Sole Anesthetic Technique Research Articles

Combined femoral and sciatic nerve blocks for lower limb anaesthesia in anticoagulated patients with severe cardiac valvular lesions

Peripheral nerve block (PNB) in anticoagulated patients is controversial and guidelines are not defined. We report two patients with severe cardiac valvular lesions, who underwent emergency surgeries for lower limb. Both the patients were on anticoagulants, warfarin and heparin in one and aspirin and clopidogrel in the other, with abnormal coagulation profile in the former. Combined femoral and sciatic nerve blocks were used as a sole anaesthetic technique. Postoperatively, the patients were evaluated for bleeding complications at the injection site using high-frequency ultrasound probe. Both had uneventful surgery and recovery. A close postoperative monitoring following PNBs in anticoagulated patients is necessary.

Thorakale Paravertebralblockade

Thoracic paravertebral block for postoperative pain control has been introduced more than a century ago. It is currently gaining increasing popularity. This simple and safe technique can be used for postoperative analgesia, as well as sole anesthetic technique. When compared to epidural analgesia for postthoracotomy pain control, thoracic paravertebral analgesia provides comparable analgesic efficacy, but less side-effects. Regarding concomitant use of anticoagulants and antiplatelet drugs, paravertebral blockade is considered a central nerve block.

Continuous spinal anaesthesia for laparotomy

Continuous spinal anaesthesia (CSA) for laparotomy was described more than 100 years ago. Recent literature on CSA suggests that this technique can be used as a sole anaesthetic technique for laparotomy especially in patients with severe cardio-respiratory disease who would otherwise be considered unlikely to tolerate general anaesthesia or where general anaesthesia could result in a prolonged stay in the intensive care unit. This article describes how to use the technique of CSA in high risks patients undergoing laparotomy, potential problems that might be encountered and how they can be treated and prevented.

105. Feasibility and Effectiveness of Ultrasound Guided Supraclavicular Brachial Plexus Block as the Sole Anaesthetic Technique for Day-Case Hand Surgery

105. Feasibility and Effectiveness of Ultrasound Guided Supraclavicular Brachial Plexus Block as the Sole Anaesthetic Technique for Day-Case Hand Surgery

Feasibility and Effectiveness of Ultrasound Guided Supraclavicular Brachial Plexus Block as the Sole Anaesthetic Technique for Day-Case Hand Surgery

Feasibility and Effectiveness of Ultrasound Guided Supraclavicular Brachial Plexus Block as the Sole Anaesthetic Technique for Day-Case Hand Surgery

105: Feasibility and Effectiveness of Ultrasound Guided Supraclavicular Brachial Plexus Block as the Sole Anaesthetic Technique for Day-Case Hand Surgery

105: Feasibility and Effectiveness of Ultrasound Guided Supraclavicular Brachial Plexus Block as the Sole Anaesthetic Technique for Day-Case Hand Surgery

Intraoperative Circulatory Collapse With Paravertebral Block

Thoracic paravertebral block is one of the safer and effective techniques for providing postoperative analgesia and as sole anesthetic technique for breast surgery. We report a case where a middle aged lady was undergoing mastectomy with axillary clearance under general anesthesia with thoracic paravertebral block who suffered a circulatory collapse during the surgery. The likely possibility of such scenario is discussed. The case is particularly important because it suggests the likelihood of more than one condition responsible for it.

40: Shoulder arthroplasty: the efficiency of the posterior interscalene brachial plexus block used as the sole anesthetic technique

40: Shoulder arthroplasty: the efficiency of the posterior interscalene brachial plexus block used as the sole anesthetic technique

Paravertebral Blocks Provide Superior Same-Day Recovery over General Anesthesia for Patients Undergoing Inguinal Hernia Repair

Inguinal herniorrhaphy is commonly performed on an outpatient basis under nerve blocks or local or general anesthesia (GA). Our hypothesis is that use of paravertebral blocks (PVB) as the sole anesthetic technique will result in shorter time to achieve home readiness and improved same-day recovery over a 'fast-track' GA. Fifty patients were randomly assigned to receive either PVB or GA under standardized protocols (PVB = 0.75% ropivacaine, followed by propofol sedation; GA = dolasetron 12.5 mg, propofol induction, rocuronium, endotracheal intubation; desflurane; bupivacaine 0.25% for field block). Eligibility for postanesthetic care unit (PACU) bypass and data on time-to-postoperative pain, ambulation, home readiness, and incidence of adverse events were collected. More patients in the PVB group (71%) met the criteria to bypass the postanesthetic care unit compared with patients in the GA group (8%; P < 0.001). Only 3 (13%) of patients in the PVB group requested treatment for pain while in the hospital, compared with 12 (50%) patients in the GA group, despite infiltration with local anesthetic (P = 0.005). Patients in the PVB group were able to ambulate earlier (102 +/- 55 minutes) than those in the GA group (213 +/- 108 minutes; P < 0.001). Time-to-home readiness and discharge times were shorter for patients in the PVB group (156 +/- 60 and 253 +/- 37 minutes) compared with those in the GA group (203 +/- 91 and 218 +/- 93 minutes) (P < 0.001). Adverse events (e.g., nausea, vomiting, sore throat) and pain requiring treatment in the first 24 hours occurred less frequently in patients who had received PVB than in those who had received GA. In outpatients undergoing inguinal herniorrhaphy, PVB resulted in faster time to home readiness and was associated with fewer adverse events and better analgesia before discharge than GA.

Peripheral Foot Blockade Versus Popliteal Fossa Nerve Block: A Prospective Randomized Trial in 51 Patients

The majority of foot and ankle operations are performed on an outpatient basis and often under some form of regional anesthesia. In this prospective, randomized study of 51 patients undergoing elective unilateral forefoot procedures, we compared 2 different anesthetic techniques: the peripheral foot blockade and the popliteal sciatic nerve block. Variables assessed included the quality of surgical anesthesia, postoperative analgesia, and the incidence of postoperative complications. The anesthesia was classified as effective if it was the sole anesthetic technique for the forefoot surgery. We found successful results in both groups: 92% in the foot block group and 96% in the popliteal block group. Analysis of time required to perform the anesthetic procedure showed a significant difference between the 2 groups, with foot block being considerably faster (14.3 minutes vs 19.2 minutes for popliteal block) (P = .0078). Foot block patients demonstrated 10.96 hours of analgesia, whereas popliteal block patients exhibited 14.32 hours (P = .132). With a mean follow-up of 5.7 months, we did not find anesthesia-related complications in any of the patients. Both techniques showed a high level of safety and efficacy, with no significant difference detected between them. Our patients showed a high rate of satisfaction with both procedures (96% for foot block patients and 96.1% for popliteal block patients) and reported a good discharge disposition. These data show that both procedures are safe and effective anesthetic techniques and well suited to forefoot ambulatory surgery.

Regional anesthesia as an alternative to general anesthesia for abdominal surgery in patients with severe pulmonary impairment

Background It is known that smokers and patients with chronic obstructive pulmonary disease (COPD) experience a higher rate of pulmonary-related complications following abdominal surgery. The impact of anesthetic technique (regional [RA] versus general [GA] versus combination of both) on the complication rate has not been established. This study examined the outcomes of abdominal surgery performed using RA (epidural or continuous spinal) as the sole anesthetic technique in patients with severe pulmonary impairment (SPI). Methods We reviewed a series of 8 general surgery cases performed using RA alone (T4–T6 sensory level) in patients with SPI, as evidenced by an forced expiratory volume in 1 second (FEV 1) less than 50% predicted and/or home oxygen requirement. One patient also received postoperative epidural analgesia. FEV 1 ranged from 0.3 to 1.84 L; 3 patients required home oxygen therapy, and 5 of the 8 were American Society of Anesthesiology (ASA) class 4. Operations included segmental colectomy (n = 2), open cholecystectomy (n = 1), incisional herniorrhaphy (n = 1), and laparoscopic herniorrhaphy (n = 4). Results Intraoperative conditions were adequate with RA alone for successful completion of the procedure in all cases. All patients recovered uneventfully except for 1 who developed postoperative pneumonia that resolved with standard therapy. Length of stay was less than 24 hours for 5 of 8 patients. Mortality was 0%. Conclusions Abdominal surgery can be safely performed using RA alone in selected high-risk patients, making this option an attractive alternative to GA for those with severe pulmonary impairment.

Tumescent local anesthesia for the surgical treatment of burns and postburn sequelae in pediatric patients.

Tumescent local anesthesia is a technique for regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large volumes of local anesthetic. The advantages of this technique are (1) simplicity, (2) prolonged postoperative analgesia, (3) low incidence of bleeding, and (4) anesthetization of a large area of the body. There are no reports on the use of tumescent local anesthesia in pediatric patients. In 30 consecutive pediatric burn patients with American Society of Anesthesiologists physical status class I or II who were 1-120 months old (34 +/- 31.6 months), after induction of anesthesia with nitrous oxide-oxygen-sevoflurane, infiltration with 0.05% (14 ml/kg) or 0.1% (7 ml/kg) lidocaine solution was performed. Anesthesia was maintained with patients spontaneously breathing with 1.5% sevoflurane in nitrous oxide-oxygen (50%). The maximum dose of lidocaine used was 7 mg/kg. Postoperative pain was assessed by using the Children's Hospital of Eastern Ontario Pain Scale (for patients aged up to 5 yr) and by using a visual analog scale (for patients older than 5 yr). A comparison with a historic control group not treated with the tumescent local anesthesia technique was performed. No patients were excluded from the study, and no significant variations in the monitored intraoperative parameters were observed. Five patients had an increase in heart rate and respiratory rate at the beginning of surgery, and of these, two needed a temporary increase in sevoflurane concentration. After the initial incision, no response to painful stimulus was observed. No complications occurred. Six patients required postoperative acetaminophen administration, and 24 patients did not require analgesic treatment. Tumescent local anesthesia with maximum dose of 7 mg/kg lidocaine seems to be safe and the sole possible effective locoregional anesthesia technique for the surgical treatment of noncontiguous pediatric burns.

High thoracic epidural anaesthesia as the sole anaesthetic technique for minimally invasive direct coronary artery bypass in a high-risk patient.

High thoracic epidural anaesthesia as the sole anaesthetic technique for minimally invasive direct coronary artery bypass in a high-risk patient.

Cutaneous nerve blocks of the lower extremity

Cutaneous nerve blocks of the lower extremity are useful anesthetic techniques that can be used as a sole anesthetic technique for minor surgical procedures. More commonly, these blocks are used as an adjunct to the major conduction blocks of the lower extremity. These blocks are superficial, require minimal equipment, are relatively simple to accomplish and learn, and should be in the armamentarium of every practitioner. Copyright 2003, Elsevier Science (USA). All rights reserved.

Regional Anesthesia for Laparoscopy

A variety of laparoscopic procedures can be performed on patients under regional anesthesia. Diagnostic laparoscopy in elective and emergency patients, pain mapping, laparoscopy for infertility, and tubal sterilization are some examples. The key benefits of regional anesthesia include less emesis, less postoperative pain, shorter postoperative stay, improved patient satisfaction, and overall safety. Regional techniques, such as rectus sheath blocks, inguinal blocks, and caudal blocks, are useful adjuncts to general anesthesia and facilitate postoperative analgesia. Other techniques, such as spinal and epidural anesthesia, and combination of the two, are suitable as a sole anesthetic technique for laparoscopy. The physiologic changes during laparoscopy in the awake patient appear to be tolerated well under regional anesthesia. It is reasonable to assume that with advances in instrumentation and surgical techniques, the role of laparoscopy will increase in the future. The benefits conferred by regional anesthesia make it an attractive option to general anesthesia for many patients and procedures. Successful implementation of regional anesthesia is an important determinant of how anesthesiologists, surgeons, and surgical facilities cope with new challenges. In the future, it could be possible to provide "walk-in/walk-out" regional anesthesia with a real possibility of fast tracking patients through the recovery process after ambulatory surgery. For maximal patient safety, however, facilities offering regional anesthesia must have appropriately trained anesthesia personnel and the equipment necessary for monitoring and providing full resuscitation in the event of complications or a need to convert to general anesthesia.

Supraclavicular brachial plexus block as a sole anaesthetic technique in children: an analysis of 200 cases.

Classical supraclavicular brachial plexus block was used as the sole anaesthetic technique in 200 children aged between 5 and 12 years undergoing closed reduction of arm fractures. The local anaesthetic used was lidocaine 1.5% with epinephrine. The block was graded as satisfactory if surgical manipulation could be performed without discomfort and unsatisfactory if general anaesthesia had to be given. In 182 children, the procedure was carried out under the block alone, whereas the remaining 18 patients required general anaesthesia. The mean (SD) time required for performing the block was 9.1 (3.7) min and the mean (SD) time to sensory blockade was 8.3 (2.3) min. The mean duration of analgesia was approximately 3.5 h. There were few complications, with no incidence of pneumothorax in any patient. The acceptability of the block by the children and the parents was 72 and 85%, respectively. The classical supraclavicular brachial plexus block was found to be acceptable, effective and with a good success rate.

Popliteal fossa neural blockade as the sole anesthetic technique for outpatient foot and ankle surgery.

Foot and ankle operations are being performed with greater frequency as outpatient procedures. Although the surgical procedure remains the same whether the operation is done in an inpatient or an outpatient setting, the anesthesia and postoperative analgesia are greatly affected when patients must be discharged soon after their operation. We have evaluated a regional anesthetic technique which blocks the sciatic nerve in the popliteal fossa and the saphenous nerve block at the knee. This was the sole anesthetic technique for both the operation and the immediate postoperative period. This technique appears to have several advantages: 1) Excellent anesthesia during the operation and for about ten hours postoperatively; 2) Use of a proximal calf tourniquet, and 3) Absence of systemic or local complications as might be seen with general, spinal or epidural anesthesia.

Significance of polar dinosaurs in Gondwana : Rich T.M., Memoirs - Queensland Museum, 1996, 39/3 (711–717)

Pneumoperitoneum during laparoscopic cholecystectomy (LC) can cause hypercapnia, hypoxemia, hemodynamic changes and shoulder pain. General anesthesia (GA) enables the control of intraoperative pain and ventilation. The need for GA has been questioned by studies suggesting that neuraxial anesthesia (NA) is adequate for LC.To quantify the prevalence of intraoperative pain and to verify whether evidence on the maintenance of ventilation, circulation and surgical anesthesia during NA compared with GA is consistent.Systematic review with meta-analyses.Anesthesia for laparoscopic cholecystectomy.We searched Medline, Cochrane and EBSCO databases up to 2016 for randomized controlled trials that compared LC in the two groups under study, neuraxial (subarachnoid or epidural) and general anesthesia.The primary outcome was the prevalence of intraoperative pain referred to the shoulder in the NA group. Hemodynamic and respiratory outcomes and adverse effects in both groups were also collected.Eleven comparative studies were considered eligible. The pooled prevalence of shoulder pain was 25%. Intraoperative hypotension and bradycardia occurred more frequently in patients who received NA, with a risk ratio of 4.61 (95% confidence interval [CI] 1.70–12.48, p = 0.003) and 6.67 (95% CI 2.02–21.96, p = 0.002), respectively. Postoperative nausea and vomiting was more prevalent in patients who submitted to GA. The prevalence of postoperative urinary retention did not differ between the techniques. Postoperative headache was more prevalent in patients who received NA, while the postoperative pain intensity was lower in this group. Performing meta-analyses on hypertension, hypercapnia and hypoxemia was not possible.NA as sole anesthetic technique, although feasible for LC, was associated with intraoperative pain referred to the shoulder, required anesthetic conversion in 3.4% of the cases and did not demonstrate evidence of respiratory benefits for patients with normal pulmonary function.

Regional Anesthesia Techniques for Outpatient Shoulder Arthroscopy

In Response: We appreciate the comments made by Dr. Mulroy. However, we have a different interpretation of the existing evidence. Although there may be initial evidence to suggest that a total regional technique has advantages over general anesthesia in outpatient shoulder arthroscopy, there has never been a well designed prospective study to support this conclusion. Both Brown et al.'s [1] and D'Alessio et al.'s [2] studies are retrospective reviews. Interscalene block could be used as the only anesthetic technique in shoulder surgery. However, the success rate of interscalene block is variable. Even with the supplementation of the superficial cervical block [3] or upper thoracic paravertebral block [4], the failure rates range from 3.4% [4] to 18% [3]. The failure rate is 16% in Brown et al.'s study [1] and 8.7% in D'Alessio et al.'s study [2]. In Brown et al.'s [1] study, the reasons for failures were inadequate block when 30 mL or less local anesthetics were used, local anesthetic toxicity, dyspnea, and inability to swallow, reflecting vagus nerve involvement [1]. The block was also complicated by Horner's syndrome and hoarseness [1]. We agree with Dr. Mulroy's suggestion that the addition of suprascapular block with a long-acting local anesthetic would provide prolonged analgesia, outlasting the usual duration of interscalene block with Lidocaine. This combined approach would also probably prove useful in outpatient shoulder arthroscopy. Since the completion of our study, we have modified our technique for the suprascapular block. Dangoisse et al. [5] described a vertical approach to the suprascapular nerve, in which paresthesia and the use of a nerve stimulator were not required. The distribution of the local anesthetic in the supraspinatous fossa was confirmed by the magnetic resonance imaging, and all patients reported good pain relief [5]. This approach is much simpler and has allowed us to perform the suprascapular block in less than 5 min. In summary, the failure rate of interscalene block as the sole anesthetic technique is variable outside major centers for regional anesthesia. The suprascapular block offers an effective alternative for prolonged perioperative analgesia and has a much more user-friendly profile. Doris Tong, MD, FRCPC Frances Chung, MD, FRCPC Ewan Ritchie, MBChB The Toronto Hospital, Western Division; Toronto, Ontario, Canada