Articles: nerve-block.
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The objective of this review is to identify the potential of peripheral nerve blocks established over the last years for perioperative pain management in breast surgery. These new blocks will be discussed with respect to their clinical effect and necessity. ⋯ Taking the pain levels after breast surgery into account, the request of additional nerve blocks has to be pondered against the potential risks and resource requirement. To reduce or avoid intraoperative or postoperative opioids, an ultrasound-guided Pecs II block proves to be the best option for perioperative pain relief.
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Case Reports
Successful emergency pain control for acute pancreatitis with ultrasound guided erector spinae plane blocks.
Pain control for patients in the Emergency Department (ED) with acute pancreatitis (AP) can be difficult and is often limited to intravenous opioids. The acute side effects from opioids are well known and their use in the treatment of AP is associated with prolonged length of hospitalization. Additionally, up to 10% of patients hospitalized for acute pancreatitis are still receiving opioids 6 months after discharge. ⋯ The ultrasound guided erector spinae plane block may be an ideal adjunct or alternative to opioids for analgesia from AP in the ED. The erector spinae plane block has already been successfully utilized by emergency physicians for pain control from rib fractures, herpes zoster, and more recently, acute appendicitis A lower thoracic erector spinae plane block targets sympathetic nerve fibers in addition to the dorsal and ventral rami via local anesthetic spread to the paravertebral space to provide both visceral and somatic analgesia. Herein, we present the first reported case of acute pancreatitis pain successfully managed by emergency physicians with the ESPB.
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A 46-year-old man presented with severe refractory posterior shoulder pain due to a left scapular fracture sustained during a motor vehicle collision. Despite multimodal oral and intravenous analgesics, the patient's pain remained difficult to control. A continuous paravertebral nerve block was performed between the second and third thoracic vertebrae resulting in excellent analgesia of the scapular pain. This case suggests that a continuous thoracic paravertebral block placed between the second and third vertebrae may be considered as part of multimodal analgesia in patients with scapular fractures.
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J. Gastrointest. Surg. · Jun 2020
Randomized Controlled TrialIntravenous Dexmedetomidine Combined with Ultrasound-Guided Rectus Sheath Block for Open Gastrectomy: a Prospective Randomized Trial.
To compare the incidences of positive hemodynamic response (HR > 100 beats min-1 or SBP > 160 mmHg) during abdominal exploration and moderate pain after surgery, when using dexmedetomidine infusion and rectus sheath block. ⋯ Dexmedetomidine infusion combined with rectus sheath block provided more hemodynamic stability during abdominal exploration and better analgesia after surgery.