Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Oct 2020
Complication rate of ultrasound-guided paravertebral block for breast surgery.
Thoracic paravertebral blockade is often used as an anesthetic and/or analgesic technique for breast surgery. With ultrasound guidance, the rate of complications is speculated to be lower than when using landmark-based techniques. This investigation aimed to quantify the incidence of pleural puncture and pneumothorax following non-continuous ultrasound-guided thoracic paravertebral blockade for breast surgery. ⋯ Pneumothorax following non-continuous ultrasound-guided thoracic paravertebral block using a parasagittal approach is an uncommon occurrence, with a similar rate to pneumothorax following breast surgery alone.
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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.