Anomalous Brachial Plexus and their Relationship to the Subclavian Artery in the Supraclavicular Region

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Vol 5 | Issue 1 | January-June 2024 | Page 30-31| Pooja Jadhao, Sandeep Diwan

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.088

Authors: Pooja Jadhao [1], Sandeep Diwan [1]

[1] Department of Anaesthesiology, Sancheti Hospital and Rehabilitation Centre, Pune, Maharashtra, India.

Address of Correspondence
Dr. Pooja Jadhao,
Department of Anaesthesiology, Sancheti Hospital and Rehabilitation Centre, Pune, Maharashtra, India.
E-mail: poojajadhao533@gmail.com

Abstract

The brachial plexus at supraclavicular division level is superior and lateral to the subclavian artery. Thus needle tip positions are already published in literature. However we report the brachial plexus divisions on the medial side of the subclavian artery. This might result in inadequate or failed blocks with landmark guided technique. Moreover with ultrasound needle tip needs to advance medial to artery making it more difficult in expert hands too. Ultrasound imaging of brachial plexus helps in identifying anamolous position of brachial plexus divisions.
Keywords- Brachial plexus divisions, Subclavian artery, Ultrasound

References

1. Kessler J, Gray AT. Sonography of scalene muscle anomalies for brachial plexus block. Reg Anesth Pain Med. 2007; 32:172-3.
2. Chin KJ, Niazi A, Chan V. Anomalous brachial plexus anatomy in the supraclavicular region detected by ultrasound. Anesth Analg.2008;107:729-31
3. Padur AA, Kumar N, Shanthakumar SR, Shetty SD, Prabhu GS, Patil J. Unusual and unique variant branches of lateral cord of brachial plexus and its clinical implications ‒ A cadaveric study. J Clin Diagn Res. 2016;10:AC01-4.
4. Royse CF, Sha S, Soeding PF, Royse AG. Anatomical study of the brachial plexus using surface ultrasound. Anaesth Intensive Care 2006; 34:203–10.
5. Ramanujam V, Kirk PV. Anatomy variation of brachial plexus trunks during supraclavicular nerve block: clinical image. Braz J Anesthesiol. 2022 Nov-Dec;72(6):834-835.
6. Chan VW, Perlas A, Rawson R, Odukoya O. Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg 2003;97: 1514–7.

How to Cite this Article: Jadhao P, Diwan S | Anomalous Brachial Plexus and their Relationship to the Subclavian Artery in the Supraclavicular Region | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 30-31 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.88

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The Ever-Evolving Landscape of Modern Communication

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The Ever-Evolving Landscape of Modern Communication

In today’s interconnected world, communication has transcended geographical boundaries and evolved at an unprecedented pace. From the simple act of exchanging letters to the complex realm of digital interactions, the ways in which we connect with one another are constantly being reshaped by technological advancements and societal shifts. Understanding this ever-evolving landscape is crucial for navigating personal relationships, professional endeavors, and the broader global community.

The Rise of Digital Communication

The advent of the internet revolutionized communication, ushering in an era of instant messaging, email, and video conferencing. These tools have not only streamlined business operations but have also transformed personal relationships, allowing individuals to stay connected with loved ones across vast distances. Social media platforms have further amplified this trend, providing avenues for individuals to share their thoughts, experiences, and perspectives with a global audience.

However, the rise of digital communication has also presented challenges. The anonymity afforded by the internet has contributed to the spread of misinformation and online harassment. The sheer volume of information available online can be overwhelming, making it difficult to discern credible sources from unreliable ones. Furthermore, the constant connectivity demanded by digital communication can lead to burnout and a sense of being perpetually “on.”

Social Media’s Impact on Society

Social media has become an undeniable force in modern society, influencing everything from political discourse to consumer behavior. Platforms like Facebook, Twitter, and instagram have provided individuals with unprecedented opportunities to connect with like-minded people, organize social movements, and promote their businesses or personal brands. News and information now spread virally, often bypassing traditional media outlets. This immediacy can be both beneficial and detrimental, allowing for rapid responses to crises but also contributing to the spread of unverified or misleading content.

The curated nature of social media profiles can also contribute to unrealistic expectations and social comparison. The constant exposure to carefully crafted images and narratives can lead to feelings of inadequacy and anxiety, particularly among young people. It’s important to remember that social media often presents a highly filtered version of reality and to cultivate a healthy perspective on the information we consume online.

The Art of Effective Communication in a Digital Age

In a world saturated with information, the ability to communicate effectively is more important than ever. Whether you’re crafting an email, giving a presentation, or engaging in a social media conversation, clear, concise, and compelling communication can make all the difference. Here are some tips for honing your communication skills in the digital age:

  • Know your audience: Tailor your message to the specific interests and needs of your audience.
  • Be clear and concise: Get to the point quickly and avoid unnecessary jargon.
  • Use visuals: Incorporate images, videos, and infographics to enhance your message.
  • Be engaging: Ask questions, tell stories, and encourage interaction.
  • Be respectful: Engage in respectful dialogue, even when you disagree with someone’s perspective.
  • Proofread your work: Errors in grammar and spelling can undermine your credibility.

Looking Ahead: The Future of Communication

The future of communication is likely to be shaped by emerging technologies such as artificial intelligence (AI), virtual reality (VR), and augmented reality (AR). AI-powered chatbots are already being used to provide customer service and personalized recommendations. VR and AR technologies have the potential to create immersive and interactive communication experiences. Imagine attending a virtual meeting where you can interact with colleagues as if you were in the same room, or using AR to overlay digital information onto the real world.

As these technologies continue to evolve, it’s important to consider their potential impact on society. Will they further enhance our ability to connect and collaborate, or will they exacerbate existing inequalities and contribute to social isolation? The answer will depend on how we choose to develop and deploy these technologies. By prioritizing ethical considerations and focusing on human-centered design, we can ensure that the future of communication is one that fosters understanding, empathy, and connection.

In conclusion, the landscape of modern communication is constantly changing, presenting both opportunities and challenges. By embracing new technologies, honing our communication skills, and remaining mindful of the potential impacts of these changes, we can navigate this evolving landscape and build a more connected and informed world.

The Enduring Appeal of Simple Pleasures in a Complex World

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The Enduring Appeal of Simple Pleasures in a Complex World

In today’s fast-paced, technologically advanced world, it’s easy to get caught up in the pursuit of success, material possessions, and constant stimulation. We are bombarded with information, notifications, and demands on our attention, leaving us feeling overwhelmed and disconnected. But amidst this complexity, there lies a profound and enduring appeal in the simple pleasures that life has to offer. These are the small, often overlooked moments that can bring genuine joy, contentment, and a sense of grounding in the present moment. Rediscovering and appreciating these simple pleasures is not just a nostalgic yearning for a bygone era, but a crucial element in cultivating a balanced and fulfilling life.

The Power of Nature’s Embrace

One of the most readily available and universally appreciated simple pleasures is the connection with nature. Whether it’s a leisurely stroll through a park, a hike in the mountains, or simply sitting by a lake, immersing ourselves in the natural world can have a profound impact on our well-being. The fresh air, the sounds of birds singing, the vibrant colors of flowers, and the gentle breeze against our skin – these sensory experiences can soothe our minds, reduce stress, and reconnect us with our inner selves. Even something as simple as tending to a small garden or watching the sunrise can be incredibly rewarding. The natural world offers a constant reminder of the beauty and wonder that surrounds us, inviting us to slow down, appreciate the present moment, and find solace in its embrace. For those seeking a thrilling experience to balance the peace of nature, sekabet giriş can offer a different kind of excitement.

The Comfort of Human Connection

In an increasingly digital age, genuine human connection is becoming more precious than ever. While social media can provide a sense of connection, it often lacks the depth and authenticity of face-to-face interactions. Spending quality time with loved ones, sharing a meal, engaging in meaningful conversations, and offering support to those in need are simple yet powerful ways to nurture our relationships and foster a sense of belonging. A warm hug, a listening ear, or a shared laugh can be incredibly uplifting and provide a sense of comfort and security. Reaching out to friends and family, volunteering in our communities, or simply engaging in small acts of kindness can create a ripple effect of positivity, enriching not only our own lives but also the lives of those around us. True connection transcends superficiality and reminds us that we are all interconnected, sharing a common humanity.

The Joy of Simple Activities

Sometimes, the most fulfilling experiences are not the grand adventures or the expensive luxuries, but the simple activities that we engage in with intention and enjoyment. Reading a good book, listening to music, cooking a delicious meal, practicing a hobby, or simply relaxing with a cup of tea can be incredibly satisfying. These activities allow us to disconnect from the pressures of daily life, engage our creativity, and cultivate a sense of inner peace. The key is to approach these activities with a sense of mindfulness, fully immersing ourselves in the experience and savoring each moment. Whether it’s the aroma of freshly baked bread, the melody of a favorite song, or the satisfaction of completing a challenging puzzle, these simple activities can bring a sense of joy and fulfillment that transcends material possessions or external validation. Finding your niche and indulging in it is what makes life exciting.

The Importance of Gratitude and Mindfulness

Underlying all of these simple pleasures is the practice of gratitude and mindfulness. Taking the time to appreciate the good things in our lives, no matter how small, can shift our perspective and cultivate a sense of contentment. Keeping a gratitude journal, expressing appreciation to others, or simply reflecting on the blessings we have can help us to focus on the positive aspects of our lives and reduce feelings of stress and negativity. Mindfulness, on the other hand, involves paying attention to the present moment without judgment. By being fully present in our experiences, we can savor the simple pleasures that life has to offer and appreciate the beauty that surrounds us. Whether it’s the taste of a delicious meal, the warmth of the sun on our skin, or the sound of laughter, mindfulness allows us to fully engage with our senses and appreciate the richness of life’s everyday moments. It’s about finding joy in the ordinary and recognizing the extraordinary in the mundane.

In conclusion, the enduring appeal of simple pleasures lies in their ability to connect us with nature, foster human connection, provide a sense of joy and fulfillment, and cultivate gratitude and mindfulness. In a world that often prioritizes complexity and achievement, rediscovering these simple pleasures is essential for cultivating a balanced, meaningful, and fulfilling life. By slowing down, appreciating the present moment, and focusing on the small joys that surround us, we can find happiness and contentment in the simplest of things.

The Fate of Lumbar Epidural Catheters in the Postoperative Period- A Retrospective Single-center Audit

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Vol 4 | Issue 2 | July-December 2023 | Page 14-17 | Sandeep Diwan, Himaunshu Dongre, Parag Sancheti

DOI: https://doi.org/10.13107/ijra.2023.v04i02.077

Submitted: 26-06-2023; Reviewed: 18-07-2023; Accepted: 23-10-2023; Published: 10-12-2023

Authors: Sandeep Diwan [1], Himaunshu Dongre [1], Parag Sancheti [2]

 

[1] Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
[2] Department of Orthopaedics, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Himaunshu Dongre,
Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra State, India.
E-mail: himaunshu.dongre@gmail.com

Abstract

This paper describes a retrospective audit of fate of epidural catheters in post operative period in adults and elderly patients (more than 65 years) receiving epidural infusion analgesia (EIA) in a single institute. Epidural catheters can either migrate inwards (inward migration of epidural catheter or IMEC) otherwise, outwards (outward migration of epidural catheter or OMEC). The OMEC can lead to failure of epidural analgesia and loss of infusate. The primary aim was to evaluate the incidence of OMEC. The secondary aim was, disconnections, kinking, knotting and breakage of catheter. The primary and secondary aim together were considered as fate of epidural catheter. Our study demonstrates the OMEC occurred at 1.12%, disconnection at 7.32%, kink and knot at 1.12% and 0.016% respectively A good communication at all levels (anesthesiologist-handlers at each level-nursing staff), in event of raised incidence (inform the QHC and concerned anesthesiologist) is mandatory to avoid mishandling of epidural assembly. After identifying some of the causes including the dressing material and fixation methods, changes were implemented which will be audited in the subsequent study.
Keywords: Epidural catheter migration, Audit, Observational Study

References

1. McWilliam A, Smith A. National UK audit projects in anaesthesia. Continuing Education in Anaesthesia, Critical Care & Pain 2008;8:5.
2. Shaw C, Costain DW. Guidelines for medical audit: seven principles. Br Med J 1989; 299: 498– 9.
3. Gülcü N, Karaaslan K, Koçoğlu H, Gümüş E. A new method for epidural catheter fixation. Agri. 2007; 19:33-7.
4. Chadwick VL, Jones M, Poulton B, Fleming BG. Epidural catheter migration: a comparison of tunnelling against a new technique of catheter fixation. Anaesth Intensive Care. 2003; 31:518-22.
5. Bishton IM, Martin PH, Vernon JM, Liu WH. Factors influencing epidural catheter migration. Anaesthesia 1992; 47: 610– 12.
6. Kumar N, Chambers WA. Tunnelling epidural catheters: a worthwhile exercise? Anaesthesia. 2000; 55:625-6.
7. Coupé M, al-Shaikh B. Evaluation of a new epidural fixation device. Anaesthesia. 1999 ; 54:98-9.
8. Bougher RJ, Corbett AR, Ramage DT. The effect of tunnelling on epidural catheter migration Anaesthesia 1996; 51: 191– 4.
9. Burstal R, Wegener F, Hayes C, Lantry G. Subcutaneous tunnelling of epidural catheters for postoperative analgesia to prevent accidental dislodgement: a randomized controlled trial. Anaesth Intensive Care. 1998; 26:147-51.
10. Tripathi M, Pandey M. Epidural catheter fixation: subcutaneous tunnelling with a loop to prevent displacement. Anaesthesia. 2000; 55:1113-6.
11. Clark MX, O’Hare K, Gorringe J, Oh T. The effect of the Lockit epidural catheter clamp on epidural migration: a controlled trial. Anaesthesia. 2001; 56: 865-70.

How to Cite this Article:  Diwan S, Dongre H, Sancheti P | The Fate of Lumbar Epidural Catheters in the Postoperative Period- A Retrospective Single-center Audit | International Journal of Regional Anaesthesia | July-December 2023; 4(2): 14-17 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.077

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Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly

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Vol 4 | Issue 2 | July-December 2023 | Page 9-13 | Tamasi Dawn, Yatindra Kumar Batra, Sunny Rupal, Komal Jit Kaur, Tanvir Samra

DOI: https://doi.org/10.13107/ijra.2023.v04i02.076

Submitted: 10-08-2023; Reviewed: 06-09-2023; Accepted: 24-10-2023; Published: 10-12-2023

Authors: Tamasi Dawn [1], Yatindra Kumar Batra [1], Sunny Rupal [1], Komal Jit Kaur [1], Tanvir Samra [2]

[1] Department of Anaethesiology Max superspeciality Hospital, Mohali, Punjab, India.
[2] Department of Anaesthesia PGIMER, Chandigarh, India.

Address of Correspondence
Dr. Tanvir Samra,
Associate Professor Department of Anaesthesia PGIMER, Chandigarh, India.
E-mail: drtanvirsamra@yahoo.co.in

Abstract

Background- The ability of the pendant position in increasing the intervertebral spaces translating in an increase in the 1st attempt spinal puncture success rate has been reported in pregnant females undergoing cesarean section. However, the same has not been done for the elderly patients in which age-related degenerative anatomical changes, decreased lordosis, disseminated sclerosis, and extensive osteophytosis is known to reduce the intervertebral space.
Materials and Methods- A prospective randomized controlled study was conducted in patients aged 60-80 years undergoing urological surgeries after approvalfrom the Institutional Ethics Committee and written informed consent from the patients. Primary aim was to compare the number of bone contacts during administration of subarachnoid block with the patient in either pendant (Group A) or traditional (Group B) position. Secondary aims were to compare the proportion of successful spinal needle placements, ease of palpation of spinous processes, patient’s comfort, number of spaces used, time to perform spinal puncture, time to reach grade III (as per modified bromage score) motor blockade, time to reach T10 sensory level and rate of complications in both the groups.
Results- Demographic data was comparable and there was no statistical difference in number of bone contacts, ease of administration, success of spinal needle placements, performance times of subarachnoid block and duration of spinal anaesthesia in both the groups. Complication rates were comparable.
Conclusion- Pendant positioning does not confer any advantage over the traditional sitting position in success rates and performance characteristics of subarachnoid block in elderly (60-80 years) patients scheduled for urological surgeries.
Keywords: Pendant position, Spinal-bone contact, Spinal Needle Puncture, Lumbar puncture, Spinal anesthesia, Aged

References

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How to Cite this Article:  Dawn T, Batra YK, Rupal S, Kaur KJ, Samra T | Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly | International Journal of Regional Anaesthesia | July- December 2023; 4(2): 9-13 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.076

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Thoracic Wall Blocks for Thoracic Surgery

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Vol 4 | Issue 2 | July-December 2023 | Page 01-08 | Neha Pangasa, Anjolie Chhabra

DOI: https://doi.org/10.13107/ijra.2023.v04i02.075

Submitted: 08-07-2023; Reviewed: 01-09-2023; Accepted: 09-10-2023; Published: 10-12-2023

Authors: Neha Pangasa [1], Anjolie Chhabra [1]

[1] Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Address of Correspondence
Dr. Neha Pangasa
Assistant Professor, Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Email- nehapangasa@gmail.com

Abstract

Thoracic epidural, paravertebral block and intercostal nerve block were the conventional methods of providing analgesia for thoracic surgery, about a decade ago. In the modern era with the advent of ultrasound guided regional anesthesia, the fascial plane blocks came as a boon to anesthesiologists. These blocks are safer, as the needle tip remains distant from the pleura and they are technically easier to perform. We have described in brief the various techniques for thoracic wall analgesia with special emphasis to fascial plane blocks, along with the current evidence for each block.
Keywords: Thoracic wall blocks, Fascial plane blocks, Local anaesthetic

References

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15. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Regional Anesthesia & Pain Medicine. 2016 Sep 1;41(5):621-7.
16. Yang H.M ,Choi Y.J, Kwon HJ, J. O, Cho T.H, Kim S.H. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia 2018, 73, 1244–50.
17. Ivanusic J, Konishi Y, Barrington M.J. A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade. Reg Anesth Pain Med 2018;43: 567–71.
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33. Beard L, Hillermann C, Beard E, et al. 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; 0 :1-6.

How to Cite this Article: Pangasa N, Chhabra A | Thoracic Wall Blocks for Thoracic Surgery | International Journal of Regional Anaesthesia | July-December 2023; 4(2): 01-08 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.075

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Supra-inguinal Fascia Iliaca Block and the Obturator Nerve Obsession

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Vol 4 | Issue 2 | July-December 2023 | Page 27-28 | Sandeep Diwan, Georg Feigl, Shivaprakash S

DOI: https://doi.org/10.13107/ijra.2023.v04i02.080

Authors: Sandeep Diwan [1], Georg Feigl [2], Shivaprakash S [3]

[1] Department of Anaesthesia, Sancheti Institute of Orthopaedic and Rehabilitation, Pune, Maharashtra, India.
[2] Department of Anatomy and Clinical Morphology, Witten / Herdecke University, Witten, Germany.
[3] Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka State, India..

Address of Correspondence
Dr. Sandeep Diwan,
Department of Anaesthesia, Sancheti Institute of Orthopaedic and Rehabilitation, Pune, Maharashtra, India.
E-mail: sdiwan14@gmail.com

To the Editor,

Anatomic block efficacy of lumbar plexus elements is based upon the involvement of the obturator nerve. However, despite the anatomic location of the obturator nerve and improbable translocation of local anesthetic beyond the confinement of the fascia iliacus plane [1], investigators struggle to study extensively, exhaustively, and try to explicitly describe the means and mechanism to block the obturator nerve [2].
Our anatomical dissections reveal three important dissimilar fascial planes (figure 1a). The quadratus lumborum, the fascia iliaca, and the circum-psoas planes are isolated from each other with tight fascial attachments [Figure 1b], impeding the dissemination of local anaesthetic agents unless inadvertently perforating the fascia. Further exploration revealed the femoral, lateral femoral cutaneous, obturator nerves and the lumbosacral trunk emerge from the lateral and medial of the psoas muscle respectively, and exits the psoas fascia (figure 1a,1b, and 1c) to take their respective course. The obturator nerve might further arise in a separate muscular fold (Figure 1c).
However, if the obturator nerve needs to be blocked, two we recommend two alternatives; We presume that with injections deep to the psoas sheath, the plausibility of involvement of all the nerves of the lumbar plexus (lateral femoral cutaneous nerve, femoral nerve, and ON) exists, as reported in a case series [3] and the obturator nerve needs to be blocked separately after a supra-inguinal fascia iliaca block.

References

1. Bendtsen TF, Pedersen EM, Moriggl B, et al. Anatomical considerations for obturator nerve block with fascia iliaca compartment block. Reg Anesth Pain Med. 2021; 46:806-12.
2. Swenson JD, Davis JJ, Stream JO, Crim JR, Burks RT, Greis PE. Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: the pattern of distribution and effects on the obturator nerve. J Clin Anesth. 2015; 27:652-7.
3. Diwan S, Nair A, Gawai N, Shah D, Sancheti P. Circumpsoas block – an anterior myofascial plane block for lumbar plexus elements: case report. Braz J Anesthesiol. 2021: S0104-0014(21)00180-9.

How to Cite this Article:   Diwan S, Feigl G, S Shivaprakash | Supra-inguinal Fascia Iliaca Block and the Obturator Nerve Obsession | International Journal of Regional Anaesthesia | July-December 2023; 4(2): 27-28 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.080

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Making Regional Anaesthesia Safe

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Vol 4 | Issue 2 | July-December 2023 | Page 21-26 | Ashish A. Bartakke

DOI: https://doi.org/10.13107/ijra.2023.v04i02.079

Submitted: 12-11-2023; Reviewed: 18-11-2023; Accepted: 25-11-2023; Published: 10-12-2023

Authors: Ashish A. Bartakke [1]

[1] Department of Anaesthesiology and Perioperative Medicine, Hospital Valle de los Pedroches, Pozoblanco, Andalucia, Spain.

Address of Correspondence
Dr. Ashish A. Bartakke,
Senior Faculty Consultant, Department of Anaesthesiology and Perioperative Medicine, Hospital Valle de los Pedroches, Pozoblanco, Andalucia, Spain.
E-mail: ashishbartakke@gmail.com

Abstract

The complexity of current practice in anaesthesiology and perioperative medicine has resulted in employing complex regional anaesthesia techniques to improve patient outcomes in terms of better postoperative pain control and thus facilitate early mobilization and recuperation of patients. However, ensuring patient safety while performing these complex procedures is of paramount importance and all efforts need to be undertaken to minimise the possibility of harm to the patient. Quality improvement and patient safety go hand in hand. Ensuring safe practices in regional anaesthesia is not just an individual task but a collective responsibility of the perioperative team. It thus involves both technical skills as well as non-technical skills and human factors.
This article provides a brief discussion of the various measures involving technical and non-technical factors to improve patient safety in modern day regional anaesthesia practice.
Keywords: Regional Anaesthesia, Patient safety, Non-technical skills, Human factors

References

1. Mellin-Olsen J, Staender S, Whitaker DK, Smith AF. The Helsinki Declaration on Patient Safety in Anaesthesiology. Eur J Anaesthesiol. 2010;27(7):592-597. doi:10.1097/EJA.0b013e32833b1adf
2. Kettner SC, Willschke H, Marhofer P. Does regional anaesthesia really improve outcome?. Br J Anaesth. 2011;107 Suppl 1:i90-i95. doi:10.1093/bja/aer340
3. Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth. 2020;125(4):492-504. doi:10.1016/j.bja.2020.06.063
4. Fanelli A, Balzani E, Memtsoudis S, Abdallah FW, Mariano ER. Regional anesthesia techniques and postoperative delirium: systematic review and meta-analysis. Minerva Anestesiol. 2022;88(6):499-507. doi:10.23736/S0375-9393.22.16076-1
5. Association of Anaesthetists of Great Britain and Ireland, Obstetric Anaesthetists’ Association, Regional Anaesthesia UK, Campbell J, Plaat F, Checketts M et al. Safety guideline: skin antisepsis for central neuraxial blockade. Anaesthesia 2014; 69: 1279e86
6. Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2013;(3):CD003949. Published 2013 Mar 28. doi:10.1002/14651858.CD003949.pub3
7. Bomberg H, Bayer I, Wagenpfeil S et al. Prolonged catheter use and infection in regional anesthesia: a retrospective registry analysis. Anesthesiol J Am Soc Anesthesiol 2018; 128: 764e73
8. Keys M, Sim BZ, Thom O, Tunbridge MJ, Barnett AG, Fraser JF. Efforts to Attenuate the Spread of Infection (EASI): a prospective, observational multicentre survey of ultrasound equipment in Australian emergency departments and intensive care units. Crit Care Resusc J Australas Acad Crit Care Med 2015; 17: 43e6
9. Ecoffey C, Bosenberg A, Lonnqvist PA, Suresh S, Delbos A, Ivani G. Practice advisory on the prevention and management of complications of pediatric regional anesthesia. J Clin Anesth. 2022;79:110725. doi:10.1016/j.jclinane.2022.110725
10. Neal JM. Ultrasound-guided regional anesthesia and patient: update of an evidence-based analysis. Reg Anesth Pain Med 2016; 41: 195e204
11. Topor B, Oldman M, Nicholls B. Best practices for safety and quality in peripheral regional anaesthesia. BJA Educ. 2020;20(10):341-347. doi:10.1016/j.bjae.2020.04.007
12. Dohlman LE, Kwikiriza A, Ehie O. Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings. Local Reg Anesth. 2020;13:147-158. Published 2020 Oct 22. doi:10.2147/LRA.S236550
13. Mulroy MF, Weller RS, Liguori GA. A checklist for performing regional nerve blocks [published correction appears in Reg Anesth Pain Med. 2014 Jul-Aug;39(4):357]. Reg Anesth Pain Med. 2014;39(3):195-199. doi:10.1097/AAP.0000000000000075
14. Stop before you block. Available from: https://www.ra-uk.org/index.php/stop-before-you-block. [Accessed 25 March 2020]

How to Cite this Article:   Bartakke AA | Making Regional Anaesthesia Safe | International Journal of Regional Anaesthesia | July-December 2023; 4(2): 21-26 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.079

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Brachial Plexus Block in Lateral Position for Fracture Shaft Humerus in Severe Thoracic Kyphoscoliosis- A Case Report

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Vol 4 | Issue 2 | July-December 2023 | Page 18-20 | Sandeep Mutha, Sushmitha K, Rajan Kothari, Deepak Phalgune

DOI: https://doi.org/10.13107/ijra.2023.v04i02.078

Submitted: 24-03-2023; Reviewed: 16-04-2023; Accepted: 11-10-2023; Published: 10-12-2023

Authors: Sandeep Mutha [1], Sushmitha K [1], Rajan Kothari [2], Deepak Phalgune [3]

[1] Department of Anaesthesiology, Poona Hospital and Research Centre, Pune, Maharashtra, India.
[2] Department of Orthopaedic Surgery, Poona Hospital and Research Centre, Pune, Maharashtra, India.

Address of Correspondence
Dr. Deepak Phalgune
Research Consultant, Poona Hospital & Research Centre, Pune, Maharashtra, India.
Email- dphalgune@gmail.com

Abstract

Patients with spine deformities, present unique challenges to the anaesthesiologists. These patients have abnormalities such as cardiovascular, pulmonary, musculo-skeletal, etc. Spinal deformities may cause difficulties with ventilation, tracheal intubation, regional anaesthesia and positioning. Due to problems associated with respiratory system, regional anaesthesia is widely preferred, though it is technically and logistically difficult. We present a case report of the anaesthetic management of an elderly female with severe thoracic kyphoscoliosis who could not lie supine on bed. She had a fracture of left upper 1/3rd shaft humerus. She was posted for open reduction and internal fixation of fractured shaft of left humerus under brachial plexus nerve block in right lateral position with a pillow under the head. The patient was given left interscalene and costoclavicular (infraclavicular) brachial plexus block under ultrasonography and peripheral nerve stimulator guidance. Major problems for brachial plexus block were positioning, approach, dosage of medications and respiratory compromise. Another difficulty was the position of the patient during the surgical procedure. The surgery was successful and the patient was pain free both intra and postoperatively. Intraoperatively no sedation or anxiolysis were required
Keywords: Kyphoscoliosis, Brachial plexus block, Fracture humerus, Patient position.

References

1) Roberta H, Katherine M. Stoelting’s Anesthesia and Co-existing Disease. 5th ed. Philadelphia: Churchill Livingstone; 2008. pp. 459–60.
2) Kaur M, Aujla KS, Gosal JS. Anesthetic Challenges in a Patient with Severe Thoracolumbar Kyphoscoliosis. Anesth Essays Res. 2020; 14 (1): 170–2.
3) Libby DM, Briscoe WA, Boyce B, Smith JP. Acute respiratory failure in scoliosis or kyphosis: prolonged survival and treatment. Am J Med. 1982; 73 (4):532–8.
4) Misra S, Shukla A, Rao KG. Subarachnoid block in kyphoscoliosis: A reliable technique? Med J DY Patil Univ. 2016; 9 (6):761–4.
5) Kearon C, Viviani GR, Kirkley A, Killian KJ. Factors determining pulmonary function in adolescent idiopathic thoracic scoliosis. Am Rev Respir Dis 1993; 148 (2):288-94.
6) Kulkarni AH, Ambareesha M. Scoliosis and anesthetic considerations. Indian J Anaesth. 2007; 51 (6):486–95.
7) Gupta S, Singariya G. Kyphoscoliosis and pregnancy- A case report. Indian J Anaesth. 2004; 48 (3):215–20.
8) Bansal N, Gupta S. Anaesthetic management of a parturient with severe kyphoscoliosis. Kathmandu Univ Med J. 2008; 6 (23):379–82.

How to Cite this Article:   Mutha S, Sushmitha K, Kothari R, Phalgune D | Brachial Plexus Block in Lateral Position for Fracture Shaft Humerus in Severe Thoracic Kyphoscoliosis- A Case Report | International Journal of Regional Anaesthesia | July-December 2023; 4(2): 18-20 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.078

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Comments on- Time to Adequately Heed Acute Pain in the Emergency Department – More Regional Blocks Warranted

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Vol 4 | Issue 1 | January-June 2023 | Page 33-34 | Arun Nagdev

DOI: https://doi.org/10.13107/ijra.2023.v04i01.074

Authors: Arun Nagdev [1]

[1] Highland Hospital/Alameda Health System.
[2] University of California, San Francisco, USA.

Address of Correspondence
Dr. Arun Nagdev,
Director, Emergency Ultrasound, Highland Hospital/Alameda Health System.
Associate Clinical Professor, University of California, San Francisco, USA.
E-mail: arunnagdev@gmail.com

To the Editor,

I read the recent article “Time to Adequately Heed Acute Pain in the Emergency Department – More Regional Blocks Warranted” by Dr. Zundert, et al. with much interest [1]. The central argument of offering adequate multimodal acute pain control to our most vulnerable patients has been the core tenant of my clinical practice and research for the last 15 years. I completely agree that If we (as the field of medicine) hope to succeed in equitable acute pain management, leveraging the skill of numerous clinicians (emergency physicians, surgeons, orthopedics, etc.) to perform single injection regional blocks will be needed [2]. Like other skills (endotracheal intubation, lumbar puncture, central venous cannulation, etc.) that have been adapted from innovators in one field and then taught to the various other specialties, ultrasound-guided regional anesthesia needs to be brought from the expert regional anesthesiologists and to the clinicians who are at the bedside caring for this cohort of patients.

Working at an academic trauma center in a low resource setting, we have had to build patient-centered pain pathways that both treat acute pain as well as ensure a reduction in opioid use. With the help of our anesthesia colleague at University of California, San Francisco, we have integrated ultrasound-guided regional blocks into our clinical practice for more than 10 years in the emergency department (ED). Just as Dr. Zundert has pointed out, this collaboration between our Anesthesia and Emergency Medicine colleagues has been an amazing success, leading to timely pain control in our acutely injured patients as well as improved patient care. For hip fractures specifically, we have worked with our anesthesia and orthopedic colleagues to develop a practice standard that asks our clinicians to perform a block in under 1 hour after recognition of a hip fracture [3]. This collaborative non-siloed based practice standard between all services dealing with acutely injured patients (trauma surgery, orthopedics, anesthesia and emergency medicine) has fostered interdepartmental education, multiple research publications and most importantly improved patient care [4, 5,6, 7].

Sincerely,

Arun Nagdev, MD
Director, Emergency Ultrasound
Highland Hospital/Alameda Health System
Associate Clinical Professor
University of California, San Francisco

References

[1] Van Zundert TCRV, Van Zundert AAJ. Time to adequately heed Acute Pain in the Emergency Department – More Regional Blocks Warranted. Int J Reg Anaesth. 2022;3(2):37-41.
[2] Wroe P, O’Shea R, Johnson B, Hoffman R, Nagdev A. Ultrasound-guided forearm nerve blocks for hand blast injuries: case series and multidisciplinary protocol. Am J Emerg Med. 2016;34(9):1895-1897.
[3] Johnson B, Herring A, Shah S, Krosin M, Mantuani D, Nagdev A. Door-to-block time: prioritizing acute pain management for femoral fractures in the ED. Am J Emerg Med. 2014;32(7):801-803.
[4] Lin DY, Woodman R, Oberai T, et al. Association of anesthesia and analgesia with long-term mortality after hip fracture surgery: an analysis of the Australian and New Zealand hip fracture registry. Reg Anesth Pain Med. 2023;48(1):14-21.
[5] Morrison RS, Dickman E, Hwang U, et al. Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial. J Am Geriatr Soc. 2016;64(12):2433-2439.
[6] Pawa A, El-Boghdadly K. Regional anesthesia by nonanesthesiologists. Curr Opin Anaesthesiol. 2018;31(5):586-592.
[7] Stone A, Goldsmith AJ, Pozner CN, Vlassakov K. Ultrasound-guided regional anesthesia in the emergency department: an argument for multidisciplinary collaboration to increase access while maintaining quality and standards. Reg Anesth Pain Med. 2021;46(9):820-821.

How to Cite this Article: Nagdev A | Comments on- Time to Adequately Heed Acute Pain in the Emergency Department – More Regional Blocks Warranted | International Journal of Regional Anaesthesia | January-June 2023; 4(1): 33-34 | DOI: https://doi.org/10.13107/ijra.2023.v04i01.074

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