Saudi journal of anaesthesia
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Thoracic paravertebral block (TPVB) has become the gold standard to provide postoperative analgesia in breast surgery. Recently, ultrasound-guided (USG) pectoralis (PECS) block and serratus anterior plane (SAP) block have been described as an alternative to TPVB. The objectives were to compare TPVB, PECS, and SAP block in terms of analgesic efficacy and the spread of local anesthetic by ultrasound imaging, correlating it with the sensory blockade. ⋯ TPVB and SAP group result in a greater spread of the drug and provide equivalent analgesia and are superior to the PECS II block in providing analgesia for breast surgeries. SAP block is easier to perform than TPVB with lesser chances of complications and results in faster onset.
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Inadequate pain relief after thoracotomy may lead to postoperative respiratory complications. ⋯ SAP block with continuous catheter technique seems to be a safe and effective modality for the management of acute postoperative pain after thoracotomy.
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Posterior decompression and instrumentation of the cervical spine are associated with severe postoperative pain due to extensive soft tissue and muscle dissection during the surgery. In this case series, we describe bilateral continuous cervical erector spinae plane block (CESPB) placed at T1-2 through the thoracic erector spinae plane. ⋯ The CESPB block provides intense analgesia with low requirements of anesthetic drugs in the perioperative period and opioid-free analgesia in the postoperative period. The spread of local anesthetic was studied by performing CT contrast studies after obtaining informed consent.
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Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) emerged in Wuhan, China late 2019 and became a pandemic causing coronavirus disease 2019 (COVID-19). Despite its lower mortality rate compared to the other coronaviruses, it has a higher human-to-human transmission rate. Anesthesiologists may benefit from a review of the current evidence related to the obstetric patient with COVID-19. ⋯ There are several anesthetic considerations in the care of pregnant women with COVID-19 due to their unique physiological changes. We provide considerations and recommendations for departmental and institutional leadership as well as the obstetric anesthesia providers. These recommendations may apply and can be edited, for future droplet or airborne based pandemics. The rapidly evolving literature makes it important to get updates directly from the relevant medical societies' websites.
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Case Reports
Management of postdural puncture headache in pediatric using an epidural catheter for an epidural blood patch.
We report the case of an 8-year-old child suspected to have postdural puncture headache after multiple lumbar punctures for collection of cerebrospinal fluid for analysis. His symptoms included headache, nonprojectile vomiting, and lethargy. When conservative management failed, an epidural blood patch was applied and the depth of the epidural space was determined using MRI. Epidural blood patch treatment was successful, and an epidural catheter was left in situ, in case a second patch was required.