A&A practice
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Peripheral nerve blocks for postoperative pain management in distal radius fracture fixation with volar locking plates can cause undesirable motor paralysis. We performed bilateral ultrasound-guided selective sensory nerve blocks to the lateral cutaneous nerve of the forearm, superficial branch of the radial nerve, and anterior interosseous nerve for a patient undergoing bilateral distal radius fracture fixation with volar locking plates. This case report describes the first successful use of this ultrasound-guided selective sensory nerve block, which provided satisfactory postoperative analgesia and preserved the patient's motor function following distal radius fracture fixation with volar locking plates.
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It remains unclear how epidural pneumatosis affects the efficacy of neuraxial anesthesia. Spontaneous pneumomediastinum (Hamman syndrome) with epidural pneumatosis is rare. ⋯ We present a 19-year-old patient with Hamman syndrome and epidural pneumatosis who required emergency laparotomy. Effective analgesia was obtained using neuraxial anesthesia with a combined spinal-epidural anesthesia technique.
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Adenotonsillectomies are one of the most common otolaryngologic surgeries performed to alleviate obstructive sleep-disordered breathing and apnea in children. The pain management following adenotonsillectomy continues to be a challenge for both pediatric anesthesiologists and otolaryngologists due to the mortality that stems from the use of opioid pain medications in children who have an increased baseline risk airway obstruction and apnea that is exacerbated by any exposure to opioids. We present a case utilizing bilateral suprazygomatic maxillary nerve (SZMN) blocks or, more accurately, suprazygomatic infratemporal-pterygopalatine fossa injections to achieve opioid-free perioperative analgesia for pediatric adenotonsillectomy with nasal turbinate reduction.
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A transverse abdominis plane (TAP) block is one option in the management of chronic groin pain after inguinal hernia repair. Steroid-induced lipoatrophy following local injection is an infrequent complication of this procedure, but can be distressing to patients when it does occur. ⋯ The serial intralesional injection of isotonic saline is technically simple and may be an effective means of treating lipoatrophy. Pain specialists may opt to treat this procedural complication rather than refer to dermatology.
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Retroauricular or facelift approach for robotic thyroidectomy involves a long incision with extensive subcutaneous dissection causing severe pain and discomfort. Multimodal analgesic regimen with inclusion of intermediate cervical plexus block by anterior route provided excellent perioperative analgesia without affecting recurrent laryngeal nerve monitoring in 10 cases. ⋯ Median numeric pain rating scale score in 24 hours postoperatively was 3. None of the cases had any significant complications on follow-up.