Acta anaesthesiologica Belgica
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Stellate ganglion block (SGB) is utilized in the diagnosis and management of various vascular disorders and sympathetically mediated pain in upper extremity, head and neck. The stellate ganglion lies medial to the scalene muscles, lateral to longus coli muscle, esophagus, trachea and recurrent laryngeal nerve, anterior to C7 transverse process and prevertebral fascia, superior to the subclavian artery and posterior to vertebral vessels. Consequently, inadvertent placement of the needle tip into these soft tissues and vessels occur with blind technique. ⋯ The use of fluoroscopy does not visualize the blood vessels close to the stellate ganglion. Ultrasounds are the alternative. They help in visualization of soft tissues to prevent complications and help in deposition of drug subfascially, under direct visual control.
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Acta Anaesthesiol Belg · Jan 2016
Case ReportsChemical ablation of stellate ganglion for head and neck cancer pain.
We present a case of patient with orofacial cancer having pain on one side of face affecting her ability to speak, chew, swallow and sleep leading to emotional and behavioral deterioration. A diagnostic stellate ganglion block was performed followed by chemical neurolysis using phenol under ultrasound guidance, to prevent complications due to inadvertent spread of drug. Her pain scores decreased drastically, she was able to chew and swallow. Weighing the risk of permanent Horner's syndrome or motor paralysis with benefit of improvement in basic functioning of debilitated patients chemical neurolysis of stellate ganglion can be performed with advanced imaging modalities.
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Acta Anaesthesiol Belg · Jan 2016
The use of ultrasound in France: a point of view from experienced regional anesthesiologists.
A cross-sectional survey study on French practice in ultrasound-guided regional anesthesia was carried out. A questionnaire (demographic data, assessment of the likely benefits of ultrasonography, and its use in daily practice: blocks and hygiene) was emailed to all members of the French-speaking association of anesthesiologists involved in regional anesthesia. The questionnaire was filled out and returned by 634 experienced anesthesiologists. ⋯ Conversely, ultrasound guidance was rarely used for spinal or deep nerve blocks. A specific sterile sheath was used in only 43% of cases. The present study confirms that ultrasound guidance has gained in popularity for many superficial, but not deep, regional anesthesia procedures in France.
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Acta Anaesthesiol Belg · Jan 2016
Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections.
Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general anesthesia. ⋯ This retrospective study shows that a low dose administration a bupivacaine 0.5% for spinal anesthesia in cesarean section patients elicits significantly more frequent conversion to general anesthesia.
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Acta Anaesthesiol Belg · Jan 2015
Randomized Controlled Trial Comparative StudyComparison of conventional infrainguinal versus modified proximal suprainguinal approach of Fascia Iliaca Compartment Block for postoperative analgesia in Total Hip Arthroplasty. A prospective randomized study.
Fascia Iliaca Compartment Block (FICB) has been widely used as a postoperative analgesic adjunct to opioids for total hip arthroplasty (THA), either by the conventional infrainguinal approach or the modified proximal suprainguinal approach irrespective of any specific advantage of one over the other. This study was conducted to compare the analgesic efficacy of the two techniques of FICB for postoperative analgesia. The 40 patients scheduled for THA were recruited for Intervention (s) and randomized to receive FICB either by suprainguinal approach (group S) or infrainguinal approach (group I) for postoperative analgesia with 40 ml of 0.2% bupivacaine, in addition to postoperative patient controlled analgesia (PCA) with morphine. ⋯ Postoperatively, there was significant difference in time to first PCA morphine demand (356.28 ± 33.32 vs 291.48 ± 37.17, p = < 0.001, respectively) in-group S vs. group I. The postoperative morphine consumption was also significantly less in group S compared to group I at 6, 12 and 24 hours and the cumulative morphine consumption in 24 hours (6.95 ± 2.14 vs 10.50 ± 2.24, p = < 0.001 respectively) was also less. In conclusion, in THA, suprainguinal approach of FICB has a superior postoperative analgesic efficacy compared to infrainguinal approach of FICB along with significantly less morphine consumption in first 24 hours.