Local and regional anesthesia
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Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes. Increasing use of local anesthetic techniques in various healthcare settings makes contemporary understanding of LAST highly relevant. Recent data have demonstrated that the underlying mechanisms of LAST are multifactorial, with diverse cellular effects in the central nervous system and cardiovascular system. ⋯ There have been significant developments in our understanding of LAST treatment. Key advances include early administration of lipid emulsion therapy, prompt seizure management, and careful selection of cardiovascular supportive pharmacotherapy. Cognizance of the mechanisms, risk factors, prevention, and therapy of LAST is vital to any practitioner using local anesthetic drugs in their clinical practice.
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Thoracic epidural analgesia (TEA) provides superior postoperative pain control compared to parenteral opioids after major thoracic and abdominal surgeries. However, some studies with respect to benefits of continuous TEA have shown mixed results. The purpose of this study was to determine the rate of successful TEA catheter insertion into the epidural space using contrast fluoroscopy and the impact of placement location on postoperative analgesia and opioid use. ⋯ Improvement in assuring success in the technique for TEA catheter placement following major thoracic or upper abdominal surgery exists, for which contrast-enhanced fluoroscopy might be a promising solution.
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Real-time ultrasound-guided retrobulbar block vs blind technique for cataract surgery (pilot study).
Retrobulbar regional eye block aims to ensure eye globe akinesia and anesthesia during ophthalmic surgery, and despite the rarity of occurrence of complications due to the blind needle passage while performing either peribulbar or retrobulbar block, some of them are serious and may be life threatening. ⋯ There were no statistically significant difference between real-time ultrasound-guided and blind retrobulbar regional eye blocks concerning the onset of action, total volume of injected local anesthetic solution, supplemental injection required, pain scores, and degree of patient satisfaction.
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Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the terminal hair follicle of the apocrine gland-bearing skin, presenting with inflamed nodules, abscesses, and sinus tracts. Autoimmune, genetic, and infectious factors have been implicated in its pathogenesis. HS can be managed medically using topical and systemic antibiotics and with tumor necrosis factor antibody therapy in severe cases. ⋯ Erector spinae block (ESB) is a recently developed plane block used for the management of pain located in the chest wall or the abdominal wall. Ultrasound guidance is used to guide placement of the needle tip between the transverse process at the desired dermatomal level and the erector spinae muscle group. Traditional descriptions of the ESB have been at the level of the fifth transverse process to treat chest wall pain; in this case report, we describe a novel use of ESB at the level of the second transverse process to treat axillary pain after surgical debridement of axillary HS.