Saudi journal of anaesthesia
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Case Reports
Initial experience of erector spinae plane block in patients undergoing breast surgery: A case series.
Postoperative pain after breast surgery is difficult to manage owing to its complex innervation. Recently, erector spinae plane (ESP) block, an interfacial block, has been described to provide pain relief after thoracic and abdominal surgeries, multiple rib fractures, and neuropathic thoracic pain. ⋯ This may block the dorsal and ventral rami of the thoracic spinal nerves at multiple vertebral levels and the rami communicantes transmitting autonomic fibers to and from the sympathetic ganglia, causing multidermatomal somatic and visceral analgesia. The present case report demonstrates the adequate perioperative analgesia provided by the ultrasound-guided ESP block in patients undergoing various breast surgeries.
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The erector spinae plane block (ESP) is a novel interfascial block described in 2016 by Forero. Although it has been used to provide analgesia for planned abdominal and thoracic surgery, it has never been used as a rescue technique for abdominal surgery. Pain control can be a challenge for anaesthesiologists in laparotomic surgery when epidural analgesia is contraindicated. We report two cases in which the ESP block has been successfully used as a rescue technique to provide pain relief after laparotomic surgery.
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Thoracotomy needs adequate powerful postoperative analgesia. This study aims to compare the safety and efficacy of ultrasound (US)-guided serratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) for perioperative analgesia in cancer patients having lung lobectomy. ⋯ Preemptive TPVB and SAPB provide comparable levels of adequate analgesia for the first 24 h after thoracotomy. TPVB provided better analgesia after 12 h. The two procedures reduce intraoperative fentanyl and postoperative morphine consumption.
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Low back pain (LBP) is one of the most common musculoskeletal abnormalities. Epidural corticosteroid injections (ESIs) have been used long time ago for treatment of lumbar radiculopathy or discogenic back pain in case of failed medical and conservative management. Different techniques for ESIs include the interlaminar, the caudal, and the transforaminal approaches. ⋯ The infraneural (IN) epidural steroid is more favorable than the parasagittal (IL) interlaminar epidural steroid owing to its long-term improvement in physical function than the parasagittal technique with no serious side effects.
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The prevalence of in situ tracheal stents has increased in the past two decades for the management of malignant and benign central airway diseases for either palliation or definitive therapy. Recent placement of a tracheal stent has been associated with edema of the upper airway; therefore, these patients are at a great risk for airway collapse, especially within the days most recent to the procedure. The authors present the case of a morbidly obese patient with a tracheal stent admitted to the Intensive Care Unit who developed acute respiratory failure and was found to be "unable to ventilate, unable to intubate." Surgical airway approach through a cricothyroidotomy failed to provide a patent airway and the patient subsequently developed cardiac arrest and expired. The presence of tracheal stent poses a high challenge during emergent airway interventions; thus, carefully planned airway manipulation in such patients is paramount in order to avoid catastrophic outcomes.