Articles: nerve-block.
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Currently, no meta-analysis exists elucidate the analgesic effect of adding IPACK block to our current multimodal analgesia regimen after total knee replacement (TKR). The purpose of this study is to systematically review the level I evidence in the literature to ascertain whether IPACK block can bring additional analgesic benefits to existing multimodal analgesia regimens. ⋯ The addition of an IPACK block to multimodal analgesia regiments does not reduce the postoperative opioid consumption nor improve functional performance. However, it may be an appropriate method to improve immediate analgesic effects after TKR.
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Randomized Controlled Trial
Obturator Nerve Blockade vs. Neuromuscular Blockade for the Prevention of Adductor Spasm in Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized Controlled Trial.
The obturator nerve runs along the posterolateral walls of the bladder and electrosurgical stimulation in this region can result in adductor spasm which can occur suddenly and unexpectedly with potentially catastrophic results. ⋯ Both techniques are safe and efficacious for preventing adductor spasm. Our data and experience suggest that the ONB is relatively easy to perform and should be considered in patients with posterolateral bladder tumors.
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Upper-extremity injuries are frequently seen in the emergency department (ED), yet traditional analgesic methods are often ineffective (e.g., hematoma blocks) or associated with prolonged ED duration and nontrivial risk (e.g., procedural sedation). Ultrasound-guided regional anesthesia of the infraclavicular brachial plexus offers dense anesthesia of the distal upper extremity. The Retroclavicular Approach to The Infraclavicular Region (RAPTIR) is an ultrasound-guided brachial plexus block that has only recently been described in both anesthesia and emergency literature. ⋯ We report use of the RAPTIR block in an elderly patient with a subacute angulated distal radius fracture that would otherwise require surgical management. The patient presented 11 days post injury and had no hematoma to block, and her age made her high risk for procedural sedation or operative management. Using the RAPTIR block, ED providers achieved dense anesthesia of her arm, allowing for appropriate reduction of a displaced fracture 11 days after injury. The patient followed with orthopedic surgery, never required additional manipulation, and had full return to activities of daily living. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case, the RAPTIR block safely and effectively anesthetized the distal upper extremity. This block provides clear visualization of neck and thoracic structures and has a simpler technique than traditional inferior brachial plexus blocks. It achieves dense anesthesia to allow for complex or repeat reduction attempts without the need for procedural sedation, opiates, or an operative setting. Our report details this patient, the RAPTIR technique, and the state of the current literature.