Articles: nerve-block.
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Randomized Controlled Trial
A randomized-controlled trial comparing liposomal bupivacaine, plain bupivacaine, and the mixture of liposomal bupivacaine and plain bupivacaine in transversus abdominus plane block for postoperative analgesia for open abdominal hysterectomies.
Transversus abdominus plane (TAP) blocks are widely used for postoperative analgesia for abdominal surgical procedures. The purpose of this study was to compare the analgesic efficacy of plain bupivacaine, liposomal bupivacaine, and the mixture of plain bupivacaine with liposomal bupivacaine when used in a TAP block. ⋯ In this small study at risk of being under-powered, the mixture of liposomal bupivacaine with plain bupivacaine for TAP block did not improve analgesia compared with either liposomal bupivacaine or plain bupivacaine on their own.
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Reg Anesth Pain Med · Jun 2021
CommentInvasive placebos in research on peripheral nerve blocks: a follow-up study.
The Serious Harm and Morbidity "SHAM" grading system has previously been proposed to categorize the risks associated with the use of invasive placebos in peripheral nerve block research. SHAM grades range from 0 (no potential complications, eg, using standard analgesia techniques as a comparator) through to 4 (risk of major complications, eg, performing a sub-Tenon's block and injecting normal saline). A study in 2011 found that 52% of studies of peripheral nerve blocks had SHAM grades of 3 or more. ⋯ The use of invasive placebos that may be associated with serious risks in peripheral nerve block research has decreased in contemporary peripheral nerve block research.
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Upper-extremity injuries are frequently seen in the emergency department (ED), yet traditional analgesic methods are often ineffective (e.g., hematoma blocks) or associated with prolonged ED duration and nontrivial risk (e.g., procedural sedation). Ultrasound-guided regional anesthesia of the infraclavicular brachial plexus offers dense anesthesia of the distal upper extremity. The Retroclavicular Approach to The Infraclavicular Region (RAPTIR) is an ultrasound-guided brachial plexus block that has only recently been described in both anesthesia and emergency literature. ⋯ We report use of the RAPTIR block in an elderly patient with a subacute angulated distal radius fracture that would otherwise require surgical management. The patient presented 11 days post injury and had no hematoma to block, and her age made her high risk for procedural sedation or operative management. Using the RAPTIR block, ED providers achieved dense anesthesia of her arm, allowing for appropriate reduction of a displaced fracture 11 days after injury. The patient followed with orthopedic surgery, never required additional manipulation, and had full return to activities of daily living. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case, the RAPTIR block safely and effectively anesthetized the distal upper extremity. This block provides clear visualization of neck and thoracic structures and has a simpler technique than traditional inferior brachial plexus blocks. It achieves dense anesthesia to allow for complex or repeat reduction attempts without the need for procedural sedation, opiates, or an operative setting. Our report details this patient, the RAPTIR technique, and the state of the current literature.
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Reg Anesth Pain Med · Jun 2021
Automated text messaging follow-up for patients who receive peripheral nerve blocks.
Routine follow-up of patients who receive a nerve block for ambulatory surgery typically consists of a phone call from a regional anesthesia clinician. This process can be burdensome for both patients and clinicians but is necessary to assess the efficacy and complication rate of nerve blocks. ⋯ Given the wide availability of REDCap, we believe this automated text messaging system can be implemented in a variety of health systems at low cost with minimal technical expertise and will improve both the consistency of patient follow-up and the service efficiency of regional anesthesia practices.