Regional anesthesia and pain medicine
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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.
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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.
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Reg Anesth Pain Med · Oct 2020
Peripheral nerve block use in inpatient and outpatient shoulder arthroplasty: a population-based study evaluating utilization and outcomes.
Peripheral nerve block (PNB) is an effective pain management option after shoulder arthroplasty with increasing popularity over the past decade. Large-scale US data in shoulder arthroplasties are lacking, especially regarding impacts on opioid utilization. This population-based study aimed to evaluate PNB utilization patterns and their effect on outcomes after inpatient and outpatient shoulder arthroplasty. ⋯ In this first national study on PNB use in shoulder arthroplasty, we found increasing PNB use among specifically, inpatient procedures, resulting in particularly reduced opioid use on the day of surgery. While our findings may support PNB use in shoulder arthroplasty, its current low utilization and trends towards more outpatient procedures necessitate continuous monitoring of more extensive benefits.