Sole Anesthetic Technique Research Articles

Peripheral nerve block (Tetra block) - an effective alternative anesthesia for patients undergoing fractured femur neck surgery with recent myocardial infarction and low ejection fraction: a case report

The fractured neck of the femur (NOF) is a common injury among the elderly population1 . Ischemic heart disease (IHD)is a common comorbid condition in these patients, and recent myocardial infarction (MI)adds a unique challenge for the anesthesiologist1 . The best timing for the surgery is known to be the day of admission or the day after admission. However, this poses a challenge due to patients possibly being on antiplatelet or anticoagulant therapy, which means central neuraxial blockade is not an option1 . General anesthesia (GA) for these patients can lead to cardiovascular and respiratory instability due to associated low ejection fraction (EF)2 . Hemodynamic fluctuations related to anesthesia can be harmful. In this case study, a patient with a NOF fracture and a recent MI with a low EF underwent hemiarthroplasty. The procedure used a peripheral nerve block (PNB) alongside sedation as the sole anesthetic technique. The patient remained stable throughout the surgery and in the postoperative period. Keywords: Neck of femur fracture, Myocardial Infarction, Peripheral Nerve Block, Tetra block, Locoregional, Ejection Fraction.

US-guided pudendal nerve block as sole anesthetic technique in hemorrhoidectomy: our experience.

US-guided pudendal nerve block as sole anesthetic technique in hemorrhoidectomy: our experience.

Pecto-intercostal Fascial Plane Block: A Novel Technique for Analgesia in Patients with Sternal Dehiscence.

Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement.

The Gluteus Deep Investing Fascia Compartment Block: A Novel Technique for Posterior Femoral Cutaneous Nerve Block.

The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the "Gluteus-Deep Investing Fascia compartment Block (GDIF block)"for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the 'Gluteus Deep Investing Fascia Compartment'. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named"CLEFT Block." This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique. Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine. The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia. The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.

Ultrasound-guided Brachial Plexus Block as a Sole Anaesthetic Technique in a Child for Fixation of Humerus Fracture: A Case Report

Managing supracondylar fractures provides distinct problems in the complex setting of paediatric trauma. A 36-month-old male child was admitted with accidental injury and supracondylar fracture of left humerus. There were no other injuries. The child was planned open reduction and internal fixation in the right lateral position. The plan was to administer nerve block. To satisfactorily transfer the baby, the authors administered 5 mg of oral diazepam to the mother after explanation. The patient was smoothly transferred inside with syrup promethazine 5 mL. After securing an intravenous access, and an intravenous pethidine of 10 mg, he was administered ultrasound guided brachial plexus block with a supraclavicular approach with 5 mL of 0.5% bupivacaine. The pain subsided and the patient slept well. The surgery and the postoperative period were uneventful. The authors concluded that sedating the mother prior will help in separation and nerve blocks can be administered in children in precise sites with the help of ultrasound but without supplemental general anaesthesia. This report is the first case report to do without the use of any intravenous anaesthetic drugs.

Thoracic epidural as the sole anaesthetic technique for gastrostomy in a case with difficult airway: a case report

Thoracic epidural as the sole anaesthetic technique for gastrostomy in a case with difficult airway: a case report

Graded Epidural Anaesthesia as a Sole Anaesthetic Technique for Lower Limb Surgeries in Patients with Low Ejection Fraction: A Case Series

In patients with a history of ischemic heart disease with low ejection fraction, it’s always a challenge for the Anaesthesiologist to make a decision on whether to administer General Anaesthesia (GA), central neuraxial blockade, or both. When the Left ventricular ejection fraction (LVEF) percentage reduces to less than 35%, it indicates the presence of severe systolic dysfunction. Both general anaesthesia and regional anaesthesia carry potential risks due to these patients' low cardiac output status. Hemodynamic fluctuations associated with anaesthesia can be detrimental in these patients. A clear intraoperative plan should be designed to manage the hemodynamics of these patients. Here we report two cases of ischemic heart disease with low ejection fraction posted for orthopedic surgeries. Graded epidural anaesthesia was used as a sole anaesthetic technique. The patients were hemodynamically stable in the intraoperative as well as postoperative period. Keywords: Ischemic heart disease, Low Left Ventricular Ejection Fraction, Graded Epidural Anaesthesia, Cemented modular hemiarthroplasty, PFNA2.

PENG block associated with dexmedetomidine sedation for intramedullary femoral fixation in high-risk elderly patients: a case series and review of the literature.

Hip fracture is a major cause of hospitalization among the elderly population. The standard surgical treatment involves early repair to reduce mortality and morbidity. One type of treatment in the case of intertrochanteric and subtrochanteric fractures is intramedullary nailing, as it decreases soft tissue damage and permits early weight bearing. The most common anesthesia technique combines spinal anesthesia with a peripheral block. In cases where spinal anesthesia is contraindicated, general anesthesia is preferred. However, both techniques can lead to significant complications, especially in patients with multiple comorbidities. Pain management after hip surgery, particularly in elderly and frail individuals, poses a challenge. The pericapsular nerve group block (PENG) targets the innervation of the anterior portion of the hip joint and is increasingly used for pain management related to hip surgery. This paper presents a case series of three elderly patients who underwent pericapsular nerve group block (PENG) block combined with dexmedetomidine sedation for intramedullary femoral fixation. The PENG block can be effectively used as the sole anesthetic technique for managing elderly patients undergoing intramedullary femoral fixation while on antiplatelet drugs. This procedure effectively controlled pain during both the surgical and postoperative periods. The addition of dexmedetomidine for sedation enables comfortable and safe procedures, minimizing the risk of perioperative neurocognitive dysfunctions and without adverse effects on cardiorespiratory function.

Safety and Feasibility of SAB in Otherwise Healthy Individuals Undergoing Laparoscopic Cholecystectomy

Background: The safety and feasibility of utilizing SAB as the sole anesthetic technique in otherwise healthy individuals undergoing laparoscopic cholecystectomy have been increasingly recognized. SAB offers potential advantages in terms of reduced complications, improved pain control, and avoidance of general anesthesia-related risks. Objective: To assess safety and feasibility of SAB in otherwise healthy individuals undergoing laparoscopic cholecystectomy. Method: The study included a cohort of 40 patients who underwent elective laparoscopic cholecystectomy and met specific inclusion criteria. All patients received a subarachnoid block (SAB) with 3 ml of 0.5% bupivacaine and 25 micrograms of fentanyl at the L2-L3 level. The laparoscopic cholecystectomy procedure was performed using a standard 4-port technique, while maintaining a low intra-abdominal pressure of 9-10 mm Hg through CO2 pneumoperitoneum. The patients were followed up at various time points, including 30 minutes, 4 hours, the time of discharge, and on the 7th day after the operation. Any voluntary or involuntary movements or exaggerated diaphragmatic excursions during the operation were carefully monitored. The study recorded parameters such as operation time, duration of operating room occupancy, length of hospital stay, post-operative pain levels, analgesic requirements, occurrences of nausea, vomiting, headache, right shoulder pain, wound-related complications, and patient satisfaction. Results: SAB demonstrated efficacy in all 40 patients undergoing surgery. Conversion to general anesthesia was required in two cases due to persisting low oxygen saturation. Hypotension occurred in 23.7% of patients, while 10.5% experienced right shoulder pain. The average operating time was 37.3 minutes, ranging from 21 to 77 minutes. Awkward movements and exaggerated respiratory excursions were observed in 23.7% and 18.4% of cases, respectively. Only two cases required conversion to general anesthesia. The mean hospital stay duration was 29.3 hours. No major complications were reported during the study. Conclusion: These findings suggest that SAB can be successfully and effectively used for laparoscopic cholecystectomy in healthy patients, providing a safe alternative to general anesthesia.

High Thoracic Epidural Anesthesia and Dexmedetomidine for Awake Off-Pump Coronary Artery Bypass Grafting: A Feasible Option for Patients with Severe Pulmonary Disease.

High thoracic epidural anesthesia in cardiac surgery as the sole anesthetic technique is used in a select groups of patients having severe pulmonary co morbidities. We describe a case series of three patients at high risk for post operative pulmonary complications where this technique was used along with dexmedetomidine infusion for conscious sedation in off pump coronary artery bypass grafting. Proper selection of patients, proper placement of the epidural catheter at the appropriate level and timing of catheter insertion and removal are of paramount importance.

A peripheral nerve stimulator guided popliteal sciatic nerve block combined with adductor canal block in lower leg surgery- A sole anesthetic technique

In lower leg surgeries involving fractures of distal tibia, ankle surgeries, debridement and PVD surgeries choice of anesthesia is usually regional anesthesia. When these patients are associated with co-morbid cardio-respiratory problems then it will become challenge for anesthesiologist to maintain homeostasis with good surgical anesthesia. Ayukut urfalioglu suggested another alternative technique in the form of Adductor canal block plus Lateral approach popliteal sciatic block as good alternative for these surgeries with better Intra-operative Haemodynamic Stability, additional post-operative pain relief and less requirement of systemic analgesia post-operatively.In this prospective randomised controlled trial, we aim to explore the efficacy of Adductor canal block plus Popliteal Sciatic Block for Lower leg surgeries. Sixty patients (ASA I, II, III) undergoing lower limb surgeries were randomly allocated in 2 groups (30 patients in each group). In Group P patients received PNS guided Adductor canal block combined with popliteal sciatic block and in group S patients received unilateral spinal anesthesia.: The primary objectives were to evaluate duration of sensory and motor block and post-operative pain relief. Secondary objectives included intra operative requirements of additional anesthesia and intraoperative haemodynamic stability.There was significant intraoperative haemodynamic stability and post-operative pain relief attributable to Group P. Time for first requirement of rescue analgesia post-operatively was significantly higher in Group P compared to Group S (Group P Mean SD15.9±5.26 vs 6.05±1.23 in Group S with p= < 0.0001).Combined adductor canal block and popliteal sciatic block can be an alternative technique with advantage of prolonged post-operative analgesia and haemodynamic stability.

Bilateral rectus sheath block as the sole anesthetic technique for urgent incarcerated umbilical hernia repair

Bilateral rectus sheath block as the sole anesthetic technique for urgent incarcerated umbilical hernia repair

A Combination of Ultrasound-guided Popliteal Sciatic Nerve Block and Adductor Canal Block as a Sole Anaesthetic Technique for below Knee Amputation in High-risk Patients: A Case Series

Below-knee amputation in high-risk patients is associated with significant mortality and morbidity. Spinal anaesthesia is linked to an increased incidence of hypotension and bradycardia, and it is relatively contraindicated in patients with coagulation abnormalities. General anaesthesia is used as an alternative when spinal anaesthesia is contraindicated, but it is associated with a considerable increase in perioperative morbidity and the need for postoperative ventilatory support and Intensive Care Unit (ICU) care. A combination of sciatic nerve block and femoral block has been employed for below-knee surgeries as it provides complete anaesthesia below the knee. Adductor canal block, compared to femoral nerve block, is motor-sparing and, when combined with popliteal sciatic nerve block, offers complete anaesthesia below the knee. Below-knee amputation requires complete motor and sensory blockage, making regional block for below-knee amputation more challenging for the anaesthesiologist. Present case series is of five cases of below-knee amputation performed under a combination of ultrasound-guided popliteal sciatic nerve block and adductor canal block. Ultrasound-guided popliteal sciatic nerve block was administered with a combination of 10 mL of bupivacaine 0.5% and 5 mL of lignocaine 2% with adrenaline (1:200,000) diluted with 5 mL of distilled water to a total volume of 20 mL. Ultrasound-guided adductor canal block was performed with 8 mL of bupivacaine 0.5% and 4 mL of lignocaine 2% with adrenaline (1:200,000), diluted with 4 mL of distilled water to a total volume of 16 mL. All patients achieved adequate surgical anaesthesia, and none experienced any anaesthesia-related complications.

Bilateral rectus sheath block as the sole anesthetic technique for urgent incarcerated umbilical hernia repair

El bloqueo de la vaina de los rectos es una técnica analgésica interesante para la reparación de la hernia umbilical y hay casos descritos donde incluso se ha usado como único anestésico. Describimos el caso clínico de un paciente que precisó reparación urgente de una hernia umbilical incarcerada y que fue manejado con éxito con un bloqueo de la vaina de los rectos bilateral junto con sedación ligera. El bloqueo ecoguiado de la vaina de los rectos bilateral aportó anestesia quirúrgica para nuestro paciente, evitando los riesgos de la anestesia general y espinal en su peculiar situación clínica y consiguió una analgesia posoperatoria excelente, una rápida recuperación y alta hospitalaria sin complicaciones.

Combined fascial plane blocks as the sole regional anesthesia technique for breast surgery in high-risk patients.

The quest for an effective regional anaesthesia technique in breast surgery has always been eluded by its apparent complexity. Various techniques had been described as anaesthetic techniques for breast cancer surgeries. Fascial plane blocks had been used as analgesic techniques for this procedure. We describe a case series of 12 patients who were given a combination of erector spinae plane block (ESP), Pectoralis I (Pecs I) and serratus anterior plane (SAP) block as sole anaesthetic technique with high risk surgical morbidity. Two patients had discomfort during retraction of axillary apex towards the end of surgery, and one patient had discomfort during medial parasternal incision, which needed a single bolus of low dose ketamine injection. Combined fascial plane blocks could be effectively utilized as a sole regional anesthesia modality for breast cancer surgeries with mild sedation.

Combined psoas compartment block and sciatic nerve block versus unilateral subarachnoid block as a sole anaesthetic technique for lower limb orthopaedic surgery – A prospective randomised controlled study

: Nerve block as a part on regional anaesthesia extends analgesia time and gives better haemodynamic stability, so comparison of nerve block like psoas compartment block and sciatic nerve block with spinal anaesthesia is our main aim of study. Total 96 patients of tibial surgeries with any gender of ASA grade I, II and III were assigned and randomly divided into two groups:- group P- psoas compartment block plus sciatic nerve block and group S-unilateral subarachnoid block. Parameters compared were onset, peak effect and duration of sensory and motor blockage, haemodynamic parameters, postoperative duration of analgesia and requirement of rescue analgesics post-operatively. Onset of motor and sensory block were faster in group S than group P. There was no significant difference in haemodynamic parameters in both the group. Duration of analgesia in group P was 16.79 ±2.3 hours as compared to group S was 5.57 ±0.49 hours, which was highly significant. Number of rescue analgesic required was significantly less in group P(1.10 ± 0.30) as compared to group S (3.04 ± 0.20) without significant complications in both the groups.Combined psoas compartment block with sciatic nerve block provides prolonged duration of analgesia over subarachnoid block and less numbers of rescue analgesics required postoperatively with good haemodynamic stability.

Ultrasound Guided Pecs II and Serratus Anterior Blocks as a Sole Anesthetic Technique for Reduction Mastopexy under Light Sedation in Elderly Female with Multiple Comorbidities

Ultrasound Guided Pecs II and Serratus Anterior Blocks as a Sole Anesthetic Technique for Reduction Mastopexy under Light Sedation in Elderly Female with Multiple Comorbidities

Successful Management of Ex-Utero Intrapartum Treatment Procedure for Cystic Teratoma Under Sole Spinal Anesthesia: an Anesthetic Challenge Case Report

The Ex-Utero Intrapartum Treatment (EXIT) procedure is a technique that establishes the fetus’s airway, while uteroplacental fetal circulation is still maintained. Anesthesia for this specific procedure requires special anesthetic considerations; such as, uterine relaxation, maternal hemodynamic parameters, the establishment of a fetal airway and maintenance of postpartum uterine contraction. In most cases, general anesthesia is used as the preferred method, due to its effect on uterine relaxation. This presented case demonstrated that a sole spinal anesthetic technique can be used safely for an EXIT procedure.

Ankle Block for Acute Pain Management in a Patient with Mitral Valve Prolapse and Infective Endocarditis with Dry Gangrene of Toes

AbstractAnkle block represents a regional anesthesia technique to provide anesthesia for the procedures related to the foot. It is mainly used as a sole anesthesia technique or as an adjunct for postoperative pain relief in foot operations. It is an infiltrative block with advantages like being technically easier, safe, having minimal side effects, and having a high success rate. Management of postoperative pain is an essential service provided by a cardiac anesthesiologist to patients undergoing operative procedures, but the knowledge in providing regional anesthesia may be used beyond the operating room or critical care unit. In the present case, we administered an ankle block to alleviate the pain in case of dry gangrene.

Ultrasound-Guided Rectus Sheath Block as the Single Anaesthetic Technique for Umbilical Hernia Repair: A Report of 3 Cases.

In this study, we report 3 cases of ultrasound-guided rectus sheath block used for anaesthetic management of simple periumbilical surgery. We selected 3 patients based on the American Society of Anaesthesiology I-II and defect sizes known to be smaller than 4 cm without peritoneal involvement. We applied a rectus sheath block with 10 mL of 0.5% bupivacaine and 5 mL of 2% lidocaine bilaterally deposited in the space between rectus abdominis and posterior rectus sheath under real-time ultrasonography. Two of our patients tolerated surgery well with minimal sedoanalgesia; however, one of our patients needed dissociative anaesthesia to be compatible because the surgeon found out that the defect was bigger and adjacent to the peritoneum. Rectus sheath block is an underused technique that has the potential to be used as a sole anaesthetic technique in selected cases. So it would be wise to improve and consider rectus sheath block as a valuable tool when there is no better.