, Matas, Braun and Pages among others, developed expertise in infiltrating local anesthetics and regional anesthesia to be able to complement their operations trying to achieve better and safer operating conditions. The Argentinian, Alberto Gutierrez (figure 1) was an accomplished author, anatomist and surgeon; like those named above; he initially looked for alternatives to the general anesthetics (ether or chloroform) prevalent in the early YX Century. In order to facilitate and improve the care of his patients, he became acquainted with epidural anesthesia. And by careful observation, he once noted the disappearance of a drop of fluid hanging from the hub of a needle. From then on, he began to study why and how it happened. As he became more passionately involved with “extradural anesthesia,” he not only joined a group of physicians practicing anesthesia, but also founded and edited their journal and participated in their congresses. For the last half century, he has received greater recognition for his description of the “hanging drop method” to identify the epidural space than for the many contributions that he made to the surgical literature.

The arteriovenous fistula.

The ground-breaking article by Brescia and Cimino in 1966 ([1][1]) revolutionized the creation of the vascular access, and the Cimino fistula was soon used in almost all dialysis patients. Unfortunately, subsequent wide-spread use of PTFE grafts instead of AV fistulae occurred because of the ease of

Videoscopic surgery under local and regional anesthesia with helium abdominal insufflation.

High-risk patients may not be good candidates for laparoscopic surgery due to the metabolic consequences of transperitoneal absorption of insufflated CO(2) gas and the necessity of general anesthesia because CO(2) insufflation produces pain. Helium gas is metabolically inert and does not produce pain. Thus it permits an alternative approach to performing laparoscopic surgery in high-risk patients. Laparoscopic cholecystectomy, appendectomy, hernia repair, and peritoneal dialysis catheter procedures were performed under local or regional anesthesia in high-risk patients utilizing helium gas as the insufflation agent. Twenty-one patients underwent laparoscopic procedures under local or regional anesthesia. None of the procedures initiated under local-regional anesthesia required abandonment of the laparoscopic approach or conversion to general anesthesia. There were no operative or perioperative mortalities. Two incidences of pneumothorax occurred with extraperitoneal hernia repair; one required a tube thoracostomy. Helium gas should be considered the agent of choice for intraperitoneal insufflation in high-risk patients not only because helium avoids the metabolic consequences of CO(2) insufflation but also because it permits selected procedures to be performed under local-regional anesthesia. Helium may be contraindicated for laparoscopic procedures involving extraperitoneal insufflation due to the increased risk for pneumothoraces.

Preservative-free lidocaine 1 % anterior chamber irrigation as an adjunct to topical anesthesia

Purpose: To evaluate the effect on the central corneal endothelium of anterior chamber irrigation with preservative-free lidocaine 1 % as an adjunct to topical anesthesia during phacoemulsification.Setting: Department of Ophthalmology, Hospital Capuchos, Lisbon, Portugal.Methods: This prospective, randomized, controlled study comprised 59 eyes. Thirtyone eyes had phacoemulsification (in-the-bag cracking technique) under topical anesthesia with anterior chamber irrigation by preservative-free lidocaine 1%. Twenty-eight eyes having the same procedure but with local-regional anesthesia served as the control group. All eyes had preoperative and postoperative specular microscopy and computer-assisted morphometry. A Student's t-test was used for between-group comparison of the following parameters: patient age, central corneal endothelial cell loss, mean endothelial cell size variation, and phacoemulsification ultrasound time. Follow-up was 4 weeks.Results: The between-group differences in mean patient age and ultrasound time were not significant. The differences between groups in the endothelial cell parameters were also not significant. Mean postoperative endothelial cell loss was 3.59% ± 2.79 (SD) in the topical anesthesia group and 4.37 ± 2.00% in the control group. Mean variation in cell size was 3.71 ± 1.57% and 3.79 ± 1.07%, respectively.Conclusion: Intracameral infusion of preservative-free lidocaine 1 % had no effect on the corneal endothelial cell loss rate or mean cell size variation in this short-term assessment.

Schmerztherapie nach Leistenbruch- und Leistenhodenoperationen mit Paracetamol im Kindesalter

The application of opiates after day case surgery in childhood is discussed controversially because of possible complications. Therefore many anaesthetists try to avoid these substances and prefer peripheral analgesics for postoperative pain control. By distributing a questionnaire concerning the arguments connected with postoperative pain to 267 parents (a total of 78.3% of the questionnaires was returned) of children that had undergone inguinal herniorrhaphy or orchidopexy we hoped to gain insight into the judgement of peripheral analgesics-in this case acetaminophen-following inguinal herniorrhaphy or orchidopexy. During standardized anaesthesia the children received acetaminophen suppositories (15-20 mg/kg BW). After release from the hospital on the same day this drug was administered by the parents in case of necessity. Need for analgesics was significantly higher in the group of orchidopexy than in the group of herniorrhaphy (p < .01) and even memory of pain three days after the operation seemed to be higher in this group. The sleep patterns were more influenced by orchidopexy. Surprisingly 75% of the children following herniorrhaphy received no analgesics at all after release from the hospital (6 hours postoperatively). Following herniorrhaphy the postoperative pain therapy with acetaminophen seems to be sufficient. For the postoperative pain treatment after orchidopexy additional measures like local nerve blocks, regional anesthesia or wound infiltrations with local anaesthetics should be considered.

Penile Prosthesis Surgery with the Patient Under Local Regional Anesthesia

A total of 20 patients underwent penile prosthesis implantation while under local regional anesthesia with a pudendal nerve blockade at the perineum. The method is safe, performed as an outpatient procedure and showed no complication. It avoids the need to inject a local anesthetic intracorporeally, which is risky in elderly patients.

Reply

Obadia et al. have presented an interesting idea of using superior thyroid artery for patch angioplasty when carotid endarterectomy is performed under local-regional anesthesia. Their initial results with 58 operations during the year are excellent: no postoperative strokes and no evidence of early recurrent stenoses. Our study demonstrated that postoperative neurologic complications and late ipsilateral stroke, regardless of method of arterial closure, were not statistically different. Recurrent carotid stenosis, however, in general, is a “late” phenomenon, and this was reemphasized by our study, as recurrent stenosis in all patient groups occurred late (i.e., 24 to 60 months after operation). We await, and encourage, long-term follow-up on these patients operated on by Dr. Obadia's group for assessment of recurrent carotid stenosis. Although patch angioplasty in our study was not statistically superior to primary closure in preventing recurrent stenosis, it appears to be appropriate in habitual smokers and patients with small internal carotid arteries, most of whom are women. Until a large multicenter randomized trial answers the question of which is the most appropriate means to close the carotid artery after endarterectomy, a technically perfect operation appears to be the surest means of reducing the incidence of perioperative stroke, late ipsilateral stroke, and recurrent stenosis.

Letter: local-regional anesthesia during childbirth and newborn behavior.

Letter: local-regional anesthesia during childbirth and newborn behavior.

Response : Local-Regional Anesthesia During Childbirth and Newborn Behavior

<i>Response</i> : Local-Regional Anesthesia During Childbirth and Newborn Behavior

Local-regional anesthesia during childbirth: effect on newborn behaviors.

Administration of local-regional anesthesia during norgnal deliveries was correlated significantly with newborn behaviors as evaluated by the Brazelton neonatal assessment scale. Three days after birth, infants whose mothers received local-regional anesthesia were more irritable and motorically less mature than those infants whose mothers were not medicated.

Urinary tract infection in patients with rheumatoid arthritis.

Urinary tract infection in patients with rheumatoid arthritis.

Local infiltration and regional nerve block anesthesia in pedal surgery.

Local infiltration and regional nerve block anesthesia in pedal surgery.