Saudi Journal of Anaesthesia最新文献

Effective pain management post-knee surgery is critical for recovery and minimizing opioid use. We present a case of a patient undergoing ORIF for a comminuted patellar fracture and subsequent hardware removal because of persistent medial knee pain from hardware prominence. Despite initial opioid administration under general anesthesia, severe postoperative pain necessitated rescue with peripheral nerve blocks. Adductor canal, anterior femoral cutaneous, and vastus lateralis blocks provided significant pain relief without additional opioids. This approach reduces systemic opioid exposure, crucial in the current opioid crisis. Peripheral nerve blocks, especially the vastus lateralis block, effectively managed severe postoperative pain, highlighting their role in opioid-sparing strategies. These findings advocate for the broader adoption of regional anesthesia to enhance perioperative outcomes amid opioid-related challenges while supporting early mobilization and rehabilitation.

Background: Pain management for Caesarean section focuses on multimodal analgesia with a growing interest in the use of regional techniques. Currently, there is no gold standard peripheral regional analgesia technique for Caesarean section. The Erector Spinae Plane Block is a relatively new fascial plane block that may be used to provide analgesia for numerous surgical procedures of the trunk. In recent years it is the fascial plane block that has accumulated the most enthusiasm and debate. Its use in Caesarean section has grown over the past three years.

Objective: To determine the scope of literature published on ESPB in Caesarean sections and to identify deficits in the literature to guide future research.

Methodology: This study was conducted using Arksey and O'Malley's framework for scoping reviews. This included a search of four databases searching for articles published between 2016 and 2022. Studies involving patients receiving ESPB as part of an analgesic strategy after a Caesarean section were included.

Findings: Sixteen articles were included for final review. The most common primary outcomes measured were postoperative pain scores and analgesia consumption. Six ESPB studies recorded a statistically significant reduction in pain scores while three studies described a statistically significant reduction in postoperative analgesia consumption.

Conclusion: The use of ESPB for Caesarean section is gaining momentum however insufficient evidence currently exists to support its widespread use. Further research is required to evaluate the potential benefits of ESPB in specific patient cohorts and in terms of its efficacy about multidimensional patient-centric outcomes.

Aspiration pneumonia is of great concern in the elderly population, often leading to severe respiratory compromise necessitating ventilator support. This case report highlights the critical care and anesthetic management of a geriatric patient with an intertrochanteric fracture presenting with aspiration pneumonia undergoing orthopedic surgery. The patient's clinical presentation and application of therapeutic bronchoalveolar lavage as a novel intervention are discussed. The report outlines the critical care and perioperative management strategies employed to ensure optimal outcomes in this challenging clinical scenario.

[This retracts the article on p. 509 in vol. 18, PMID: 39600461.].

Serious neurological problems following spinal anesthesia are rare, although they can occur. We report a case of a 31-year-old female patient, parturient, Gravida 2 Para 1, with a body mass index (BMI) of 25 kg/m2 who had a paramedian approach spinal anesthesia using 23-gauge Quincke spinal needle for an emergent cesarean section due to failure to progress. Four attempts were required to achieve successful spinal blockade. The procedure was successfully performed with no complications. On the first postoperative day, the patient started to complain of pressure headache and abdominal pain radiating to the lower back. Magnetic resonance imaging (MRI) lumbar spine revealed right peri-nephric and retroperitoneal subacute hematoma and no evidence of cerebrospinal fluid (CSF) leak or collection. Computed tomography (CT) angiography affirmed the diagnosis of large retroperitoneal hematoma extending to inferior vena cava, measuring about 5 × 15 × 16 cm in its maximum antero-posterior, transverse, and cranio-caudal diameters, respectively, corresponding to about 620 ml volume. No active bleeding was demonstrated.

Awake fibreoptic intubation is the gold standard of airway management in anticipated difficult airways. Paediatric patients with orofacial defects pose unique challenges to the anaesthetist as management requires meticulous planning and preparation as well as titration of drugs to maintain spontaneous ventilation without losing the airway. We report a case of an 11-year-old patient with Tessier cleft type 4,6 posted for orbital reconstruction and discuss the management with awake fibreoptic intubation.

Thoracoscopic surgery in high-risk patients with severe respiratory disease is associated with a high morbidity and mortality rate. Though general anesthesia is the first-line anesthetic strategy for thoracoscopic surgeries, it poses a significant risk. When the hazards of general anesthesia outweigh the benefits of the procedure, there is a moral quandary over whether thoracoscopy should still be the option for patients with severe respiratory disorders. Thoracic segmental spinal anesthesia in combination with erector spinae block may emerge as an excellent alternative to general anesthesia in terms of analgesic efficacy, patient recovery profile, and minimal complication rates if administered by experienced hands. Unfortunately, there is paucity of literature exploring the impact of regional techniques and their outcomes on these patients. In this case series, we aim to emphasize that combined thoracic segmental spinal anesthesia and erector spinae plane block are a safe and effective alternative to general anesthesia in thoracoscopic surgeries.