Best practice & research. Clinical anaesthesiology
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The purpose of this manuscript is to provide a brief discussion of the current direction in pediatric regional anesthesia, highlighting both newer nerve blocks and techniques and traditional nerve blocks. ⋯ As the push for multimodal analgesia increases and the breadth of pediatric regional anesthesia continues to expand, further large prospective studies will be needed to demonstrate continued efficacy and overall safety.
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewTruncal regional nerve blocks in clinical anesthesia practice.
Regional anesthetic techniques are important components of successful multimodal analgesic strategies. When used successfully, truncal nerve blocks of the chest wall, abdomen, and, paraneuraxial nerves, in combination with other analgesic modalities, may offer similar analgesic efficacy as neuraxial techniques, which are associated with a greater risk profile. Moreover, in comparison to neuraxial techniques, truncal nerve blocks are relatively simple to perform and technically straightforward to learn. ⋯ Different variations of the quadratus lumborum block may provide visceral and sensory analgesic coverage. Moreover, truncal blocks, including ilioinguinal, iliohypogastric, pectoralis nerve (PECS) blocks, serratus anterior, intercostal, and erector spinae plane blocks, have gained routine clinical use for various surgeries. In this review, we discuss the techniques, anatomy, indications, complications, and benefits of truncal nerve blocks commonly used in clinical practice.
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewLiposomal bupivacaine and novel local anesthetic formulations.
Novel preparations allowing for the extended duration of action of local anesthetics have many clinically relevant benefits. With regard to this, the development of liposomal bupivacaine has the potential to significantly impact patient care by improving perioperative pain control. The unique liposomal bilayer that encapsulates bupivacaine allows for a sustained release of local anesthetic for up to 72 h after a single use and can significantly decrease postoperative opioid consumption. ⋯ HTX-011 is an investigational extended-release local anesthetic formulation currently undergoing Phase 3 clinical trials. HTX-011 is composed of a bioerodible polymer with bupivacaine and low-dose meloxicam in which the polymer undergoes hydrolysis and allows for sustained release of bupivacaine and meloxicam for 3 days. The present investigation reviews pharmacologic considerations related to the formulation of liposomal bupivacaine, current FDA-approved indications for its use, and future extended-release local anesthetic formulations currently under investigation.
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewNovel utilization of fascial layer blocks in hip and knee procedures.
of review: Novel motor-sparing peripheral nerve blocks in hip and knee procedures are desirable. ⋯ Recent advancements in US have transformed the clinical performance of fascial layer blocks, evidenced in their novel indications in hip, knee, and spine analgesia. The combination of various motor-sparing fascial plane blocks providing different areas of innervation is particularly useful in fast-track hip and knee surgeries.
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Best Pract Res Clin Anaesthesiol · Dec 2019
Review Observational StudyIncidence of vocal cord paresis following ultrasound-guided interscalene nerve block: An observational cohort study.
Interscalene brachial plexus block (IBPB) has become a standard practice for perioperative analgesia for shoulder procedures. However, several side effects may occur owing to its anatomic location. We have chosen to evaluate vocal cord paresis and dysphonia following interscalene blocks. ⋯ Although larger studies are required to determine the true incidence of vocal cord paresis following US-guided IBPB, our results suggest that incidence of unwanted nerve blockade other than brachial plexus is much lower than that previously described.