Articles: nerve-block.
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Reg Anesth Pain Med · Jun 2022
Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study.
During total hip arthroplasty (THA) using the direct anterior approach, orthopaedic surgeons can identify all anatomical landmarks required for pericapsular nerve group (PENG) blocks and carry out the latter under direct vision. This cadaveric study investigated the success of surgeon-performed PENG block. Success was defined as dye staining of the articular branches of the femoral and accessory obturator nerves. ⋯ Surgeon-performed PENG block during direct anterior THA reliably targets the articular branches of the femoral and accessory obturator nerves. Future trials are required to compare surgeon-performed PENG block with anaesthesiologist-performed, ultrasound-guided PENG block, and surgeon-performed periarticular local anaesthetic infiltration.
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This manuscript aims to review the risks and the current treatments for postdural puncture headache (PDPH). ⋯ PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals. Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH, as may factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself. Long-term complications including chronic headache for years following dural puncture have brought into question of the historical classification of PDPH as a self-limiting headache. So far, the underlying mechanism governing PDPH remains under investigation, while a wide variety of prophylactic and therapeutic measures have been explored with various degree of success. In case of mild PDPH, conservative management involving bed rest and pharmacological management should be used as first-line treatment. Nerve blocks are highly efficient alternatives for PDPH patients who do not respond well to conservative treatment. In case of moderate-to-severe PDPH, epidural blood patch remains the therapy of choice. An interdisciplinary approach to care for patients with PDPH is recommended to achieve optimal outcomes.
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Review Meta Analysis
Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis.
Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery. ⋯ ESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. PROSPERO registration number: CRD42021233362.