Articles: nerve-block.
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Arch Orthop Trauma Surg · Jan 2021
The continuous infusion fascia iliaca compartment block: a safe and effective analgesic modality in geriatric hip fracture patients.
Hip fractures are common orthopaedic injuries in the elderly. Opioids can provide peri-operative pain relief in hip fracture patients, but may have side effects. Peripheral nerve blocks such as the fascia iliaca compartment block (FICB) have become an established part of the multimodal analgesic regime administered peri-operatively to hip fracture patients. We compare the efficacy of the continuous infusion FICB (CFICB) on peri-operative pain relief, opioid usage, its associated complications and the short as well as long term rehabilitation status in geriatric hip fractures patients. ⋯ The CFICB provides safe and effective post-operative pain relief in geriatric hip fracture patients. Post-operative opioid usage is decreased in older hip fracture patients treated with CFICB. Rehabilitation milestones are slower in the short term, but have no significant difference at 1-year post surgery.
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Persistent headaches and migraines are common in pediatrics with various treatment options. The sphenopalatine ganglion (SPG) has been identified as communicating with the parasympathetic autonomic nervous system and pain receptors. In adults, SPG block is an established treatment but there is no published literature in pediatrics. ⋯ With 100% technical success, statistically significant pain reduction, and no complications, we support SPG block in the pediatric population as a simple, efficacious, and safe treatment option for refractory headaches. It is routinely performed in less than 10 minutes and commonly negates the need for inpatient headache pain management. Given its minimal invasivity, we support the use of SPG blockade as a therapeutic treatment in refractory pediatric migraines as it reduces the need for intravenous medications, prolonged pain control, or hospital admission.
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The accuracy and reliability of ultrasound are still insufficient to guarantee complete and safe nerve block for all patients. Injection of local anaesthetic close to, but not touching, the nerve is key to outcomes, but the exact relationship between the needle tip and nerve epineurium is difficult to evaluate, even with ultrasound. Ultrasound has insufficient resolution, tissues are difficult to discern due to acoustic impedance and needles are more difficult to see with increased angulation. ⋯ Micro-ultrasound at the tip of the needle is in development. Early images using 40MHz in anaesthetised pigs reveal muscle striation, distinct epineurium and 30-40 fascicles > 75 micron in diameter. The next few years will see a technological revolution in tip-tracking technology that has the potential to improve patient safety and, in doing so, change practice.