Use Of Regional Anesthetic Techniques Research Articles

The Impact of Regional Anesthesia in Masking Acute Compartment Syndrome after Limb Trauma.

Regional anesthesia has shown to be successful in controlling major pain in trauma patients. However, the possibility of masking acute compartment syndrome (ACS) after peripheral nerve blocks for limb injuries is still controversially discussed. Therefore, we aimed to summarize the current literature regarding this topic to shed light on the impact of peripheral regional anesthesia on the diagnosis of ACS in trauma patients. We searched Pubmed, Google Scholar and the Cochrane Library for literature following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The analysis of these reports was included in the context of the current literature concerning this topic. We found no (randomized) studies, and only six case reports dealing with the impact of peripheral nerve blocks and ACS in patients after a limb trauma met our criteria and were included in our review. Only one reported a delay in the diagnosis of ACS. In most of the cases (5 of 6), the breakthrough pain, despite the nerve block, proved to be a good indicator of a developing ACS. However, despite some narrative articles about the topic including some recommendations about the possibly safe use of regional anesthesia techniques for limb trauma, there is still no international consensus and only one national guideline focusing on the possibly safe use of peripheral nerve blocks in trauma patients at risk of ACS. After reviewing the respective literature, we consider that intra-articular analgesia, sensory blocks, fascial plane blocks and low-concentration continuous peripheral nerve blocks are effective for analgesia and a low-risk analgesia tool for trauma and postsurgical patients at risk of ACS due to the fact that they do not lead to a dense block. Finally, we summarized suggestions based on the results of the literature for the different regional anesthesia modalities in these patients in a table to facilitate the use of these techniques.

Regional Anaesthesia Techniques for Orthopaedic Surgery at Tertiary Care Teaching Hospital

Background: Regional anaesthesia has found its uses in many aspects of orthopaedic surgery including more recently, spine surgery. Neuraxial or regional anaesthesia are often the preferred techniques for surgical anaesthesia in patients with multiple comorbidities. For instance, osteoporosis-related complications such as hip fractures are common in the growing geriatric population. Orthopaedic surgery aims to recover functional capacity in patients but it carries a specific morbidity and mortality. Orthopaedic surgery conveys several challenges for the anaesthesiologist, including prevention of thromboembolic complications, reduction of peri- and postoperative bleeding and management of autologus blood transfusion and postoperative pain. Material and Methods: This is a prospective study was conducted in the Department of orthopaedic and Anaesthesia at Shadan Institute of Medical Sciences, Teaching Hospital and Research Center. Three hundred and ten consecutive cases posted for orthopaedic surgeries were taken up for study. Anaesthesia technique was decided based on the nature of surgery, willingness and medical status of the patient and experience of the anaesthesiologists. RA was planned whenever possible. In the morning of operation the RA technique was explained to the patients and intravenous (IV) access established. Preoperative medication was given using IV fentanyl and midazolam in titrated doses. Ketamine was used in children and appropriate block given using standard technique. Nerve stimulator was used wherever applicable Results: Age of the patients ranged from three months to 92 years. Maximum number of patients belonged to the age group of 21- 50 years (63.2%). As per the demographic data. In our study, Knee arthroscopy and repair was 28.38%, Femoral was 17.41%, Radius and ulna was 15.16% and least were Ankle and foot, Wrist and hand surgery was 1.93%. In our study Subarachnoid block was 40.96% followed by Combined spinalepidural 17.09%, General anaesthesia 12.90%. Conclusion: In a conclusion, the use of regional anesthesia techniques for postoperative outcomes in orthopedic surgeries has been investigated in lots of clinical studies and case reports. Most of the authors proposed that regional anesthesia in orthopedic patients may be associated with better postoperative pain control and a reduction in intraoperative blood loss when compared with general anesthesia. In the future regional anesthesia techniques will be more preferable anesthetic technique in orthopedic surgeries

Regional anesthesia and sickle cell crisis in pediatric patients: An educational-focused review.

Sickle cell disease (SCD) is the most common inherited hemoglobinopathy, affecting approximately 100 000 patients in United States and millions worldwide. Although the mainstay of pain management for VOC remains systemic opioids, given the potential for adverse effects including respiratory depression and hypoxemia, there remains interest in the use of regional anesthetic techniques (neuraxial or peripheral nerve blockade). A systematic search of pubMed, Scopus, and Google Scholar was conducted using the terms sickle cell disease, sickle cell crisis, pain crisis, vaso-occlusive crisis, regional anesthesia, peripheral nerve blockade, and neuraxial anesthesia. We identified 7 publications, all of which were retrospective case series or single case reports, outlining the use of neuraxial anesthesia in a total of 26 patients with SCD. Additionally, we identified 4 publications, including one retrospective case series and 3 single case reports, entailing the use of peripheral blockade in patients with VOC and SCD. The available literature, albeit all retrospective or anecdotal, suggests the potential utility of regional anesthesia to treat pain in patients with SCD. Additional benefits have included avoidance of the potential deleterious physiologic effects of systemic opioids and in one case series, an improvement in respiratory function as judged by pulse oximetry. The anecdotal and retrospective nature of the available reports with an absence of prospective trials limits the evidence based medicine available from which to develop to guidlines for the optimal local anesthetic agent to use, its concentration, the rate of infusion, and the choice of adjunctive agents.

Pain management for liver transplant recipients.

Liver transplant recipients pose several pain management challenges. Altered hepatic drug metabolism and clearance in end-stage liver disease patients complicates the use of certain medications, while existing coagulopathy and thrombocytopenia can limit the use of regional anesthetic techniques. Largely due to a high prevalence of substance use disorders, these patients have increased vulnerability to opioid misuse in the perioperative period, which can make acute postoperative pain difficult to control and potentiates prolonged and painful recovery, increasing the risk of developing chronic postsurgical pain. We present current evidence-based literature that reviews optimal pain management strategies for this challenging patient demographic. Multiple studies have shown that thoracic epidurals provide superior pain control in open hepatic resections. Recent data suggests thoracic epidurals may be safely considered in select liver transplant recipients with normal preoperative coagulation status; however, this evidence is limited, and further studies are needed. When the risks of coagulopathy prohibit epidural placement, truncal blocks such as transversus abdominis plane blocks or quadratus lumborum blocks and abdominal wound catheters can serve as alternative regional modalities. Specialized teams should manage pain using a multimodal approach. Thoracic epidural analgesia may be an option for liver transplant recipients with normal coagulation profiles prior to surgery; however, additional studies are warranted. Other regional techniques are also available. Emphasis should be placed on optimizing multimodal pain medication management. Nonpharmacological interventions should also be considered.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

The practice of regional anesthesia during the COVID-19 pandemic: an international survey of members of three regional anesthesia societies.

PurposeTo determine the preferences and attitudes of members of regional anesthesia societies during the COVID-19 pandemic.MethodsWe distributed an electronic survey to members of the American Society of Regional Anesthesia and Pain Medicine, Regional Anaesthesia-UK, and the European Society of Regional Anaesthesia & Pain Therapy. A questionnaire consisting of 19 questions was developed by a panel of experienced regional anesthesiologists and distributed by email to the participants. The survey covered the following domains: participant information, practice settings, preference for the type of anesthetic technique, the use of personal protective equipment, and oxygen therapy.ResultsThe survey was completed by 729 participants from 73 different countries, with a response rate of 20.1% (729/3,630) for the number of emails opened and 8.5% (729/8,572) for the number of emails sent. Most respondents (87.7%) identified as anesthesia staff (faculty or consultant) and practiced obstetric and non-obstetric anesthesia (55.3%). The practice of regional anesthesia either expanded or remained the same, with only 2% of respondents decreasing their use compared with the pre-pandemic period. The top reasons for an increase in the use of regional anesthesia was to reduce the need for an aerosol-generating medical procedure and to reduce the risk of possible complications to patients. The most common reason for decreased use of regional anesthesia was the risk of urgent conversion to general anesthesia. Approximately 70% of the responders used airborne precautions when providing care to a patient under regional anesthesia. The most common oxygen delivery method was nasal prongs (cannula) with a surgical mask layered over it (61%).ConclusionsGiven the perceived benefits of regional over general anesthesia, approximately half of the members of three regional anesthesia societies seem to have expanded their use of regional anesthesia techniques during the initial surge of the COVID-19 pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12630-021-02150-8.

COVID-19: Regional Anesthesia, Benefits, and Practical Recommendations.

During coronavirus disease 2019 (COVID-19) pandemic, efforts have been made to rethink the health system and provide various recommendations to the best care of patients and for the protection of health personnel. In patients with suspicion or confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who require surgical intervention and anesthetic management, strategies must be established to minimize aerosol-generating procedures. Regional anesthesia (RA) is not considered an aerosol-generating procedure per se and is currently proposed such as a safe strategy and part of comprehensive perioperative care. However, the preoperative evaluation has undergone changes in the context of the COVID-19 pandemic, so in addition to routine preoperative evaluation, a patient-oriented history, clinical, laboratory, and radiologic evaluation should be performed, and a series of general recommendations should be taken into account before, during, and after the performance of RA procedure. A search of PubMed/MEDLINE, Web of Science, and Google Scholar databases was performed until August 22, 2020, using the words: 〞regional anesthesia or nerve block or peripheral nerve block or spinal anesthesia or epidural anesthesia and SARS-CoV-2 or COVID-19 or MERS or SARS-CoV-1 or influenza.〞 We included in this review all articles, regardless of design, published in the English language. Given the benefits reported with the use of RA techniques, both for the patient and for healthcare personnel, it has recently been suggested that RA should be considered as the first choice. However, it is important to generate more precise and homogeneous management guidelines based on the evidence obtained every day during the care of patients with COVID-19.

Spinal Anesthesia: Much More Than Single Shot of Hyperbaric Bupivacaine

There is significant and renewed attentiveness in the use of regional anesthesia techniques for many common surgeries. The vast majority of anesthesiologists world wide use the routinely the hyperbaric solution of bupivacaine for almost all types of surgery. However, they ignore that spinal anesthesia has more to offer. A different kind of technique for a different kind of patients. The understanding of spinal anesthesia in relation to sensory and motor blocks with hyperbaric and isobaric solutions is shown in this article. The possibilities of performing unilateral spinal anesthesia are described.

Maternal and perinatal outcomes in repeated cesarean section

Aim. To analyze the maternal and perinatal outcomes in repeated caesarean section. The first group included 50 laboring women who received combined endotracheal anesthesia for a repeat cesarean section. The second group included 50 laboring women who received spinal anesthesia during the operative delivery. The condition of 100 newborns born by repeated cesarean section was studied.Results. In postpartum period in the women of first group very often, develop endometritis (24%), in second group – 36%, hematometra in first group we see in 12%, in second – 26%. Tracheobronhitis occur in first group among 30%. Research of the condition and course of early neonatal period in newborns showed, that combined anesthesia initiates pathological course of this period. The main complications were asphyxia (28%), and neurological disorders (22%).Conclusions. Different types of analgesia initiate different types of complications in the postoperative period, but better neonatal outcomes with the use of regional anesthesia techniques qualify them as the anesthesia method of choice for repeat cesarean section.

A Randomized Comparative Trial to Study the effect of Preoperative single shot Epidural with Ropivacaine in Lumbar Laminectomy

Background: laminectomy surgeries are usually performed in cases of spinal canal stenosis, disc prolapse etc. It has been reported that the use of regional anesthesia techniques in combination to general anaesthesia has shown better heamodynamic stability intraoperatively, better pain scores and reduced intraoperative blood loss. The present study was conducted to evaluate the efficacy of fusion technique of combining epidural and general anaesthesia in patients undergoing lumbar laminectomies. Aim: To evaluate the efficacy of combined epidural general anesthesia for lumbar laminectomy surgeries with epidural ropivacaine. Materials and Methods: A prospective randomised study was conducted in 100 patients who are scheduled for lumbar laminectomy surgeries belonging to ASA Class I and II age between 40-60 years were randomly allocated into two groups (Group E and Group F) of 50 each. Group E: 12ml of 0.5% Ropivacaine and 50µg fentanyl epidurally. Group F:12ml of Normal Saline and 50µg fentanyl epidurally. The parameters recorded were intraoperative analgesia by heart rate and blood pressure, Rescue analgesia, Blood loss. Results: Intraoperatively requirement of general anesthetics, Heart rate, MBP, Blood loss, is lesser in Group E when compared with Group F. It was observed that longer time to rescue analgesia in group E than in group F. Conclusion: combined epidural general anesthesia with local anesthetic (ropivacaine) with narcotic (fentanyl) is a better technique for anesthetic management of patients posted for lumbar laminectomy. Thus from our study we conclude that combined epidural general anesthesia technique with epidural ropivacaine is a better alternative to general anesthesia providing stable hemodynamics, reducing dose of general anesthetics, less blood loss.

Breast Regional Anesthesia Practice in the Italian Public Health System (BRA-SURVEY): A Survey-Based National Study.

Breast cancer is the most common malignancy in women. Surgery is a mainstay therapy unfortunately burdened by complications as severe postoperative pain. Regional anesthesia may play a role in a multimodal strategy for prevention and treatment of postoperative pain. The main purpose of this survey was to investigate the rate of use of regional anesthesia techniques in patients undergoing breast surgery in the Italian public hospital system. We designed an online survey that consisted of 22 questions investigating the anesthesia management of breast surgery, particularly focused on regional anesthesia. The survey lasted from November 18, 2019 to February 28, 2020. Directors of anesthesia departments of 168 Italian public health system hospitals were contacted and invited to forward the survey to every anesthesiologist in their unit. A total of 935 anesthesiologists received the survey; among them 460 entered the final analysis. Regional anesthesia was not used by 44.6% of the anesthesiologists and lack of experience/training was the main cause (75.6%). Logistic regression models revealed that anesthesiologists with more than 15 years of experience (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.33-0.93) or working most of their days in intensive care unit (ICU) compared to operating theater (OR = 0.25; 95% CI, 0.14-0.43) were less likely to perform regional anesthesia techniques. Low implementation of regional anesthesia techniques in breast surgery emerges from our survey and the major reason cited is a lack of proper training. An improved training program in regional anesthesia, especially in residents' curricula, could be useful to increase its rate of use and to standardize its practice.

Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review.

Moderate-to-severe postoperative pain persists for longer than the duration of single-shot peripheral nerve blocks and hence continues to be a problem even with the routine use of regional anaesthesia techniques. The administration of local anaesthetic adjuncts, defined as the concomitant intravenous or perineural injection of one or more pharmacological agents, is an attractive and technically simple strategy to potentially extend the benefits of peripheral nerve blockade beyond the conventional maximum of 8-14hours. Historical local anaesthetic adjuncts include perineural adrenaline that has been demonstrated to increase the mean duration of analgesia by as little as just over 1 hour. Of the novel local anaesthetic adjuncts, dexmedetomidine and dexamethasone have best demonstrated the capacity to considerably improve the duration of blocks. Perineural dexmedetomidine and dexamethasone increase the mean duration of analgesia by up to 6hour and 8hour, respectively, when combined with long-acting local anaesthetics. The evidence for the safety of these local anaesthetic adjuncts continues to accumulate, although the findings of a neurotoxic effect with perineural dexmedetomidine during in-vitro studies are conflicting. Neither perineural dexmedetomidine nor dexamethasone fulfils all the criteria of the ideal local anaesthetic adjunct. Dexmedetomidine is limited by side-effects such as bradycardia, hypotension and sedation, and dexamethasone slightly increases glycaemia. In view of the concerns related to localised nerve and muscle injury and the lack of consistent evidence for the superiority of the perineural vs. systemic route of administration, we recommend the off-label use of systemic dexamethasone as a local anaesthetic adjunct in a dose of 0.1-0.2mg.kg-1 for all patients undergoing surgery associated with significant postoperative pain.

Regional Anaesthesia, The Seed of Opportunity In COVID-19 Crisis: The Balance Has Shifted

Albert Einstein once said, “in the midst of every crisis, lies great opportunity.” There’s no question that we’re in the midst of a global crisis. There’s no doubt that a crisis creates problems, lots of them, but it also creates opportunities. Something that every anaesthetist does day in day out safely, intubation of trachea, is now become a risk factor for spread of the disease. So where is the opportunity in this crisis? In the west, regional anaesthesia is often used as an adjunct rather than as sole anaesthetic technique, as part of multimodal analgesia in patients who are being operated under general anaesthesia. Unfortunately, general anaesthesia requires airway manipulation that is associated with aerosol generation and risks transmission of corona virus. This is a risk that can be averted with use of regional anaesthesia techniques for procedures that can be done with patient awake rather than asleep. At the beginning of the pandemic with surge of patients requiring endotracheal intubation and ventilation, increased intensive care admissions affected anaesthesia services in many ways. The increased number of patients needing critical care increased the demand for drugs used in both anaesthesia and critical care and this demand led to shortage of anaesthesia drugs and led the Association of Anaesthetists (AOA) and the Royal College of Anaesthetists (RCoA), working closely with the Chief Pharmaceutical Officer at NHS England to produce a guidance which summarised potential mitigations to be used in the management of such demand. Direct alternative drugs and techniques were offered (1). The options identified in the guidelines were not exhaustive but give a way of thinking about this situation we all have landed up in. We were unsure of how long this demand would continue and how we would manage the situation. This is where the opportunity to use regional anaesthesia for procedures that could be done purely under neuraxial or peripheral nerve blocks became

A Comparative Study of Effectiveness of Ultrasound-Guided Transversus Abdominis Plane (TAP) Block vs Epidural Analgesia for Post-Operative Pain Relief in Lower Abdominal Surgeries

Background: An increase in the use of regional anesthesia techniques for postoperative pain relief for analgesia following lower abdominal surgeries. Epidural anesthesia considered as the "gold standard" has been established to provide excellent analgesia as well as attenuation of neurogenic contribution to inflammation. The TAP block provides reliable somatic analgesia in lower abdominal incision surgeries. Use of ultrasound helps incorrect localization of the plane and accurate placement of the needle and catheter.Subjects and Methods:In TAP group under USG guidance 20 ml 0.2% Inj. Ropivacaine was deposited on each side of the abdominal wall. In Epidural group 10 ml of 0.2% Inj. Ropivacaine was administered at skin closure.Results:Systolic and diastolic blood pressure levels were significantly lower in group B as compared to group A (p<0.05). . VAS score was significantly higher in group B as compared to group A (P<0.05). It was observed that a significantly higher number of patients in epidural group required rescue analgesia and at higher dosages (p<0.05).Conclusion:TAP block has almost no complications, keeps the patient hemodynamically stable and offers a good early postoperative analgesia (till 24 hours) when compared to a more accepted modality like epidural analgesia.

What has happened since the First World Congress on Pediatric Pain in 1988? The past, the present and the future.

The present article summarizes the development within the field of pediatric pain during the last 30 years, with a special focus on pediatric postoperative pain. Insights concerning pain ontogeny, how pain influences the neuro-endocrine stress response and the induction of a "pain memory" is discussed as well as established and new options with regards to treatment of postoperative pain. Lastly, some aspects concerning future development within this field is discussed. It is now well-established that even the unborn fetus reacts with behavioral responses indicative of pain and is also capable of producing a neuro-endocrine stress response if subjected to a painful stimulus. These responses can successfully be treated by opioid administration. The babies stress response if proportional to the magnitude of the surgical procedure and various ways to provide better pain relief to babies undergoing major surgery has been shown to reduce morbidity and mortality. A wide variety of different options exist to treat postoperative pain both in infants and older children. The use of regional anesthetic techniques should be used whenever possible and combined with appropriate systemic options, thereby producing multi-modal analgesia. However, new concepts and drugs are unfortunately few and, thus, progress often lies in using established drugs in more efficient ways. The concept of Enhanced Recovery After Surgery (ERAS) also provides a framework where high-quality postoperative pain relief is of essence for the best possible outcome after both minor and major surgery.

Regional Anesthesia for Pain Management After Orthopedic Procedures for Treatment of Lower Extremity Length Discrepancy.

IntroductionThe use of regional anesthesia techniques continues to expand in a wide variety of surgical procedures as the benefits and safety are increasingly appreciated. Limb-lengthening procedures are often associated with significant postoperative pain and high opioid requirements which may impact patient’s recovery and increase risk of chronic pain and long-term opioid use.MethodsThe current study retrospectively reviews our experience utilizing a novel peripheral nerve catheter (PNC) protocol for postoperative pain management in patients undergoing elective limb-lengthening procedures. We measure total opioid consumption following 48 hrs in the postoperative period between groups.ResultsA total of 70 patients were included from which 41 received general plus regional anesthesia (RA) and 29 were managed with general anesthesia alone (NORA). Postoperative pain needs were calculated as morphine equivalents (ME). There were no differences in the demographic characteristics between the groups. Over the first 48 postoperative hours, opioid use was 0.5 mg/kg ME (IQR 0.3, 0.9) in the RA group versus 1.7 mg/kg ME (IQR 1.1, 3.1) in the NORA group (p<0.001). Subgroup analysis between femoral lengthening and tibial-fibular lengthening procedures demonstrated the same opioid-sparing effect favoring the RA group compared to the NORA group. Hospital length of stay was significantly shorter in the femoral lengthening RA group compared to NORA group (32 hrs [IQR 29, 35] versus 53 hrs [IQR 33, 55], respectively). There was no significant difference in length of stay between the RA group and NORA group after tibial-fibular lengthening procedures.DiscussionRegional anesthesia via continuous catheter infusions has a clinically significant opioid-sparing effect for postoperative pain management after limb-lengthening procedures and may facilitate earlier hospital discharge.

Postoperativna analgezija kod dece

In many centres for pediatric surgery too many children still experience intense postoperative pain. Factors that contribute to inadequate postoperative pain control in children are: lack of the experience, inadequate use of pain scales, interpatient variability in pain perception and analgesic requirements, differences in pharmacodynamics and pharmacokinetics, age restricted drug licensing and a relative paucity of researches. The proper pain estimation scales are dependent on the child's age and their understanding of pain and of the scale. Most commonly used drugs in pediatric postoperative pain relief are opioid and nonopioid analgesics (nonsteroidal anti-inflammatory drugs, paracetamol, metamizole, ketamine, Dexamethasone and Alpha-2-agonists). The use of regional anesthesia techniques is becoming increasingly popular in postoperative analgesia following pediatric surgery. Severe acute postoperative pain in children can have significant long term effects such as chronic pain. Of great importance is that acute postoperative pain in children is optimally managed from the outset.

Effect of intraoperative paravertebral or intravenous lidocaine versus control during lung resection surgery on postoperative complications: A randomized controlled trial

BackgroundUse of minimally invasive surgical techniques for lung resection surgery (LRS), such as video-assisted thoracoscopy (VATS), has increased in recent years. However, there is little information about the best anesthetic technique in this context. This surgical approach is associated with a lower intensity of postoperative pain, and its use has been proposed in programs for enhanced recovery after surgery (ERAS). This study compares the severity of postoperative complications in patients undergoing LRS who have received lidocaine intraoperatively either intravenously or via paravertebral administration versus saline.Methods/designWe will conduct a single-center randomized controlled trial involving 153 patients undergoing LRS through a thoracoscopic approach. The patients will be randomly assigned to one of the following study groups: intravenous lidocaine with more paravertebral thoracic (PVT) saline, PVT lidocaine with more intravenous saline, or intravenous remifentanil with more PVT saline. The primary outcome will be the comparison of the postoperative course through Clavien-Dindo classification. Furthermore, we will compare the perioperative pulmonary and systemic inflammatory response by monitoring biomarkers in the bronchoalveolar lavage fluid and blood, as well as postoperative analgesic consumption between the three groups of patients. We will use an ANOVA to compare quantitative variables and a chi-squared test to compare qualitative variables.DiscussionThe development of less invasive surgical techniques means that anesthesiologists must adapt their perioperative management protocols and look for anesthetic techniques that provide good analgesic quality and allow rapid rehabilitation of the patient, as proposed in the ERAS protocols. The administration of a continuous infusion of intravenous lidocaine has proven to be useful and safe for the management of other types of surgery, as demonstrated in colorectal cancer. We want to know whether the continuous administration of lidocaine by a paravertebral route can be substituted with the intravenous administration of this local anesthetic in a safe and effective way while avoiding the risks inherent in the use of regional anesthetic techniques. In this way, this technique could be used in a safe and effective way in ERAS programs for pulmonary resection.Trial registrationEudraCT, 2016–004271-52; ClinicalTrials.gov, NCT03905837. Protocol number IGGFGG-2016 version 4.0, 27th April 2017.

Anesthesia during deployment of a military forward surgical unit in low income countries: A register study of 1547 anesthesia cases.

BackgroundMilitary anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations.ObjectiveThis study aimed to describe and analyze French anesthetic activity in a deployed military setting.MethodsBetween October 2015 and February 2018, all patients managed by Sainte-Anne Military Hospital anesthesiologists deployed in mission were included. Anesthesia management was described and compared with the same surgical procedures in France performed by the same anesthesia team (hernia repair, lower and upper limb surgeries). Demographics, type of surgical procedure, and surgical activity were also described. The primary endpoint was to describe anesthesia management during the deployment of forward surgical teams (FST). The secondary endpoint was to compare anesthesia modalities during FST deployment with those usually used in a military teaching hospital.ResultsDuring the study period, 1547 instances of anesthesia were performed by 11 anesthesiologists during 20 missions, totaling 1237 days of deployment in nine different theaters. The majority consisted of regional anesthesia, alone (43.5%) or associated with general anesthesia (21%). Compared with France, there was a statistically significant increase in the use of regional anesthesia in hernia repair, lower and upper limb surgeries during deployment. The majority of patients were civilians as part of medical support to populations.ConclusionIn the context of an austere environment, the use of regional anesthesia techniques predominated when possible. These results show that the training of military anesthetists must be complete, including anesthesia, intensive care, pediatrics, and regional anesthesia.

Evaluation of the attitudes of surgeons about regional anesthesia: a survey study.

BackgroundThe intraoperative attending anaesthesiologist ultimately makes decisions about the anaesthesiology technique to be performed, but the attitudes of surgeons and preferences of patients on this subject may affect their choice. In this questionnaire-based study, we aimed to evaluate the attitudes and behaviors of surgeons about the use of regional anaesthesia (RA) in surgical operations.MethodsSurgeons from different surgical branches with residencies at 4 different hospitals were asked to complete questionnaires that included reasons for preferring (12 reasons) and not preferring (13 reasons) the use of RA techniques for surgeries, using a 5-point Likert scale.ResultsA total of 156 surgeons from 4 hospitals, out of 167 surgeons who were approached to participate in the study, completed the questionnaire. The most commonly observed reason for a preference towards regional anaesthesia among the surgeons was the risk of general anaesthesia for patients with an American Society of Anesthesiologists (ASA) risk class of III and above. The second most commonly observed reason was for protection from the complications of general anaesthesia, and the third most commonly observed reason was the lower risk of thromboembolisms with regional anaesthesia. The most commonly observed reasons for not choosing regional anaesthesia were found to be incompatibility of the patients and patients’ fears of feeling pain during surgery.ConclusionWe conclude that programmes for informing surgeons and educating patients about the advantages of RA may increase the preference ratio among surgeons and decrease patients’ refusals to choose this procedure.