Local and Regional Anesthesia最新文献

Permanent transitions of care from one anesthesia provider to another are associated with adverse events and mortality. There are currently no available data on how to mitigate these poor patient outcomes other than to reduce the occurrence of such handoffs. We used data from an ambulatory surgery center to demonstrate the steps that can be taken to achieve this goal. First, perform statistical forecasting using many months of historical data to create optimal, as opposed to arbitrary shift durations. Second, consider assigning the anesthesia providers designated to work late, if necessary, to the ORs estimated to finish the earliest, rather than latest. We performed multiple analyses showing the quantitative advantage of this strategy for the ambulatory surgery center with multiple brief cases. Third, sequence the cases in the 1 or 2 ORs with the latest scheduled end times so that the briefest cases are finished last. If a supervising anesthesiologist needs to be relieved early for administrative duties (eg, head of the group to meet with administrators or surgeons), assign the anesthesiologist to an OR that finishes with several brief cases. The rationale for these recommendations is that such strategies provide multiple opportunities for a different anesthesia provider to assume responsibility for the patients between cases, thus avoiding a handoff altogether.

Background: Alpha-2 adrenergic agonists like clonidine and dexmedetomidine prolong the duration of postoperative analgesia and improve the quality of subarachnoid block (SAB) when used as adjuvant in various routes. However, addition of these drugs by IV or intrathecal routes are known to cause hemodynamic instability. The subcutaneous (SC) route provides similar efficacy as IV administration with less hemodynamic instability and prolonged effect. Aims: To compare the efficacy of clonidine and dexmedetomidine as adjuvants to SAB when used subcutaneously. Materials and methods: A total of 90 patients were randomized into one of the three groups: Group P received 1 ml of Normal saline SC, Group D received 0.5 mcg/kg of dexmeditomedine SC and Group C received 1 mcg/kg of clonidine SC respectively after SAB with 3ml of 0.5% hyperbaric bupivacaine (15 mg). Time of onset of sensory and motor block, intraoperative hemodynamics, postoperative VAS scores, Richmond agitation sedation scale, duration of postoperative analgesia and mean paracetamol requirement in 24 hours were recorded. Results: Mean duration of postoperative analgesia was prolonged in group D (838.10±348.22 minutes) and group C (816.67±230.48 minutes) when compared to group P (332.10±110.91 minutes). Total paracetamol consumption was less in group D (1400.00±770.13 mg) and group C (1600.00±674.66 mg), whereas it was 1900.00±758.86 mg in group P. Hemodynamic parameters, maximum sensory level attained, and time to attain maximum sensory levels were comparable among the two groups. Conclusion: Both subcutaneous clonidine and dexmedetomidine prolonged the duration of postoperative analgesia and reduced analgesic requirements when used as adjuvants to SAB with stable hemodynamics, hence both of these drugs can be used effectively as adjuvants to SAB.

Background: Hypotension is common during spinal anesthesia (SA) and is caused by a decrease in systemic vascular resistance (SVR) and/or cardiac output (CO). The effect of the dose of bupivacaine administered intrathecally on the changes in CO in elderly patients is largely unknown. This study investigated the hemodynamic effect of SA in elderly patients by studying the effect of two different dosages of intrathecal bupivacaine.

Methods: This prospective cohort study included 64 patients aged >65 years scheduled for procedures under SA; the patients received either 15 mg bupivacaine (the medium dose [MD] group) or 10 mg bupivacaine and 5 μg sufentanil (the low dose [LD] group). Blood pressure and CO were monitored throughout the procedure using Nexfin™, a noninvasive continuous monitoring device using a finger cuff.

Results: Thirty-three patients received MD and 31 received LD and there was no mean difference in baseline hemodynamics between the groups. On an average, the CO decreased 11.6% in the MD group and 10.0 % in the LD group. There was no significant change in SVR. Incidence of a clinically relevant decrease in stroke volume (SV) (>15% from baseline) was 67% in the MD and 45% in the LD groups (P<0.05).

Conclusion: CO and blood pressure decreased significantly after the onset of SA in elderly patients. This is mainly caused by a decrease in SV and not by a decrease in SVR. There was no difference in CO and blood pressure change between dosages of 10 or 15 mg bupivacaine.

We report the use of celiac plexus block (CPB) as a diagnostic aid in the evaluation of median arcuate ligament syndrome (MALS) in a pediatric patient. MALS is a rare cause of severe, debilitating, abdominal postprandial pain associated with nausea, vomiting, occasional diarrhea, unintentional weight loss, and abdominal bruit. MALS is a diagnosis of exclusion, after multiple investigations. This is the first case report where CPB was used to confirm candidacy for corrective surgery in the pediatric population and has served as the cornerstone in diagnosis of MALS.

Objective: The purpose of this study was to determine if the standardization of using liposomal bupivacaine in transversus abdominis plane (LB TAP) blocks eliminated the benefit of intrathecal morphine (ITM) in patients after undergoing a cesarean section.

Methods: This was a retrospective review of 358 patients who underwent cesarean section over an 11-month period. Patients were divided into two groups: those who received only an LB TAP (67 patients) vs those who received an LB TAP and ITM (291 patients). All blocks were placed bilaterally under ultrasound guidance after closure of the surgical incision, and morphine was added to the spinal used for the case.

Results: The group that received ITM in addition to the LB TAP received less opioids in the first 24 hours (median 5 range 0-150 mg morphine equivalents [ME] vs 15 range 0-76 mg ME; P<0.001) and less opioids overall (35 mg range 0-450 mg ME vs 47.5 mg range 0-189 mg ME; P=0.041) when compared to the LB TAP block only group. There was no difference between the two groups in opioid use from 24 to 48 hours or 48 to 72 hours.

Conclusion: Patients who received ITM in addition to an LB TAP block received less opioids in the first 24 hours and overall when compared to those who received an LB TAP alone. This suggests that ITM still plays a role in providing analgesia to patients who have also received an LB TAP block as a part of their multimodal pain regimen for cesarean sections.

Purpose: Postoperative cognitive dysfunction has gained much attention over the last years. Multiple clinical trials have attempted to differentiate the effect of local vs general anesthesia on postoperative cognitive function. The aim of this work was to study the effect of local anesthesia with lidocaine vs bupivacaine on cognitive function.

Patients and methods: This was a prospective randomized trial carried out on 61 patients undergoing elective cataract surgery by phacoemulsification under local anesthesia. Twenty-eight patients received lidocaine 2% and 33 patients received bupivacaine 0.5%. Cognitive assessment for all patients was done preoperatively and 1 week postoperatively using paired associate learning test (PALT) and category verbal fluency (VF) test (animal category).

Results: Regarding cognitive assessment of patients in lidocaine group, there was a statistically significant difference between the mean value of preoperative PALT and postoperative PALT (P-value =0.004), and between the mean value of preoperative VF and postoperative VF (P-value =0.002). As for bupivacaine group, there was a statistically significant difference between the mean value of preoperative PALT and postoperative PALT (P-value =0.021), and between the mean value of preoperative VF and postoperative VF (P-value =0.037). On comparing lidocaine and bupivacaine groups in pre and postoperative PALT & VF scores, there was no statistically significant difference between both groups.

Conclusion: Both lidocaine and bupivacaine caused postoperative cognitive impairment. Lidocaine was found to have a worse effect on cognitive function than bupivacaine, but the difference was not statistically significant.