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Background and objectives Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of our study was to identify the incidence of the main adverse events associated with regional anesthesia, particularly during anesthetic PNB, and to evaluate the associated healthcare and social costs. Methods According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search on EMBASE and PubMed with the following search strategy: (“regional anesthesia” OR “nerve block”) AND (“complications” OR “nerve lesion” OR “nerve damage” OR “nerve injury”). Studies on patients undergoing a regional anesthesia procedure other than spinal or epidural were included. Targeted data of the selected studies were extracted and further analyzed. Results Literature search revealed 487 articles, 21 of which met the criteria to be included in our analysis. Ten of them were included in the qualitative and 11 articles in the quantitative synthesis. The analysis of costs included data from four studies and 2,034 claims over 51,242 cases. The median claim consisted in 39,524 dollars in the United States and 22,750 pounds in the United Kingdom. The analysis of incidence included data from seven studies involving 424,169 patients with an overall estimated incidence of 137/10,000. Conclusions Despite limitations, we proposed a simple model of cost calculation. We found that, despite the relatively low incidence of adverse events following PNB, their associated costs were relevant and should be carefully considered by healthcare managers and decision makers.

Background: Different regional anesthesia (RA) techniques have been used for laparoscopic cholecystectomy (LC), but there is no consensus on their comparative effectiveness. Our objective was to evaluate the effect of RA techniques on patients undergoing LC using a network meta-analysis approach.Methods: We conducted a systematic review and network meta-analysis. We searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (Science and Social Science Citation Index) using the following PICOS criteria: (P) adult patients undergoing LC; (I) any RA single-shot technique with injection of local anesthetics; (C) placebo or no intervention; (O) postoperative opioid consumption expressed as morphine milligram equivalents (MME), rest pain at 12 h and 24 h post-operation, postoperative nausea and vomiting (PONV), length of stay; and (S) randomized controlled trials.Results: A total of 84 studies were included. With the exception of the rectus sheath block (P = 0.301), the RA techniques were superior to placebo at reducing opioid consumption. Regarding postoperative pain, the transversus abdominis plane (TAP) block (−1.80 on an 11-point pain scale) and erector spinae plane (ESP) block (−1.33 on an 11-point pain scale) were the most effective at 12 and 24 h. The TAP block was also associated with the greatest reduction in PONV.Conclusions: RA techniques are effective at reducing intraoperative opioid use, postoperative pain, and PONV in patients undergoing LC. Patients benefit the most from the bilateral paravertebral, ESP, quadratus lumborum, and TAP blocks.

Background Orthopedic procedures concerning the upper extremity commonly use a brachial plexus nerve block to achieve postoperative analgesia. The addition of dexamethasone to peripheral nerve blocks has been shown to significantly prolong its effect. We hypothesize that 1 mg doses of dexamethasone will prolong brachial plexus nerve block with similar efficacy to 4 mg and better than ropivacaine alone. Methods Seventy-nine patients who received a brachial plexus nerve block prior to undergoing upper extremity surgery were randomized to 1 of 4 treatment groups: group 1 received only 30 mL of 0.5% ropivacaine without dexamethasone (control); groups 2, 3, and 4 received 4, 2, and 1 mg of dexamethasone, respectively, added to 30 mL of 0.5% ropivacaine. Results Comparison of block duration, specifically “first signs of the block wearing off” to the 0-mg group, referencing the 1-, 2-, and 4-mg groups ( P = .02, .04, and .01, respectively) that received steroid adjuvant therapy demonstrated a significant increase in time until the block began to wear off. All study groups receiving steroids also demonstrated a significant increase in duration of the block prior to its effects being completely gone when compared with the control group ( P < .01 for all groups). Conclusions Our findings demonstrate that adjuvant dexamethasone can prolong brachial plexus nerve blocks effectively at low doses compared with high doses, in addition to prolonging analgesia compared with local anesthetic alone.

Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and cleft palate that presents with airway obstruction and developmental delay with or without other congenital anomalies. These patients’ anesthesia management is challenging because of difficult ventilation and intubation. Regional anesthesia methods should be considered for these patients on a case-by-case basis. This report presents primary use of regional anesthesia for circumcision of a 9-year-old boy with PRS.

Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for “block view” (which visualizes the block site and is maintained for needle insertion/injection). A “strong recommendation” was made if ≥75% of participants rated any structure as “definitely include” in any round. A “weak recommendation” was made if >50% of participants rated it as “definitely include” or “probably include” for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a “strong recommendation” was made for 60 structures on orientation scanning and 44 on the block view. A “weak recommendation” was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.

The use of regional analgesic techniques as part of multimodal analgesia regimens provides better control of acute pain. Effective anesthesia is one of the key tasks in the treatment of the wounded at all stages of medical care. Three clinical cases of the use of prolonged regional analgesic blockades as part of a multimodal analgesia regimen in the treatment of patients with gunshot wounds of the extremities are presented. Catheterizations of the perineural space of the peripheral nerves were performed using ultrasound imaging. Clinical case 1 - a patient with a gunshot shrapnel through wound of the left tibia with gunshot comminuted fractures of both bones of the lower third of the left tibia and the upper third of the fibula of the left tibia, was admitted two days after the injury. Performed catheterization of the perineural space of the left sciatic nerve in the popliteal fossa, constant infusion of 0.25% bupivacaine solution at a rate of 5 ml per hour using a perfusor. A satisfactory analgesic effect was observed, narcotic analgesics were not prescribed. Clinical case 2 - a patient with a gunshot shrapnel through wound of the left shoulder with a gunshot comminuted fracture of the left humerus in the middle third and with damage to the neurovascular bundle, was admitted more than 6 weeks after the injury. Performed catheterization of the perineural space of the left brachial plexus interscalene access, continuous infusion of 0.25% bupivacaine solution at a rate of 5 ml per hour using a perfusor. However, in the absence of complaints of soreness at the fracture sites and postoperative wounds, the patient began to be disturbed by neuropathic pain.Satisfactory analgesic effect was observed sporadically, narcotic analgesics were prescribed. On the second day of observation, dislocation of the catheter was detected.Considering that the patient was more concerned about pain in the distal part of the limb, catheterization of the perineural space of the left brachial plexus was performed by supraclavicular access, and a constant infusion of 0.25% bupivacaine solution was started at a rate of 5 ml per hour using a perfusor. Satisfactory analgesic effect was observed sporadically, narcotic analgesics were prescribed. Clinical case 3 - a patient with a gunshot shrapnel through wound of the left thigh with a gunshot comminuted fracture of the left femur in the lower third and with damage to the popliteal artery, was admitted three weeks after the injury. Performed paravertebral catheterization of the left lumbar plexus, constant infusion of 0.25% bupivacaine solution at a rate of 5 ml per hour using a perfusor. In combination with oral analgesic adjuvants (effect on neuropathic pain), a satisfactory analgesic effect was observed without the prescription of narcotic analgesics.After repeated surgical treatment with the installation of the VAC-system on the posterior surface of the thigh, an unsatisfactory effect of non-opiate analgesia was observed, and narcotic analgesics were additionally prescribed., Использование регионарных техник обезболивания в составе схем мультимодальной аналгезии обеспечивает лучший контроль над острой болью. Эффективное обезболивание является одной из ключевых задач при лечении раненых на всех этапах оказания медицинской помощи. Представлены три клинических случая использования пролонгированных регионарных анальгетических блокад в составе схемы мультимодальной аналгезии при лечении пациентов с огнестрельными ранениями конечностей. Катетеризации периневрального пространства периферических нервов были выполнены с помощью ультразвуковой визуализации. Клинический случай 1 – пациент с огнестрельным осколочным сквозным ранением левой голени с огнестрельными оскольчатыми переломами обеих костей нижней трети левой голени и верхней трети малоберцовой кости левой голени, поступил через двое суток после получения ранения. Выполнена катетеризация периневрального пространства левого седалищного нерва в подколенной ямке, постоянная инфузия 0,25% раствора бупивакаина со скоростью 5 мл в час с помощью перфузора. Наблюдался удовлетворительный анальгетический эффект, наркотические анальгетики не назначались. Клинический случай 2 – пациент с огнестрельным осколочным сквозным ранением левого плеча с огнестрельным оскольчатым переломом левой плечевой кости в средней трети и с повреждением сосудисто-нервного пучка, поступил более чем через 6 недель после получения ранения. Выполнена катетеризация периневрального пространства левого плечевого сплетения межлестничным доступом, постоянная инфузия 0,25% раствора бупивакаина со скоростью 5 мл в час с помощью перфузора. Однако, при отсутствии жалоб на болезненность в местах перелома и послеоперационных ран, пациента начала беспокоить невропатическая боль. Удовлетворительный анальгетический эффект наблюдался эпизодически, назначались наркотические анальгетики. На вторые сутки наблюдения выявлена дислокация катетера. Учитывая, что пациента больше беспокоила боль в дистальной части конечности, выполнена катетеризация периневрального пространства левого плечевого сплетения надключичным доступом, начата постоянная инфузия 0,25% раствора бупивакаина со скоростью 5 мл в час спомощью перфузора. Удовлетворительный анальгетический эффект наблюдался эпизодически, назначались наркотические анальгетики. Клинический случай 3 – пациент с огнестрельным осколочным сквозным ранением левого бедра с огнестрельным оскольчатым переломом левой бедренной кости в нижней трети и с повреждением подколенной артерии, поступил через три недели после получения ранения. Выполнена катетеризация левого поясничного сплетения паравертебрально, постоянная инфузия 0,25% раствора бупивакаина со скоростью 5 мл в час с помощью перфузора. В комбинации с анальгетическими адъювантами перорально (действие на невропатическую боль) наблюдался удовлетворительный анальгетический эффект без назначения наркотических анальгетиков. После проведения повторной хирургической обработки с установкой ВАК-системы по задней поверхности бедра, наблюдался неудовлетворительный эффект безопиатной аналгезии, дополнительно назначались наркотические анальгетики., Використання реґіонарних технік знеболення у складі схем мультимодальної аналгезії забезпечує кращий контроль над гострим болем. Ефективне знеболення є одним із ключових завдань при лікуванні поранених на всіх етапах надання медичної допомоги. Наведено три клінічних випадки використання пролонгованих реґіонарних анальгетичних блокад у складі схеми мультимодальної аналгезії, при лікуванні пацієнтів з вогнепальними пораненнями кінцівок. Катетеризації периневрального простору периферичних нервів були проведені за допомогою ультразвукової візуалізації. Клінічний випадок 1 – пацієнт з вогнепальним осколковим наскрізним пораненням лівої гомілки з вогнепальними уламковими переломами обох кісток нижньої третини лівої гомілки та верхньої третини малогомілкової кістки лівої гомілки, надійшов через дві доби після отримання поранення. Виконано катетеризацію периневрального простору лівого сідничого нерва в підколінній ямці, постійна інфузія 0,25% розчину бупівакаїну зі швидкістю 5мл на годину за допомогою перфузора. Спостерігався задовільний анальгетичний ефект, наркотичні анальгетики не призначалися. Клінічний випадок 2 – пацієнт з вогнепальним осколковим наскрізним пораненням лівого плеча з вогнепальним уламковим переломом лівої плечової кістки в середній третині та з ушкодженням судинно-нервового пучка, надійшов більше ніж через 6 тижнів після отримання поранення. Виконано катетеризацію периневрального простору лівого плечового сплетення міждрабинчастим доступом, постійна інфузія 0,25% розчину бупівакаїну зі швидкістю 5 мл на годину за допомогою перфузора. Однак, при відсутності скарг на болючість у місцях перелому та післяопераційних ран, пацієнта почав турбувати невропатичний біль. Задовільний анальгетичний ефект спостерігався епізодично, призначалися наркотичні анальгетики. На другу добу спостереження виявлено дислокацію катетера. Враховуючи, що пацієнта більше турбує біль в дистальній ділянці кінцівки, виконано катетеризацію периневрального простору лівого плечового сплетення надключичним доступом, розпочато постійну інфузію 0,25% розчину бупівакаїну зі швидкістю 5 мл на годину за допомогою перфузора. Задовільний анальгетичний ефект спостерігався епізодично, призначалися наркотичні анальгетики. Клінічний випадок 3 – пацієнт з вогнепальним осколковим наскрізним пораненням лівого стегна з вогнепальним уламковим переломом лівої стегнової кістки в нижній третині та з пошкодженням підколінної артерії, надійшов через три тижні після отримання поранення. Виконано катетеризацію лівого поперекового сплетення паравертебрально, постійна інфузія 0,25% розчину бупівакаїну зі швидкістю 5мл на годину за допомогою перфузора. В комбінації з анальгетичними ад’ювантами перорально (дія на невропатичний біль) спостерігався задовільний анальгетичний ефект без призначення наркотичних анальгетиків. Після проведення повторної хірургічної обробки із встановленням ВАК-системи по задній поверхні стегна, спостерігався незадовільний ефект безопіатної аналгезії, додатково призначалися наркотичні анальгетики.

The concern about pain management in exotic mammals is increasing. However, only a few studies describe locoregional anesthesia techniques in rabbits. Thus, this report aims to describe the lumbar paravertebral block, guided by peripheral nerve stimulation, in a rabbit undergoing mid-femoral amputation. We received a one-year-old rabbit weighing 1.27kg with a history of non-union of the right femur and osteomyelitis. The animal came to us for high pelvic limb amputation. After premedication with ketamine, midazolam, and morphine, the patient was maintained under general anesthesia in a non-rebreathing circuit under spontaneous ventilation with isoflurane vaporized in 0.6 oxygen. Using a peripheral nerve stimulator, we performed the lumbar paravertebral block, positioning the needle between the L5 and L6 vertebrae and injecting 0.2mL/kg bupivacaine. The patient remained stable throughout the procedure, without the need for analgesic rescue with opioids during surgery and postoperatively. The discharge occurred after 24 hours. The lumbar paravertebral block proved efficient for trans and postoperative analgesia for high pelvic limbic amputation in rabbits. RESUMO A preocupação quanto ao manejo da dor em mamíferos exóticos é crescente, entretanto existem poucos estudos que descrevem o uso de técnicas de anestesia locorregional em coelhos. Assim, este relato tem por objetivo descrever o bloqueio paravertebral lombar guiado por neurolocalizador em um coelho submetido à amputação mediofemoral. Um coelho de um ano de idade e 1,27kg foi atendido com histórico de não união de fêmur direito e osteomielite, sendo encaminhado para amputação alta do membro pélvico. Após pré-medicação com cetamina, midazolam e morfina, o paciente foi mantido sob anestesia geral em circuito sem reinalação de gases, sob ventilação espontânea com isoflurano vaporizado em 0,6 de oxigênio. O bloqueio do plexo lombar foi realizado pela abordagem paravertebral, com o auxílio de neurolocalizador, sendo a agulha posicionada entre as vértebras L5 e L6 e injeção de 0,2mL/kg de bupivacaína 0,5%. O paciente manteve-se estável durante todo o procedimento, sem a necessidade de resgate analgésico com opioides no trans e no pós-operatório. O paciente recebeu alta médica após 24 horas. O bloqueio lombar paravertebral demonstrou-se eficiente para analgesia trans e pós-operatória no procedimento de amputação alta de membro pélvico de coelho.

Worldwide, most Cesarean sections (CS) are performed under neuraxial anesthesia. However, neuraxial anesthesia can fail and intraoperative breakthrough pain can occur. The aim of the present investigation was to evaluate the incidence of breakthrough pain in consecutive CS and to describe the potential risk factors for breakthrough pain. In a two center, prospective audit all CS performed under neuraxial anesthesia were included and the occurrence of breakthrough pain as well as all possible risk factors of breakthrough pain were recorded as well as the alternative anesthetic strategy. A total of 393 patients were enrolled in the study over 6 months, 206 in UZ Leuven and 187 in ZNA Middelheim, 295 elective CS and 98 secondary CS. Of all 393 participants, 65 experienced breakthrough pain during the CS (16.5%). Twoo significant risk factors for breakthrough pain during CS were observed: the duration of surgery (p

Short procedures constitute a large proportion of hand surgeries. Most of them are done as 1-day surgery. Regional anesthesia is considered the best option for these operations. Compared with general anesthesia, regional anesthesia improves early outcome after wrist and hand surgery. Distal nerve blocks have the benefits of lying away from critical structures and the preservation of proximal muscle function of the upper limb. Thus, this type of nerve block is ideal for short procedures where patients can tolerate a tourniquet.

Background and aims: Coronavirus disease 2019 (COVID-19) has posed many challenges for healthcare workers around the world. This study aims to present the most appropriate and evidence-based scientific advice for safe regional anesthesia practice during the COVID-19 pandemic. Methods: To perform regional anesthesia during respiratory disease outbreaks, several databases were investigated, including PubMed, Google Scholar, Up-to-date, and ScienceDirect. Searches were in English during a timeframe spanning from February 15, 2019, until February 15, 2021, and the applied keywords were "COVID-19 anesthesia", "surgery", and "operating room" Results: We have focused on definite areas such as workforce and resource planning, modification of clinical setting, preparation of equipment, supplies, and medications, selection of proper personal protective equipment (PPE), cardiorespiratory monitoring of the patient, and sedation and oxygen therapy. Other fields were assessing safe regional anesthesia techniques and monitoring during anesthesia, post-anesthesia care, and follow-ups. In these recommendations, keeping the patients safe while protecting healthcare providers from potential exposure to infection is of particular interest. Conclusion: The safety of healthcare workers and patients during the anesthesia management of suspected and positive COVID-19 cases is of utmost importance. Although there is limited evidence regarding performing regional anesthesia, these presented suggestions summarize the best accessible data and explain some doubts in this respect.

The rapid development of evidence-based medicine in Ukraine and in the the world clearly demonstrates the effectiveness of multimodal anesthesia in the perioperative period. In addition to oral and intravenous nonsteroidal anti-inflammatory drugs, the use of regional methods of anesthesia plays a special role. The safety, efficacy of regional anesthesia and the reduction of intra- and postoperative complications are no longer in doubt. There is no anatomical area that cannot be anesthetized without the use of peripheral or central nerve blocks. However, the issue of which block as well as its anatomical basis should be used to minimize the risk for patients has to date been debatable and relevant. The aim: to review and analyze modern sources of information in the field of anesthesiology, intensive care, and regional anesthesia; to determine the place of the ESP block among other fascial blocks and demonstrate the world experience and features of applying ESP block in different pathologies and in different surgical interventions. The main and continuing priority in the daily work of an anesthesiologist is patient safety and the principle – “Do no harm”. A huge range of regional anesthesia methods are popular among anesthesiologists and intensivists. However, it is still unclear which one of these is as safe as it is effective. Conclusions. ESP block is a universal, effective and relatively simple method of regional anesthesia, which effectively improves patient outcomes and reduces the number of intra- and postoperative complications.

Early diagnosis and prompt definitive management of acute compartment syndrome (ACS) are paramount in preventing the significant morbidity associated with compartment syndrome. The diagnosis of compartment syndrome can be difficult, given the pain associated with the procedure in the immediate postoperative period. Obesity, anticoagulation, postoperative epidural infusion, and prolonged operative time have been reported as risk factors for ACS. In addition to maintaining high clinical suspicion in patient with risk factors for ACS after joint replacement, emphasis on limiting modifiable risk factors should be practiced, including meticulous hemostasis, careful patient positioning, and limiting prolonged postoperative regional anesthesia when not required.

The article reports an example of the simultaneous use of brachial plexus block and combined two-segment spinal-epidural anesthesia with fixation of an epidural catheter in the subcutaneous canal in an 81-year-old patient after receiving a household injury - closed fracture of the olecranon of the right ulna with displacement of fragments and closed transtrochanteric fracture with a fracture of the right femur fragments. After preoperative preparation and examination, the patient underwent two consecutive surgical interventions within a day: open reduction of comminuted transtrochanteric fracture of the right hip, dynamic femoral screw osteosynthesis and open reduction of fracture of the right olecranon, Weber’s osteosynthesis. Surgical interventions were carried out under regional anesthesia: block of the brachial plexus via supraclavicular access and combined two-segment spinal-epidural anesthesia with a method developed in our clinic for fixing an epidural catheter in the subcutaneous canal using a modified spinal needle. After the operation, the patient underwent postoperative pain relief in the form of epidural analgesia for 72 hours. The postoperative period passed without complications. On the 13th day, the patient was discharged for outpatient treatment by a traumatologist. The use of local anesthesia in the form of two methods of regional anesthesia during two consecutive surgical interventions, in an elderly patient with a high anesthetic risk, followed by long-term postoperative anesthesia in the form of epidural analgesia with a reliable method of epidural catheter fixation in the subcutaneous canal without the use of narcotic analgesics, contributed to the successful carrying out two surgical interventions at once, early activation of the patient, absence of complications in the postoperative period. Reliable catheter fixation is very important for the quality of epidural analgesia. Dislocation of catheters by more than 2 cm can lead to migration of catheters from the epidural space, changing the course of anesthesia, deteriorating its quality, or even interrupting it altogether. The new method of catheter fixation in the subcutaneous canal developed by us made it possible to prevent catheter dislocation.

To determine the preferences and attitudes of members of regional anesthesia societies during the COVID-19 pandemic.We distributed an electronic survey to members of the American Society of Regional Anesthesia and Pain Medicine, Regional Anaesthesia-UK, and the European Society of Regional AnaesthesiaPain Therapy. A questionnaire consisting of 19 questions was developed by a panel of experienced regional anesthesiologists and distributed by email to the participants. The survey covered the following domains: participant information, practice settings, preference for the type of anesthetic technique, the use of personal protective equipment, and oxygen therapy.The survey was completed by 729 participants from 73 different countries, with a response rate of 20.1% (729/3,630) for the number of emails opened and 8.5% (729/8,572) for the number of emails sent. Most respondents (87.7%) identified as anesthesia staff (faculty or consultant) and practiced obstetric and non-obstetric anesthesia (55.3%). The practice of regional anesthesia either expanded or remained the same, with only 2% of respondents decreasing their use compared with the pre-pandemic period. The top reasons for an increase in the use of regional anesthesia was to reduce the need for an aerosol-generating medical procedure and to reduce the risk of possible complications to patients. The most common reason for decreased use of regional anesthesia was the risk of urgent conversion to general anesthesia. Approximately 70% of the responders used airborne precautions when providing care to a patient under regional anesthesia. The most common oxygen delivery method was nasal prongs (cannula) with a surgical mask layered over it (61%).Given the perceived benefits of regional over general anesthesia, approximately half of the members of three regional anesthesia societies seem to have expanded their use of regional anesthesia techniques during the initial surge of the COVID-19 pandemic.RéSUMé: OBJECTIF: Déterminer les préférences et les attitudes des membres des sociétés d’anesthésie régionale pendant la pandémie de COVID-19. MéTHODE: Nous avons distribué un sondage électronique aux membres de l’American Society of Regional Anesthesia and Pain Medicine, de Regional Anesthesia-UK et de l’European Society of Regional AnaesthesiaPain Therapy. Un questionnaire composé de 19 questions a été élaboré par un panel d’anesthésiologistes régionaux d’expérience et distribué par courriel aux participants. Le sondage couvrait les domaines suivants : les renseignements sur les participants, les contextes de pratique, leur préférence quant au type de technique d’anesthésie, l’utilisation d’équipement de protection individuelle et l’oxygénothérapie RéSULTATS: Le sondage a été complété par 729 participants provenant de 73 pays différents, avec un taux de réponse de 20,1 % (729/3630) pour le nombre de courriels ouverts et de 8,5 % (729/8572) pour le nombre de courriels envoyés. La plupart des répondants (87,7 %) se sont identifiés comme anesthésiologistes (académique ou consultant) et pratiquaient l’anesthésie obstétricale et non obstétricale (55,3 %). Leur pratique de l’anesthésie régionale s’est étendue ou est demeurée inchangée, et seulement 2 % des répondants ont indiqué avoir diminué leur utilisation de cette pratique par rapport à la période pré-pandémique. Les principales raisons d’une augmentation de l’utilisation de l’anesthésie régionale étaient de réduire la nécessité d’une intervention médicale générant des aérosols et de réduire le risque de complications potentielles pour les patients. La raison la plus courante de diminution du recours à l’anesthésie régionale était le risque de conversion urgente à une anesthésie générale. Environ 70 % des intervenants ont utilisé des précautions en matière de propagation des aérosols lorsqu’ils procuraient des soins à un patient sous anesthésie régionale. La méthode d’administration d’oxygène la plus fréquemment utilisée était les canules nasales avec un masque chirurgical superposé (61 %). CONCLUSION: Compte tenu des avantages perçus de l’anesthésie régionale par rapport à l’anesthésie générale, environ la moitié des membres de trois sociétés d’anesthésie régionale semblent avoir élargi leur utilisation des techniques d’anesthésie régionale pendant la vague initiale de la pandémie de COVID-19.

Objective. This study aims to compare two different methods of regional anesthesia applied for knee arthroscopy in terms of patient and surgeon satisfaction. Materials and Methods. Eighty patients who underwent knee arthroscopy either with spinal anesthesia (SA) or unilateral sciatic and femoral nerve block (SFNB) were included in the study. A nurse conducted a blind study questionnaire to assess the surgeon and patient satisfaction from anesthesia performed at the end of the surgery. Pain score, demographical data, duration of surgery, motor and sensory block duration, time of first rescue analgesia were recorded and analyzed statistically. Results. A statistically significant difference was found between the patient (p = 0.001; p

With migration of medically complex patients undergoing more extensive surgical procedures to the ambulatory setting, selecting the appropriate patient is vital. Patient selection can impact patient safety, efficiency, and reportable outcomes at ambulatory surgery centers (ASCs). Identifying suitability for ambulatory surgery is a dynamic process that depends on a complex interplay between the surgical procedure, patient characteristics, and the expected anesthetic technique (eg, sedation/analgesia, local/regional anesthesia, or general anesthesia). In addition, the type of ambulatory setting (ie, short-stay facilities, hospital-based ambulatory center, freestanding ambulatory center, and office-based surgery) and social factors, such as availability of a responsible individual to take care of the patient at home, can also influence patient selection. The purpose of this review is to present current best evidence that would provide guidance to the ambulatory anesthesiologist in making an informed decision regarding patient selection for surgical procedures in freestanding ambulatory facilities.

Cataract surgeries are among the most common procedures requiring anesthesia care. Cataracts are a common cause of blindness. Surgery remains the only effective treatment of cataracts. Patients are often elderly with comorbidities. Most cataracts can be treated using topical or regional anesthesia with minimum or no sedation. There is minimal risk of adverse outcomes. There is general consensus that cataract surgery is extremely low risk, and the benefits of sight restoration and preservation are enormous. We present the Society for Ambulatory Anesthesia (SAMBA) position statement for preoperative care for cataract surgery.

Lay abstract Acute low back pain is one of the most common reasons patients present to the emergency department (ED), and it is often difficult to treat. The erector spinae plane block (ESPB) is a nerve block used to treat thoracic, rib, spine and abdominal wall pain. There is currently limited evidence to support its use in treating low back pain in the ED. This case series looks at outcomes of six patients who presented to the ED with low back pain who were treated with an ESPB that targets the low back muscles. Visual Analog Scale pain score reduction after the procedure ranged between 71 and 100%, with an average of 81.8%. The average length of stay (LOS) prior to the nerve block was 225 min, with a range of 107–480 min. Average LOS after the block was 73.5 min, with a range of 26–180 min. Five of six patients did not have any return ED visits for back pain. All six patients required no opiates after the procedure in the ED or after discharge. These cases show the ESPB is a promising technique that gives emergency physicians a rapid, safe and opiate-sparing option for the treatment of low back pain. ESPBs can result in decreased pain, decreased LOS, decreased opiate requirements and decreased admission for refractory pain.

Objective: To compare the outcome in early versus delayed oral intake in patients after cesarean section under regional anesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Lahore, from Dec 2017 to May 2018. Methodology: A total of 352 women undergoing elective cesarean section under regional anesthesia, nil by mouth for at least 8 hours before surgery were divided in 2 groups. In group 1, patients were given sips of clear oral fluid (water)

The data on the factors of development of postoperative immunosuppression (PI) are presented. Among them, an important role in the development of PI belongs to hyperactivity during operations of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal system. It has been shown that PI is prevented by regional anesthesia, primarily epidural anesthesia and postoperative epidural analgesia, as well as prolonged ganglioplegia. It is concluded that the preventive action of regional anesthesia in relation to the development of PI is largely associated with the sympatholytic component of action.

The article presents original approach to anesthesia during vaginal hysterectomy with plasty. Nowadays, indications for vaginal hysterectomy are: the elderly age, morbid obesity, complete uterine prolapse, somatic condition of the patient, which allows for the operation. In order to prevent intraoperative and postoperative complications, it is very important to provide the patient with the most effective and safe method of anesthesia, which will minimize the use of analgesics during the surgery and in the early postoperative period. The purpose of the study was to evaluate the effectiveness of intraoperative and postoperative anesthesia when methods of regional anesthesia (subarachnoid anesthesia + caudal analgesia) are combined with ultrasound during vaginal hysterectomy with plasty. Combined regional anesthesia (spinal anesthesia + caudal analgesia) using ultrasound support was performed in 32 patients. Caudal block with visualization of the epidural space by means of ultrasound scanner allows it to be applied to almost all patients with nearly 100 % of success. The quality of anesthesia was determined by the well-being of the patients themselves, who noted the adequacy of anesthesia and comfort on the operating table and in the postoperative period. Pain relief after surgery was carried out without opioids. The caudal epidural block with visualization of the epidural space and determination of its width by means of ultrasound scanner allows using it in almost all patients to whom it was indicated. The exceptions are patients with anatomical defects of sacrum formation. Professional training does not take much time and was mastered by all, without exception, doctors from anesthesiology department. The scheme of combined regional anesthesia shows advantages over general anesthesia and isolated subarachnoid anesthesia in these groups of patients., В статье рассматривается оригинальный подход к обезболиванию влагалищной экстирпации матки с пластикой. Осуществлено обезболивание 32 больных с использованием комбинации методов региональной анестезии (субарахноидальная анестезия + каудальная анальгезия) с ультразвуковым сопровождением. Каудальная блокада с визуализацией эпидурального пространства при помощи ультразвукового сканера позволяет применять ее практически у всех больных, которым она показана, с почти 100% успехом блокады. Качество обезболивания определялось самочувствием самих пациенток, которые отмечали адекватность обезболивания и комфортность на операционном столе и в послеоперационном периоде. Обезболивание после операции осуществлялось без применения опиоидов. Предложенная схема обезболивания показывает преимущества над проведением общего обезболивания и изолированной субарахноидальной анестезии у данной категории больных, У статті розглядається оригінальний підхід до знеболювання при операціях черезпіхвової екстирпації матки з пластикою. Здійснено знеболювання 32 хворих із застосуванням комбінації методів регіональної анестезії (субарахноїдальна анестезія + каудальна аналгезія) із ультразвуковим супроводом. Каудальна блокада з віазулізацією епідурального простору за допомогою ультразвукового сканера дозволяє застосувати її практично у всіх хворих, яким вона показана, з майже 100% успіхом блокади. Якість знеболювання визначалася самопочуттям самих пацієнтів, які відмічали адекватність знеболювання і комфортність на операційному столі і в післяопераційному періоді. Знеболювання після операції здійснювалось без застосування опіоїдів. Запропонована схема знеболювання показує переваги над проведенням загального знеболювання та ізольованої субарахноїдальної анестезії в даної категорії хворих.

Историю хирургии можно разделить на два основных этапа: до 1846 года и после него. В этой работе авторы представили в хронологическом порядке основные этапы развития анестезиологии в Украине, сосредоточив внимание на врачах, которые впервые проводили хирургические вмешательства под общим и местным обезболиванием. В 1846 году по инициативе В.А. Караваева и А.П. Вальтера, учеников Н.И. Пирогова, при Киевском университете была организована комиссия по изучению влияния эфира на организм. Исследовав в эксперименте влияние эфира на животный организм, В.А. Караваев 18 февраля 1847 года сделал первую в Киеве операцию под эфирным наркозом. Вторую в Украине операцию под эфирным наркозом выполнил Т.Л. Ванцетти в Харькове 28 февраля 1847 года. А уже к концу 1847 года хлороформный наркоз в Киеве применил В.А. Караваев. В 1871 году в Харькове В.Ф. Грубе выполнил первую операцию под наркозом закисью азота. В 80–90-е годы XIX века в хирургическую практику широко внедряются методы местной и проводниковой анестезии кокаином. Украинские хирурги были пионерами местной анестезии. В 1886 году киевский хирург А.И. Лукашевич провел на себе и на других здоровых людях опыты по применению проводниковой анестезии. Выпускник медицинского факультета Киевского университета Св. Владимира В.Ф. Войно-Ясенецкий в Санкт-Петербурге в 1915 году издает монографию «Регионарная анестезия», иллюстрированную автором. В послереволюционный период обезболиванию уделяют все больше внимания, количество хирургов, проводящих операции с обезболиванием, растет в геометрической прогрессии. Возникает потребность в постоянном надзоре за состоянием пациента и в медперсонале, который будет его проводить. Это и было началом формирования анестезиологии как науки и отдельной специальности.

Regional anesthesia (RA) may be used in femoral shaft fracture surgery to decrease pain and opioid consumption. However, the impact of RA on inpatient and outpatient opioid demand in patients undergoing femoral shaft fracture surgery is largely unknown. The aim of this study was to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand in patients undergoing femoral shaft fracture surgery.Inpatient opioid consumption and outpatient opioid demand in all patients undergoing femoral shaft fracture surgery was recorded at a single, Level I trauma center from 7/2013 - 7/2018 (n=436). In addition to RA, baseline and treatment factors including age, sex, race, body mass index (BMI), smoking, chronic opioid use, American Society of Anesthesiologists (ASA) score, injury mechanism, additional injuries, open injury, and additional inpatient surgery were recorded. Unadjusted and adjusted multivariable models were used to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand.Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.9 estimated OE's without RA vs 8.8 OE's with RA from 48-72 hours post-op, p0.05) but no significant differences at other timepoints (10.3 estimated OE's without RA vs 9.2 OE's with RA from 0-24 hours post-op, 8.2 vs 8.8 from 24-48 hours post-op, p0.05). Estimated cumulative outpatient opioid demand did not differ significantly in patients with RA (82.3 OE's without RA vs 94.8 with RA from discharge to two-weeks, 105.4 vs 116.3 OE's to 6-weeks, and 124.5 vs 137.9 OE's to 90-days, all p0.05). Late opioid refills were significantly more common in patients with RA (1.57 odds at 2-weeks to 6-weeks, 1.69 odds at 6-weeks to 90-days, p0.05) DISCUSSION: In femoral shaft fracture surgery, RA was not associated with decreased opioid demand after adjusting for baseline patient and treatment characteristics. These results provide a real-world estimate of the impact of RA on opioid demand in femoral shaft fracture surgery and encourage providers to seek alternative analgesic modalities.Level III, retrospective, therapeutic cohort study.

Background Postoperative pain after complex revision spine surgery, especially for the treatment of persistent spinal pain syndrome (PSPS), is frequently severe and can be debilitating, requiring the use of intravenous and oral opioids. To the best of our knowledge, the present study is the first to evaluate the effectiveness and safety of a continuous infusion regional anesthesia pump placed after thoracopelvic fusion for the treatment of PSPS. Methods We performed a retrospective comparative study of consecutive patients who had undergone thoracopelvic fusion for PSPS. The patients included in the present study had either had a continuous infusion regional anesthesia pump placed during surgery or had not (control). Demographics, use of preoperative and postoperative opioids, postoperative adverse events, length of hospital stay, and 90-day readmission were recorded. Results The patients in the pump group (n = 14) had used fewer opioids during their hospital stay compared with the control group (n = 12; P = 0.6). This difference was greater for postoperative days 1 and 2 (P = 0.3 and P = 0.2, respectively). No significant difference was found in opioid usage during the first 14 days after surgery (P = 0.8) or at the 3-month postoperative follow-up evaluation (P = 0.8). Furthermore, no significant difference was found between the 2 groups in terms of postoperative complications. The pump group had a 1.4-day shorter hospital stay (P = 0.7). The control group had more 90-day readmissions than did the pump group (P = 0.2). Conclusions Despite showing a trend toward less usage of opioids during the first 2 days after surgery and a shorter hospital stay with no increased complications in the pump group, the study data failed to demonstrate a statistically significant difference between the two groups.

SUMMARY Geriatric hip fractures are complicated by increased morbidity and mortality, and their incidence continues to rise around the world. Frequent considerations in treating geriatric hip fractures include optimal time to surgery, need for preoperative cardiac clearance, risks of operating through anticoagulation, utilization of regional anesthesia, and collaborative care between treatment teams. This article aims to summarize these factors as well as to provide some tips and tricks that can be helpful in their surgical management.

IntroductionData are lacking on the pharmacokinetic profile and safety of levobupivacaine (LB) used for regional anesthesia of the maxilla and mandibles in dogs.MethodsInfraorbital block (n = 10), inferior alveolar block (n = 10) or both infraorbital and inferior alveolar blocks (n = 10) were administered to dogs undergoing dental surgery under isoflurane anesthesia. The dose of LB was calculated as 0.11 ml/kg2/3 for the infraorbital block and 0.18 ml/kg2/3 for the inferior alveolar block. Blood samples were collected before and immediately after administration of the oral blocks, and 3, 4, 7, 12, 17, 32, 47, 62, 92, and 122 min thereafter. Quantification of LB in plasma was performed by LC-MS/MS.Results and discussionThe results are presented as median and interquartile range. In dogs in which all four quadrants of the oral cavity were desensitized with LB, the Cmax was 1,335 (1,030–1,929) ng/ml, the Tmax was 7 (4–9.5) min, and the AUC(0 → 120) was 57,976 (44,954–96,224) ng min/ml. Plasma concentrations of LB were several times lower than the reported toxic concentrations, and no signs of cardiovascular depression or neurotoxicity were observed in any of the dogs, suggesting that the occurrence of severe adverse effects after administration of LB at the doses used in this study is unlikely.

Blunt trauma patients commonly present with multiple rib fractures, which increases overall morbidity and mortality due to pulmonary complications. Effective chest wall analgesia may be challenging due to positioning difficulty, body habitus, anticoagulation issues with neuraxial interventions, etc. Serratus anterior plane block has been shown to be beneficial in anterior and lateral rib fractures in recent studies. We propose the efficacy of this block in posterior rib fractures as well, through this small case series of blunt trauma patients with posterior rib fractures, reporting significant pain relief after the block.

BackgroundErector spinae plane (ESP) and retrolaminar (RL) blocks show unreliable spread. We hypothesize that the combination of ESP and RL blocks provides more extensive and reliable spread of dye than single ESP blocks. Our primary objective was to compare the spread of dye to the paravertebral spaces after the combination block and ESP block in Thiel embalmed cadavers. Spread, the primary end point, was defined as the number of paravertebral spaces colored with dye per injection.Materials and methodsA single anesthetist performed ultrasound-guided ESP (20 mL) and combination of ESP and RL (10 mL each) blocks at the third thoracic vertebra of eight soft embalmed Thiel cadavers. Tissue displacement was visualized on an adjacent strain elastography image. Cadavers were dissected 24 hours later and anatomical structures were inspected for the presence of dye.FindingsDye was visualized in more paravertebral spaces with the combination block (median 3 (IQR 3–5 (range 0–8)) vs 1.5 (IQR 0.25–2.75 (range 0–3) and difference (1.5 (0–4), p=0.04). Six out of seven (86%) combined erector spinae and RL blocks spread to at least three paravertebral spaces compared with two out of eight (25%) ESP blocks (RR 3.4, 95% CI 1.0 to 11.8; p=0.04). Contralateral spread occurred in three combination blocks and in one ESP block (OR 9.0, 95% CI 4.0 to 21.1; pConclusionsIn conclusion, the combination of ESP and RL blocks was more extensive and reliable than ESP block alone.

Patients with pelvic and acetabular fractures often have considerable pain in the perioperative period. Regional anesthesia (RA) including peripheral nerve blocks and spinal analgesia may reduce pain. However, the real-world impact of these modalities on inpatient opioid consumption and outpatient opioid demand is largely unknown. The purpose of this study was to evaluate the impact of perioperative RA on inpatient opioid consumption and outpatient opioid demand. This is a retrospective, observational review of inpatient opioid consumption and outpatient opioid demand in all patients ages 18 and older undergoing operative fixation of pelvic and acetabular fractures at a single Level, I trauma center from 7/1/2013–7/1/2018 (n = 205). Unadjusted and adjusted analyses were constructed to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand while controlling for age, sex, race, body mass index (BMI), smoking, chronic opioid use, ASA score, injury mechanism, additional injuries, open injury, and additional inpatient surgery. Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (12.6 estimated OE’s without RA vs 16.1 OE’s with RA from 48 to 72 h post-op, p 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA at discharge to 90 days post-op (and 156.8 vs 207.9 OE’s to 90 days, p 0.05). In pelvis and acetabulum fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics. Regional anesthesia may not be beneficial for these patients.

Purpose of review To describe current developed regional blocks, their indications and clinical use. Furthermore, describe new local anesthetics recently introduced and the new agents in pipeline. Recent findings There are multiple new blocks recently developed with the introduction of ultrasound to regional anesthesia and studies demonstrate effect in different surgical procedures. However, majority of the studies do not compare with gold standard and are relatively small to change clinical practice. Some of these blocks are: erector spinae plane block, infiltration between the popliteal artery and capsule of the posterior knee, pectoral nerve blocks, quadratus lumborum and transversus abdominis plane block. New local anesthetics and adjuvants have been developed in recent years. However, the studies with even with the oldest one introduced Exparel is currently questioned, large future studies are needed to determine efficacy and safety profile and compared with conventional local anesthetics. Summary New regional block techniques and new local anesthetics have been introduced recently. However, the efficacy/safety and comparison to conventional techniques and local anesthetics are still needed. Future studies must focus on prolonging analgesia with least invasive regional technique and compare new local anesthetics with current ones.

Effective multimodal analgesia techniques are required when pigs are used as models in orthopedic human research. Regional anesthesia is a widely used technique to provide perioperative analgesia in animals undergoing orthopedic surgery. The brachial plexus (BP) block is indicated to desensitize the forelimb in many species but has not been yet described in pigs. The main aims of this study were to develop an ultrasound-guided axillary approach for the BP and to evaluate injectate spread and nerve staining in pig cadavers. Eight fresh F1 cross breed German Large White and German Landrace male pig cadavers were enrolled. Two cadavers were used for anatomical dissection of the axillary space and to determine the disposition of the BP. Six cadavers were used to perform a bilateral axillary ultrasound-guided approach for the BP, and after injecting 0.3 ml/kg of a solution of 2% lidocaine and new methylene blue (L-NMB), these were dissected to determine injectate spread and nerve staining. Upon dissection, the BP was observed in all the cases surrounded by the axillary sheath and in close proximity to the axillary artery. Ultrasonographic scanning and guidance for the approach to the BP was feasible in all cadavers and upon dissection, all the nerves forming the BP were stained in all their quadrants and in all the cases. In conclusion, the injection of 0.3 ml/kg of L-NMB through an ultrasound-guided axillary approach to the BP was feasible and adequate to entirely stain the BP in all pig cadavers. Further clinical studies are required to evaluate the effectiveness of this technique in live animals.

While writing the article, we analyzed all the studies related to ropivacaine for the first half of 2021, which were published in PubMed. Previous review articles on ropivacaine were also analyzed. Purpose: collection and analysis of the latest research results on ropivacaine. Assessment of the place of ropivacaine in modern regional anesthesia., Во время написания статьи были проанализированы все исследования, касавшиеся ропивакаина, за первое полугодие 2021 г., которые были опубликованы на ресурсе PubMed. Также были проанализированы предыдущие обзорные статьи, касающиеся ропивакаина. Цель: сбор и анализ новейших результатов исследования ропивакаина. Оценка места ропивакаина в современной регионарной анестезии., Під час написання статті було проаналізовано всі дослідження, які стосувалися ропівакаїну, за перше півріччя 2021 р., що були опубліковані на ресурсі PubMed. Також було проаналізовано попередні оглядові статті, що стосуються ропівакаїну. Мета: збір та аналіз найновіших результатів дослідження ропівакаїну. Оцінка місця ропівакаїну в сучасній регіонарній анестезії.

Objective: To compare emergency surgeries under spinal anesthesia in COVID-19 pandemic with pre-COVID period in a tertiary care hospital of a developing country. Study Design: Prospective observational study. Place and Duration of Study: Main Operation Theatre, Frontier Corps Hospital Quetta, from Mar to May 2020. Methodology: All emergency surgeries done under Spinal Anesthesia, were compared to emergency cases done in the pre-COVID period. Anesthesia notes were reviewed. Emergency cases done under general anesthesia and personal protective equipment worn were also noted. Ages of the patients were from 18-75 years. Spinal anesthesia was performed by consultant anesthesiologist. Result: Among total cases, 260 emergency cases were performed in the main operation theatre during the 3 months of pre-COVID period as compared to only 89 cases in the 3 months duration of COVID-19. Spinal anesthesia was used in 154 (59.2%) cases in the pre-COVID study period, while in COVID-19 pandemic 77 (86.5%) emergency cases were performed under spinal anesthesia. Conclusion: Spinal anesthesia has a significant role in the surgical management of patients in pre-COVID and especially in COVID pandemic. It provides high-quality perioperative care for patients whilst minimizing exposure to staff and utilization of scarce resources of personal protective equipment. © 2021, Army Medical College. All rights reserved.

The purpose of this study was to evaluate the outcomes of fracture nonunion repair with autogenous iliac crest bone graft (ICBG) under regional anesthesia alone or in combination with other techniques compared to other anesthesia techniques. Overall, 137 patients were identified who underwent ICBG as part of a repair of a long bone fracture nonunion between January 1, 2013 and October 1, 2020. Surgical and anesthetic records were reviewed to classify patients by anesthesia type. General, spinal, and regional anesthetics were used as either the primary anesthetic or as a combination of regional nerve block with general or spinal anesthesia. Administration of regional anesthesia alone or in combination with general or spinal anesthesia (RA) and general or spinal anesthesia only (GS) groups differed in nonunion site distribution (p

PURPOSE OF REVIEW To explore the role and impact of e-learning technologies on regional anesthesia. RECENT FINDINGS 21st century technologies, such as 'smart' medical appliances, personal computers, sophisticated apps, the ubiquitous Internet, and online 'e-learning' curricula, are having a powerful impact on anesthesia training: when we learn, what we learn, and how we learn. But is 'new' necessarily 'better'? The answer will result from the application of developments in IT technology through the current vision of architects of future anesthesia training programs. This narrative review aims to summarize the recent developments in anesthesia e-learning, and to forecast trends using regional anesthesia as an example. SUMMARY The review offers some recommendations to ensure that the blessings promised to human learning by this 'Brave New Cyberworld' do not become its nemesis.

Background: Venipuncture is one of the one of the most commonly performed, minimally-invasive procedures; however, it may lead to peripheral nerve injury. Here, we describe the diagnosis, treatment, and prognosis of two self-reported cases of nerve injury during venipuncture with the aim of drawing attention to possible needle-related nerve injuries.Case: Two anesthesiologists in our hospital experienced an injury of the lateral antebrachial cutaneous branch of the musculocutaneous nerve during venipuncture. Immediately, they underwent ultrasound examinations and nerve blocks with oral medication, resulting in full recovery.Conclusions: Ultrasonography is important for the early and confirmative diagnosis of a nerve injury during venipuncture, and for immediate treatment with a nerve block. Moreover, it is imperative for both the practitioner and the patient to be aware of the possible complication of nerve injury after venipuncture.

The following discussion aims to provide a review of current trends in the subspeciality of pediatric regional anesthesia, highlighting recent evidence-based literature, especially with respect to improved outcomes with newer techniques. Much of the recent literature focuses on novel truncal blocks and alternate approaches to regional anesthesia for urologic surgery. In many cases, these newer techniques have been shown to improve postoperative pain scores and lower rescue analgesic requirements. Current trends in pediatric regional anesthesia are focused on providing innovative and alternative approaches to pain relief that are patient-specific and tailored to surgical needs. A variety of new blocks expand the regionalist’s ability to offer better analgesia to children and improve parental satisfaction. As more regional block options become available, the iterative process of making changes and assessing outcomes facilitates our ability to continue providing high quality care to children.

Eine 78-jahrige Patientin erhalt zur perioperativen Schmerztherapie bei Implantation einer inversen Schulterprothese einen interskalenaren Plexuskatheter (ISK). Nach stimulationsgestutzter Punktion unter sonographischer Kontrolle werden zunachst 25 ml Lokalanasthetikum (LA) verabreicht und anschliesend der Katheter mittels „Durch-die-Nadel-Technik“ platziert. Unmittelbar nach der Gabe von weiteren 5 ml LA uber den einliegenden Katheter zeigt die Patientin Symptome einer hohen Spinalanasthesie, sodass sie intubiert und beatmet werden muss. In der folgenden computertomographischen Diagnostik des Halses zeigt sich eine intrathekale Fehllage des Plexuskatheters, dessen Spitze dorsal der A. vertebralis auf Hohe der HWK 5/6 liegt. Im Verlauf kann der Katheter problemlos entfernt werden; neurologische Folgeschaden bestehen keine. Die Verwendung von Ultraschall, insbesondere in Kombination mit der Nervenstimulation, erhoht die Sicherheit bei Anlage eines interskalinaren Kathetes, da eine eindeutige Identifikation der Nervenwurzeln C5–C7 und deren umgebende Strukturen moglich ist. Sofern die Ausbreitung des LA wahrend der Injektion nicht visualisierbar sein sollte, muss die Injektion sofort abgebrochen werden. Des Weiteren darf die Nadelspitze bzw. die Eindringtiefe der Nadel wahrend der Katheteranlage nicht verandert werden. Die erstmalige Gabe eines LA uber den Kathteter sollte unter kontrollierten Bedingungen stattfinden, vorzugsweise unter Uberwachung der Vitalwerte sowie unter fortlaufender klinisch-neurologischer Kontrolle des wachen Patienten. Eine Notfallausrustung muss unmittelbar verfugbar sein.

Aim. To analyze the maternal and perinatal outcomes in repeated caesarean section. The first group included 50 laboring women who received combined endotracheal anesthesia for a repeat cesarean section. The second group included 50 laboring women who received spinal anesthesia during the operative delivery. The condition of 100 newborns born by repeated cesarean section was studied.Results. In postpartum period in the women of first group very often, develop endometritis (24%), in second group – 36%, hematometra in first group we see in 12%, in second – 26%. Tracheobronhitis occur in first group among 30%. Research of the condition and course of early neonatal period in newborns showed, that combined anesthesia initiates pathological course of this period. The main complications were asphyxia (28%), and neurological disorders (22%).Conclusions. Different types of analgesia initiate different types of complications in the postoperative period, but better neonatal outcomes with the use of regional anesthesia techniques qualify them as the anesthesia method of choice for repeat cesarean section.

Background and objectivesWhile there are several published recommendations and guidelines for trainees undertaking subspecialty Fellowships in regional anesthesia, a similar document describing a core regional anesthesia curriculum for non-fellowship trainees is less well defined. We aimed to produce an international consensus for the training and teaching of regional anesthesia that is applicable for the majority of worldwide anesthesiologists.MethodsThis anonymous, electronic Delphi study was conducted over two rounds and distributed to current and immediate past (within 5 years) directors of regional anesthesia training worldwide. The steering committee formulated an initial list of items covering nerve block techniques, learning objectives and skills assessment and volume of practice, relevant to a non-fellowship regional anesthesia curriculum. Participants scored these items in order of importance using a 10-point Likert scale, with free-text feedback. Strong consensus items were defined as highest importance (score ≥8) by ≥70% of all participants.Results469 participants/586 invitations (80.0% response) scored in round 1, and 402/469 participants (85.7% response) scored in round 2. Participants represented 66 countries. Strong consensus was reached for 8 core peripheral and neuraxial blocks and 17 items describing learning objectives and skills assessment. Volume of practice for peripheral blocks was uniformly 16–20 blocks per anatomical region, while ≥50 neuraxial blocks were considered minimum.ConclusionsThis international consensus study provides specific information for designing a non-fellowship regional anesthesia curriculum. Implementation of a standardized curriculum has benefits for patient care through improving quality of training and quality of nerve blocks.

This article examines and analyzes the dependence of the state of the central nervous system (CNS) in the postoperative period in patients who underwent penetrating keratoplasty. MATERIAL AND METHODS: The analysis of cognitive status was performed using neuropsychological testing involving the scale of frontal dysfunctions (Frontal Assessment BatteryFAB) and a short scale for assessing mental status (Mini-Mental State ExaminationMMSE). The results were assessed on the eve of the operation, 6 h after the operation, and 7 and 21 days after the operation. Depending on the applied method of anesthesia, several groups were identified. In group d, general anesthesia (OA) was used with dexmedetomidine infusion 40 min before surgery. In group b (before surgery), a wing-palatine fossa block was performed 20 min, in addition to general anesthesia. Anesthesia was maintained with sevofluraneoxygen mixture at a low gas flow. The groups were statistically comparable in terms of age and gender. The depth of anesthesia and sedation was assessed using the bispectral index and analgesia nociception index, respectively. RESULTS: According to the results of testing on the MMSE and FAB scales, the cognitive indicators in the first 6 h after surgery were higher in group d than in group b. However, by day 21, these indicators differed slightly (p 0.05). Thus, the following tendencies were observed in group b 6 h after the operation: a decrease in indicators on the MMSE scale by 20.8% and on the FAB scale by 28.6% from the initial level. For group d, the indicators on the MMSE scale were reduced by 8.3%, and those on the FAB scale were reduced by 13.3% at the same stage of the study. When testing on the same scales 21 days after surgery, the indicators of cognitive functions were restored to the initial level in both groups. CONCLUSION: The levels of cognitive functions of ophthalmic surgical patients after surgery involving regional anesthesia and dexmedetomidine differed significantly in the first hours of the postoperative period. After 21 days, the neuropsychological status did not differ significantly (p 0.05).

The use of central segmental blockades (spinal and epidural) is associated with a large number of contraindications and complications including life-threatening. The combination of general anesthesia with opioids is associated with a slow recovery of the gastrointestinal tract and other side effects of their systemic application. Therefore the search for alternative methods of pain relief in the context of Enhanced Recovery After Surgery protocols is becoming an increasingly relevant research topicn. Relative to central blocks, the fascial sheath block of peripheral nerves under ultrasound guidance is a technically simple and safe technique. This article provides a brief overview of the main blocks used for anesthesia of the anterior abdominal wall.

The use of ultrasound guided regional blocks is supported by the National Institute for Health and Care Excellence of the United Kingdom, for its safety and efficacy. This is a technique guide which is a culmination of the experiences gained in administering regional anesthesia under ultrasound guidance for ankle blocks as part of everyday podiatric surgery practice, based on a sound understanding of the principles of ultrasound science and instrumentation. It is in the opinion of the authors that the positioning of the patient is key, combined with an in-plane ultrasound guided technique, to perform a successful block of the selected nerve based on a foundation of knowledge and experience of anatomy and use of ultrasound respectively. This technique guide depicts annotated ultrasound images of the sonoanatomy to include the five nerves which innovate the foot that are required to be anesthetized for a selective or complete regional ankle block offering predictable peri-operative anesthesia, post-operative analgesia and early ambulatory discharge.

There is concern that regional anesthesia is associated with increased risk of complications, including return to the hospital for uncontrolled pain once the regional anesthetic wears off.Retrospective database review of patients who underwent open reduction and internal fixation of a closed ankle fracture from 2014-16 who received general anesthesia alone (GA) or general anesthesia plus regional anesthesia (RA).9459 patients met inclusion criteria. Patients in the RA group had significantly longer operative duration in both inpatient (GAI=71min vs RAI=79min, p=0.002) and outpatient setting (GAO=66min vs RAI=72min, p0.001), lower overall LOS (GA=1.7 days vs RA=1.1 days, p0.001), and higher readmission rate for pain (RAO=4 [0.3%] vs GAO=1 [0.0%], p=0.007).Patients who received supplemental regional anesthesia had shorter hospital LOS, increased operative time, and increased readmission rates for rebound pain. However, the small number of patients needing readmission are not clinically significant demonstrating that regional anesthesia is safe, effective and readmission for rebound pain should not be a concern.III.

Objective Regional anesthesia techniques are gaining traction in cardiac surgery. The aim of this study was to compare the analgesic efficacy of erector spinae plane block catheters (ESPBC), serratus anterior plane block catheters (SAPBC), and paravertebral single-shot block (PVB) versus no block after robotic minimally invasive direct coronary artery bypass (MIDCAB). Design This was a retrospective observational study of routinely recorded data. Setting The study was performed at a single healthcare system. Participants All patients underwent robotic MIDCAB. Intervention Data were analyzed from 346 patients during a 53-month period. The clinical data warehouse was queried for all robotic MIDCAB surgeries. Variables abstracted included type of nerve block, age, sex, use of adjuncts, Society of Thoracic Surgeons predicted short length of stay (PSLOS), total opioid consumption during the 72 hours after surgery, and postoperative hospital length of stay (LOS). The primary outcome was total oral morphine milligram equivalents (MME) consumed during the first 72 hours after surgery. The secondary outcome was hospital LOS. Measurements and Main Results In a model adjusting for PSLOS, the authors did not observe an association between ESPBC and the reduction of total administered oral MME within 72 hours after surgery. There was no significant difference in MME when comparing patients who received PVB to patients with ESPBC. Older age and female sex were associated with significantly lower MME. Patients who received ESPBC had a significantly shorter hospital LOS than patients with SAPBC. Conclusions These findings suggested that postoperative pain after MIDCAB surgery might not be completely covered by ESPBC. Prospective studies are needed to further elucidate the value of this technique for robotic MIDCAB.

Historically, clavicle fracture repairs have been performed with patients under general anesthesia. However, in the past few years, the combination of an interscalene brachial plexus block and a modified superficial cervical plexus block has been described to provide adequate anesthesia for clavicle fracture surgery, with the added benefit of postoperative analgesia. In March 2013, members of our anesthesiology department began using this block with sedation for a subset of patients undergoing clavicle fracture fixation.This study was a retrospective review of patients who underwent clavicle fracture repair at a single institution between June 2014 and November 2017. The decision on the type of anesthesia (regional vs. general) was made jointly by the patient, anesthesiologist, and surgeon. Demographic data, relevant perioperative times, and intraoperative pain medication consumption were recorded, and comparisons of these variables were made between the regional and general anesthesia groups.A total of 110 patients with 110 fractures were included. Of these patients, 52 received only regional anesthesia with the combined block whereas 58 received general anesthesia with an interscalene brachial plexus block. No major anesthetic-related complications were noted in any patients, and there were no cases in which regional anesthesia had to be converted to general anesthesia because of block failure. The anesthesia start time was significantly longer in the general anesthesia group (29 minutes vs. 20 minutes, P = .022), as was the total case time (164 minutes vs. 131 minutes, P.001). Patients in the general anesthesia group required significantly more intraoperative fentanyl to be administered (207 μg vs. 141 μg, P = .002).Regional anesthesia using a combined brachial plexus and modified superficial cervical plexus block is a reliable, efficacious technique. The combined block appears to be a reasonable alternative to general anesthesia with an interscalene brachial plexus block, and it may have benefits regarding the anesthesia start time and total case time.