Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Oct 2020
ReviewDaring discourse: are we ready to recommend neuraxial anesthesia and peripheral nerve blocks during the COVID-19 pandemic? A pro-con.
The recent joint statement from the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anesthesia and Pain Therapy (ESRA) recommends neuraxial and peripheral nerve blocks for patients with coronavirus disease 2019 (COVID-2019) illness. The benefits of regional anesthetic and analgesic techniques on patient outcomes and healthcare systems are evident. Regional techniques are now additionally promoted as a mechanism to reduce aerosolizing procedures. ⋯ In this Daring Discourse, we present two opposing perspectives on adopting the ASRA/ESRA recommendation. Areas of controversy in the literature and opportunities for research to address knowledge gaps are highlighted. We hope this will stimulate dialogue and research into the optimal techniques to improve patient outcomes and ensure practitioner safety during the pandemic.
-
Reg Anesth Pain Med · Oct 2020
Use of three-dimensional printing of a lumbar skeletal model for intrathecal administration of nusinersen: a brief technical report.
Spinal muscular atrophy (SMA) is an autosomal recessive hereditary neurodegenerative disease causing progressive muscle atrophy, weakness and kyphoscoliosis. Nusinersen is a therapeutic agent for SMA that should be administered intrathecally. ⋯ Here, we present our experience of intrathecal administration of nusinersen in an SMA patient with severe kyphoscoliosis using a life-size three-dimensional printing (3D) skeletal model created with 3D printer. With this strategy, we were able to rapidly and safely perform the lumbar puncture.
-
The pericapsular nerve group (PENG) block is a novel regional technique indicated for analgesia for hip joint pain. We administered PENG blocks and performed catheter insertion for continuous infusions in patients with femur fractures on hospital admission. In this case series, we describe our initial experience of pain management in 10 patients with continuous infusion and its associated adverse events. ⋯ Overall, eight patients had femoral neck fractures, and two patients had intertrochanteric fractures. All 10 patients reported good pain relief. The median (IQR) Numerical Rating Scale (NRS) score decreased from 7 (6-7) before the block to 2 (2-2.75) 20 min after PENG catheter placement. The median (IQR) NRS score after 12, 24 and 48 hours were 2 (2-3), 2 (2-3), and 2 (0.25-2), respectively. Patients underwent surgery 24-48 hours following catheter placement. Catheters were removed by an Acute Pain Service nurse 72 hours postinsertion. We want to highlight the potential for intravascular catheter placement in this anatomical region. Further studies are required to confirm if this is a technical error or an associated complication of continuous PENG blocks.