A&A practice
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The lateral pectoral nerve (LPN) innervates anterior shoulder structures. We report a novel technique for radiofrequency ablation (RFA) of the articular branch of the LPN (abLPN) to treat persistent anterior shoulder pain. ⋯ As a result, the patient has continued substantial relief of resting and dynamic deep anterior shoulder pain beyond 3 months. Ablation of the abLPN may provide anterior shoulder analgesia without causing motor weakness.
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Case Reports
Paravertebral Block for a Patient With Achalasia Undergoing a Peroral Endoscopic Myotomy Procedure: A Case Report.
In 2016, the American Medical Association officially dismissed pain as a vital sign quoting the opioid epidemic as a major reason. Clinically, pain remains very relevant and we present the case of a patient with achalasia treated via peroral endoscopic myotomy procedure (POEM). Given that similar patients previously failed traditional pain management modalities, regional anesthesia was used in this patient's pain management. The positive outcomes yielded from this technique convinced our gastroenterological colleagues to request regional anesthesia for future patients, altering their approach to pain management.
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Operating room waste is categorized as noncontaminated solid waste (SW) and regulated medical waste (RMW). RMW is treated by autoclaving at an increased economic and environmental cost. ⋯ We collaborated with product representatives, anesthesia and perioperative staff, and waste management personnel to identify opportunities and barriers for recycling and waste reduction. Ultimately, we agreed to discard CO2 absorbers as SW instead of RMW, a strategy that is practical, less expensive, and more environmentally appropriate.
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Case Reports
Focused Transesophageal Echocardiography for Bedside Diagnosis of Iatrogenic Cardiac Perforation: A Case Report.
We describe an extremely rare complication of chest tube placement and focused transesophageal echocardiography (TEE) in the diagnosis of a life-threatening condition. It illustrates the value and utility of point-of-care ultrasound (POCUS) by way of a focused TEE in confirming a diagnosis and contributing toward the expeditious operative management of a life-threatening scenario. ⋯ However, incorporation of POCUS training into curriculum of anesthesia residency programs is still in the infancy stages. Our report demonstrates the need for development and standardization of POCUS training for anesthesiologists in the perioperative setting.