Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewPECS, serratus plane, erector spinae, and paravertebral blocks: A comprehensive review.
Thoracic planar blocks represent a novel and rapidly expanding facet of regional anesthesia. These recently described techniques represent the potential for excellent analgesia, enhanced technical safety profiles, and reduced physiological side effects versus traditional techniques in thoracic anesthesia. ⋯ In the present investigation, we describe the history, common indications, technique, and limitations of pectoral nerves (PECS), serratus plane, erector spinae plane, and thoracic paravertebral plane blocks. In summary, these techniques provide excellent analgesia and merit consideration in thoracic surgery.
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewNovel utilization of fascial layer blocks in hip and knee procedures.
of review: Novel motor-sparing peripheral nerve blocks in hip and knee procedures are desirable. ⋯ Recent advancements in US have transformed the clinical performance of fascial layer blocks, evidenced in their novel indications in hip, knee, and spine analgesia. The combination of various motor-sparing fascial plane blocks providing different areas of innervation is particularly useful in fast-track hip and knee surgeries.
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Best Pract Res Clin Anaesthesiol · Sep 2019
ReviewPeripheral nerve blocks for postoperative analgesia: From traditional unencapsulated local anesthetic to liposomes, cryoneurolysis and peripheral nerve stimulation.
Peripheral nerve blocks (PNBs) using local anesthetics either via single injection or continuous perineural catheter have been the mainstay for regional anesthesia and are a vital component of postoperative multimodal opioid-sparing pain management. There are some limitations to PNBs, however, mainly its limited duration of action, but also risk of catheter-associated infection and dislodgements. Furthermore, local anesthetic-based blocks can induce sensory deficits and motor weakness, possibly increasing the risk of falling and/or decreasing the ability to participate in postoperative rehabilitation. In this review, we first discuss various local anesthetic-based PNB techniques for major surgery and then review newer modalities, including liposome bupivacaine, cryoanalgesia, and peripheral nerve stimulation; all of which may offer advantages over single and continuous local anesthetic-based PNBs.
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Best Pract Res Clin Anaesthesiol · Sep 2019
ReviewPostoperative acute pain challenges in patients with cancer.
It is expected that the number of surgical procedures to diagnose, treat, and palliate cancers will increase in the near future. While many of those interventions can be performed with minimally invasive techniques, others require surgical large incisions and in some instances, they involve multiple areas of the body (i.e., tumor resections with flap reconstructions). Pain after major oncological procedures can be severe and many times difficult to treat as patients can present to the operating room with several conditions including preoperative pain (i.e., rapidly growing tumors and painful neuropathies), opioid tolerance, and contraindications to nonopioid analgesics or regional anesthesia. ⋯ Furthermore, it has been theorized that poorly treated pain is associated with cancer recurrence and a reduced survival. Lastly, recent research questions the oncological safety of robotic surgery in gynecological procedures and indicates the need of open surgeries, which will be associated with an increased risk in moderate-to-severe postoperative pain. In conclusion, the management of acute postoperative pain in patients with cancer can be challenging.
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Opioid-free anesthesia (OFA) is emerging as a new stimulating research perspective. The rationale to propose OFA is based on the aim to avoid the negative impact of intraoperative opioid on a patient's postoperative outcomes and also on the physiology of pathways involved in intraoperative nociception. ⋯ OFA has been shown to be feasible but the literature is still scarce on the clinically meaningful benefits for patients as well as on the side effects and/or complications that might be associated with it. This review focused first on the physiology of nociception, the reasons for using or not using opioids during anesthesia, and then on the literature reporting evidence-based proofs of benefits/risks associated with OFA.