Department Anaesthesia, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands Dear editor With great interest we have read the article by Mangla et al recently published in Local and Regional Anaesthesia. In this article, they present the anaesthetic considerations of a trauma patient with bilateral radial fractures. Because of posttraumatic orofacial swelling combined with a sore throat after a previous anaesthesia, they anticipated a possible difficult airway. The patient was motivated for a bilateral brachial plexus anaesthesia combined with midazolam and propofol infusion. A infraclavicular block on the right and a supraclavicular block on the left were performed under ultrasound guidance. We would like to share our thoughts regarding this anaesthetic plan with respect to patient safety. Firstly, combining different local anaesthetics is common but their toxicity is additive. Calculating maximal doses becomes blurred. Blocks become unpredictable due to changes in pKa values and alterations in free fractions of these local anaesthetics. Secondly, when pulmonary complications are a real concern we suggest to perform a bilateral axillary block since there are no concerns regarding pulmonal failure (diaphragm palsy, pneumothorax). In combination with a skin ring block to address the intercostobrachial nerve, patients will have sufficient anaesthesia to tolerate a tourniquet (if needed). Third, Mangla et al performed a bilateral brachial block using bupivacaine 0.5%. Regarding LA toxicity, ropivacaine has largely replaced bupivacaine as the most commonly used long-acting local anaesthetic in peripheral nerve blockade. In equivalent doses, it produces less motor blockade compared to bupivacaine but an equally effective sensory block. Most important ropivacaine is less cardiotoxic compared to bupivacaine. The volume of LA that was given to perform the brachial blocks was 30–40mL. An increased volume will increase the spread of local anaesthetics, increasing the chance of blocking the phrenic nerve. Especially as 20 mL of ropivacaine 0.75% or low dose ropivacaine 0.375% is sufficient in a ultrasound guided supraclavicular block. Determining the anaesthetic plan is always a delicate balance between patient wishes, surgical options, surgical and/or anaesthesia risks. Anaesthesiologists should implement the plan that minimizes the risk to the patient.
{"title":"Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures [Letter]","authors":"Eva Hendriksen, C. Slagt","doi":"10.2147/lra.s233411","DOIUrl":"https://doi.org/10.2147/lra.s233411","url":null,"abstract":"Department Anaesthesia, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands Dear editor With great interest we have read the article by Mangla et al recently published in Local and Regional Anaesthesia. In this article, they present the anaesthetic considerations of a trauma patient with bilateral radial fractures. Because of posttraumatic orofacial swelling combined with a sore throat after a previous anaesthesia, they anticipated a possible difficult airway. The patient was motivated for a bilateral brachial plexus anaesthesia combined with midazolam and propofol infusion. A infraclavicular block on the right and a supraclavicular block on the left were performed under ultrasound guidance. We would like to share our thoughts regarding this anaesthetic plan with respect to patient safety. Firstly, combining different local anaesthetics is common but their toxicity is additive. Calculating maximal doses becomes blurred. Blocks become unpredictable due to changes in pKa values and alterations in free fractions of these local anaesthetics. Secondly, when pulmonary complications are a real concern we suggest to perform a bilateral axillary block since there are no concerns regarding pulmonal failure (diaphragm palsy, pneumothorax). In combination with a skin ring block to address the intercostobrachial nerve, patients will have sufficient anaesthesia to tolerate a tourniquet (if needed). Third, Mangla et al performed a bilateral brachial block using bupivacaine 0.5%. Regarding LA toxicity, ropivacaine has largely replaced bupivacaine as the most commonly used long-acting local anaesthetic in peripheral nerve blockade. In equivalent doses, it produces less motor blockade compared to bupivacaine but an equally effective sensory block. Most important ropivacaine is less cardiotoxic compared to bupivacaine. The volume of LA that was given to perform the brachial blocks was 30–40mL. An increased volume will increase the spread of local anaesthetics, increasing the chance of blocking the phrenic nerve. Especially as 20 mL of ropivacaine 0.75% or low dose ropivacaine 0.375% is sufficient in a ultrasound guided supraclavicular block. Determining the anaesthetic plan is always a delicate balance between patient wishes, surgical options, surgical and/or anaesthesia risks. Anaesthesiologists should implement the plan that minimizes the risk to the patient.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"109 - 110"},"PeriodicalIF":2.9,"publicationDate":"2019-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/lra.s233411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45529275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Department of Anesthesiology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA Dear editor We would like to thank Dr Hendrickson et al for their interest in our work and writing about their opinion. We agree with the comment that mixing local anesthetics might make individual safe doses unknown, so maximum recommended doses of each local anesthetic should not be used. There are no human studies but it can be presumed to be additive based on some animal studies. We mixed local anesthetics in our patients so that we could decrease the volume of more toxic local anesthetics (Bupivacaine) by using some less toxic ones (like chloroprocaine). We also used doses of each local anesthetic of well below the recommended toxic doses and did spacing in our blocks to avoid toxicity. Though axillary blocks along with medial brachial cutaneous and intercostobrachial block can be used, we chose not to perform bilateral axillary blocks because it requires individual blockage of the terminal nerves which might lead to inadequate coverage, and also, performance of the block time and onset time is longer. Instead, we did infraclavicular block on one side, which greatly decreases the chances of phrenic nerve palsy. Dr Hendricken made a very good point of using ropivacaine instead of bupivacaine due to less toxicity, but unfortunately we do not have ropivacaine available at our institution. Lastly, smaller volume of local anesthetics can be used with the use of ultrasound for a successful block. We used 30 mL volume for each block, as we wanted to ensure complete coverage of surgical anesthesia and to avoid any supplementation/ deeper sedation or general anesthesia in case of an incomplete block. Also, our second block was more than two hours later, hence we avoided the overlap of peak plasma concentration of the local anesthetics from first and second blocks.
{"title":"Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures [Response To Letter]","authors":"Chanchal Mangla, H. Kamath, J. Yarmush","doi":"10.2147/lra.s238432","DOIUrl":"https://doi.org/10.2147/lra.s238432","url":null,"abstract":"Department of Anesthesiology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA Dear editor We would like to thank Dr Hendrickson et al for their interest in our work and writing about their opinion. We agree with the comment that mixing local anesthetics might make individual safe doses unknown, so maximum recommended doses of each local anesthetic should not be used. There are no human studies but it can be presumed to be additive based on some animal studies. We mixed local anesthetics in our patients so that we could decrease the volume of more toxic local anesthetics (Bupivacaine) by using some less toxic ones (like chloroprocaine). We also used doses of each local anesthetic of well below the recommended toxic doses and did spacing in our blocks to avoid toxicity. Though axillary blocks along with medial brachial cutaneous and intercostobrachial block can be used, we chose not to perform bilateral axillary blocks because it requires individual blockage of the terminal nerves which might lead to inadequate coverage, and also, performance of the block time and onset time is longer. Instead, we did infraclavicular block on one side, which greatly decreases the chances of phrenic nerve palsy. Dr Hendricken made a very good point of using ropivacaine instead of bupivacaine due to less toxicity, but unfortunately we do not have ropivacaine available at our institution. Lastly, smaller volume of local anesthetics can be used with the use of ultrasound for a successful block. We used 30 mL volume for each block, as we wanted to ensure complete coverage of surgical anesthesia and to avoid any supplementation/ deeper sedation or general anesthesia in case of an incomplete block. Also, our second block was more than two hours later, hence we avoided the overlap of peak plasma concentration of the local anesthetics from first and second blocks.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"125 - 126"},"PeriodicalIF":2.9,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/lra.s238432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48507115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial anesthesia can be challenging to place in the obese parturient, but is the preferred anesthetic for cesarean delivery to avoid airway manipulation, minimize aspiration risk, prevent fetal exposure to volatile anesthetic, and decrease risk of post-partum hemorrhage from volatile anesthetic exposure. Monitoring and positioning of these patients for surgery may pose specific challenges. Functional labor epidural catheters can be topped up to provide conditions suitable for surgery. In the absence of a working epidural catheter, a combined spinal epidural anesthetic is often the technique of choice due to relative ease of placement versus a single shot spinal technique as well as the ability to extend the anesthetic through the epidural portion. For cesarean delivery with a vertical supraumbilical skin incision, a two-catheter technique may be beneficial. Concern for thromboembolism necessitates early mobilization and a multimodal analgesic regimen can help accomplish this. In addition, thromboprophylaxis is recommended in this population after delivery—especially cesarean delivery. These patients also need close monitoring in the post-partum period when they are at increased risk for several complications.
{"title":"Obesity And Obstetric Anesthesia: Current Insights","authors":"C. Taylor, J. Dominguez, A. Habib","doi":"10.2147/LRA.S186530","DOIUrl":"https://doi.org/10.2147/LRA.S186530","url":null,"abstract":"Abstract Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial anesthesia can be challenging to place in the obese parturient, but is the preferred anesthetic for cesarean delivery to avoid airway manipulation, minimize aspiration risk, prevent fetal exposure to volatile anesthetic, and decrease risk of post-partum hemorrhage from volatile anesthetic exposure. Monitoring and positioning of these patients for surgery may pose specific challenges. Functional labor epidural catheters can be topped up to provide conditions suitable for surgery. In the absence of a working epidural catheter, a combined spinal epidural anesthetic is often the technique of choice due to relative ease of placement versus a single shot spinal technique as well as the ability to extend the anesthetic through the epidural portion. For cesarean delivery with a vertical supraumbilical skin incision, a two-catheter technique may be beneficial. Concern for thromboembolism necessitates early mobilization and a multimodal analgesic regimen can help accomplish this. In addition, thromboprophylaxis is recommended in this population after delivery—especially cesarean delivery. These patients also need close monitoring in the post-partum period when they are at increased risk for several complications.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"111 - 124"},"PeriodicalIF":2.9,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S186530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46230308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Postherpetic neuralgia is a common and potentially debilitating neuropathic pain condition. Current pharmacologic therapy can be inadequate and intolerable for patients. We present a case of a gentleman with refractory postherpetic neuralgia in the intercostobrachial nerve distribution that was successfully treated with cryoneurolysis/cryoanalgesia therapy.
{"title":"Case Report Of Cryoneurolysis For The Treatment Of Refractory Intercostobrachial Neuralgia With Postherpetic Neuralgia","authors":"G. Weber, K. Saad, M. Awad, Tiffany H. Wong","doi":"10.2147/LRA.S223961","DOIUrl":"https://doi.org/10.2147/LRA.S223961","url":null,"abstract":"Abstract Postherpetic neuralgia is a common and potentially debilitating neuropathic pain condition. Current pharmacologic therapy can be inadequate and intolerable for patients. We present a case of a gentleman with refractory postherpetic neuralgia in the intercostobrachial nerve distribution that was successfully treated with cryoneurolysis/cryoanalgesia therapy.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"103 - 107"},"PeriodicalIF":2.9,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S223961","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47907977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ferda Yılmaz İnal, Yadigar Yılmaz, H. Daşkaya, M. Toptaş, H. Koçoğlu, H. Uysal, I. Akkoc
Background The intraoperative attending anaesthesiologist ultimately makes decisions about the anaesthesiology technique to be performed, but the attitudes of surgeons and preferences of patients on this subject may affect their choice. In this questionnaire-based study, we aimed to evaluate the attitudes and behaviors of surgeons about the use of regional anaesthesia (RA) in surgical operations. Methods Surgeons from different surgical branches with residencies at 4 different hospitals were asked to complete questionnaires that included reasons for preferring (12 reasons) and not preferring (13 reasons) the use of RA techniques for surgeries, using a 5-point Likert scale. Results A total of 156 surgeons from 4 hospitals, out of 167 surgeons who were approached to participate in the study, completed the questionnaire. The most commonly observed reason for a preference towards regional anaesthesia among the surgeons was the risk of general anaesthesia for patients with an American Society of Anesthesiologists (ASA) risk class of III and above. The second most commonly observed reason was for protection from the complications of general anaesthesia, and the third most commonly observed reason was the lower risk of thromboembolisms with regional anaesthesia. The most commonly observed reasons for not choosing regional anaesthesia were found to be incompatibility of the patients and patients’ fears of feeling pain during surgery. Conclusion We conclude that programmes for informing surgeons and educating patients about the advantages of RA may increase the preference ratio among surgeons and decrease patients’ refusals to choose this procedure.
{"title":"Evaluation of the attitudes of surgeons about regional anesthesia: a survey study","authors":"Ferda Yılmaz İnal, Yadigar Yılmaz, H. Daşkaya, M. Toptaş, H. Koçoğlu, H. Uysal, I. Akkoc","doi":"10.2147/LRA.S211469","DOIUrl":"https://doi.org/10.2147/LRA.S211469","url":null,"abstract":"Background The intraoperative attending anaesthesiologist ultimately makes decisions about the anaesthesiology technique to be performed, but the attitudes of surgeons and preferences of patients on this subject may affect their choice. In this questionnaire-based study, we aimed to evaluate the attitudes and behaviors of surgeons about the use of regional anaesthesia (RA) in surgical operations. Methods Surgeons from different surgical branches with residencies at 4 different hospitals were asked to complete questionnaires that included reasons for preferring (12 reasons) and not preferring (13 reasons) the use of RA techniques for surgeries, using a 5-point Likert scale. Results A total of 156 surgeons from 4 hospitals, out of 167 surgeons who were approached to participate in the study, completed the questionnaire. The most commonly observed reason for a preference towards regional anaesthesia among the surgeons was the risk of general anaesthesia for patients with an American Society of Anesthesiologists (ASA) risk class of III and above. The second most commonly observed reason was for protection from the complications of general anaesthesia, and the third most commonly observed reason was the lower risk of thromboembolisms with regional anaesthesia. The most commonly observed reasons for not choosing regional anaesthesia were found to be incompatibility of the patients and patients’ fears of feeling pain during surgery. Conclusion We conclude that programmes for informing surgeons and educating patients about the advantages of RA may increase the preference ratio among surgeons and decrease patients’ refusals to choose this procedure.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"89 - 95"},"PeriodicalIF":2.9,"publicationDate":"2019-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S211469","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46034519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ferda Yılmaz İnal, Yadigar Yılmaz, H. Daşkaya, M. Toptaş, H. Koçoğlu, H. Uysal, I. Akkoc
[This corrects the article DOI: 10.2147/LRA.S211469.].
[这更正了文章DOI: 10.2147/LRA.S211469.]。
{"title":"Evaluation Of The Attitudes Of Surgeons About Regional Anesthesia: A Survey Study [Corrigendum]","authors":"Ferda Yılmaz İnal, Yadigar Yılmaz, H. Daşkaya, M. Toptaş, H. Koçoğlu, H. Uysal, I. Akkoc","doi":"10.2147/lra.s231688","DOIUrl":"https://doi.org/10.2147/lra.s231688","url":null,"abstract":"[This corrects the article DOI: 10.2147/LRA.S211469.].","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"97 - 97"},"PeriodicalIF":2.9,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/lra.s231688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43020175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deepanshu Mallan, Sandeep Sharan, S. Saxena, T. Singh, .. Faisal
Abstract Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24–48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose between variants of a TAP block and its complications and safety profile.
{"title":"Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks","authors":"Deepanshu Mallan, Sandeep Sharan, S. Saxena, T. Singh, .. Faisal","doi":"10.2147/LRA.S138537","DOIUrl":"https://doi.org/10.2147/LRA.S138537","url":null,"abstract":"Abstract Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24–48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose between variants of a TAP block and its complications and safety profile.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"81 - 88"},"PeriodicalIF":2.9,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S138537","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47302588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract We report a case of a 41-year-old male with anticipated difficult airway undergoing a repair of a bilateral radial fracture under bilateral sequential brachial plexus block. Anesthesiologists are reluctant to perform bilateral blocks because of the fear of complications like diaphragmatic paralysis, local anesthetic (LA) toxicity, and pneumothorax. We advise that with the correct application of LA pharmacokinetics, careful patient selection and usage of ultrasound, bilateral blocks can be done safely. We used chloroprocaine as an LA in one of the blocks to reduce the dose required for the more toxic LAs. chloroprocaine’s fast metabolism also helped us to prevent the overlapping of peak plasma concentration of different LAs. To our knowledge, this is the first reported case in the literature where chloroprocaine was used for bilateral brachial plexus block.
{"title":"Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures","authors":"Chanchal Mangla, H. Kamath, J. Yarmush","doi":"10.2147/LRA.S225471","DOIUrl":"https://doi.org/10.2147/LRA.S225471","url":null,"abstract":"Abstract We report a case of a 41-year-old male with anticipated difficult airway undergoing a repair of a bilateral radial fracture under bilateral sequential brachial plexus block. Anesthesiologists are reluctant to perform bilateral blocks because of the fear of complications like diaphragmatic paralysis, local anesthetic (LA) toxicity, and pneumothorax. We advise that with the correct application of LA pharmacokinetics, careful patient selection and usage of ultrasound, bilateral blocks can be done safely. We used chloroprocaine as an LA in one of the blocks to reduce the dose required for the more toxic LAs. chloroprocaine’s fast metabolism also helped us to prevent the overlapping of peak plasma concentration of different LAs. To our knowledge, this is the first reported case in the literature where chloroprocaine was used for bilateral brachial plexus block.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"99 - 102"},"PeriodicalIF":2.9,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S225471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47119115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Schubert, S. Müller, H. Wulf, T. Steinfeldt, T. Wiesmann
Background Skeletal muscle microvascular blood flow plays a critical role in many myopathologies. The influence of bupivacaine and adjuvants on skeletal muscle microvascular perfusion and tissue oximetry is poorly understood but might be a relevant risk factor for myopathies after local anesthetic administration. The aim of this experimental study was to determine the effects of bupivacaine alone or in combination with epinephrine or clonidine on skeletal muscle perfusion and tissue oximetry. Methods Combined tissue spectrophotometry and Laser-Doppler flowmetry and tissue oximetry were used to assess local muscle blood flow in anesthetized pigs after topical administration of test solutions (bupivacaine, bupivacaine with epinephrine or clonidine, saline). Measurements were performed for up to 60 mins. Results The application of bupivacaine alone did not alter relative muscle blood flow significantly, whereas the addition of epinephrine or clonidine to bupivacaine resulted in a significant reduction of relative muscle blood flow at T30 and T60. However, bupivacaine resulted in a significant decrease of tissue oximetry values when compared to saline control group at T30 and T60. The application of bupivacaine combined with clonidine or epinephrine resulted in no significant reduction of tissue oximetry when compared to bupivacaine alone. Conclusion Bupivacaine alone results in a significant decrease of tissue oximetry in skeletal muscle which is not increased by the addition of epinephrine or clonidine despite further reductions of microcirculatory perfusion. Overall, bupivacaine alone or with adjuvants does produce local muscle ischemia for which pathological consequences need to be addressed in further studies.
{"title":"Effect of bupivacaine and adjuvant drugs on skeletal muscle tissue oximetry and blood flow: an experimental study","authors":"A. Schubert, S. Müller, H. Wulf, T. Steinfeldt, T. Wiesmann","doi":"10.2147/LRA.S203569","DOIUrl":"https://doi.org/10.2147/LRA.S203569","url":null,"abstract":"Background Skeletal muscle microvascular blood flow plays a critical role in many myopathologies. The influence of bupivacaine and adjuvants on skeletal muscle microvascular perfusion and tissue oximetry is poorly understood but might be a relevant risk factor for myopathies after local anesthetic administration. The aim of this experimental study was to determine the effects of bupivacaine alone or in combination with epinephrine or clonidine on skeletal muscle perfusion and tissue oximetry. Methods Combined tissue spectrophotometry and Laser-Doppler flowmetry and tissue oximetry were used to assess local muscle blood flow in anesthetized pigs after topical administration of test solutions (bupivacaine, bupivacaine with epinephrine or clonidine, saline). Measurements were performed for up to 60 mins. Results The application of bupivacaine alone did not alter relative muscle blood flow significantly, whereas the addition of epinephrine or clonidine to bupivacaine resulted in a significant reduction of relative muscle blood flow at T30 and T60. However, bupivacaine resulted in a significant decrease of tissue oximetry values when compared to saline control group at T30 and T60. The application of bupivacaine combined with clonidine or epinephrine resulted in no significant reduction of tissue oximetry when compared to bupivacaine alone. Conclusion Bupivacaine alone results in a significant decrease of tissue oximetry in skeletal muscle which is not increased by the addition of epinephrine or clonidine despite further reductions of microcirculatory perfusion. Overall, bupivacaine alone or with adjuvants does produce local muscle ischemia for which pathological consequences need to be addressed in further studies.","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"12 1","pages":"71 - 80"},"PeriodicalIF":2.9,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S203569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41400627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-29eCollection Date: 2019-01-01DOI: 10.2147/LRA.S210462
Costantino Fontana, Monica Rocco, Luigi Vetrugno, Elena Bignami
Continuous peripheral nerve block is a relevant part of multimodal treatment of postoperative pain. In this context the continuous popliteal nerve block is described as an option for postoperative pain management for surgical procedures on the leg, and particularly on the ankle and foot. We applied continuous popliteal nerve block for different types of anesthesia and postoperative pain management via the same catheter. No clear evidence of this specific use has been described in the literature. A 38 year-old patient wounded in combat with a displaced fracture of left tibia and extensive loss of substance needed orthopedic surgeries as well as several reconstructive procedures. A continuous popliteal nerve block was applied via ultrasound-guided catheter for anesthesia at different times, and postoperative pain control for all surgical procedures. The continuous popliteal nerve block and its long-term positioning, of non-common evidence in literature, was utilized to treat a poly-traumatized patient, thereby avoiding repeated general anesthesia and opioid use and their adverse effects. This technique, within a complicated combat field environment, was demonstrated to be clinically effective with high patient satisfaction.
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