Pub Date : 2022-03-31DOI: 10.1136/rapm-2022-103487
Laurel Walfish, Sultan Alobaikan, Zubin Lahijanian, C. Saint-Martin, Maria del Pilar Cortes Nino, P. Ingelmo
Background There is increasing evidence for the use of multilevel epidural catheter-guided blood patches to treat spontaneous cerebrospinal fluid leaks in adults. Yet, there are scarce data for their use in children. Furthermore, higher level epidural blood patches are uncommon in both adult and pediatric populations. Case presentation An adolescent boy with multilevel cerebrospinal fluid leaks associated with status migrainosus failed conservative pain management treatment. As he remained severely symptomatic, epidural blood patches were required to mitigate his symptoms. Given his multilevel leaks, a catheter-guided blood patch approach was used to treat multiple cervicothoracic and thoracolumbar leaks. After three separate uneventful blood patch procedures, the patient was free of symptoms. Other than some rebound intracranial hypertension, the patient maintained full neurological capacity without further complications. Following the resolution of treatment, he has not sought help for pain since his last blood patch over a year ago. Conclusions Multilevel catheter-guided blood patches have the potential to be administered to higher level spinal regions to the pediatric population suffering from multiple spontaneous cerebrospinal fluid leaks.
{"title":"Catheter-guided multilevel epidural blood patches in an adolescent boy","authors":"Laurel Walfish, Sultan Alobaikan, Zubin Lahijanian, C. Saint-Martin, Maria del Pilar Cortes Nino, P. Ingelmo","doi":"10.1136/rapm-2022-103487","DOIUrl":"https://doi.org/10.1136/rapm-2022-103487","url":null,"abstract":"Background There is increasing evidence for the use of multilevel epidural catheter-guided blood patches to treat spontaneous cerebrospinal fluid leaks in adults. Yet, there are scarce data for their use in children. Furthermore, higher level epidural blood patches are uncommon in both adult and pediatric populations. Case presentation An adolescent boy with multilevel cerebrospinal fluid leaks associated with status migrainosus failed conservative pain management treatment. As he remained severely symptomatic, epidural blood patches were required to mitigate his symptoms. Given his multilevel leaks, a catheter-guided blood patch approach was used to treat multiple cervicothoracic and thoracolumbar leaks. After three separate uneventful blood patch procedures, the patient was free of symptoms. Other than some rebound intracranial hypertension, the patient maintained full neurological capacity without further complications. Following the resolution of treatment, he has not sought help for pain since his last blood patch over a year ago. Conclusions Multilevel catheter-guided blood patches have the potential to be administered to higher level spinal regions to the pediatric population suffering from multiple spontaneous cerebrospinal fluid leaks.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"87 1","pages":"430 - 433"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79522010","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 : 2022-03-28DOI: 10.1136/rapm-2021-103307
N. Hussain, Jatinder S. Gill, Jarod Speer, M. Abdel-Rasoul, A. Abd-Elsayed, Safdar N. Khan, A. Nguyen, Thomas T Simopoulos, T. Weaver
Introduction While spinal cord stimulator implant is an increasingly safe procedure, one of the most feared complications is spinal cord injury. Still, literature regarding its incidence remains highly variable. This retrospective analysis aims to evaluate the incidence of spinal cord injury after spinal cord stimulator implant using a large-scale claims database. Methods The PearlDiver-Mariner database of national all payer claims was used to identify patients who underwent spinal cord stimulator implant (percutaneous or paddle) and developed subsequent spinal cord injury within 45 days. The primary outcome was to determine the overall incidence of spinal cord injury after spinal cord stimulator implant. Secondary outcomes included an evaluation of potential factors associated with developing spinal cord injury using univariable and multivariable regression analysis. Results A total of 71,172 patients who underwent a spinal cord stimulator implant were included in the analysis, of which 52,070 underwent percutaneous and 19,102 underwent paddle spinal cord stimulator lead implant. The overall incidence of spinal cord injury after spinal cord stimulator implant (any lead type) was found to be 0.42% (302 patients). The incidence of spinal cord injury after percutaneous and paddle lead implants did not differ at 0.45% (233 patients) and 0.36% (69 patients)(p=0.12), respectively. Overall, variables associated with a significantly increased OR (95% confidence interval) of developing spinal cord injury included male gender by 1.31 times (1.04 to 1.65)(p=0.02); having a claim for low molecular weight heparin within 30 days by 3.99 times (1.47 to 10.82)(p<0.01); a diagnosis for osteoporosis within 1 year by 1.75 times (1.15 to 2.66)(p<0.01); and a diagnosis of cervical or thoracic spinal canal stenosis within 1 year by 1.99 (1.37 to 2.90)(p<0.001) and 4.00 (2.63 to 6.09)(p<0.0001) times, respectively. Conclusions Overall, our results support the notion that spinal cord stimulator implant continues to be a safe procedure for chronic pain patients. However, risk factor mitigation strategies for the prevention of spinal cord injury after spinal cord stimulator implant should be undertaken prior to performing the procedure.
{"title":"Evaluating the incidence of spinal cord injury after spinal cord stimulator implant: an updated retrospective review","authors":"N. Hussain, Jatinder S. Gill, Jarod Speer, M. Abdel-Rasoul, A. Abd-Elsayed, Safdar N. Khan, A. Nguyen, Thomas T Simopoulos, T. Weaver","doi":"10.1136/rapm-2021-103307","DOIUrl":"https://doi.org/10.1136/rapm-2021-103307","url":null,"abstract":"Introduction While spinal cord stimulator implant is an increasingly safe procedure, one of the most feared complications is spinal cord injury. Still, literature regarding its incidence remains highly variable. This retrospective analysis aims to evaluate the incidence of spinal cord injury after spinal cord stimulator implant using a large-scale claims database. Methods The PearlDiver-Mariner database of national all payer claims was used to identify patients who underwent spinal cord stimulator implant (percutaneous or paddle) and developed subsequent spinal cord injury within 45 days. The primary outcome was to determine the overall incidence of spinal cord injury after spinal cord stimulator implant. Secondary outcomes included an evaluation of potential factors associated with developing spinal cord injury using univariable and multivariable regression analysis. Results A total of 71,172 patients who underwent a spinal cord stimulator implant were included in the analysis, of which 52,070 underwent percutaneous and 19,102 underwent paddle spinal cord stimulator lead implant. The overall incidence of spinal cord injury after spinal cord stimulator implant (any lead type) was found to be 0.42% (302 patients). The incidence of spinal cord injury after percutaneous and paddle lead implants did not differ at 0.45% (233 patients) and 0.36% (69 patients)(p=0.12), respectively. Overall, variables associated with a significantly increased OR (95% confidence interval) of developing spinal cord injury included male gender by 1.31 times (1.04 to 1.65)(p=0.02); having a claim for low molecular weight heparin within 30 days by 3.99 times (1.47 to 10.82)(p<0.01); a diagnosis for osteoporosis within 1 year by 1.75 times (1.15 to 2.66)(p<0.01); and a diagnosis of cervical or thoracic spinal canal stenosis within 1 year by 1.99 (1.37 to 2.90)(p<0.001) and 4.00 (2.63 to 6.09)(p<0.0001) times, respectively. Conclusions Overall, our results support the notion that spinal cord stimulator implant continues to be a safe procedure for chronic pain patients. However, risk factor mitigation strategies for the prevention of spinal cord injury after spinal cord stimulator implant should be undertaken prior to performing the procedure.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"20 1","pages":"401 - 407"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84353415","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 : 2022-03-16DOI: 10.1136/rapm-2022-103607
R. Greengrass
I read with interest the recent article by Mentsoudis et al regarding the risk/benefits of midazolam preoperatively in a total joint arthroplasty population. They reported no association of midazolam with delirium, a significantly decreased incidence of cardiac and pulmonary complications and an increased incidence of falls. In a previously published review using the same Premier Healthcare Database examining the same total joint population as the current article, the authors determined that patients receiving shortacting benzodiazepines had significantly lower risks of postoperative delirium. The lesser incidences of delirium may have been because of neuroprotection accorded by midazolam during periods of vascular embolization incurred by arthroplasty surgery. Indeed, cerebral protective effects from midazolam have been previously reported by Michenfelder and others. 4 In the current database analysis, the authors confirm that there is no increased risk of delirium from midazolam (and cite collateral investigations thus the long held view that midazolam results in increased incidences of delirium may be unfounded. Of interest in an article cited by some members of the ASA regarding inappropriate medication use in older adults, it is stated “all benzodiazepines increase risk of delirium”; however, midazolam is not mentioned in this article and no citations are listed to substantiate this statement. In the current article, the authors also determined a significantly decreased risk of pulmonary and cardiac complications in patients who received midazolam which leads to speculation of additive cardiac and pulmonary protective effects in this subset of patients. The possible association of increased falls is difficult to understand particularly with the knowledge of decreased delirium associated with midazolam administration and rapid dissolution of midazolam effect if only given preoperatively. The authors also determined that gabapentinoids when combined with midazolam increased sedationrelated complications which would be expected when adding any sedative agent. I concur with the authors that indiscriminate use of any drug, including midazolam, should be discouraged; however, the documented benefits of decreased delirium, and lesser pulmonary and cardiac complications in a total joint population should not preclude its use in this population of patients when indicated.
{"title":"Midazolam and delirium: can you have it both ways?","authors":"R. Greengrass","doi":"10.1136/rapm-2022-103607","DOIUrl":"https://doi.org/10.1136/rapm-2022-103607","url":null,"abstract":"I read with interest the recent article by Mentsoudis et al regarding the risk/benefits of midazolam preoperatively in a total joint arthroplasty population. They reported no association of midazolam with delirium, a significantly decreased incidence of cardiac and pulmonary complications and an increased incidence of falls. In a previously published review using the same Premier Healthcare Database examining the same total joint population as the current article, the authors determined that patients receiving shortacting benzodiazepines had significantly lower risks of postoperative delirium. The lesser incidences of delirium may have been because of neuroprotection accorded by midazolam during periods of vascular embolization incurred by arthroplasty surgery. Indeed, cerebral protective effects from midazolam have been previously reported by Michenfelder and others. 4 In the current database analysis, the authors confirm that there is no increased risk of delirium from midazolam (and cite collateral investigations thus the long held view that midazolam results in increased incidences of delirium may be unfounded. Of interest in an article cited by some members of the ASA regarding inappropriate medication use in older adults, it is stated “all benzodiazepines increase risk of delirium”; however, midazolam is not mentioned in this article and no citations are listed to substantiate this statement. In the current article, the authors also determined a significantly decreased risk of pulmonary and cardiac complications in patients who received midazolam which leads to speculation of additive cardiac and pulmonary protective effects in this subset of patients. The possible association of increased falls is difficult to understand particularly with the knowledge of decreased delirium associated with midazolam administration and rapid dissolution of midazolam effect if only given preoperatively. The authors also determined that gabapentinoids when combined with midazolam increased sedationrelated complications which would be expected when adding any sedative agent. I concur with the authors that indiscriminate use of any drug, including midazolam, should be discouraged; however, the documented benefits of decreased delirium, and lesser pulmonary and cardiac complications in a total joint population should not preclude its use in this population of patients when indicated.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"118 1","pages":"449 - 450"},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77396824","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 : 2022-03-14DOI: 10.1136/rapm-2022-103482
Nitchanant Kitcharanant, P. Leurcharusmee, Pakawat Wangtapun, P. Kantakam, N. Maikong, P. Mahakkanukrauh, D. Tran
Background During total hip arthroplasty (THA) using the direct anterior approach, orthopaedic surgeons can identify all anatomical landmarks required for pericapsular nerve group (PENG) blocks and carry out the latter under direct vision. This cadaveric study investigated the success of surgeon-performed PENG block. Success was defined as dye staining of the articular branches of the femoral and accessory obturator nerves. Methods 11 cadavers (18 hip specimens) were included in the current study. To simulate THA in live patients, an orthopaedic surgeon inserted trial prostheses using the direct anterior approach. Subsequently, a block needle was advanced until contact with the bone (between the anterior inferior iliac spine and iliopubic eminence). 20 mL of 0.1% methylene blue was injected. Cadavers were then dissected to document the presence and dye staining of the femoral, lateral femoral cutaneous, obturator and accessory obturator nerves as well as the articular branches of the femoral, obturator and accessory obturator nerves. Results Methylene blue stained the articular branches of the femoral nerve and the articular branches of the accessory obturator nerve (when present) in all hip specimens. Therefore, surgical PENG block achieved a 100% success rate. Dye stained the femoral and obturator nerve in one (5.6%) and two (11.1%) hip specimens, respectively. No dye staining was observed over the accessory obturator nerve in the pelvis nor the lateral femoral cutaneous nerve. Conclusion Surgeon-performed PENG block during direct anterior THA reliably targets the articular branches of the femoral and accessory obturator nerves. Future trials are required to compare surgeon-performed PENG block with anaesthesiologist-performed, ultrasound-guided PENG block, and surgeon-performed periarticular local anaesthetic infiltration.
{"title":"Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study","authors":"Nitchanant Kitcharanant, P. Leurcharusmee, Pakawat Wangtapun, P. Kantakam, N. Maikong, P. Mahakkanukrauh, D. Tran","doi":"10.1136/rapm-2022-103482","DOIUrl":"https://doi.org/10.1136/rapm-2022-103482","url":null,"abstract":"Background During total hip arthroplasty (THA) using the direct anterior approach, orthopaedic surgeons can identify all anatomical landmarks required for pericapsular nerve group (PENG) blocks and carry out the latter under direct vision. This cadaveric study investigated the success of surgeon-performed PENG block. Success was defined as dye staining of the articular branches of the femoral and accessory obturator nerves. Methods 11 cadavers (18 hip specimens) were included in the current study. To simulate THA in live patients, an orthopaedic surgeon inserted trial prostheses using the direct anterior approach. Subsequently, a block needle was advanced until contact with the bone (between the anterior inferior iliac spine and iliopubic eminence). 20 mL of 0.1% methylene blue was injected. Cadavers were then dissected to document the presence and dye staining of the femoral, lateral femoral cutaneous, obturator and accessory obturator nerves as well as the articular branches of the femoral, obturator and accessory obturator nerves. Results Methylene blue stained the articular branches of the femoral nerve and the articular branches of the accessory obturator nerve (when present) in all hip specimens. Therefore, surgical PENG block achieved a 100% success rate. Dye stained the femoral and obturator nerve in one (5.6%) and two (11.1%) hip specimens, respectively. No dye staining was observed over the accessory obturator nerve in the pelvis nor the lateral femoral cutaneous nerve. Conclusion Surgeon-performed PENG block during direct anterior THA reliably targets the articular branches of the femoral and accessory obturator nerves. Future trials are required to compare surgeon-performed PENG block with anaesthesiologist-performed, ultrasound-guided PENG block, and surgeon-performed periarticular local anaesthetic infiltration.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"26 1","pages":"359 - 363"},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87091217","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 : 2022-03-10DOI: 10.1136/rapm-2022-103545
Craig Morrison, D-Yin Lin, R. Jaarsma, H. Kroon, Brigid Brown
{"title":"Letter to the Editor in response to Dr Eochangain","authors":"Craig Morrison, D-Yin Lin, R. Jaarsma, H. Kroon, Brigid Brown","doi":"10.1136/rapm-2022-103545","DOIUrl":"https://doi.org/10.1136/rapm-2022-103545","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"368 1","pages":"387 - 387"},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77203542","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 : 2022-03-10DOI: 10.1136/rapm-2022-103503
A. Ni Eochagain
{"title":"Letter to the editor: response to Morrison et al","authors":"A. Ni Eochagain","doi":"10.1136/rapm-2022-103503","DOIUrl":"https://doi.org/10.1136/rapm-2022-103503","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"17 1","pages":"386 - 387"},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85452880","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 : 2021-10-19DOI: 10.1136/rapm-2021-ASRAspringmtg2021
Dan Varonin, N. Schott, E. Soffin, Lauren A. Wilson, M. Fiasconaro, Beena Green, B. Heidotten, E. Buckley, Theresa Brands, Jessica Talbert, L. Wase, Joy Chen, K. Nouri, Cathy Michalsky, Catherine McCarthy, G. Answini, W. Hurford
{"title":"Scientific Abstracts from the 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, March 13–15, 2021, Lake Buena Vista, Florida","authors":"Dan Varonin, N. Schott, E. Soffin, Lauren A. Wilson, M. Fiasconaro, Beena Green, B. Heidotten, E. Buckley, Theresa Brands, Jessica Talbert, L. Wase, Joy Chen, K. Nouri, Cathy Michalsky, Catherine McCarthy, G. Answini, W. Hurford","doi":"10.1136/rapm-2021-ASRAspringmtg2021","DOIUrl":"https://doi.org/10.1136/rapm-2021-ASRAspringmtg2021","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"76 1","pages":"1018 - 1028"},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80624392","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 : 2020-06-01Epub Date: 2019-10-25DOI: 10.1136/rapm-2019-101042
Hongye Zhang, Yongsheng Miao, Zongyang Qu
{"title":"Refining a great idea: the consolidation of PECS I, PECS II and serratus blocks into a single thoracic fascial plane block, the SAP block-a concern on the muscle pain.","authors":"Hongye Zhang, Yongsheng Miao, Zongyang Qu","doi":"10.1136/rapm-2019-101042","DOIUrl":"10.1136/rapm-2019-101042","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"54 1","pages":"480"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78461471","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}
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