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Dis Markers 2022 20;2022:8494796. Epub 2022 Jun 20.

Department of Orthopedics, Huizhou Third People's Hospital, No. 1 Dongsheng Road, Huicheng District, Huizhou, Guangdong, China 516001.

The incidence rate of lower limb fractures is high and has increased over the recent years, which affects the physical and mental health and the daily activities of patients. Lower limb fractures are often treated surgically. Therefore, an effective anesthesia regimen is crucial for a smooth and stable operation. Read More

J Int Med Res 2022 Jun;50(6):3000605221108101

Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.

Objective: Interlaminar cervical epidural steroid injections (ICESIs) are commonly used to treat axial neck pain and cervical radicular pain. However, local anesthetics can spread to and block the phrenic nerve and upper segments of the thoracic spinal cord where the sympathetic innervation of the lungs emerges. Therefore, changes in lung function may occur following ICESIs. Read More

J Clin Med 2022 Jun 10;11(12). Epub 2022 Jun 10.

Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.

Peripheral nerve block (PNB) for patients with total knee arthroplasty (TKA) is one of the recommended interventions in ERAS protocols. However, most existing studies involved unilateral TKA (UTKA). As such, this study aimed to evaluate the effectiveness of PNB in terms of immediate postoperative analgesia, length of hospital stays (LOS), and early functional outcomes in both UTKA and simultaneous bilateral TKAs (BTKAs). Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2022 Jun 21;57(6):417-427. Epub 2022 Jun 21.

Perioperative analgesia plays an important role in thoracic surgery, regarding not only patient satisfaction, but also in preventing postoperative complications such as pneumonia. Ultrasound-guided thoracic wall blocks close the gap between opiate based and neuraxial pain management concepts.The following article explores the different ultrasound-guided approaches to anesthetize the thoracic wall, ranging from the ventral blocks such as parasternal or PECS I/II, followed by the lateral blocks (i. Read More

A A Pract 2022 Jun 7;16(6):e01591. Epub 2022 Jun 7.

Department of Anesthesiology, Sree Balaji Medical College & Hospital, BIHER, Chennai, India.

Sensory innervation of the breast is complex, thereby making it difficult to perform any surgical procedure with a single regional anesthesia technique. Because of the involvement of pectoral muscles and extension of the incision into the axilla, a modified radical mastectomy makes it further challenging and requires multiple techniques. We have used a new combination of regional techniques in this case series and found that it provided complete surgical anesthesia with a smaller volume of local anesthetic. Read More

Cureus 2022 Apr 27;14(4):e24524. Epub 2022 Apr 27.

Pain Management, Shifa International Hospital Islamabad, Islamabad, PAK.

Introduction With recent developments in postoperative pain management after total knee replacement (TKR), the continuous femoral nerve block is becoming a common practice. The purpose of this study was to compare a femoral nerve block with time-tested epidural analgesia in a tertiary care setup in a developing country. Methodology A randomized control trial took place at Shifa International Hospital (SIH), Islamabad, Pakistan. Read More

J Clin Anesth 2022 09 25;80:110869. Epub 2022 May 25.

Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.

Reg Anesth Pain Med 2022 Aug 20;47(8):494-499. Epub 2022 May 20.

Department of Anesthesiology and Pain Medicine, Hyogo Medical University, School of Medicine, Nishinomiya, Hyogo, Japan

Introduction: A curative-intent surgical procedure, pleurectomy/decortication, for malignant pleural mesothelioma is accompanied by a high incidence of major postoperative complications. Although epidural block, which suppresses nociception during and after surgery, reportedly has both benefits and disadvantages in terms of outcomes after thoracic surgery for other diseases, the effects of epidural block on major complications after pleurectomy/decortication have not been evaluated. The aim of this study was to evaluate the association between epidural block and major postoperative complications following pleurectomy/decortication. Read More

Front Surg 2022 2;9:880007. Epub 2022 May 2.

Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei City, Taiwan.

Introduction: In most developed countries, lung cancer is associated with the highest mortality rate among all cancers. The number of elderly patients with lung cancer is increasing, reflecting the global increase in aging population. Patients with impaired lung or cardiac function are at a high risk during intubated general anesthesia, which may preclude them from surgical lung cancer treatment. Read More

Clin Neurophysiol Pract 2022 22;7:129-134. Epub 2022 Apr 22.

Department of Neurosurgery, University of Szeged, Hungary.

Introduction: Intramedullary hematoma is an uncommon, serious neurological disease, representing a diagnostic challenge. The preferred treatment is surgical. In most of the cases the lesion can be identified macroscopically. Read More

Reg Anesth Pain Med 2022 Aug 17;47(8):459-463. Epub 2022 May 17.

Department of Radiology, Hospital for Special Surgery, New York, New York, USA.

Background: Cervical epidural steroid injections are commonly performed to manage pain from cervical spine disease. Cadaveric studies have demonstrated incomplete ligamentum flavum fusion in the central interlaminar region with resultant midline gaps. We performed an MR-based characterization of cervical ligamentum flavum midline gaps to improve understanding of their prevalence and guide interventionalists in procedural planning. Read More

Phys Med Rehabil Clin N Am 2022 05;33(2):475-487

Anesthesiology and Critical Care, Duke University, 2080 Duke University Road, Durham, NC 27708, USA.

For patients with chronic pain or cancer-related pain, the most common indication for sympathetic block is to control visceral pain arising from malignancies or other alterations of the abdominal and pelvic viscera. When it is recalcitrant to conservative care, or if the patient is intolerant to pharmacotherapy, consideration of sympathetic blocks or neurolytic procedures is considered. Potential advantages of a neurolytic procedure, compared with spinal and epidural anesthetic infusions, include cost savings and avoidance of hardware. Read More

J Korean Med Sci 2022 May 2;37(17):e137. Epub 2022 May 2.

Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Korea.

Background: Lumbar transforaminal epidural block (TFEB) is an effective treatment modality for radicular pain due to lumbar disc herniation (LDH). The addition of steroids is more effective than local anesthetic alone in TFEBs for patients with LDH. Moreover, the efficacy of TFEBs has been reported to be positively correlated with the volume of injectate. Read More

Bone Joint J 2022 May;104-B(5):567-574

Royal Derby Spinal Centre, Derby, UK.

Aims: Cervical radiculopathy is a significant cause of pain and morbidity. For patients with severe and poorly controlled symptoms who may not be candidates for surgical management, treatment with transforaminal epidural steroid injections (CTFESI) has gained widespread acceptance. However, a paucity of high-quality evidence supporting their use balanced against perceived high risks of the procedure potentially undermines the confidence of clinicians who use the technique. Read More

Ann Thorac Surg 2022 Apr 27. Epub 2022 Apr 27.

Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas.

Background: Intercostal nerve cryoablation with the Nuss procedure has been shown to decrease opioid requirements and hospital length of stay; however, few studies have evaluated the impact on complications and hospital costs.

Methods: A retrospective cohort study was performed for all Nuss procedures at our institution from 2016 through 2020. Outcomes were compared across 4 pain modalities: cryoablation with standardized pain regimen (n = 98), patient-controlled analgesia (PCA; n = 96), epidural (n = 36), and PCA with peripheral nerve block (PNB; n = 35). Read More

Pediatr Transplant 2022 Apr 22:e14296. Epub 2022 Apr 22.

Department of Anesthesiology and Perioperative Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Background: Adequate perioperative analgesia for pediatric abdominal transplant surgery is essential for patient recovery. However, the risks of commonly used medications such as hepatotoxicity, nephrotoxicity, bleeding concerns, and poor graft results with opioids limit pain management in this population. Thoracic epidural, continuous erector spinae plane, and type-1 quadratus lumborum blocks (QLBs) have been described and utilized in the adult population in this setting. Read More

Br J Pain 2022 Apr 3;16(2):228-236. Epub 2021 Sep 3.

Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.

Background: Post-dural puncture headache (PDPH) is a severe positional headache that appears usually within 72 hours after inadvertent dural puncture, secondary to cerebrospinal fluid leakage. It is treated first by conservative treatment (including bed rest, hydration, caffeine and simple analgesia) and then by invasive procedures such as blood patch. This study aims to evaluate factors associated with PDPH among a sample of Lebanese patients and assess the rate of success of different treatment modalities administered in a specific sequence: conservative treatment first, then ultrasound-guided bilateral greater occipital nerve block (GONB) if failure of conservative treatment and finally epidural blood patch (EBP) if failure of GONB. Read More

Sci Rep 2022 04 8;12(1):5954. Epub 2022 Apr 8.

Department of Anesthesiology and Critical Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Transforaminal epidural block (TEB) is a widely accepted technique and minimally invasive procedure for the treatment of lumbosacral radicular pain. This study aimed to evaluate the accuracy, efficacy, and safety of ultrasound and nerve stimulator guidance lumbar transforaminal epidural block (UNTEB) for the patients with unilateral lower lumbar radicular pain. The accuracy of this method was evaluated by fluoroscopy. Read More

J Int Med Res 2022 Apr;50(4):3000605221085062

Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea.

Objective: To compare the clinical outcomes among three analgesic techniques, continuous femoral nerve block (CFNB), epidural patient-controlled analgesia (EPCA) and periarticular injection (PAI), in patients undergoing total knee arthroplasty (TKA).

Methods: This retrospective case-control study enrolled patients that underwent TKA. Visual analogue scale (VAS) pain scores, sleep disturbance, additional opioid consumption and incidence of opioid-related side-effects were assessed. Read More

Cureus 2022 Feb 28;14(2):e22701. Epub 2022 Feb 28.

Anaesthesiology, Ibra Hospital, Ibra, OMN.

This case series describes the use of ultrasound (US)-guided dorsal sacral foraminal block (DSFB) for providing postoperative analgesia in six patients who underwent foot and ankle surgeries under spinal anesthesia. Postoperatively, all of them received a US-guided DSFB at the level of the brim of the second sacral foramina (SF2). Needle placements were confirmed with fluoroscopic (FL) images and injected radiocontrast defined the diffusion with a postoperative CT scan. Read More

Korean J Anesthesiol 2022 Apr 4. Epub 2022 Apr 4.

Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Translational Research Unit for Anatomy and Analgesia, Yonsei University College of Medicine, Seoul, Republic of Korea.

Many techniques for regional anesthesia and analgesia of the thorax are currently being used in clinical practice. Among them, a recent international consensus anatomically classified paraspinal blocks in the thoracic spine region into four different types: paravertebral block, retrolaminar block, erector spinae plane block, and intertransverse process block. These blocks have different anatomical targets, thus the spreading patterns of the injectate differ. Read More

Genet Res (Camb) 2022 11;2022:1384609. Epub 2022 Mar 11.

Chun'an Hospital of Traditional Chinese Medicine, No. 1 Xin'an West Road, Qiandaohu Town, Chun'an County, Zhejiang Province 311700, China.

Objective: The increase of hip fractures is related to the aging of the population, which has caused a huge medical burden in many countries. Hip replacement has been approved as a highly successful surgical intervention for the patients with hip fractures. Different anesthesia choices in the surgical intervention are associated with the prognosis of patients. Read More

J Anaesthesiol Clin Pharmacol 2021 Oct-Dec;37(4):565-568. Epub 2022 Jan 6.

Department of Orthopedics, Sancheti Hospital, Pune, Maharashtra, India.

Background And Aims: The outcomes of plexus and peripheral nerve blocks depend on needle-nerve contact and the spread of local anesthetic (LA) around the plexus or nerve. Needle-nerve distance and spread of LA could be visualized during US-guided lumbar plexus block (LPB).

Material And Methods: After Institutional Ethics Committee approval and after obtaining informed consent, 24 American Society of Anesthesiologists'-physical status I-III patients who underwent surgical fixation of fractures of proximal femur were enrolled. Read More

Pain Physician 2022 03;25(2):145-160

Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.

Background: Selective nerve root block has been widely used to treat degenerative disc disease (DDD), but no detailed research data is provided to compare the efficacy of epidural injection of anesthetics with or without steroids on the DDD treatment.

Objectives: This study aimed to  provide the first comparison of steroids + local anesthetic (LA) or LA alone for the treatment of DDD.

Study Design: We systematically searched PubMed, Medline, Embase, and Cochrane. Read More

World J Clin Cases 2022 Mar;10(7):2174-2183

Department of Anesthesiology, Handan Central Hospital, Handan 056001, Hebei Province, China.

Background: Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response, loss of hemodynamic stability, and decreased immune function. Herein, we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia, in combination with general anesthesia, for thoracic surgery for lung cancer. The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block. Read More

Anesth Analg 2022 05;134(5):1072-1081

From the Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.

Background: Regional anesthesia (RA) has been used to reduce pain and opioid usage in elective orthopedic surgery. The hypothesis of this study was that RA would be associated with decreased opioid demand in tibial plateau fracture surgery.

Methods: Inpatient opioid consumption and 90-day outpatient opioid prescribing in all patients ≥18 years of age undergoing tibial plateau fracture surgery from July 2013 to July 2018 (n = 264) at a single, level I trauma center were recorded. Read More

J Clin Anesth 2022 08 18;79:110725. Epub 2022 Mar 18.

Giorgio Ivani, MD, Department of Anesthesiology, Regina Margherita Children's Hospital, Turin, Italy.

Study Objectives: To develop evidence-based recommendations for prevention and management of infections, bleeding, and local anesthetic toxicity in children undergoing regional anesthesia.

Design: A joint committee of the European Society of Regional Anesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) studied electronic literature databases of pediatric regional anesthesia to construct evidence-based recommendations.

Main Results: For epidural anesthesia lumbar or thoracic placement is preferred. Read More

Turk J Emerg Med 2022 Jan-Mar;22(1):51-53. Epub 2022 Jan 20.

Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Pain due to rib fracture leads to respiratory impairment and bilateral fractures impact respiratory mechanics in the worst manner. Thoracic epidural analgesia is the gold standard for bilateral rib fractures but is technically difficult, entails potentially serious complications, and necessitates patient repositioning. Ultrasound-guided serratus anterior plane block (SAPB) has recently gained favor for alleviating thoracic pain and can be performed in patients lying supine, rendering it particularly useful in polytrauma patients who are unable to sit up or turn lateral for regional blocks on the back. Read More

Anesth Essays Res 2021 Apr-Jun;15(2):208-212. Epub 2021 Dec 16.

Department of Anesthesia and Pain Management, King Hamad University Hospital, Al Sayh Bahrain, Bahrain.

Background: Postoperative pain relief after total knee arthroplasty (TKA) can be attained by using several techniques such as intravenous analgesia, epidural analgesia, and peripheral nerve blocks that include femoral nerve and saphenous nerve. Several authors recommended intra-articular injection of local anesthetic (IALA) as a part of multimodal analgesia regimens for TKA instead of other techniques.

Aims: The present study compares IALA technique efficacy with single-shot femoral nerve block (FNB) as part of multimodal analgesia regimen in TKA patients for postoperative pain management. Read More

Anesth Essays Res 2021 Apr-Jun;15(2):220-226. Epub 2021 Dec 16.

Department of Anesthesiology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India.

Background: Open inguinal hernia repair is one of the routine day-care procedures performed across the world. A multitude of anesthetic techniques have been outlined for painless inguinal hernia repair, comprising general anesthesia and regional anesthesia such as spinal, epidural, and nerve blocks; with regional anesthetic techniques often favored for uncomplicated open inguinal hernia repair. Ultrasound-guided peripheral nerve blocks have made rapid strides and are gaining popularity because of the reduced incidence of adverse events. Read More