Articles: post-operative.
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Case Reports
Bilateral Sphenopalatine Ganglion Block With Liposomal Bupivacaine Followed by Severe Hypertension: A Case Report.
We reviewed a case of bilateral sphenopalatine ganglion (SPG) blockade with liposomal bupivacaine for sinus surgery. The case was complicated by severe postoperative hypertension refractory to antihypertensives and needing intensive care unit (ICU) admission. ⋯ We discuss how local anesthetic spread beyond the SPG may have caused prolonged parasympathetic blockade and hypertension. Before approved indications are established, we recommend avoiding the use of liposomal bupivacaine in off-label settings when the function of bilateral autonomic structures could be affected.
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Review Meta Analysis
Efficacy and safety of rhomboid intercostal block for analgesia in breast surgery and thoracoscopic surgery: a meta-analysis.
Rhomboid intercostal block (RIB) is a new regional anesthesia technique that provides postoperative analgesia for breast surgery and thoracoscopic surgery. The published papers are not yet fully integrated and do not adequately address the impact and safety of the RIB on postoperative pain. ⋯ This review shows that RIB was more effective in controlling acute pain after breast surgery and thoracoscopic surgery than general analgesia. And it is a trend that RIB may be a kind of effective and safe nerve bock technology and it requires further studies.
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A 27-year-old man with a history of bronchiolitis obliterans caused by a severe viral illness during early childhood that necessitated lung transplantation who was receiving tacrolimus therapy presented with rapidly worsening mental status. Prior to his change in mental status, his postoperative course was complicated by severe primary graft dysfunction and acute renal failure due to acute tubular necrosis that required continuous renal replacement therapy (CRRT). The patient had a prolonged intubation that required periodic BAL for mucous plugging. ⋯ After arousing that morning, the patient became combative, violent, and confused. This altered mentation progressed throughout the day to somnolence and lethargy, necessitating endotracheal intubation for airway protection. The patient experienced subsequent hypotension that necessitated low-dose epinephrine and vasopressin infusions.
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Anesthesia and analgesia · Mar 2022
Association Between Changes in Postoperative Opioid Utilization and Long-Term Health Care Spending Among Surgical Patients With Chronic Opioid Utilization.
There is growing interest in identifying and developing interventions aimed at reducing the risk of increased, long-term opioid use among surgical patients. While understanding how these interventions impact health care spending has important policy implications and may facilitate the widespread adoption of these interventions, the extent to which they may impact health care spending among surgical patients who utilize opioids chronically is unknown. ⋯ Among patients with chronic opioid utilization before surgery, subsequent increases in opioid utilization during the first postoperative year were associated with increased health care spending during that timeframe, while subsequent decreases in opioid utilization were associated with decreased health care spending.