A&A practice
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Caudal epidural catheters threaded to the thoracic levels are increasingly utilized in infants undergoing thoracic and abdominal surgery, compared to lumbar or thoracic epidural techniques. Estimating catheter length traditionally relies on anatomical landmarks, but the lack of spine ossification in infants makes ultrasonography a valuable and noninvasive tool. We present 3 cases where real-time ultrasonography facilitated caudal to thoracic epidural catheter placement in infants undergoing thoraco-abdominal surgeries. Incision-congruent placement of the catheter tip ensured effective perioperative analgesia with low doses of bupivacaine administered as intermittent boluses resulting in potent and prolonged analgesia with reduced opioid requirements.
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Hip disarticulation is a morbid procedure for those whose bony or soft tissues are unable to be salvaged. It involves extensive resection, and the patient featured in this report expressed mechanical pain from their sacroiliac joint (SIJ) as well as phantom limb pain (PLP). Spinal cord stimulation is known to assist with neuropathic pain syndromes, and SIJ fusion is effective in these cases of multifactorial pain. This report presents a successful off-label use of thoracic spinal cord stimulation in a complex pain condition consisting of coexisting PLP and mechanical SIJ pain in a hip disarticulation patient.
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Patients presenting with large ventral abdominal wall hernias require pretreatment with injection botulinum toxin A before surgery. Currently, multipoint and multilayered botulinum injection techniques are practiced. We are describing a new ultrasound-guided, 1-point, single interfascial plane botulinum toxin A injection technique for the closure of big hernial defects.