Blog Elements

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

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

December 10, 2023/4,190 Comments/in Volume 4; Issue 2: July-December 2023/by Ijraijraadmin

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. […]

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

May 10, 2023/13,281 Comments/in Volume 4; Issue 1: January-June 2023/by Ijraijraadmin

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 […]

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

December 10, 2023/4,190 Comments/in Volume 4; Issue 2: July-December 2023/by Ijraijraadmin

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

May 10, 2023/13,281 Comments/in Volume 4; Issue 1: January-June 2023/by Ijraijraadmin

Full Sized Blog Element (Big Preview Pic)

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

December 10, 2023/4,190 Comments/in Volume 4; Issue 2: July-December 2023/by Ijraijraadmin

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

(Abstract Text HTML) (Download PDF)

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

May 10, 2023/13,281 Comments/in Volume 4; Issue 1: January-June 2023/by Ijraijraadmin

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

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

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

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

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

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

Full Sized Blog Element (Big Preview Pic)

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

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

(Abstract Text HTML) (Download PDF)

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

Authors: Arun Nagdev [1]

(Abstract Text HTML) (Download PDF)

License

Business Hours

Editorial Office