Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewSingle-injection applications for foot and ankle surgery.
Foot or ankle surgery is often performed in an ambulatory care setting. The post-operative pain that follows can be moderate to severe in intensity and difficult to control with oral analgesics. Regional anaesthetic techniques have been advocated for such procedures. ⋯ Patients can be safely discharged even when long-acting local anaesthetics are used. In major surgery a continuous technique can be proposed. When the prone position is impossible the lateral approach is an efficient alternative.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewThe Holy Grail: long-acting local anaesthetics and liposomes.
The ability to provide an extended duration of analgesia of days following a single injection without the need for catheters, pumps and infusion systems would be a great benefit in acute and chronic pain. Exciting progress is being made in our ability to combine local anaesthetics with liposomes and polymer microspheres. These interesting formulations in animal models have allowed up to 4 days of analgesia. Their use clinically will be a great advance which could possibly occur in the near future.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewSpinal anaesthesia: local anaesthetics and adjuncts in the ambulatory setting.
Intrathecal lidocaine remains a popular choice for ambulatory spinal anaesthesia due to its reliability, rapid onset and predictable rapid recovery profile. However, concerns with transient neurological symptoms (TNS) and their significant association with lidocaine have generated interest in alternative local anaesthetic agents to provide adequate spinal anaesthesia with the briefest possible recovery period. ⋯ Controversies regarding the possible lower risk of TNS with newer spinal anaesthetic techniques and new discharge criteria are reviewed. The final section provides technical pearls to optimize ambulatory spinal anaesthetic outcomes.
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Early and efficient rehabilitation is necessary for improving outcome after shoulder surgery. Pain, which is severe to very severe in this condition, is the major factor which compromises early physical therapy. Interscalene block is a well recognized and efficient technique for controlling pain after major open shoulder surgery. ⋯ However, the application of a continuous infusion of local anaesthetics through an interscalene catheter is actually the best technique available to achieve pain relief at rest and on movement after this type of surgery. This chapter emphasizes the advantages of the modified lateral approach, the use of patient-controlled interscalene analgesia and the traps and tricks of the interscalene block. Thus, this chapter demonstrates why interscalene anaesthesia and analgesia are the most appropriate techniques for shoulder surgery.
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Surgical procedures of the knee are increasingly common in outpatient centres. Advances in arthroscopy and other technologies allow more complex knee procedures to be performed on an outpatient basis. ⋯ Specific nerve blocks and local anaesthetics suitable for various knee procedures are discussed. The use of perineural catheters in the outpatient management of major knee surgery patients is also considered.