Article Notes « metajournal.com

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Brachial plexus block with sedation for shoulder surgery is not a technique I employ. It would be interesting to see a direct comparison between stroke rates between this technique and one using block plus GA. Though, it is comforting to know that stroke risk is incredibly low, in spite the considerable number of intraoperative hypotensive events.

Yadeau JT, Casciano M, Liu SS et al. Stroke, regional anesthesia in the sitting position, and hypotension: a review of 4169 ambulatory surgery patients. Reg Anesth Pain Med. 2011 Sep 1;36(5):430-5.

Chris Tan

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Evidence v practice.....dare I share this with the General Surgeon I work with!!!!!

Nordin P, Zetterström H, Gunnarsson U et al. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet. 2003 Sep 13;362(9387):853-8.

Allan Palmer

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In a nutshell allows the patient to tolerate the surgery better but no effect on underlying disease. Nevertheless, any improvement is an improvement!

Sun Y, Li T, Gan TJ. The Effects of Perioperative Regional Anesthesia and Analgesia on Cancer Recurrence and Survival After Oncology Surgery: A Systematic Review and Meta-Analysis. Reg Anesth Pain Med. 2015 Sep 1; 40 (5): 589-98.

Allan Palmer

summary
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Collection: Sphenopalatine ganglion block for postdural puncture headache

First described in 1909, and then used for treatment of various types of headache and facial pain, the sphenopalatine ganglion block may offer a novel, simple and less-invasive treatment for post-dural puncture headache.

Very little has been published, primarily case studies, case series and retrospective audits. This limited data does however suggest that the technique may be as effective as the traditional epidural blood patch, though with significantly fewer risks.

Larger studies are however needed to properly define the block's role in treating PDPH.

Publications describe a trans-nasal approach, either sitting or supine. First topicalising with co-phenylcaine spray, then placing 2%-4% viscous lignocaine-soaked cotton-tipped applicators for 10 minutes, and finally repeated for a further 20 minutes. Success appears to range from 30-70%.

The mechanism of action may result from parasympathetic blockade at the SPG, resulting in reversal of the cerebral vasodilation thought to be associated with post dural puncture headache.

Several videos showing how simple SPG techniques:

Daniel Jolley

pearl
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Transversus abdominus plane block after caesarean section does not reduce morphine consumption when compared to wound infiltration with equivalent local anaesthesia.

Telnes A, Skogvoll E, Lonnée H. Transversus abdominis plane block vs. wound infiltration in Caesarean section: a randomised controlled trial. Acta Anaesthesiol Scand. 2015 Apr 1;59(4):496-504.

Daniel Jolley

pearl
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Hyaluronidase 100 IU/mL when added to ropivacaine speeds onset of axillary nerve blockade.

Koh WU, Min HG, Park HS et al. Use of hyaluronidase as an adjuvant to ropivacaine to reduce axillary brachial plexus block onset time: a prospective, randomised controlled study. Anaesthesia. 2015 Mar 1;70(3):282-9.

Daniel Jolley

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So 4mg for PONV is the target.

But can we get away with even less?

De GS, Castro-Alves LJ, Ahmad S et al. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth. Analg. 2013 Jan 1;116(1):58-74.

Allan Palmer

pearl
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