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pearl
1
Anesthesia neurotoxicity may affect the developing human brain, however methodological challenges limit the conclusiveness of current evidence.
Olsen EA Brambrink AM. Anesthesia for the young child undergoing ambulatory procedures: current concerns regarding harm to the developing brain. Curr Opin Anaesthesiol. 2013 Dec 1;26(6):677-84.
  Daniel Jolley
summary
0
Nerve block duration may be extended by adrenaline, clonidine, dexmedetomidine, dexamethasone, and possibly midazolam, tramadol and magnesium. Other than adrenaline there is however no longterm data demonstrating safety. Intra-articular adjuvant benefit has been shown for tramadol, magnesium, dexmedetomidine, clonidine, ketamine, ketorolac and morphine, but the evidence is not strong enough to support routine use.
Barreveld A, Witte J, Chahal H et al. Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth. Analg. 2013 May 1;116(5):1141-61.
  Daniel Jolley
summary
1
Barreveld et al. show that LA administered either IV or via block; before, during or after surgery, significantly reduces postoperative pain and opioid consumption.
Specifically in:
• Total knee arthroplasty (femoral, sciatic and lumbar plexus b., single-shot or continuous)
• Total hip arthroplasty (continuous lumbar plexus; intra-articular LA)
• Knee arthroscopy (single-shot lumbar plexus; IA LA; single-shot femoral nerve ± sciatic).
• Arthroscopic shoulder surgery - interscalene b., single-shot or continuous. IA is not beneficial.
• Hand & forearm surgery - axillary b. offers analgesic benefits only on day of surgery.
• TAP block is beneficial for laparoscopic, open appendectomy, abdominal surgery, cesarean section, and TAH.
Barreveld A, Witte J, Chahal H et al. Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth. Analg. 2013 May 1;116(5):1141-61.
  Daniel Jolley
pearl
0
Intravenous lidocaine is efficacious and may be a suitable alternative to regional anesthesia when contraindicated or not performed.
Barreveld A, Witte J, Chahal H et al. Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth. Analg. 2013 May 1;116(5):1141-61.
  Daniel Jolley
pearl
0
Nerve blocks in general have a beneficial analgesic effect, regardless of whether pre- or post-incision, and are superior to intra-articular LA.
Barreveld A, Witte J, Chahal H et al. Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth. Analg. 2013 May 1;116(5):1141-61.
  Daniel Jolley
summary
1
Monitoring neuromuscular blockade with TOF at the eye muscles (orbicularis oculi) results in a 5 times greater risk (adjusted odds ratio) of postoperative residual curarization (PORC) than monitoring at the hand (adductor pollicis) when PORC is defined by TOFR < 90% using acceleromyography.
PORC was nonetheless common in both groups, occurring in 52% and 22% respectively.
Thilen SR, Hansen BE, Ramaiah R et al. Intraoperative neuromuscular monitoring site and residual paralysis. Anesthesiology. 2012 Nov 1;117(5):964-72.
  Daniel Jolley
summary
1
Fink & Hollman describe and refute several commonly-held myths regarding neuromuscular pharmacology. Their evidence-supported arguments are:
1. Intubating patients without muscle relaxants is less safe and sub-optimal.
2. Even if you know muscle relaxant pharmacokinetics, it is sufficiently unpredictable that neuromuscular monitoring and reversal is still necessary.
3. Post-operative residual curarization (PORC) is clinically significant with real consequences.
4. Postoperative residual curarization (PORC) is common.
5. Postoperative residual curarisation (PORC) (TOFR < 0.9) can only be diagnosed with a quantitative neuromuscular monitor. Clinical tests are insufficient and poorly sensitive.
Fink H Hollmann MW. Myths and facts in neuromuscular pharmacology. New developments in reversing neuromuscular blockade. Minerva Anestesiol. 2012 Apr 1;78(4):473-82.
  Daniel Jolley
pearl
1
Use of the LMA ProSeal when compared with intubation for gynae-laparoscopy does not decrease post-operative pain or PONV.
Griffiths JD, Nguyen M, Lau H et al. A prospective randomised comparison of the LMA ProSeal™ versus endotracheal tube on the severity of postoperative pain following gynaecological laparoscopy. Anaesth Intensive Care. 2013 Jan 1;41(1):46-50.
  Daniel Jolley
summary
1
Perioperative lidocaine (1.5 mg/kg bolus then 1.5 mg/kg/h until 1 h after skin closure) reduces the incidence of persistent post-surgical pain after breast cancer surgery at 3 months.
Grigoras A, Lee P, Sattar F et al. Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery. Clin J Pain. 2012 Sep 1;28(7):567-72.
  Daniel Jolley
pearl
0
Perioperative lidocaine reduces the incidence of persistent post-surgical pain after breast cancer surgery.
Grigoras A, Lee P, Sattar F et al. Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery. Clin J Pain. 2012 Sep 1;28(7):567-72.
  Daniel Jolley