Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Apr 2024
Observational StudyCutaneous sensory block area of the ultrasound-guided subcostal transversus abdominis plane block: an observational study.
The transversus abdominis plane block (TAP) can be applied using different approaches, resulting in varying cutaneous analgesic distributions. This study aimed to assess the cutaneous sensory block area (CSBA) after ultrasound-guided TAP (US-TAP) using the subcostal approach. ⋯ The subcostal US-TAP results in a heterogeneous non-dermatomal CSBA with varying size and distribution across the medial abdominal wall.
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Primary failure of thoracic epidural analgesia (TEA) remains an important clinical problem, whose incidence can exceed 20% in teaching centers. Since loss-of-resistance (LOR) constitutes the most popular method to identify the thoracic epidural space, the etiology of primary TEA failure can often be attributed to LOR's low specificity. Interspinous ligamentous cysts, non-fused ligamenta flava, paravertebral muscles, intermuscular planes, and thoracic paravertebral spaces can all result in non-epidural LORs. ⋯ In the hands of experienced operators, real-time ultrasound guidance of the epidural needle has been demonstrated to provide comparable efficacy and efficiency to fluoroscopy. Further research is required to determine the most cost-effective confirmatory modality as well as the best adjuncts for novice operators and for patients with challenging anatomy. Moreover, future trials should elucidate if fluoroscopy and electrical stimulation could potentially decrease the secondary failure rate of TEA, and if a combination of confirmatory modalities could outperform individual ones.
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Reg Anesth Pain Med · Apr 2024
Combined erector spinae plane block with surgical intercostal nerve cryoablation for Nuss procedure is associated with decreased opioid use and length of stay.
Pain management for patients undergoing the Nuss procedure for treatment of pectus excavatum can be challenging. In an effort to improve pain management, our institution added bilateral single injection erector spinae plane (ESP) blocks to surgeon placed intercostal nerve cryoablation. We aimed to assess the efficacy of this practice change. ⋯ In a single-center academic practice, the addition of bilateral single injection ESP blocks at T6 to surgeon performed cryoablation reduced opioid consumption without a change in subjectively reported pain scores. The results from this pilot study can provide effect size estimates to guide the design of future randomized trials.
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Reg Anesth Pain Med · Apr 2024
Transitioning from intrathecal bupivacaine to mepivacaine for same-day discharge total joint arthroplasty: a quality improvement study.
Same-day discharge total knee and hip arthroplasty is becoming more common. Anesthetic approaches that optimize readiness for discharge are important. Based on an institutional change from low-dose bupivacaine to mepivacaine, we aimed to assess the impact on postanesthesia care unit (PACU) recovery in a quaternary care, academic medical center. ⋯ Intrathecal mepivacaine was associated with increased perioperative OMME consumption and PACU pain scores, but still realized a decreased PACU length of stay.