Ultrasound Guided Regional Anaesthesia for Breast Surgery in High Risk Patients- A Retrospective Observational Study
Vol 3 | Issue 2 | July-December 2022 | Page 93-97 | Harshal D Wagh, Shruthi Pendalya, Mandar Nadkarni
DOI: 10.13107/ijra.2022.v03i02.061
Authors: Harshal D Wagh [1], Shruthi Pendalya [1], Mandar Nadkarni [2]
[1] Department of Anaesthesia, Kokilaben Ambani Hospital, Mumbai, Maharashtra, India.
[2] Department of Oncosurgery, Kokilaben Ambani Hospital, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Harshal D Wagh,
Department of Anaesthesia, Kokilaben Ambani Hospital, Mumbai, Maharashtra, India.
E-mail: drhdw2701@gmail.com
Abstract
Introduction: Modified radical mastectomy (MRM) or breast conservative surgery (BCS) done under general anaesthesia (GA) in high-risk patients may be associated with significant morbidity, Intensive Care Unit stay and increased hospital stay leading to cost issues. In this case-series, we describe our experience with regional anesthesia for MRM or BCS and sentinel / complete axillary clearance in 61 patients with breast carcinoma who were high risk for perioperative complications in view of their co-morbidities. None required ICU or increased hospital stay postoperatively.
Material & Methods: Sixty-one ASA III/IV patients operated under regional anaesthesia for carcinoma of the breast were included. Multiple level USG guided thoracic paravertebral block (PVB), PECS block (1/2), Pecto-intercostal fascial block (PIFB), Serratus-anterior plane block (SAPB), brachial plexus block, Superficial cervical plexus blocks (SCPB), Erector spinae block (ESB) were given in different combinations.
Result: There were 60 female patients (Age: 30-97 years) and 1 male patient (59 years) (Left side -27 patients, right side- 34 patients). Of the total 61 patients, 23 patients underwent BCS with axillary dissection, 36 patients underwent MRM with axillary dissection, 2 patients had MRM with Pectoralis Major muscle resection. Patients received different combinations of blocks PVB or ESB, PECS1/2 and SAPB. 43 patients received the PVB, 61 got the PECS1/2, 12 patients received ESP, 32 patients required SCPB, 1 infra-clavicular block and 35 patients got PIFB. All procedures were completed under regional anaesthesia with 51 patients getting intravenous midazolam (0.01-0.02mg/kg), 59 patients were given IV fentanyl (1-3ug/kg , 43 patients were given IV propofol (1-2mg/kg), These were given in small aliquots during the duration of the procedure. 2 patients had IV ketamine (0.5mg/kg) and 1 patient had IV dexmeditomidine (0.2-0.3ug/kg/hr). IV paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDS) ie. Inj Diclofenac Sodium IV in the dose of 1mg/kg (max 75mg) were given when not contraindicated.
There was single case of axillary hematoma with no other complications. No patient required ICU care postoperatively and were discharged as routine.
Conclusion: A combination of blocks may be an option for surgical anaesthesia for breast surgeries in high risk patients. Careful planning, patient counseling and attention to toxic dose of local anaesthetics must always be considered.
Keywords: Paravertebral block, Thoracic wall blocks, PECS block, Serratus Anterior plane block, Pecto-intercorstal fascial block, Superficial cervical plexus, Modified radical mastectomy, Breast conservative surgery.
References
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13. Greengrass R1, O’Brien F, Lyerly K, Hardman D, Gleason D, D’Ercole F, Steele S. Paravertebral block for breast cancer surgery. Can J Anaesth. 1996 Aug;43(8):858-61.
14. Schnabel A1, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK.Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 2010 Dec;105(6):842-52.
15. Robert B. Maniker, Rebecca L. Johnson, De Q. Tran. Interfacial Plane Blocks for Breast Surgery: Which Surgery to Block, and Which Block to Choose? www.anesthesia-analgesia.org June 2020 • Volume 130 • Number 6.
| How to Cite this Article: Wagh HD, Pendalya S, Nadkarni M | Ultrasound Guided Regional Anaesthesia for Breast Surgery in High Risk Patients- A Retrospective Observational Study | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 93-97. |
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Deciding the Better Dose- A Prospective Randomized Double Blind Study of Two Different Doses of Perineural Dexmedetomidine in Axillary Brachial Block
Vol 3 | Issue 2 | July-December 2022 | Page 83-87 | Sheetal Y Chiplonkar, Jalpa A Kate, Dinesh B Vadranapu, Pratibha Toal
DOI: 10.13107/ijra.2022.v03i02.059
Authors: Sheetal Y Chiplonkar [1], Jalpa A Kate [1], Dinesh B Vadranapu [2], Pratibha Toal [1]
[1] Department of Anaesthesiology, BARC Hospital, Anushaktinagar, Mumbai, Maharashtra, India.
[2] Department of Critical Care, P.D. Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Jalpa A Kate,
Consultant, Department of Anaesthesiology, BARC Hospital, Anushaktinagar, Mumbai, Maharashtra, India.
E-mail: dr.japs@gmail.com
Abstract
Background: Axillary brachial plexus block is generally regarded as the safest and reliable technique for forearm and hand surgeries. Dexmedetomidine, a potent alpha (α)-2-adrenergic receptor agonist when used as an additive in any peripheral nerve block can improve quality of block and postoperative analgesia, though uncertainity prevails regarding the dose in patients undergoing hand and forearm surgeries.
Methods: In this prospective, randomized, comparative, double blind study, 80 patients were included. Each participant fulfilling the inclusion criteria then received axillary brachial plexus block using 15cc 2% lignocaine with adrenaline (1:200000)and 0.5% bupivacaine 5cc mixed with dexmedetomidine either 0.5 µg /kg (group A) or 1 µg /kg ( group B)in 2cc normal saline. Duration of post-operative analgesia was the primary outcome.
Result: Duration of analgesia was significantly prolonged in group B (493.77±115.62 min) compared to group A (434.62±45.18 min, P <0.01).
Conclusion: Between the two doses of dexmedetomidine, block characteristics and analgesia obtained were better with higher dose (1 µg/kg) but chances of side effects like bradycardia increased. Hence 0.5 µg/kg can be a better dose with improved block characteristics yet negligible side effects.
Keywords: Brachial plexus block, Dexmedetomidine Perineural, Peripheral nerve stimulator, Ultrasonography
References
1. Thakur A, Singh J, Kumar S, Rana S, Sood P, Verma V. Efficacy of Dexmedetomidine in two Different Doses as an Adjuvant to Lignocaine in Patients Scheduled for Surgeries under Axillary Block. J Clin Diagn Res JCDR. 2017; 11(4):UC16–21.
2. Klein SM, Pietrobon R, Nielsen KC, Warner DS, Greengrass RA, Steele SM. Peripheral Nerve Blockade with Long-Acting Local Anesthetics: A Survey of The Society for Ambulatory Anesthesia. Anesth Analg. 2002; 94(1):71–76.
3. Sanghvi KS, Shah VA, Patel KD. Comparative study of bupivacaine alone and bupivacaine along with buprenorphine in axillary brachial plexus block: a prospective, randomized, single blind study. Int J Basic Clin Pharmacol. 2013; 2(5):640–644.
4. Biradar PA, Kaimar P, Gopalakrishna K. Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study. Indian J Anaesth. 2013; 57(2):180–4.
5. Lee AR, Yi H, Chung IS, Ko JS, Ahn HJ, Gwak MS, et al. Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block. Can J Anesth Can Anesth. 2012; 59(1):21–27.
6. Rojas González A. Dexmedetomidine as an adjuvant to peripheral nerve block. Rev Soc Esp Dolor 2019; 26(2):115-117.
7. Cai, H., Fan, X., Feng, P, et al. Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials. BMC Anesthesiol 21, 233 (2021).
8. Jie F, Yuncen S, Fang D et al. The effect of perineural dexamethasone on rebound pain after ropivacaine single injection nerve block: A randomised controlled trial. BMC Anesthesiology 2021; 21(1) doi: 10.1186/s12871-021-01267-z.
9. Agarwal S, Aggarwal R, Gupta P. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2014; 30(1):36–40.
10. Gupta A, Mahobia M, Narang N, Mahendra R. A comparative study of two different doses of dexmedetomidine as adjunct to lignocaine in intravenous regional anaesthesia of upper limb surgeries. Int J Sci Study. 2014; 2(3):53–62.
11. Kaygusuz K, Kol IO, Duger C, Gursoy S, Ozturk H, Kayacan U, et al. Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block. Curr Ther Res Clin Exp. 2012; 73(3):103–11.
12. Brummett CM, Hong EK, Janda AM, Amodeo FS, Lydic R. Perineural Dexmedetomidine Added to Ropivacaine for Sciatic Nerve Block in Rats Prolongs the Duration of Analgesia by Blocking the Hyperpolarization-activated Cation Current. Anesthesiology. 2011; 115(4):836–43.
13. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine Added to Levobupivacaine Prolongs Axillary Brachial Plexus Block. Anesth Analg. 2010 Dec; 111(6):1548–1551.
14. Bangera A, Manasa M, Krishna P. Comparison of effects of ropivacaine with and without dexmedetomidine in axillary brachial plexus block: A prospective randomized double-blinded clinical trial. Saudi J Anaesth. 2016; 10(1):38–44.
15. Koraki E, Stachtari C, Kapsokalyvas I, Stergiouda Z, Katsanevaki A, Trikoupi A. Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block. J Clin Pharm Ther. 2018; 43(3):348–52.
16. Paranjpe JS. Dexmedetomidine: Expanding role in anesthesia. Med J Dr DY Patil Univ. 2013; 6(1):5.
17. Leudi MM, Upadek V, Vogt AP, Steinfeldt T, Eichenberger U, Sauter AR. Swiss nationwide survey shows that dual guidance is the preferred approach for peripheral nerve blocks. SciRep.2019 24:9(1):9178.doi:10.1038/s41598-019-45700-3.
| How to Cite this Article: Chiplonkar SY, Kate JA, Vadranapu DB, Toal P| Deciding the Better Dose- A Prospective Randomized Double Blind Study of Two Different Doses of Perineural Dexmedetomidine in Axillary Brachial Block | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 83-87. |
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Serratus Anterior Block for Rib Fractures: A Systematic Review and Meta-analysis
Vol 3 | Issue 2 | July-December 2022 | Page 76-82 | Lijiin Zhen, Matthew Bright, Matthew McHugh, Damon Reardon, Leigh White
DOI: 10.13107/ijra.2022.v03i02.058
Authors: Lijiin Zhen [1], Matthew Bright [2], Matthew McHugh [2], Damon Reardon [2], Leigh White [1, 3]
[1] Department of Anaesthesia, Sunshine Coast University Hospital, Queensland, Australia.
[2] Department of Anaesthesia, Princess Alexandra Hospital, Queensland, Australia.
[3] Department of Anaesthesia, Griffith University, Queensland, Australia.
Address of Correspondence
Dr. Lijiin Zhen,
Department of Anaesthetics, Sunshine Coast University Hospital, Birtinya QLD 4575, Australia.
E-mail: lijiin.zhen@health.qld.gov.au
Abstract
Background: Effective analgesia is the mainstay of the management of traumatic rib fractures. Serratus anterior block is a newer regional anaesthesia technique used in traumatic rib fractures which may have a favourable safety profile compared to other regional techniques. There is currently a lack of evidence for serratus anterior block and its role in the improvement of mortality, pain, duration of stay and pulmonary complications in patients with traumatic rib fractures in comparison to other regional anaesthesia techniques.
Methods: Web of Science and PubMed were searched from inception until April 2022 for studies reporting on the use of a serratus anterior block compared to another therapy for the management of traumatic rib fractures. Primary outcomes were measures of analgesic efficacy. Secondary outcomes were the incidence of intervention related adverse events, hospital length of stay, intensive care unit length of stay and mortality.
Results: Seven studies with 649 patients were included. No significant difference was found between serratus anterior block and intravenous opiates in terms of resting pain scores and achievement of mild or no pain after the chosen intervention(p>0.05). There was a statistically, but not clinically significant difference post block pain scores compared to other regional techniques (WMD= 0.63; 95% CI= 0.45 to 0.80; p< 0.00001). Significant differences were found in favour of blocks, specifically thoracic epidural and paravertebral blocks over serratus anterior block in terms of achieving mild or no pain after the block (OR= 0.54; 95% CI=0.32 to 0.90; I2= 0%; p= 0.02). No significant difference was found for any other outcomes.
Conclusions: Current literature comparing the serratus anterior block to alternative analgesic options is limited by the end points assessing block success. No data was available assessing the effect on pain during deep inspiration and coughing. This meta-analysis demonstrated similar analgesic efficacy to other regional anaesthesia techniques but a lower incidence of mild or no pain post block compared to traditional epidural or paravertebral techniques. Future studies need to be directed towards important outcomes such as dynamic pain scores and respiratory complication rates.
Keywords: Rib fractures, Serratus Anterior, Chest trauma
References
1. Flagel, B.T.; Luchette, F.A.; Reed, R.L.; Esposito, T.J.; Davis, K.A.; Santaniello, J.M.; Gamelli, R.L. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005 Oct;138(4):717-723; discussion 723-715.
2. Griffiths, R.; Surendra Kumar, D. Major trauma in older people: implications for anaesthesia and intensive care medicine. Anaesthesia. 2017 Nov;72(11):1302-1305.
3. Barry, R.; Thompson, E. Outcomes after rib fractures in geriatric blunt trauma patients. Am J Surg. 2018 Jun;215(6):1020-1023.
4. El-Boghdadly, K.; Wiles, M.D. Regional anaesthesia for rib fractures: too many choices, too little evidence. Anaesthesia. 2019 May;74(5):564-568.
5. Kim, M.; Moore, J.E. Chest Trauma: Current Recommendations for Rib Fractures, Pneumothorax, and Other Injuries. Curr Anesthesiol Rep. 2020;10(1):61-68.
6. Womack, J.; Pearson, J.D.; Walker, I.A.; Stephens, N.M.; Goodman, B.A. Safety, complications and clinical outcome after ultrasound-guided paravertebral catheter insertion for rib fracture analgesia: a single-centre retrospective observational study. Anaesthesia. 2019 May;74(5):594-601.
7. Adhikary, S.D.; Liu, W.M.; Fuller, E.; Cruz-Eng, H.; Chin, K.J. The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia. 2019 May;74(5):585-593.
8. Benyamin, R.; Trescot, A.M.; Datta, S.; Buenaventura, R.; Adlaka, R.; Sehgal, N.; Glaser, S.E.; Vallejo, R. Opioid complications and side effects. Pain Physician. 2008 Mar;11(2 Suppl):S105-120.
9. Kunhabdulla, N.P.; Agarwal, A.; Gaur, A.; Gautam, S.K.; Gupta, R.; Agarwal, A. Serratus anterior plane block for multiple rib fractures. Pain Physician. 2014 Sep-Oct;17(5):E651-653.
10. Rose, P.; Ramlogan, R.; Sullivan, T.; Lui, A. Serratus anterior plane blocks provide opioid-sparing analgesia in patients with isolated posterior rib fractures: a case series. Can J Anaesth. 2019 Oct;66(10):1263-1264
11. Higgins, J.P.; Altman, D.G.; Gotzsche, P.C.; Juni, P.; Moher, D.; Oxman, A.D.; Savovic, J.; Schulz, K.F.; Weeks, L.; Sterne, J.A.; Cochrane Bias Methods, G.; Cochrane Statistical Methods, G. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct 18;343:d5928.
12. Sterne, J.A.; Hernan, M.A.; Reeves, B.C.; Savovic, J.; Berkman, N.D.; Viswanathan, M.; Henry, D.; Altman, D.G.; Ansari, M.T.; Boutron, I.; Carpenter, J.R.; Chan, A.W.; Churchill, R.; Deeks, J.J.; Hrobjartsson, A.; Kirkham, J.; Juni, P.; Loke, Y.K.; Pigott, T.D.; Ramsay, C.R.; Regidor, D.; Rothstein, H.R.; Sandhu, L.; Santaguida, P.L.; Schunemann, H.J.; Shea, B.; Shrier, I.; Tugwell, P.; Turner, L.; Valentine, J.C.; Waddington, H.; Waters, E.; Wells, G.A.; Whiting, P.F.; Higgins, J.P. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016 Oct 12;355:i4919.
13. Abu-Elwafa, W.A.E-G.; Ragab, I.A.; Abdelrahman, A.H.; Mahmoud, W.A. Comparative Study between Efficacy of Serratus Anterior Muscle Block as A Regional Analgesia Technique and I.V Morphine Infusion in Patient with Fracture Ribs. The Egyptian Journal of Hospital Medicine. 2021 Jan;82(2):348-353.
14. Beard, L.; Hillermann, C.; Beard, E.; Millerchip, S.; Sachdeva, R.; Gao Smith, F.; Veenith, T. Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures. Reg Anesth Pain Med. 2020 May;45(5):351-356.
15. Bhalla, P.I.; Solomon, S.; Zhang, R.; Witt, C.E.; Dagal, A.; Joffe, A.M. Comparison of serratus anterior plane block with epidural and paravertebral block in critically ill trauma patients with multiple rib fractures. Trauma Surg Acute Care Open. 2021;6(1):e000621.
16. Diwan, S.; Nair, A. A retrospective study comparing analgesic efficacy of ultrasound-guided serratus anterior plane block versus intravenous fentanyl infusion in patients with multiple rib fractures. J Anaesthesiol Clin Pharmacol. 2021 Jul-Sep;37(3):411-415.
17. Riley, B.; Malla, U.; Snels, N.; Mitchell, A.; Abi-Fares, C.; Basson, W.; Anstey, C.; White, L. Erector spinae and serratus anterior blocks for the management of rib fractures: A retrospective exploratory matched study. Am J Emerg Med. 2020 Aug;38(8):1689-1691.
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| How to Cite this Article: Zhen L, Bright M, McHugh M, Reardon D, White L | Serratus Anterior Block for Rib Fractures: A Systematic Review and Meta-analysis | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 76-82. |
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An Observational Study of Efficacy of Infraclavicular Brachial Plexus Block for Arterio-Venous Fistula Surgeries- Comparison of Two Techniques Using Ultrasound and Ultrasound with Peripheral Nerve Stimulation
Vol 3 | Issue 2 | July-December 2022 | Page 88-92 | Trupti Pethkar, R. Janki
DOI: 10.13107/ijra.2022.v03i02.060
Authors: Trupti Pethkar [1], R. Janki [1]
[1] Department of Anaesthesia, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.
[2] Critical Care Department, Caritas Hospital, Kottayam, Kerala, India.
Address of Correspondence
Dr. Trupti Pethkar,
Consultant Anesthesiologist, Department of Anaesthesia, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.
E-mail: truptipethkar@yahoo.co.in
Abstract
Background: Success of the brachial plexus block depends equally on the performer’s skill and the availability of specific equipments. Here, the efficacy of infraclavicular brachial plexus block was assessed using two different techniques.
Material and Methods: In 72 patients divided in equal groups, the time taken to perform the block, onset and degree of sensory and motor blockade, complications and supplements, if required were noted in patients undergoing arterio-venous fistula creation. An infraclavicular brachial plexus block was performed either with ultrasound only (group-A) or with ultrasound and nerve stimulation (group-B). Collected data underwent rigorous statistical analysis.
Results: Onset of sensory, motor blockade and block success achieved in both groups was statistically insignificant. Time taken for block administration and the mean time for complete sensory blockade were statistically significant.
Conclusion: Though time taken for the block administration was longer and complete sensory blockade was earlier by dual guidance, the block success rate and the degree of block were comparable in both the techniques. Dual modality blocks are challenging in view of obtaining an evoked motor response and visualization of the needle at the same time.
Keywords: Infraclavicular brachial plexus block, Sonosite, Peripheral nerve Stimulator
References
1. Emmannuel Dingemans, Stephan R. Williams, Genevie `ve Arcand, Philippe Chouinard, Patrick Harris, Monique Ruel, RN* Franc ¸ois Girard et al. Neurostimulation in ultrasound guided Infraclavicular Block: A Prospective Trial. Anaesth Analg 2007; 104; 1275-80.
2. Y. Gürkan, M. Tekin, S. Acar, M. Solak and K. Toker. Is nerve stimulation needed during an ultrasound-guided lateral sagittal infraclavicular block? Acta Anaesthesiol Scand 2010; 54: 403–407.
3. FMT Azmin & YC Choy. Regional infraclavicular blocks via the coracoid approach for below-elbow surgery: a comparison between ultrasound guidance with, or without, nerve stimulation, South Afr J Anaesth Analg 2013, 19(5):263-269.
4. Shrestha BR. Nerve Stimulation Under Ultrasound Guidance Expedites Onset of Axillary Brachial Plexus Block. J Nepal Health Res Counc 2011 Oct; 9(19):145-49.
5. Bloc S, Garnier T, Komly B, Leclerc P, Mercadal L, Morel B, Dhonneur G. Ultrasound-guided infraclavicular block: a preliminary study of feasibility. Ann Fr Anesth Reanim 2007; 26: 627–37.
6. Chan VWS, Perlas A, McCartney CJL, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007; 54: 176-182.
7. Richard Brull, MD Æ Mario Lupu, MD Æ Anahi Perlas, MD Æ Vincent W. S. Chan, MD Æ Colin J. L. McCartney, MB. Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance.Can J Anaesth 2009 Nov; 56(11): 812-8.
| How to Cite this Article: Pethkar T, Janki R | An Observational Study of Efficacy of Infraclavicular Brachial Plexus Block for Arterio-Venous Fistula Surgeries- Comparison of Two Techniques Using Ultrasound and Ultrasound with Peripheral Nerve Stimulation | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 88-92. |
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Time to adequately heed Acute Pain in the Emergency Department – More Regional Blocks Warranted
Vol 3 | Issue 2 | July-December 2022 | Page 37-41 | Tom C. R. V. Van Zundert, André A. J. Van Zundert
DOI: 10.13107/ijra.2022.v03i02.054
Authors: Tom C. R. V. Van Zundert [1, 2], André A. J. Van Zundert [2, 3]
[1] Department of Emergency Medicine, Holy Heart Hospital, Mol, Belgium.
[2] Udayana University, Bali, Indonesia.
[3] Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Brisbane, QLD, Australia.
Address of Correspondence
Professor André A.J. Van Zundert,
Professor and Chair of Anaesthesiology, Royal Brisbane and Women’s Hospital & The University of Queensland, Brisbane, QLD, Australia.
E-mail: vanzundertandre@gmail.com
Introduction
All healthcare stressors converge in the emergency department (ED), which sees an annual increase of 6-7% with more than 25 million patient visits in the UK. This translates to 44,435 attendances per 100,000 population in the period 2019-2020 [1]. Acute pain is the primary reason patients seek emergency medical care. Consequently, substandard acute pain treatment is one of the most frequently heard complaints and has been labelled as a public health problem [2]. Pain remains under-acknowledged, -assessed and -treated, mainly in case of overcrowding in the ED and especially in the more vulnerable groups, including the elderly and children. Many patients express an initial pain score of 10 out of 10 on the visual analogue scale (VAS) in the ED. Generally, initial pain treatment combines oral acetaminophen, NSAID and/or (IV) opioids. Nevertheless, despite these pain killers, most patients continue to suffer and score their pain at 8/10 or higher. Untreated pain can have both short- and long-term effects, including sensitisation to pain episodes in later life [3].
Most visits to the emergency department involve patients with conditions that include: a) injuries and trauma from (motor vehicle) accidents, physical assaults or falls, with or without circulatory shock; b) cardiovascular and cerebral attacks or loss of consciousness; c) severe pain of diverse causes, both acute and chronic origin; d) acute worsening of a serious illness or disease, including problems with breathing and bleeding; e) mental illness; f) burns; g) anaphylactic and allergic reactions; g) drug overdoses and poisoning; and h) pregnancy-related complications. In most of these cases, patients present with pain as a substantial factor.
Keywords: Emergency department, Hip fracture, Pain, Regional anaesthesia, Nerve blocks, Ultrasonography
References
1. NHS Report. Hospital Accident & Emergency Activity 2020-21. 30.09.2021. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident–emergency-activity/2020-21# (accessed 20.05.2022).
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| How to Cite this Article: Van Zundert TCRV, Van Zundert AAJ | Time to Adequately Heed Acute Pain in the Emergency Department- More Regional Blocks Warranted | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 37-41. |
(Abstract Text HTML) (Download PDF)
Opioid Sparing Anaesthetic Technique in Downs Syndrome Child with Congenital Heart Disease and Atlanto-Occipital Instability: A Case Report
Vol 3 | Issue 1 | January-June 2022 | Page 31-34 | Himaunshu V. Dongre, Sandeep M. Diwan, Ganesh P. Bhong, Parag K. Sancheti
DOI: 10.13107/ijra.2022.v03i01.052
Authors: Himaunshu V. Dongre [1], Sandeep M. Diwan [1], Ganesh P. Bhong [1], Parag K. Sancheti [2]
[1] Department of Anaesthesia, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Address of Correspondence
Dr. Himaunshu V. Dongre,
Department of Anaesthesia, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: himaunshu.dongre@gmail.com
Abstract
Downs syndrome, a common chromosomal abnormality is associated with hip and patellar instability and also atlanto-axial instability. Recurrent dislocation of the hip joint leads to potential disability requiring surgical intervention. Femoral varus derotation osteotomy and fixation is one of the procedures performed to stabilise the hip joint. (1) We report a case of Downs syndrome associated with congenital heart disease (CHD) and atlanto-axial instability which successfully underwent femoral varus derotation osteotomy procedure.
Keywords: Downs Syndrome, Atlanto-axial instability
References
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| How to Cite this Article: Dongre HV, Diwan SM, Bhong GP, Sancheti PK | Opioid Sparing Anaesthetic Technique in Downs Syndrome Child with Congenital Heart Disease and Atlanto-Occipital Instability: A Case Report | International Journal of Regional Anaesthesia | January-June 2022; 3(1): 31-34.
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