Local and regional anesthesia
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Transversus abdominis plane block (TAP block) is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our study was to gauge the analgesic efficacy of ultrasound-guided TAP block in patients undergoing unilateral inguinal hernia repair. ⋯ The ultrasound-guided TAP block provides good postoperative analgesia, reduces analgesic requirements, and provides good VAS scores with fewer complications following inguinal hernia surgery.
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Obtaining patient informed consent for a regional analgesia block on the day of surgery can result in surgical case delays. We hypothesized that implementing a preoperative electronic surgical order, undertaking patient education, and obtaining informed consent for a regional block in our preoperative assessment clinic prior to the day of surgery would reduce surgical case delays attributed to our regional anesthesia pain service and increase the percentage of patients for whom our regional anesthesia pain service was requested to provide a block. ⋯ When performed before the day of surgery, a surgeon's electronic order, patient education, and informed consent for regional postoperative analgesia can improve patient throughput, thereby reducing block-related operating room delays. The preoperative assessment clinic can serve as a venue to achieve this goal, thereby adding value by decreasing downstream delays on the day of surgery.
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A systematic review of the literature on the use of regional anesthesia (RA) and patient-controlled analgesia (PCA) was conducted in patients who require orthopedic extremity procedures to determine whether either analgesic technique contributes to a delayed diagnosis of compartment syndrome (CS). A total of 34 relevant articles (28 case reports and six research articles) were identified. Of all case report articles published after 2009, the majority (75%) concluded that RA does not put the patient at an increased risk of a delayed diagnosis of CS. ⋯ Neither study resulted in any cases of CS. However, both had relatively small sample sizes. Given the lack of evidence identified in this systematic review, prospective studies or large-scale retrospective data reviews are needed to more strongly advocate the use of one modality of analgesia over the other in this patient population.
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A popliteal block is effective in managing postoperative pain for foot surgery, but since the duration of analgesia is limited following a single-shot popliteal fossa block technique, methods to prolong effective postoperative analgesia are mandatory. The aim of this study was to assess the effect of adjuvants to ropivacaine on the duration of sensory and motor block. ⋯ Addition of DXM and clonidine to ropivacaine significantly prolonged the duration of postoperative sensory and motor block.
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Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure) is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children's hospital, in patients undergoing the Nuss procedure. ⋯ There is no significant difference in managing postoperative pain overall between the three epidural regimens employed at our center. However, in managing day-1 postoperative pain and minimizing nausea/vomiting, our study suggests that a hydromorphone-ropivacaine epidural regimen appears to have more favorable results than a fentanyl-bupivacaine regimen or a hydromorphone-bupivacaine regimen.