Articles: nerve-block.
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J. Cardiothorac. Vasc. Anesth. · Jun 2019
Controlled Clinical TrialUltrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an Enhanced Recovery Program Is Associated with Decreased Opioid Consumption and Improved Patient Postoperative Rehabilitation After Open Cardiac Surgery-A Patient-Matched, Controlled Before-and-After Study.
Open cardiac surgery may cause severe postoperative pain. The authors hypothesized that patients receiving a bundle of care using continuous erector spinae plane blocks (ESPB) would have decreased perioperative opioid consumption and improved early outcome parameters compared with standard perioperative management. ⋯ The authors report for the first time that the use of a bundle of care including a continuous bilateral ESPB is associated with a significant decrease in intraoperative and postoperative opioid consumption, optimized rapid patient mobilization, and chest tube removal after open cardiac surgery.
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Acta clinica Croatica · Jun 2019
ReviewULTRASOUND SKILLS IN LOWER EXTREMITY TRAUMATOLOGY AND ORTHOPEDICS - REGIONAL ANESTHESIA AND BEYOND.
During the last two decades ultrasound guidance has been established as an invaluable tool for performing peripheral nerve blocks. Ultrasound guidance reduces block performance time, volume of local anesthetic, risk of intravascular injection and need for opioid rescue analgesia compared to landmark based and neurostimulator guided techniques. The use of ultrasound guidance must not be understood as a surrogate to, but should complement a thorough understanding of anatomy. The purpose of this overview is to present ultrasound guided techniques for performing basic lower extremity blocks, as well as to discuss more recent trends in providing regional analgesia for patients undergoing lower extremity surgery.
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Clin Neurol Neurosurg · Jun 2019
Migraine in patients with fibromyalgia and outcomes of greater occipital nerve blockage.
The aim of this study is to evaluate the efficacy of greater occipital nerve (GON) blockage in patients with migraine and fibromyalgia (FM) comorbidity. ⋯ GON blockage reduces pain severity, headache frequency and duration and increases QoL in patients with migraine and FM comorbidity.
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Neck pain is one of the most common causes of chronic pain and the fourth leading cause of disability worldwide; it is estimated that between 36% and 67% of this pain is due to facet arthropathy. For patients who have pain refractory to conservative treatments literature supports management with diagnostic cervical medial branch blocks (MBBs) to identify the associated facet innervation as the source of pain followed by therapeutic radiofrequency ablation (RFA) of the identified nerves. Cervical RFA has good published outcomes; however, the procedure is dependent upon the specificity of the diagnostic block to achieve maximal success. Currently, this prerequisite test has false positive rates between 27% and 63% and recent studies have shown that this may, in part, be a consequence of currently accepted injection volumes of 0.50 mL or more, which may decrease the sensitivity of MBBs. ⋯ Results suggest that 0.50 mL injections of local anesthetic during cervical MBBs contacts many nonintended targets, thus decreasing the specificity of a targeted diagnostic cervical MBB. Furthermore, we demonstrated that 0.25 mL of injectate reliably bathed the cervical medial branches without extensive extravasation. This indicates that there would potentially be fewer local anesthetic effects on distant tissues, increasing the specificity of cervical MBBs and likely improving RFA planning.
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Surgical procedure causes tissue damage which activates systemic inflammatory response and leads to changes in endocrine and metabolic system. Anaesthesia and pain can further disrupt immune performance. Regional anaesthesia causes afferent nerve blockade and in this way mediates immune protection. ⋯ It was shown that transversus abdominis plane block and epidural analgesia have the same effect on postoperative pain, but transversus abdominis plane block was better regarding hemodynamic stability and hospital stay. Multimodal approach combining regional and systemic analgesia is currently the most appropriate perioperative pain management strategy. More studies should be done to give recommendations.