Pub Date : 2022-04-20DOI: 10.1136/rapm-2022-103657
N. Elkassabany, E. Mariano, S. Kopp, E. Albrecht, M. Wolmarans, K. El-Boghdadly
To the editor We thank Sethuraman and Narayanan for their interest in our work. We agree with them that the PECS2 block as initially described by Blanco et al, included two injection points. As highlighted by Sethuraman and Narayanan, this was often misinterpreted as one injection between the pectoralis minor and the serratus anterior muscles. The issue they raise in their letter is exactly why leaders of ASRA Pain Medicine and ESRA agreed to conduct the standardizing nomenclature project. A large international group of experts in regional anesthesia agreed that giving one name for a block that describes two injection sites was confusing. The general principle agreed on when naming any fascial plane block is to give the block a name that describes the location of the needle tip during the injection. This name should be based on the surrounding sonoanatomical landmarks. With this in mind, if someone wishes to refer to the PECS2 block as originally described, we encourage that they refer to it as two separate blocks: the interpectoral block and the pectoserratus plane block. This approach simplifies the description and makes it anatomically relevant. During the Delphi process, 69% of experts contributing to the study agreed with this approach, meaning that there was consensus, weak though it may be. We suspect that history and familiarity of practitioners with the original nomenclature (PECS1 and PECS2) are the main reason why a strong consensus was not achieved. It is worth noting that the rhomboid intercostal subserratus block was another technique that described two injection points. The same principle was followed to simplify and standardize the nomenclature. In essence, practitioners should consider that they are performing two blocks instead of one block if they are injecting in two different target locations.
{"title":"PECS2 or PICK2","authors":"N. Elkassabany, E. Mariano, S. Kopp, E. Albrecht, M. Wolmarans, K. El-Boghdadly","doi":"10.1136/rapm-2022-103657","DOIUrl":"https://doi.org/10.1136/rapm-2022-103657","url":null,"abstract":"To the editor We thank Sethuraman and Narayanan for their interest in our work. We agree with them that the PECS2 block as initially described by Blanco et al, included two injection points. As highlighted by Sethuraman and Narayanan, this was often misinterpreted as one injection between the pectoralis minor and the serratus anterior muscles. The issue they raise in their letter is exactly why leaders of ASRA Pain Medicine and ESRA agreed to conduct the standardizing nomenclature project. A large international group of experts in regional anesthesia agreed that giving one name for a block that describes two injection sites was confusing. The general principle agreed on when naming any fascial plane block is to give the block a name that describes the location of the needle tip during the injection. This name should be based on the surrounding sonoanatomical landmarks. With this in mind, if someone wishes to refer to the PECS2 block as originally described, we encourage that they refer to it as two separate blocks: the interpectoral block and the pectoserratus plane block. This approach simplifies the description and makes it anatomically relevant. During the Delphi process, 69% of experts contributing to the study agreed with this approach, meaning that there was consensus, weak though it may be. We suspect that history and familiarity of practitioners with the original nomenclature (PECS1 and PECS2) are the main reason why a strong consensus was not achieved. It is worth noting that the rhomboid intercostal subserratus block was another technique that described two injection points. The same principle was followed to simplify and standardize the nomenclature. In essence, practitioners should consider that they are performing two blocks instead of one block if they are injecting in two different target locations.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"47 1","pages":"450 - 451"},"PeriodicalIF":0.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87144087","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}
T. Mallick-Searle, Jeremy Adler, E. Bortey, Jay Joshi, Sfian Albik, Akwasi Amponsah, Corey Snyder
Nerve Stimulation Temporarily to Treat a CRPS Flare in a Patient With a Spinal Cord Stimulator
神经刺激暂时治疗脊髓刺激器患者的CRPS发作
{"title":"ASRA 2022 Pain Meeting abstracts","authors":"T. Mallick-Searle, Jeremy Adler, E. Bortey, Jay Joshi, Sfian Albik, Akwasi Amponsah, Corey Snyder","doi":"10.1136/rapm-2022-ASRA","DOIUrl":"https://doi.org/10.1136/rapm-2022-ASRA","url":null,"abstract":"Nerve Stimulation Temporarily to Treat a CRPS Flare in a Patient With a Spinal Cord Stimulator","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"31 1","pages":"388 - 394"},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83323477","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 : 2022-04-11DOI: 10.1136/rapm-2022-103612
Tricia M Vecchione, K. Boretsky
To the Editor The article by Dwyer et al entitled “Regional anesthesia and acute compartment syndrome: principles for practice” summarizes the most common trauma and elective orthopedic surgical procedures in adults associated with the development of acute compartment syndrome (ACS), stratifies relative ACS risk, and offers recommendations for the use of regional anesthesia (RA) in these cases. The article provides valuable information for the anesthesiologist and pain management team, emphasizing the importance of early identification of ACS. However, we disagree with the concluding statement “that regional anesthesia should be considered contraindicated” in surgeries at high risk for compartment syndrome. The author’s opinions on when RA is contraindicated is predicated on the unsubstantiated belief that RA can mask ischemic pain and delay timely diagnosis of ACS. The controversy first arose in 1996 when it was asserted that a single injection femoral nerve block masked pain from a tibia open reduction and internal fixation, which would require sciatic nerve blockade, and the subsequent development of ACS. This set the tone for the ensuing debate and publication bias whereby anesthesiologists claim a lack of evidence while surgeons assert notions without a solid evidencebased background. The pediatric community has been more outspoken with both the European and the American Societies of Regional Anesthesia acknowledging the lack of evidence supporting that RA increases the risk of ACS or leads to delay in diagnosis in children. The literature compromises of sporadic case reports describing patients who, sometimes did and sometimes did not, develop pain prior to the development of ACS when regional anesthesia was part of the pain management plan with conclusions both in support and rejection of the assertion. It is increasingly clear that the traditional teaching that pain out of proportion to injury being the hallmark of ACS is not absolute and not all ACS, regardless of the presence of RA, presents with pain. Recently, an entity of ACS termed “silent” is recognized by the development of ACS in the absence of pain. Subsequent cases have been reported. 5 These were responsive, competent, sensate patients without nerve blocks. Two separate studies, again in pediatric patients, report a 12% incidence of confirmed ACS presenting without pain in the absence of RA. 7 Currently, for medicolegal reasons, many surgeons and anesthesiologists likely avoid RA in patients at higher risk of ACS as Dwyer et al suggests. This continues to reinforce the belief that RA can mask ACS pain while posing a disservice to patients who may benefit from RA for adequate analgesia. It also indirectly may create a misdirected blame when patients undergoing surgeries considered low risk for ACS present with painless ACS in the setting of RA. We advocate that it will serve patients and clinicians better to understand the complex and unpredictable presentation of ACS complex.
{"title":"Concerns regarding “Regional anesthesia and acute compartment syndrome: principles for practice”","authors":"Tricia M Vecchione, K. Boretsky","doi":"10.1136/rapm-2022-103612","DOIUrl":"https://doi.org/10.1136/rapm-2022-103612","url":null,"abstract":"To the Editor The article by Dwyer et al entitled “Regional anesthesia and acute compartment syndrome: principles for practice” summarizes the most common trauma and elective orthopedic surgical procedures in adults associated with the development of acute compartment syndrome (ACS), stratifies relative ACS risk, and offers recommendations for the use of regional anesthesia (RA) in these cases. The article provides valuable information for the anesthesiologist and pain management team, emphasizing the importance of early identification of ACS. However, we disagree with the concluding statement “that regional anesthesia should be considered contraindicated” in surgeries at high risk for compartment syndrome. The author’s opinions on when RA is contraindicated is predicated on the unsubstantiated belief that RA can mask ischemic pain and delay timely diagnosis of ACS. The controversy first arose in 1996 when it was asserted that a single injection femoral nerve block masked pain from a tibia open reduction and internal fixation, which would require sciatic nerve blockade, and the subsequent development of ACS. This set the tone for the ensuing debate and publication bias whereby anesthesiologists claim a lack of evidence while surgeons assert notions without a solid evidencebased background. The pediatric community has been more outspoken with both the European and the American Societies of Regional Anesthesia acknowledging the lack of evidence supporting that RA increases the risk of ACS or leads to delay in diagnosis in children. The literature compromises of sporadic case reports describing patients who, sometimes did and sometimes did not, develop pain prior to the development of ACS when regional anesthesia was part of the pain management plan with conclusions both in support and rejection of the assertion. It is increasingly clear that the traditional teaching that pain out of proportion to injury being the hallmark of ACS is not absolute and not all ACS, regardless of the presence of RA, presents with pain. Recently, an entity of ACS termed “silent” is recognized by the development of ACS in the absence of pain. Subsequent cases have been reported. 5 These were responsive, competent, sensate patients without nerve blocks. Two separate studies, again in pediatric patients, report a 12% incidence of confirmed ACS presenting without pain in the absence of RA. 7 Currently, for medicolegal reasons, many surgeons and anesthesiologists likely avoid RA in patients at higher risk of ACS as Dwyer et al suggests. This continues to reinforce the belief that RA can mask ACS pain while posing a disservice to patients who may benefit from RA for adequate analgesia. It also indirectly may create a misdirected blame when patients undergoing surgeries considered low risk for ACS present with painless ACS in the setting of RA. We advocate that it will serve patients and clinicians better to understand the complex and unpredictable presentation of ACS complex. ","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"24 1","pages":"451 - 452"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83993789","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 : 2022-04-11DOI: 10.1136/rapm-2022-103685
D. Burns, T. Dwyer, A. Nauth, R. Brull
We thank Drs. Vecchione and Boretsky for their comments on our recent manuscript discussing the suitability of regional anesthesia (RA) for common orthopedic injuries and procedures that may be associated with acute compartment syndrome (ACS). Although our manuscript did not specifically aim to address the use of RA in pediatric patients at risk of ACS, we agree with Drs. Vecchione and Boretsky that the diagnosis of ACS can be more challenging in young children. Missed ACS is a devastating injury that can result in limbs that are absent of function and leave both adults and children alike permanently disabled for life. A significant percentage of ACS injuries culminate in amputation. As has been widely expressed in the literature, diagnosing ACS can be difficult; it requires a high degree of clinical suspicion and recognition that certain injuries have a greater potential to cause ACS. Vigilant clinicians caring for children must anticipate and recognize the three As of pediatric compartment syndrome: agitation, anxiety and increasing analgesic requirements, which can precede the classic presentation of disproportionate pain. It stands to reason that a sensory block, however partial or mild, can potentially mask each of these three As. We acknowledge that some specialized centers, such as the ones at which Drs. Vecchione and Boretsky work, may have the clinical and logistical expertise to effectively manage a RA program for children who are at high risk of ACS. We nonetheless urge caution regarding the use of RA in highrisk clinical situations and discussion with the orthopedic surgeons who are ultimately charged with the diagnosis and treatment of ACS to save the limb and potentially life of these patients.
{"title":"In reply: Concerns regarding ‘Regional anesthesia and acute compartment syndrome: principles for practice’","authors":"D. Burns, T. Dwyer, A. Nauth, R. Brull","doi":"10.1136/rapm-2022-103685","DOIUrl":"https://doi.org/10.1136/rapm-2022-103685","url":null,"abstract":"We thank Drs. Vecchione and Boretsky for their comments on our recent manuscript discussing the suitability of regional anesthesia (RA) for common orthopedic injuries and procedures that may be associated with acute compartment syndrome (ACS). Although our manuscript did not specifically aim to address the use of RA in pediatric patients at risk of ACS, we agree with Drs. Vecchione and Boretsky that the diagnosis of ACS can be more challenging in young children. Missed ACS is a devastating injury that can result in limbs that are absent of function and leave both adults and children alike permanently disabled for life. A significant percentage of ACS injuries culminate in amputation. As has been widely expressed in the literature, diagnosing ACS can be difficult; it requires a high degree of clinical suspicion and recognition that certain injuries have a greater potential to cause ACS. Vigilant clinicians caring for children must anticipate and recognize the three As of pediatric compartment syndrome: agitation, anxiety and increasing analgesic requirements, which can precede the classic presentation of disproportionate pain. It stands to reason that a sensory block, however partial or mild, can potentially mask each of these three As. We acknowledge that some specialized centers, such as the ones at which Drs. Vecchione and Boretsky work, may have the clinical and logistical expertise to effectively manage a RA program for children who are at high risk of ACS. We nonetheless urge caution regarding the use of RA in highrisk clinical situations and discussion with the orthopedic surgeons who are ultimately charged with the diagnosis and treatment of ACS to save the limb and potentially life of these patients.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"313 1","pages":"452 - 452"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80050615","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 : 2022-04-08DOI: 10.1136/rapm-2022-103611
M. Forero, Rami A. Kamel, Philip S. L. Chan, E. Maida
Background Recalcitrant complex regional pain syndrome (CRPS) type 1 is a devastating condition. Case presentation We report a case of a patient in their twenties with left hand and forearm CRPS type I, transiently responsive to spinal cord stimulation, thoracic sympathectomy, and multimodal analgesia. The investigators initiated a trial of a single-shot erector spinae plane block at the T2 level, resulting in a clinically significant improvement in pain, function, vasomotor and sudomotor symptoms transiently for a 36-hour interval. As a result, a permanent e-port catheter implantation under combined ultrasound and fluoroscopic guidance was trialed. Two-year follow-up of the continuous erector spinae plane block (CESPB) indicated an 80% reduction in pain scores from baseline, and a 50% reduction in opiate consumption, with a clinically significant reduction in swelling, color changes, allodynia, and temperature asymmetry. Conclusion Recalcitrant CRPS type 1 is a challenging life-altering condition that results in a cyclical triad of chronic pain, disability, and impaired psychosocial health. The profound and prolonged analgesic response to CESPB, highlights the clinical utility of this technique, and warrants more clinical investigation.
{"title":"Two years follow-up of continuous erector spinae plane block in a patient with upper extremity complex regional pain syndrome type I","authors":"M. Forero, Rami A. Kamel, Philip S. L. Chan, E. Maida","doi":"10.1136/rapm-2022-103611","DOIUrl":"https://doi.org/10.1136/rapm-2022-103611","url":null,"abstract":"Background Recalcitrant complex regional pain syndrome (CRPS) type 1 is a devastating condition. Case presentation We report a case of a patient in their twenties with left hand and forearm CRPS type I, transiently responsive to spinal cord stimulation, thoracic sympathectomy, and multimodal analgesia. The investigators initiated a trial of a single-shot erector spinae plane block at the T2 level, resulting in a clinically significant improvement in pain, function, vasomotor and sudomotor symptoms transiently for a 36-hour interval. As a result, a permanent e-port catheter implantation under combined ultrasound and fluoroscopic guidance was trialed. Two-year follow-up of the continuous erector spinae plane block (CESPB) indicated an 80% reduction in pain scores from baseline, and a 50% reduction in opiate consumption, with a clinically significant reduction in swelling, color changes, allodynia, and temperature asymmetry. Conclusion Recalcitrant CRPS type 1 is a challenging life-altering condition that results in a cyclical triad of chronic pain, disability, and impaired psychosocial health. The profound and prolonged analgesic response to CESPB, highlights the clinical utility of this technique, and warrants more clinical investigation.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"63 1","pages":"434 - 436"},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84075990","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 : 2022-04-06DOI: 10.1136/rapm-2022-103661
K. El-Boghdadly, J. M. Jack, A. Heaney, Nickolis Black, Marina F Englesakis, H. Kehlet, V. Chan
To the Editor We thank Drs Koning and Teunissen for their interest in our study. 2 They highlight important points for discourse. First, we thank the authors for highlighting potentially unclear descriptions of studies by Koning et al and Wongyingsinn et al, which did indeed compare spinal analgesia with intrathecal opioid versus control. Importantly, we analyzed the studies appropriately, though the description may have been unclear. We also agree that Wongyingsinn et al were included in the analysis and interpretation, and after removing all studies that only include length of stay (LOS) ≤5 days in the manuscript revisions, one of the Wongyingsinn studies was not included in figures 2 and 3. This had no impact on our findings. Second, Drs Koning and Teunissen highlight an important gap in the literature. They state that intrathecal opioid dosing for colorectal surgery should be in the range of 200–300 μg, but the only evidence presented that this is an appropriate dose was published in 1993, long before the introduction of enhanced recovery after surgery (ERAS). The relevance of these data is uncertain. The evidence published to support a lower dose of opioids in lower limb surgery remains applicable in terms of adverse effects, as these are independent of surgery but rather dependent on the intrathecal morphine dose itself. Given that there remains a dearth of evidence to support any dose ranges in colorectal surgery and the sideeffect profile is not procedure specific, we respectfully disagree with the suggestion of high doses until robust safety and efficacy data support it. Third, Drs Koning and Teusnissen argue our conclusion that “the possible prolonged LOS after epidural analgesia in laparoscopic surgery is a bit overstated”. The basis of this argument is ambiguous. First, we clearly state in table 2 that the certainty of evidence is very low and that there was no evidence of improved LOS with epidural analgesia. We further state in the text that the results were not statistically significant. Moreover, we highlight that for reasons of potentially prolonged LOS, along with delayed mobilization and complications, spinal analgesia should be favored. Taken together, this is a tempered interpretation of the data. That said, we do agree that reducing pain and adverse effects of analgesia are important, but the risks of epidural analgesia on these outcomes suggest that an alternative such as spinal analgesia may be more suitable in laparoscopic settings. Notably, Drs Koning and Teusnissen go on to recommend intrathecal morphine as the gold standard, thereby agreeing with our conclusions. Finally, we thank Drs Koning and Teusnissen for agreeing that studies with a LOS>5 days may not be transferable to contemporary practice and also encourage further studies in this setting, particularly looking at the mode and dosing of regional anesthetic techniques. We encourage further dialogue on this subject with the aims of both understanding the true rol
{"title":"Regional anesthesia and enhanced recovery: we need more data","authors":"K. El-Boghdadly, J. M. Jack, A. Heaney, Nickolis Black, Marina F Englesakis, H. Kehlet, V. Chan","doi":"10.1136/rapm-2022-103661","DOIUrl":"https://doi.org/10.1136/rapm-2022-103661","url":null,"abstract":"To the Editor We thank Drs Koning and Teunissen for their interest in our study. 2 They highlight important points for discourse. First, we thank the authors for highlighting potentially unclear descriptions of studies by Koning et al and Wongyingsinn et al, which did indeed compare spinal analgesia with intrathecal opioid versus control. Importantly, we analyzed the studies appropriately, though the description may have been unclear. We also agree that Wongyingsinn et al were included in the analysis and interpretation, and after removing all studies that only include length of stay (LOS) ≤5 days in the manuscript revisions, one of the Wongyingsinn studies was not included in figures 2 and 3. This had no impact on our findings. Second, Drs Koning and Teunissen highlight an important gap in the literature. They state that intrathecal opioid dosing for colorectal surgery should be in the range of 200–300 μg, but the only evidence presented that this is an appropriate dose was published in 1993, long before the introduction of enhanced recovery after surgery (ERAS). The relevance of these data is uncertain. The evidence published to support a lower dose of opioids in lower limb surgery remains applicable in terms of adverse effects, as these are independent of surgery but rather dependent on the intrathecal morphine dose itself. Given that there remains a dearth of evidence to support any dose ranges in colorectal surgery and the sideeffect profile is not procedure specific, we respectfully disagree with the suggestion of high doses until robust safety and efficacy data support it. Third, Drs Koning and Teusnissen argue our conclusion that “the possible prolonged LOS after epidural analgesia in laparoscopic surgery is a bit overstated”. The basis of this argument is ambiguous. First, we clearly state in table 2 that the certainty of evidence is very low and that there was no evidence of improved LOS with epidural analgesia. We further state in the text that the results were not statistically significant. Moreover, we highlight that for reasons of potentially prolonged LOS, along with delayed mobilization and complications, spinal analgesia should be favored. Taken together, this is a tempered interpretation of the data. That said, we do agree that reducing pain and adverse effects of analgesia are important, but the risks of epidural analgesia on these outcomes suggest that an alternative such as spinal analgesia may be more suitable in laparoscopic settings. Notably, Drs Koning and Teusnissen go on to recommend intrathecal morphine as the gold standard, thereby agreeing with our conclusions. Finally, we thank Drs Koning and Teusnissen for agreeing that studies with a LOS>5 days may not be transferable to contemporary practice and also encourage further studies in this setting, particularly looking at the mode and dosing of regional anesthetic techniques. We encourage further dialogue on this subject with the aims of both understanding the true rol","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"1 1","pages":"507 - 508"},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89984178","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 : 2022-04-01DOI: 10.1136/rapm-2022-103489
M. Popovic, J. Beathe, E. Gbaje, Marla Sharp, S. Memtsoudis
Introduction Spontaneously breathing patients undergoing procedures under regional anesthesia can expose operating room personnel to infectious agents. The use of localized negative pressure within proximity of a patient’s airway is expected to reduce the amount of bioaerosols dispersed particularly for anesthesia staff who are frequently near the patient’s airway. Methods In the experiment, aerosols were produced using a polydisperse aerosol generator with nebulized saline. A portable negative pressure unit was set up at set distances of 10 cm and 30 cm with the aim of reducing aerosol particle counts detected by a laser-based particle counter. Results Without the portable negative pressure unit, the median concentration of 0.5 µm aerosols detected was 3128 (1533, 22832) particles/ft3/min. With the portable negative pressure unit 10 cm and 30 cm from the site of aerosol emittance, the median concentration compared with background concentration was −0.5 (−8, 8) particles/ft3/min and 398 (89, 1749) particles/ft3/min, respectively. Conclusions For particle concentrations of 0.5 µm, 0.7 µm, and 1.0 µm a significant amount of aerosol reduction was observed (p<0.001). Further experiments are warranted to assess the safety of staff when encountering a potentially infectious patient in the operating room.
{"title":"Effect of portable negative pressure units on expelled aerosols in the operating room environment","authors":"M. Popovic, J. Beathe, E. Gbaje, Marla Sharp, S. Memtsoudis","doi":"10.1136/rapm-2022-103489","DOIUrl":"https://doi.org/10.1136/rapm-2022-103489","url":null,"abstract":"Introduction Spontaneously breathing patients undergoing procedures under regional anesthesia can expose operating room personnel to infectious agents. The use of localized negative pressure within proximity of a patient’s airway is expected to reduce the amount of bioaerosols dispersed particularly for anesthesia staff who are frequently near the patient’s airway. Methods In the experiment, aerosols were produced using a polydisperse aerosol generator with nebulized saline. A portable negative pressure unit was set up at set distances of 10 cm and 30 cm with the aim of reducing aerosol particle counts detected by a laser-based particle counter. Results Without the portable negative pressure unit, the median concentration of 0.5 µm aerosols detected was 3128 (1533, 22832) particles/ft3/min. With the portable negative pressure unit 10 cm and 30 cm from the site of aerosol emittance, the median concentration compared with background concentration was −0.5 (−8, 8) particles/ft3/min and 398 (89, 1749) particles/ft3/min, respectively. Conclusions For particle concentrations of 0.5 µm, 0.7 µm, and 1.0 µm a significant amount of aerosol reduction was observed (p<0.001). Further experiments are warranted to assess the safety of staff when encountering a potentially infectious patient in the operating room.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"8 1","pages":"426 - 429"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76454816","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 : 2022-03-31DOI: 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}
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