Articles: nerve-block.
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Reg Anesth Pain Med · Jun 2021
CommentAvoid suboptimal perioperative analgesia during major surgery by enhancing thoracic epidural catheter placement and hemodynamic performance.
Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention to patient selection is upheld. Recently, the use of fascial plane blocks (FPBs) has evolved as an alternative to TEA most likely because these blocks avoid problems such as neurological comorbidity, coagulation disorders, epidural catheter failure and hypotension due to sympathetic denervation. ⋯ Also, the true efficacy of FPBs is questioned. Thus, should we prioritize less efficient analgesic regimens with FPBs when preventive treatment strategies for epidural catheter failure and hypotension exist for TEA? It is time to promote and underscore the benefits of TEA provided to patients undergoing major open surgical procedures. In our mind, FPBs and landmark-guided techniques should be limited to less extensive surgery and when either neuraxial blockade is contraindicated or resources for optimal epidural catheter placement and maintenance are not available.
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Journal of anesthesia · Jun 2021
Cervical erector spinae plane block as a perioperative analgesia method for shoulder arthroscopy: a case series.
Shoulder arthroscopy, a common intervention for severe rotator cuff injuries, is associated with severe postoperative pain. Upon performing cervical erector spinae plane (ESP) blocks at the C7 TP (tip or posterior tip) or the posterior tip of the C6 TP posterior tubercle in six patients undergoing shoulder arthroscopy, sensory block was detectable in congruent cervico-thoracic dermatomes. Effective intraoperative and postoperative analgesia were consistently obtained for all six patients. This preliminary study illustrated that the cervical ESP block can be considered a potential simple regional anesthesia method for providing analgesia during shoulder arthroscopy with low risks of diaphragmatic paresis, upper extremity motor paresis, nerve injury and persistent hypotension.
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Reg Anesth Pain Med · Jun 2021
Review Meta AnalysisThe analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: a systematic review and meta-analysis with trial sequential analysis.
Liposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial. ⋯ The beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.