Really really good summary article of the current state of play in Anaesthesia for ECT
Its truly amazing what medical students will volunteer for ....!
Brachial plexus block with sedation for shoulder surgery is not a technique I employ. It would be interesting to see a direct comparison between stroke rates between this technique and one using block plus GA. Though, it is comforting to know that stroke risk is incredibly low, in spite the considerable number of intraoperative hypotensive events.
Evidence v practice.....dare I share this with the General Surgeon I work with!!!!!
In a nutshell allows the patient to tolerate the surgery better but no effect on underlying disease. Nevertheless, any improvement is an improvement!
First described in 1909, and then used for treatment of various types of headache and facial pain, the sphenopalatine ganglion block may offer a novel, simple and less-invasive treatment for post-dural puncture headache.
Very little has been published, primarily case studies, case series and retrospective audits. This limited data does however suggest that the technique may be as effective as the traditional epidural blood patch, though with significantly fewer risks.
Larger studies are however needed to properly define the block's role in treating PDPH.
Publications describe a trans-nasal approach, either sitting or supine. First topicalising with co-phenylcaine spray, then placing 2%-4% viscous lignocaine-soaked cotton-tipped applicators for 10 minutes, and finally repeated for a further 20 minutes. Success appears to range from 30-70%.
The mechanism of action may result from parasympathetic blockade at the SPG, resulting in reversal of the cerebral vasodilation thought to be associated with post dural puncture headache.
Transversus abdominus plane block after caesarean section does not reduce morphine consumption when compared to wound infiltration with equivalent local anaesthesia.
Hyaluronidase 100 IU/mL when added to ropivacaine speeds onset of axillary nerve blockade.
So 4mg for PONV is the target.
But can we get away with even less?
Dexamethasone does not affect sugammadex neuromuscular reversal in children.