Journal articles: 'LOCOREGIONAL ANAESTHESIA'

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Abbadi, Abdel Karim Al Oweidi Al, Iulian Constantin, Aurelia Romila, Alina Mihaela Calin, Laurian Lucian Frincu, Ciprian Dinu, and Alina Mihaela Elisei. "The Morphological Substrate of the Sensory Pathways - Anatomy, Neurotransmission, Neurochemistry in Intraosseous Anaesthesia." Revista de Chimie 70, no. 6 (July 15, 2019): 2218–21. http://dx.doi.org/10.37358/rc.19.6.7308.

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In order to apply the most accurate and efficient locoregional techniques, the knowledge of the anatomical characteristics of the oro-maxilo-facial territory becomes imperatively necessary, without which the installation and the effect of the locoregional anaesthetics may be poor. Due to the many advantages it presents, locoregional anaesthesia is considered as a current use method during routine dental care. A good local or locoregional anaesthetic must be harmless to the tissues, must have no local or general toxicity, must lead to a high quality and durable anaesthetic, must not cause lesions to nerve endings, to be subject to dental surgery or of oral surgery, can be satisfactorily solved by using locoregional anaesthesia techniques, which are used successfully in patients with balanced psychic, who are calm and cooperative. A good anaesthesia suppresses pain, prevents pain-induced shock, and allows the dentist to work in optimal conditions. Although modern anaesthesia techniques have greatly changed the working environment in dental surgeries or outpatient facilities of oral and maxillo-facial surgery, emotion and anxiety, fears continue to exist in patients who will have to undergo care treatments. In order to apply the most accurate and effective locoregional anaesthetic techniques, the knowledge of the anatomical characteristics of oro-maxilo-facial territory becomes imperatively necessary, without which the location and effect of locoregional anaesthetics may be poor. The study includes 114 patients studied in the period 2015-2017 on which we used Stabident system intraosseous anaesthesia of company Fairfax under two available systems: Stabident Regular and Stabident Alternative. Intraosseous anaesthesia reduces the amount of injected anaesthesia, thus reducing the toxicity of anaesthetic procedures; this technique allows the use of vasoconstrictors for the immediate delivery of anaesthesia to the teeth affected by pulpitis without the risk of necrosis. Intraosseous anaesthesia is an anaesthesia technique similar to the ideal anaesthesia technique.

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Auboyer, C. "Infectious risk and locoregional anaesthesia." Annales Françaises d'Anesthésie et de Réanimation 17, no. 10 (January 1998): 1257–60. http://dx.doi.org/10.1016/s0750-7658(99)80036-7.

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Quesada, Nuria, Dario D'Ovidio, Matt Read, Paolo Monticelli, and Chiara Adami. "An Observational Survey Study on the Use of Locoregional Anaesthesia in Non-Conventional Species: Current Practice and Potential Future Developments." Animals 12, no. 11 (June 3, 2022): 1448. http://dx.doi.org/10.3390/ani12111448.

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The objectives of this study were to investigate the current attitudes of veterinarians towards the use of locoregional anaesthesia in non-conventional animal species and to identify areas for future useful research on this topic. A questionnaire was circulated online. A total of 417 veterinarians, including American and European specialists/specialists-in-training in both zoological medicine and anaesthesia/analgesia (ACZM/ECZM and ACVAA/ECVAA), participated in the study. Fifty-nine percent of respondents performed locoregional anaesthesia in rabbits, with intratesticular injections and local infiltration being the most commonly-reported techniques. ACZM/ECZM specialists reportedly performed dental blocks in rabbits more frequently than ACVAA/ECVAA specialists (p = 0.030). Forty percent of respondents performed locoregional anaesthesia in rodents, with intratesticular injections, topical/splash blocks and local infiltration being the most commonly reported techniques. The proportions of respondents who reportedly used locoregional anaesthesia in ferrets, birds and reptiles were 37.9%, 34.5% and 31.2%, respectively. The use of Tuohy (p < 0.001) and spinal needles (p < 0.001), as well as of ultrasonography (p = 0.009) and nerve-stimulators (p < 0.001), was more common among ACVAA/ECVAA compared to ACZM/ECZM specialists. Major topic areas for future research were identified as dental block techniques for rabbits and rodents and blocks for the wings of birds.

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Vullo, Cecilia, Rosalia Crupi, Rosanna Di Paola, Salvatore Cuzzocrea, Enrico Gugliandolo, Vito Biondi, and Giuseppe Catone. "Intratesticular Versus Intrafunicular Lidocaine to Reduce Perioperative Nociception and Immunological Response in Ponies Undergoing Field Castration." Veterinary Sciences 9, no. 12 (November 28, 2022): 664. http://dx.doi.org/10.3390/vetsci9120664.

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The aim of this study was to evaluate the impact of intratesticular or intrafunicular lidocaine to reduce perioperative nociception and cytokine release in ponies undergoing field castration under total intravenous anaesthesia. Before castration, one group was injected with intrafunicular (FL) lidocaine and the other received intratesticular (TL) lidocaine. All ponies were premedicated with acepromazine (0.05 mg/kg) intramuscularly. Twenty minutes after the administration of acepromazine, xylazine (1 mg/kg) and butorphanol (0.02 mg/kg) were administered intravenously. Lidocaine 2% was given 1 ml/100 kg intrafunicularly in the FL groups or 2 ml/100 kg intratesticularly on each testicular side for TL. Surgery was performed by the same team of two experienced surgeons using Serra’s emasculator and an open technique was used for all ponies in order to promote postoperative drainage. In this study, we focused on the plasmatic levels of TNF-a and IL-6. The results from this study showed a significant difference in plasmatic concentrations of TNF-a and IL-6 between the two different locoregional anaesthetic protocols. Taken together, the results suggest that the intrafunicular lidocaine locoregional anaesthesia could be a useful technique in the anaesthesia protocol for field pony castration.

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Dagnall, Clare, Peter Coss, and Alice Bird. "Ultrasound-guided blockade of the dorsal nerve of the penis in a Great Dane." Companion Animal 26, no. 11 (December 2, 2021): 243–47. http://dx.doi.org/10.12968/coan.2021.0021.

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This report describes an approach to regional anaesthesia of the dorsal nerves of the penis in a Great Dane, as part of an anaesthetic protocol for surgical urethral resection and anastomosis. Bupivacaine (0.5%) was infiltrated around the left and right dorsal nerves of the penis, with ultrasound guidance. The locoregional approach was trans-perineal, with the ultrasound probe orientated at a right angle to the anus, at the level of the ischial symphysis. The described technique provided good visualisation of the urethra and dorsal arteries of the penis. No adverse events relating to the nerve blockade were encountered and no additional analgesia, other than the methadone premedication, was required intra-operatively. The locoregional approach was subsequently repeated on a cadaver using the same technique and, on dissection, demonstrated deposition of injectate next to the target neurovascular bundles. The technique described may provide a simple method of distal penile anaesthesia in the dog, where ultrasound is available.

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Onuma, O. C., P. E. Bearn, U. Khan, P. Mallucci, and M. Adiseshiah. "The Influence of Effective Analgesia and General Anaesthesia on Patients' Acceptance of Day Case Varicose Vein Surgery." Phlebology: The Journal of Venous Disease 8, no. 1 (March 1993): 29–31. http://dx.doi.org/10.1177/026835559300800108.

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Objective: To assess the efficacy of locoregional anaesthesia and non-opiate analgesia in controlling pain after varicose vein surgery. To examine patient attitudes to day case surgery for this condition. Design: Prospective single patient group study (22 consecutive patients). Setting: University College Hospital (Teaching Hospital). Intervention: Locoregional and general anaesthesia. Non-opiate analgesia. Surgical treatment for varicose Main outcome measures: Patient interview, pain scores, analgesia requirement. Result: Post operative Pain was absent in 36% during the first 24 hours. Oral analgesia was given to 36% as inpatients but only 18% after discharge. Before surgery, 95% would have preferred DCS but only 24% at six months. The after-effects of general anaesthesia was the main reason for this change in attitude. Conclusions: Patients would like day case surgery for varicose veins but anaesthesia and analgesia must be satisfactory.

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UNGUREANU, Raluca, Ioana GRINŢESCU, and Dan TULBURE. "Ultrasound-guided regional anaesthesia for upper limb surgery." Romanian Journal of Medical Practice 10, no. 1 (March 31, 2015): 26–35. http://dx.doi.org/10.37897/rjmp.2015.1.4.

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Brachial plexus blockade is a cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. The new inovative application of ultrasound imaging may overcome the shortcomings of current techniques and increase the efficacity and safety of locoregional anesthesia. Ultrasound guidence allows the operator to see neural structures, guide the needle under real-time visualization, navigate away from sensitive anatomy, and monitor the spread of local anesthetic. This review article focuses on approaches and techniques used for ultrasound guidance of brachial plexus blocks for upper extremity surgery.

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Ruggiano, P., L. Larucci, R. Deodati, R. Giabbiani, L. Bocchi, and S. Orlandi. "Three-dimensional reconstruction of the spatial distribution of anaesthetic during locoregional anaesthesia." European Journal of Anaesthesiology 30 (June 2013): 120. http://dx.doi.org/10.1097/00003643-201306001-00374.

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Cicirelli, Vincenzo, Pasquale Debidda, Nicola Maggio, Michele Caira, Giovanni M. Lacalandra, and Giulio G. Aiudi. "Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs." Animals 11, no. 5 (April 28, 2021): 1275. http://dx.doi.org/10.3390/ani11051275.

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Orchiectomy is a common surgical procedure performed on small animals, and it requires postoperative pain management despite its relative simplicity. This study aimed to evaluate the hemodynamic stability, intraoperative administration of additional hypnotic and/or analgesic drugs, and postoperative pain scores following the combination of ultrasound-guided injection of ropivacaine hydrochloride into the spermatic cord and infiltration by the same anaesthetic of the incisional prescrotal line (ROP) or general anaesthesia. Dogs in the ROP group showed greater intraoperative hemodynamic stability and lower pain scores than the control group. The locoregional approach used in this study proved effective in minimising the responses to the surgical stimulus and ensured adequate analgesia intra- and postoperatively. This method, called ultrasound-guided funicular block, allows orchiectomy to be performed under deep sedation without general anaesthesia.

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Thakuria, Kailash K., Naveen Kumar M., and Monmohan Boro. "Outcome of major abdominal surgeries in COVID-19 positive patients with awake anaesthesia: surgeons’ perspective." International Surgery Journal 8, no. 12 (November 26, 2021): 3673. http://dx.doi.org/10.18203/2349-2902.isj20214763.

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In view of the COVID-19 pandemic, the use of locoregional anaesthesia has gained popularity as the greatest number of the major abdominal surgical cases which were usually done under general anaesthesia (GA) is now shifted towards awake anaesthesia due to fear of aerosol generation. In a COVID era, with evolving risk of aerosol generation in surgery under GA and the urge for reserving ICU beds for needy patients, this study was undertaken to assess the adequacy of surgery and other benefits with awake anaesthesia. A retrospective observational study for 8 COVID-19 positive patients, undergoing emergency major abdominal surgeries with locoregional anaesthesia in pre-operatively diagnosed COVID positive from May 2020 to May 2021 was conducted. Low to medium risk patients (ASA 1-2) were considered following assessment by anaesthesiologist. We retrospectively analysed data including perioperative events, post-op follow up. The mean operative time was 103 minutes (minimum 50 minutes; maximum 170 minutes). In one case, conversion to general anaesthesia was necessary. Post-operative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien Dindo ≥3) occurred. Early readmission after surgery never occurred. In our experience in the COVID-19 era, RA may help to limit the intubation-related risk of contagions inside theatres and could be feasible, safe, and painless alternative to GA in selected cases and this approach could become part of an ICU-preserving strategy.

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Halim, B., I. Schneider, M. A. Claeys, and F. Camu. "The use of midazolam and flumazenil in locoregional anaesthesia: an overview." Acta Anaesthesiologica Scandinavica 34 (June 1990): 42–46. http://dx.doi.org/10.1111/j.1399-6576.1990.tb03181.x.

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Giannoni, M. F., E. Sbarigia, M. A. Panico, F. Speziale, M. Antonini, C. Maraglino, and P. Fiorani. "Intraoperative transcranial doppler sonography monitoring during carotid surgery under locoregional anaesthesia." European Journal of Vascular and Endovascular Surgery 12, no. 4 (November 1996): 407–11. http://dx.doi.org/10.1016/s1078-5884(96)80004-9.

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Martusevicius, R., F. Swiatek, L. G. Joergensen, and H. B. Nielsen. "Ultrasound-guided Locoregional Anaesthesia for Carotid Endarterectomy: A Prospective Observational Study." European Journal of Vascular and Endovascular Surgery 44, no. 1 (July 2012): 27–30. http://dx.doi.org/10.1016/j.ejvs.2012.04.008.

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Antoniou, Asterios, Alexandros Louizakis, Dimitris Tatsis, Anestis Chrysostomidis, Athanassios Kyrgidis, and Konstantinos Vahtsevanos. "Nasal reconstruction after skin cancer surgery; presentation of treatment modalities for medically compromised patients." Hellenic Archives of Oral & Maxillofacial Surgery 23, no. 3 (December 1, 2022): 185–92. http://dx.doi.org/10.54936/haoms233185192.

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Nasal reconstruction after surgical excision of non-melanoma skin cancer defects can be a challeng- ing condition for every head and neck surgeon. There are certain technical difficulties that may arise from the tissue deficit and the area that a locoregional flap could cover. What is more, patients with a compromised medical history cannot always receive surgical manage- ment under general anaesthesia, limiting even more the defect reconstruction options. The aim of the present study is to present two patients that were treated under local anaesthesia for advanced basal cell carcinomas of the nose, with modifications of paramedian and hemi- nasal flaps that provided excellent surgical and aesthetic outcomes, despite the limits of the surgical modality.

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Williams, D. J., P. Laws, C. Imray, A. W. Lambert, and M. Horrocks. "Near-infrared spectroscopic monitoring of patients undergoing carotid endarterectomy under locoregional anaesthesia." British Journal of Surgery 86, no. 5 (May 1999): 692. http://dx.doi.org/10.1046/j.1365-2168.1999.0692b.x.

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Freitas, S., D. Henriques, F. Lança, F. Morais, and L. Ormone. "Call Fleming in pregnant: is locoregional anaesthesia a safe option? Case report." European Journal of Anaesthesiology 31 (June 2014): 178. http://dx.doi.org/10.1097/00003643-201406001-00506.

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Verstraete, L., N. Becaus, H. Swannet, W. Ceelen, L. Duchateau, and N. Speybroeck. "Long Term Outcome after Lichtenstein Hernia Repair Using General, Locoregional or Local Anaesthesia." Acta Chirurgica Belgica 115, no. 2 (January 2015): 136–41. http://dx.doi.org/10.1080/00015458.2015.11681083.

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Quetu, B., B. Tailhan, S. Tricoche, M. Laffon, and J. Fusciardi. "Remifentanil for sedation during carotid endarterectomy and locoregional anaesthesia: comparison of two doses." European Journal of Anaesthesiology 23, Supplement 37 (June 2006): 111. http://dx.doi.org/10.1097/00003643-200606001-00395.

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Dieleman, Myrthe, Marijke Wefers Bettink-Remeijer, Jan Jansen, Vincent P. T. Hoppenreijs, Ruud van der Pol, Seerp Baarsma, Korine van Dijk, Flora B. de Waard-van der Spek, Roy Gerth van Wijk, and Bart L. M. Zijlmans. "High incidence of adverse reactions to locoregional anaesthesia containing hyaluronidase after uneventful ophthalmic surgery." Acta Ophthalmologica 90, no. 3 (March 16, 2012): e245-e246. http://dx.doi.org/10.1111/j.1755-3768.2011.02377.x.

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Mendes, Ângela Barbosa, Constança Penedos, Luísa Vaz Rodrigues, Joana Varandas, Neusa Lages, and Humberto Machado. "The Role of Locoregional Anesthesia in the Covid-19 Pandemic." Acta Médica Portuguesa 33, no. 7-8 (July 1, 2020): 522. http://dx.doi.org/10.20344/amp.13853.

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Coronavirus disease 2019 (COVID-19) refers to the respiratory tract infection caused by the newly emergent coronavirus SARS-CoV-2. The present pandemic, declared on the 11th of March 2020, was first recognized in Wuhan city, and rapidly spread throughout China and other countries, including Portugal. Regional anesthesia should be considered whenever surgery is planned for a patient with suspected or confirmed COVID-19, as it minimizes not only airway management, the intervention with the highest risk of aerosolization, but also potential personnel contamination and patient recovery time, while maximizing operation room efficiency. Anesthesia techniques should be aimed at preventing airway manipulation such as endotracheal intubation, which is associated with a higher risk of pulmonary complications in infected patients. These recommendations are structured in pre-, intra-, and post-operative management in suspected or confirmed infected patients with SARS-CoV-2, based in local hospital infection committee recommendations and the most recent literature available regarding regional anaesthesia. They are aimed at anesthesiology personnel, with the main goals being both teamand patient safety. The SARS-CoV-2 virus will be not the last novel virus to trigger global pandemics, so having a well-structured regional anesthesia plan to manage this kind of cases will ensure the best outcome possible to both patients and the perioperative team.

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Marolf, Vincent, Claudia Spadavecchia, Nicole Müller, Charlotte Sandersen, and Helene Rohrbach. "Opioid requirements after locoregional anaesthesia in dogs undergoing tibial plateau levelling osteotomy: a pilot study." Veterinary Anaesthesia and Analgesia 48, no. 3 (May 2021): 398–406. http://dx.doi.org/10.1016/j.vaa.2020.10.010.

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Ciprandi, Guido, Hilmar Kjartansson, Francesca Grussu, Baldur T. Baldursson, Jacopo Frattaroli, Urbano Urbani, and Mario Zama. "Use of acellular intact fish skin grafts in treating acute paediatric wounds during the COVID-19 pandemic: a case series." Journal of Wound Care 31, no. 10 (October 2, 2022): 824–31. http://dx.doi.org/10.12968/jowc.2022.31.10.824.

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Objective: More specific strategies are needed to support children requiring skin grafting. Our goal was to identify procedures that reduce operating times, post-operative complications, pain and length of hospital stay. Patient safety, optimal wound bed support and quick micro-debridement with locoregional anaesthesia were prioritised. Ultimately, a novel acellular fish skin graft (FSG) derived from north Atlantic cod was selected for use. Method: We admitted consecutive paediatric patients with various lesions requiring skin grafting for definitive wound closure. All FSGs were applied and bolstered in the operating room following debridement. Results: In a cohort of 15 patients, the average age was 8 years and 9 months (4 years 1 month–13 years 5 months). Negative pressure wound therapy (NPWT) was given to 12 patients. Rapid wound healing was observed in all patients, with a wound area coverage of 100% and complete healing in 95% of wounds. Time until engraftment in patients receiving NPWT was reduced by about a half (to an average 12 days) from our standard experience of 21 days. Ten patients received locoregional anaesthesia and were discharged after day surgery. The operating time was <60 minutes, and no complications or allergic reactions were reported. Excellent pliability of the healed wound was achieved in all patients, without signs of itching and scratching in the postoperative period. This case series is the first and largest using FSG to treat paediatric patients with different wound aetiologies. We attribute the rapid transition to acute wound status and the good pliability of the new epidermal–dermal complex to the preserved molecular components of the FSG, including omega-3. Conclusion: FSG represents an innovative and sustainable solution for paediatric wound care that results in shorter surgery time and reduced hospital stays, with accelerated wound healing times.

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Basukala, Sunil, Raveesh Mishra, Alok Raj Gautam, Bikram Basukala, and Saurav Karki. "Locoregional Anesthesia for Major Abdominal Surgeries during COVID-19 Outbreak: An Experience in a Tertiary Care Hospital of Kathmandu, Nepal." Annapurna Journal of Health Sciences 1, no. 2 (August 8, 2021): 16–20. http://dx.doi.org/10.52910/ajhs.37.

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Introduction: Locoregional Anesthesia (LA) has many benefits over general anaesthesia in major abdominal surgeries with high risks including avoidance of endotracheal intubation thus avoiding aerosol contamination during coronavirus disease 2019 (COVID-19). Methods: A retrospective analysis was performed among patients undergone major abdominal surgery under loco regional anesthesia during April 2019 and March 2020 in 750 bedded tertiary care hospital during COVID- 19 pandemic. In all cases, locoregional anesthesia (spinal, epidural, or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative complications were monitored and was analyzed. Results: A total of twenty-four cases were included during the study period. Among the cases, majority of cases belonged to Gastrointestinal, n=17(70.83%). The mean operative time was 94 minutes (minimum 55 minutes; maximum 168 minutes). None of the cases required conversion to general anesthesia. Postoperative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien–Dindo ≥3) occurred. Three cases were found to be infected with COVID -19 infection postoperatively. Conclusion: Our study showed that major abdominal surgeries under loco regional anesthesia resulted feasible, safe, painless, and, in specific cases, was the only viable option. In such a pandemic, it could become a vital strategy to avoid contamination among Health care workers (HCWs) and could limit viral transmission inside theatres.

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Alza Salvatierra, Diego N., Manuel E. Herrera Linares, Luca Motta, and Miguel Martinez. "Ultrasound-guided erector spinae interfascial plane block for spinal surgery in three cats." Journal of Feline Medicine and Surgery Open Reports 7, no. 2 (July 2021): 205511692110438. http://dx.doi.org/10.1177/20551169211043814.

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Case series summary The erector spinae plane (ESP) block consists of an interfascial injection of local anaesthetic between the erector spinae muscle group and the transverse processes of the thoracic vertebrae. This block targets the dorsal rami of the thoracic spinal nerves to desensitise the cutaneous area near the dorsal midline, the paraspinal muscles, the dorsal vertebral laminae and the facet joints. The purpose of this case series is to describe the perioperative analgesic effect and complications of ultrasound-guided ESP block with bupivacaine in three cats undergoing spinal surgery. Only one cardiovascular response was recorded in this case series. Just one cat received intraoperative rescue analgesia. Cats 1 and 2 recorded just one high pain score in the first 24 h postoperatively, and cat 3 recorded three high pain scores. The total amount of methadone given in the 24 h postoperatively was 0.6 mg/kg in cat 1, 0.9 mg/kg in cat 2 and 0.8 mg/kg in cat 3. All three cats suffered mild and transient intraoperative complications, which were easily addressed. There were no postoperative complications. Relevance and novel information This case series documents a novel locoregional anaesthesia technique as an alternative to traditional systemic analgesia. The technique is part of a multimodal analgesia approach for spinal surgery in cats. Perioperative analgesic effect and complications presented in this case series are evaluated and discussed.

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Bhat, H. Hari Kishore, and Varsha Haridas Upadya. "Correction of whistle deformity secondary to cleft lip repair by V-Y plasty: a simple and effective technique." BMJ Case Reports 14, no. 12 (December 2021): e246303. http://dx.doi.org/10.1136/bcr-2021-246303.

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Several techniques are available for the surgical repair of the cleft lip, however, avoiding secondary deformities and achieving consistent results remains a challenge. The whistle deformity is a secondary lip deformity characterised by inadequate fullness of the central upper lip with abnormal exposure of the central incisors when the lips are at rest, giving a whistling appearance. The causes include scarring of the vermilion and failure to restore the mucosal or muscular continuity. Various surgical options are available ranging from simple procedures like V-Y plasty and Z-plasty to complex procedures like complete lip redo, locoregional flaps, fillers and grafts. V-Y plasty is a simple, effective procedure for lip lengthening that can be performed under local anaesthesia as an outpatient procedure. It is less technique sensitive and also allows for some degree of muscle repair. We present a case of whistle deformity satisfactorily corrected with V-Y plasty.

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Viscasillas, Jaime, Ariel Cañón, Eva Hernández, Agustín Martínez, Reyes Marti-Scharfhausen, Pilar Lafuente, and José Ignacio Redondo. "Clinical Assessment of Introducing Locoregional Anaesthesia Techniques as Part as the Intraoperative Analgesia Management for Canine Ovariohysterectomy in a Veterinary Teaching Hospital." Animals 12, no. 15 (July 29, 2022): 1939. http://dx.doi.org/10.3390/ani12151939.

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This study compared four methods to provide intraoperative analgesia during canine ovariohysterectomy in a veterinary teaching hospital. A retrospective study was designed to assess the nociceptive response, cardiorespiratory stability, quality of recovery and complications of four analgesic protocols: epidural analgesia (EPIDURAL group), Quadratus Lumborum block (QLB group), Transversus Abdominis Plane block (TAP group), and just systemic analgesia (GENERAL group). Undergraduate students carried out all the loco-regional techniques under the direct supervision of a qualified anaesthetist. A total of 120 cases met the inclusion criteria and were included in the study and were distributed as follows: 22, 27, 32 and 39 cases with EPIDURAL, GENERAL, QLB and TAP groups, respectively. Data were analysed with statistical software R using different statistical methods. Significant differences among groups were defined as p < 0.05. Based on our results, all the groups needed the same number of rescue analgesia during the intra-operative period. The use of loco-regional techniques anticipated a better quality of recovery compared with the general group. The EPIDURAL group showed a statistically lower expired fraction of sevoflurane. No differences were found regarding complications. In conclusion, these four analgesic methods are suitable and safe to be performed for canine ovariohysterectomy, although loco-regional techniques might have some advantages.

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Sbarigia, E., A. Schioppa, M. Misuraca, M. A. Panico, C. Battocchio, C. Maraglino, F. Speziale, and P. Fiorani. "Somatosensory Evoked Potentials versus Locoregional Anaesthesia in the Monitoring of Cerebral Function During Carotid Artery Surgery: Preliminary Results of a Prospective Study." European Journal of Vascular and Endovascular Surgery 21, no. 5 (May 2001): 413–16. http://dx.doi.org/10.1053/ejvs.2001.1342.

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Poškus, Tomas, Narimantas Evaldas Samalavičius, Romanas Kęstutis Drąsutis, Gintautas Radžiūnas, Antanas Vaitkus, and Alfredas Songaila. "Užpakalinis tarpvietės blokas operuojant išangę ir tiesiąją žarną." Lietuvos chirurgija 1, no. 3 (January 1, 2003): 0. http://dx.doi.org/10.15388/lietchirur.2003.3.2411.

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Tomas Poškus, Narimantas Evaldas Samalavičius, Romanas Kęstutis Drąsutis, Gintautas Radžiūnas, Antanas Vaitkus, Alfredas SongailaVilniaus centro universitetinės ligoninės Chirurgijos skyrius,Žygimantų g. 3, LT-2001 VilniusEl paštas: toshcus@yahoo.com Tikslas Įvertinti kombinuoto vietinės ir regioninės nejautros metodo – užpakalinio tarpvietės bloko – rezultatus atliekant išangės ir tiesiosios žarnos operacijas. Ligoniai ir metodai Nuo 2002 07 10 iki 2003 04 18 Vilniaus centro universitetinės ligoninės Chirurgijos skyriuje buvo operuota 117 ligonių, sirgusių įvairiomis išangės ir tiesiosios žarnos ligomis. Straipsnyje detaliai aprašoma užpakalinio tarpvietės bloko metodika, naudojama šių operacijų metu. Rezultatai Atliktos 29 šoninės sfinkterotomijos Notaras būdu, 65 hemoroidektomijos Nivatvongs būdu, 11 hemoroidektomijų ir šoninių sfinkterotomijų, 2 fistulektomijos dėl žemų išangės ir tiesiosios žarnos fistulių, 3 papilomektomijos dėl išangės polipų, 7 sudėtinės operacijos (hemoroidektomijos ir fistulektomijos, šoninės sfinkterotomijos ir fistulektomijos, hemoroidektomijos ir papilomektomijos) – iš viso 117 operacijų. Visi operuojami ligoniai jautė proktoskopo įstūmimo momentą, tačiau tai apibrėžė ne kaip skausmą, o kaip diskomfortą išangės srityje. Operacijos metu kitokių vaistų nuskausminimui nevartota, anesteziologų pagalbos nereikėjo. Anestetikai komplikacijų nesukėlė. Operacijos dieną 88 ligoniai išrašyti namo praėjus 2–6 valandoms po operacijos. Šlapimo susilaikymo atvejų nepasitaikė. Pooperaciniam nuskausminimui rekomenduoti nesteroidiniai vaistai nuo uždegimo, dažniausiai ciklooksigenazės-2 inhibitoriai. Išvados Užpakalinis tarpvietės blokas yra veiksmingas, saugus ir pigus nejautros metodas išangės ir tiesiosios žarnos operacijoms. Jis tinka ambulatorinei ar vienos dienos stacionaro chirurgijai. Prasminiai žodžiai: užpakalinis tarpvietės blokas, regioninė nejautra, išangės ir tiesiosios žarnos operacijos. Posterior perineal block in anorectal surgery Tomas Poškus, Narimantas Evaldas Samalavičius, Romanas Kęstutis Drąsutis, Gintautas Radžiūnas, Antanas Vaitkus, Alfredas Songaila Objective To evaluate the results of the method of locoregional anaesthesia – the posterior perineal block in anorectal operations. Patients and methods From 10 07 2002 til 18 04 2003 117 patients were operated on for various anorectal diseases at the Departament of Surgery of Vilnius Center University Hospital. A detailed description of the technique of posterior perineal block used in these cases is presented. Results Performed were 29 lateral internal sphincterotomies according to Notaras, 65 closed Nivatvongs haemorrhoidectomies, 11 such haemorrhoidectomies combined with lateral sphincterotomies, 2 fistulectomies for low anorectal fistulae, 3 polypectomies for anal polyps and 7 combined operations (e.g. haemorrhoidectomies with fistulectomies, lateral sphincterotomies with fistulectomies, haemorrhoidectomies with polypectomies), in total 117 operations. Sufficient anaesthesia was induced in all patients, no help from anaesthesiologists was required. No complications of anaesthetics was noted. All the patients felt the introduction of a Fansler proctoscope 3.2 cm in diameter, but they described it as a discomfort and not as pain; 88 patients did not require any analgesic medication on the operation day, and they were discharged on the same day. No cases of urinary retention occurred. Conclusions Posterior perineal block is an effective and safe method of anaesthesia for anorectal operations. Postoperative urinary retention is prevented, the costs of treatment are reduced, conditions for ambulatory surgery are provided by employing this technique. Keywords: posterior perineal block, regional anaesthesia, anorectal operations.

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Bennani, Imane, Raphael Lopez, Delphine Bonnet, Gregoire Prevot, Arnaud Constantin, Dominique Chauveau, Carle Paul, and Cristina Bulai Livideanu. "Improvement of Microstomia in Scleroderma after Carbon Dioxide Laser Treatment." Case Reports in Dermatology 8, no. 2 (May 24, 2016): 142–50. http://dx.doi.org/10.1159/000445821.

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Limited mouth opening (LMO) is a frequent complication of systemic sclerosis (SS). Its management is complex and there are limited treatment options. We report four patients with SS and severe LMO [interincisal distance (IID) <30 mm] treated with pulsed carbon dioxide (CO2) laser. Pulsed CO2 laser treatment of the white lips was performed after all patients had signed a written informed consent in the absence of alternative treatment. Treatment was carried out under locoregional anaesthesia using a Sharplan 30C CO2 laser in the Silk Touch® resurfacing mode. One to three laser sessions were performed at intervals of 8-12 months between sessions. Assessments were performed at 3 and 12 months with measurement of the IID using a ruler, calculation of the Mouth Handicap in Systemic Sclerosis (MHISS) scale and global evaluation by the patients. Adverse events were also reported. In all four patients, an improvement in IID occurred 3 months after the first session with a mean gain of +5 mm (range: 2-7). At 12 months, a mean gain of +8.5 mm (range: 7-10) in IID was observed. The MHISS score decreased by a mean of -14 (range: 11-17). All patients showed improvement of lip flexibility or mouth opening, allowing better phonation and mastication and easier dental care. Adverse effects were transient erythema and/or dyschromia. CO2 laser appears to be effective and well tolerated in the improvement of LMO in SS.

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Sendler, Andreas, and Karl R. Aigner. "Intra-arterial, abdominal chemoperfusion with chemofiltration in the treatment of progressive stage IV gastric cancer." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 141. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.141.

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141 Background: Treatment of patients (pts.) with progeressive stage IV gastric cancer remains a therapeutical problem. Survival of the pretreated pts. is low and the therapeutic options are sparse. In this situation, locoregional therapeutic strategies could be an option. Methods: 28 pretreated pts. (17 male, 11 female, mean age 59 y.) after resection and at least second line systemic chemotherapy were included in a phase II study of isolated abdominal perfusion and subsequent chemofiltration. All pts. had liver metastases (mets.), 50% (n = 14) had peritoneal carcinomatosis with malignant ascites. No pat. had cerebral, pulmonal or bone mets.. After insertion of a venous and arterial 21 ch. stop flow catheter via a femoral access, the v. cava was blocked beneath the right atrium, the arterial catheter was blocked above the celiac trunk. The thighs were blocked by pneumatic cuffs. Chemotherapy consisted of 35 mg/m2 cisplatinum, 20 mg/m2 adriamycin and 12 mg/m2 mitomycin q 3 weeks till progress or dead. The agents were administered via the arterial access, followed by 15 min of hypoxic abdominal perfusion via an external pump, followed by chemofiltration for 45 min. The procedure was done under general anaesthesia. Primary endpoint of the study were overall survival, secondary endpoint was control of the ascites. Results: A total of 92 cycles (mean 3.25) were administered. Toxicity was low with leucopenia CTC grad I in 9 pts., gastrointestinal disorders grad II in 8 pts. and surgical complications grad II in 40 % of the pat. (lymphatic fistula). In 9/14 (65%) of pts. with ascites, the ascites was at least controlled or vanished. One year survival was 28.6% (Kaplan-Meier), 2 year survival was 11.4%. Median survival was 6 months. Conclusions: Intra-arterial, isolated abdominal chemoperfusion with consecutive chemofiltration in heavily pretreated patients with gastric cancer metastasized to the abdominal cavity is a valuable option for palliative treatment with low side effects. In 65% of the affected pts., malignant ascites was controlled sufficiently, ameliorating the quality of life.

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Claydon, M., K. Sieunarine, M. Abbas, S. Ponosh, and R. Tripathi. "Re: The Retrojugular Route: The Ideal Exposure for Carotid Endarterectomy Performed Under Locoregional Anaesthesia. E. Neri, M. Giubbolini, F. Setacci, I. Baldi and C. Setacci. European Journal Vascular and Endovascular Surgery 26, 250–255 (2003)." European Journal of Vascular and Endovascular Surgery 27, no. 5 (May 2004): 565–66. http://dx.doi.org/10.1016/j.ejvs.2004.03.013.

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Palásthy, Zsolt, Róbert Sipka, Gábor Mihalovits, Tibor Takács, László Leindler, Zoltán Hódi, Rita Váradi, et al. "A perifériás érbetegség ellátásának változásai a Szegedi Tudományegyetemen." Magyar Sebészet 75, no. 2 (June 20, 2022): 185–93. http://dx.doi.org/10.1556/1046.2022.20015.

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Bevezetés és célkitűzés Az elmúlt évtizedekben az élet egyéb területeihez hasonlóan az egészségügy változásai is rendkívüli módon felgyorsultak. Korábban egy-egy hatékony eljárás elsajátítása révén az orvos hosszú éveken át garantálhatta betegei számára a legmagasabb szintű ellátást. Napjainkra a fejlődés dinamikájának következtében az alkalmazott gyógyítás módszereinek megújulási ciklusai lerövidültek, folyamatos tanulás és képzés nélkül már elképzelhetetlen a betegek által igényelt korszerű ellátás biztosítása. Anyag és módszerek Az érsebészeti rekonstrukciók tekintetében sokáig vezető szerepet játszó, műérrel végzett érpótlások helyett meghatározóvá vált az endovasculáris technikák elsődlegessége. Különösen nagy előnyt jelenthet ez a nagy invazivitással operálható aorta aneurysmák vonatkozásában. A katéteres módszerek érsebészek által történő elsajátítása tette lehetővé az érpálya kiterjedt érintettségével járó megbetegedések sikeresebb kezelését az ún. hybrid műtétek révén. A diabetes világszerte emelkedő prevalenciájának és a kritikus végtagischemiás betegek arányának növekedése mellett előtérbe helyeződött a multirezisztens baktériumok kóroki szerepe is, amelyek végeredményben az eddig preferált prosteticus graftok alkalmazásának háttérbe szorulását eredményezték. Az így ritkábbá váló graftinfectiók kezelésének eredményességét javítja a homograftok és a negatív nyomásterápia alkalmazása. A stroke megelőzésének hatékony eszköze a carotis endraterectomia, amelynek morbiditását csökkenti a direkt neuromonitoringot lehetővé tevő locoregionalis anaesthesia bevezetése. Eredmények/következtetések Az új eljárások elsajátítása és mindennapi gyakorlatba történő átültetése az elmúlt 10 évben folyamatos kihívás elé állította szakdolgozóinkat és orvosainkat, elért eredményeink azonban az ország vezető érsebészeti centrumai közé emelték osztályunkat.

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Demczuk Thomas, Lettycia, Ronaldo José Piccoli, Jéssica Fernanda Sinotti, Carolina Fucks de Souza, and Fabiola Bono Fukushima. "Regional Intravenous Anaesthesia (Bier's block) in Black-headed Vulture (Coragyps atratus) Submitted to Digit Amputation." Acta Scientiae Veterinariae 50 (September 25, 2022). http://dx.doi.org/10.22456/1679-9216.121354.

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Background: The Coragyps atratus flies long distances in search of food and has a marked behaviour of food competition. Since they are frequently found in areas of recent human occupation, they are subject to trauma, which may require surgical interventions. Locoregional blocks are used as part of a balanced-anaesthesia protocol and are currently being evaluated in birds, with brachial plexus block being the main technique described in the literature. However, to our knowledge, this is the first description of intravenous regional anaesthesia (Bier's block) in a vulture. Thus, we aim to report the use of Bier's block with 1% lidocaine, in a black-headed vulture submitted to digit amputation. Case: A black-headed vulture (Coragyps atratus), weighing 2 kg, was rescued and referred to the Veterinary Hospital due to its inability to fly. Physical examination revealed a swollen digit in the right pelvic limb. Radiographic examination confirmed the intermediate phalanx fracture of the 4th digit of the right pelvic limb with signs suggestive of advanced osteomyelitis. The animal was referred to surgery for amputation of the affected digit. Before surgery, water and food were withdrawn for 12 h. Pre-anaesthetic medication consisted of 1 mg/kg midazolam and 0.5 mg/kg morphine intramuscularly (IM). Anaesthetic induction was performed through face mask with isoflurane, followed by orotracheal intubation with a 3 mm-endotracheal tube. Anaesthesia was maintained with isoflurane through a non-rebreathing circuit in 100% oxygen. Using a multiparametric monitor, heart rate (HR), respiratory rate (RR), end-tidal CO2 (EtCO2), oxyhemoglobin saturation (SpO2), electrocardiography (ECG), systolic blood pressure (SBP) and core temperature (CT) were evaluated. Antisepsis of the right pelvic limb was performed and an elastic band was applied around the distal region of the affected tibia to serve as a tourniquet. A scalp vein set was used to access the lateral saphenous vein in the region distal to the tourniquet, and 5 mg/kg lidocaine 1% was injected intravenously. The patient remained stable during the procedure, with no need for analgesic rescue. The tourniquet was gradually released 40 min past its application, being completely removed after 45 min of surgery. The anaesthetic supply was interrupted, with extubation after 4 min; the patient had satisfactory anaesthetic recovery. Discussion: The present report describes the success in using the technique of intravenous regional anaesthesia with 1% lidocaine for digit amputation performed on a specimen of black-headed vulture. The pre-anaesthetic medication provided analgesia, satisfactory sedation for venoclysis, and anaesthetic induction without complications. Anaesthetic induction and maintenance in birds are preferably performed with inhaled anaesthetics, thus the choice of mask induction. Despite the reduction in RR soon after induction, the patient remained on spontaneous ventilation. Bier's block using 5 mg/kg lidocaine showed to be an easy and safe technique in vultures, but doses up to 6 mg/kg lidocaine are not associated with adverse effects in birds. The intravenous regional anaesthesia technique described in this manuscript promoted adequate analgesia for the digit amputation procedure in black-headed vultures and allowed hemodynamic stability without significant anaesthetic complications. Thus, the present report points to the potential use of this locoregional block in other birds. Keywords: locorregional block, lidocaine, anaesthesia. Título: Anestesia regional intravenosa (bloqueio bier) em urubu-de-cabeça-preta (Coragyps atratus) submetido à amputação de dígito. Descritores: bloqueio locorregional, lidocaína, anestesia.

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Romanzi, Andrea, Gaetano Gallo, Sabrina De Rango, Barbara Vignati, and Alberto Vannelli. "Pain Distraction During Awake Major Colorectal Surgery: Supporting Patients Beyond the COVID-19 Era. Preliminary Findings." Frontiers in Surgery 8 (September 17, 2021). http://dx.doi.org/10.3389/fsurg.2021.754059.

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Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, hospitals rapidly ran out of intensive care beds. Because minimally invasive surgery and general anaesthesia are both aerosol-generating procedures, their use has become controversial. We report a case series of awake undelayable colorectal surgeries which, innovatively, took advantage of intraoperative pain distraction. Moreover, we describe our frugal solution to social distancing in psychological support of inpatients.Methods: Between October 2020 and February 2021, five patients underwent acute-care colorectal surgery under locoregional anaesthesia in our department. A 3D mobile theatre (3DMT) was used during the operation to distract the patients from pain. Vital signs, pain intensity, ergonomic comfort/discomfort, sense of presence and distress were intraoperatively monitored. A postoperative “cuddle delivery” service was instituted: video messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional effects were investigated through clinical interviews conducted by a psychologist at our hospital.Results: Both intraoperative and postoperative pain were always well controlled. Conversion to general anaesthesia and postoperative intensive support/monitoring were never necessary. The “cuddle delivery” initiative helped patients fill the emotional gap created by the strict containment measures implemented inside the hospital, distracting them from emotional anxiety and physical pain.Conclusions: During the next phase of the COVID-19 pandemic and even after the COVID-19 era, awake laparotomy under locoregional anaesthesia may be a crucial option for delivering acute-care surgery to selected patients when intensive care beds are unavailable and postponing surgery is unacceptable. We also introduce a new modality for the provision of emotional support during postoperative inpatient care as a countermeasure to the restrictions imposed by social distancing measures.

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Antoniou, Asterios, Alexandros Louizakis, Dimitris Tatsis, Anestis Chrysostomidis, Athanassios Kyrgidis, and Konstantinos Vahtsevanos. "Nasal reconstruction after skin cancer surgery; presentation of treatment modalities for medically compromised patients." Hellenic Archives of Oral and Maxillofacial Surgery 23, no. 1 (April 2022). http://dx.doi.org/10.54936/haoms231o16.

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Nasal reconstruction after surgical excision of non-melanoma skin cancer defects can be a challenging condition for every head and neck surgeon. There are certain technical difficulties that arise from the tissue deficit and the area that a locoregional flap can cover. What is more, patients with a compromised medical history cannot always receive a surgical management under general anaesthesia, limitating even more the defect reconstruction. The aim of the present study is to present two patients that were treated under local anaesthesia for advanced basal cell carcinomas of the nose, with modifications of paramedian and hemi-nasal flaps that provided excellent surgical and aesthetic outcomes, despite the limits of the surgical modality.

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Paterne Mobio, Nkan Michael, Koffi Isidore Kouame, N'Guessan Yapi Francis, Kouesseu Judith Bouh, Kouassi Jean Konan, and Lacina Soro. "Intravenous Locoregional Anesthesia: An Alternative of Choice in a Country with Limited Resources (Abidjan- Cote d'Ivoire)." Archives of Anesthesia and Critical Care, June 12, 2022. http://dx.doi.org/10.18502/aacc.v8i3.9606.

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Background: ALRIV, a simple, reliable, inexpensive and easily reproducible technique, is still little practised in sub-Saharan Africa. The objective of this study is to describe our practice in order to popularize this anesthetic technique. Methods: This was a prospective and descriptive study covering a 12-month period. All patients admitted for surgical management of upper limb except the arm and lower limb except the thigh were included. The parameters studied were epidemiological, clinical, therapeutic, anaesthetic and evolutionary. Results: We selected 73 patients out of 675 (10.81%). The majority of the patients were seen in the framework of a regulated surgery against only 13.69% in emergency. The operative indications were: removal of osteosynthesis materials (52.05%), limb osteosynthesis (43.83%) and phlegmon evacuation (4.10%). The double tourniquet technique was used in (93.15%). Lidocaine 0.5% was used at a dose of 0.5ml/kg. The average duration of the procedures was 57.28 minutes. Postoperatively, all our patients received multimodal analgesia. In the postoperative monitoring room, 64.38% of patients did not experience any discomfort or pain. Conclusion: ALRIV is a simple technique of peripheral local anaesthesia that is easy to teach, consistently effective and inexpensive.

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Santonastaso, Domenico P., Annabella de Chiara, Emanuele Russo, Emiliano Gamberini, Leonardo Lucchi, Andrea Sibilio, Claude Bagaphou, et al. "A possible future for anaesthesia in breast surgery: thoracic paravertebral block and awake surgery. A prospective observational study." Tumori Journal, August 26, 2020, 030089162095162. http://dx.doi.org/10.1177/0300891620951626.

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Introduction: Quadrantectomy is a surgical procedure traditionally performed under general anaesthesia with intraoperative and postoperative opioid-based analgesia. The use of locoregional anaesthesia techniques in breast surgery has become widespread and allows excellent management of intraoperative and postoperative pain with reduced opioid consumption. We chose thoracic paravertebral block as regional anaesthesia technique in breast surgery to investigate the possibility of carrying out this surgery with the patient awake. Methods: A prospective observational study on 50 patients was designed. The primary outcome for this study was the possibility to carry out the surgery with only the paravertebral block associated with mild sedation without general anaesthesia. Forty minutes before the start of the surgery, an ultrasound-guided thoracic paravertebral block was performed at two thoracic levels, and for each level, 7 mL of ropivacaine 0.7% was injected. Sedation was obtained with target-controlled infusion of propofol. Results: Forty-nine patients underwent the operation awake; in one case, we had to place an I-gel and perform general anaesthesia. No patient needed intraoperative or postoperative opioids. The numeric rating scale, recorded at 0, 2, 6, 12, 24, and 36 hours, was greater than 3 in only five patients. Conclusions: We believe that if in the future we try to make quadrantectomy an intervention in which the anaesthesia is exclusively regional, therefore with a patient awake and collaborating, it will not be possible to ignore the use of thoracic paravertebral block.

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Donatiello, Valerio, Aniello Alfieri, Andrea Napolitano, Vincenzo Maffei, Francesco Coppolino, Vincenzo Pota, Maria Beatrice Passavanti, Maria Caterina Pace, and Pasquale Sansone. "Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysis." Journal of Anesthesia, Analgesia and Critical Care 2, no. 1 (December 19, 2022). http://dx.doi.org/10.1186/s44158-022-00076-1.

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Abstract Background Dexmedetomidine is a highly selective alpha-2 receptor agonist without any effect on the GABA receptor. It provides an excellent sedative and analgesic profile with few side effects. We report our experience with dexmedetomidine use during orthopaedic surgery under locoregional anaesthesia to ensure adequate sedation and optimal postoperative pain control. Methods In this retrospective analysis, we included 128 patients who underwent orthopaedic surgery between January 2019 and December 2021. All patients received the same local anaesthetic dose of 20 ml of ropivacaine 0.375% + mepivacaine 0.5% for axillary and supraclavicular block and 35 ml of ropivacaine 0.375% + mepivacaine 0.5% for triple nerve block (femoral, obturator and sciatic nerve). The cohort was divided into two groups based on sedation drugs used during surgery (dexmedetomidine, or group D, vs midazolam, or group M). All patients received postoperative 24-h analgesia consisting of 60 mg of ketorolac, 200 mg of tramadol and 4 mg of ondansetron. The primary outcome measured how many patients in the two groups required an analgesic rescue dose of pethidine and the time to first pethidine administration. To reduce confounding, we included patients in two groups with non-statistically different demo-anamnestic parameters and who received the same dose of intraoperative local anaesthetic and postoperative analgesia. Results The number of patients in group D who did not require a rescue dose of analgesia was significantly greater than in group M (49 vs 11, p < 0.001). Time-to-first postoperative opioid administration did not show a fundamental difference between the two groups under examination (523.75 ± 131.55 min vs 564 ± 117.84 min). Total opioid consumption was higher in the M group than in the D group (3529.8 ± 30.36 μg vs 1864.8 ± 31.59 μg, p 0.075), with a mean opioid consumption significantly higher in the M group than in the D group (26.26 ± 42.8 μg vs 69.21 ± 46.1 μg, p < 0.001): D group received 62.06% less opioid than M group. Conclusions The continuous infusion of dexmedetomidine during orthopaedic surgery performed under locoregional anaesthesia has been shown to increase the analgesic effect of local anaesthetics and reduce the consumption of major opioids in the postoperative period. Dexmedetomidine offers a unique ability to supply sedation and analgesia without respiratory depression, having a wide safety margin and an excellent sedative capacity. It does not increase the rate of postoperative complications.

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Kirchhoff, Felix, Hans-Henning Eckstein, Sofie Schmid, Sebastian Schmidt, Julia Mergen, Sofiane Dridi, Silke Wunderlich, et al. "Locoregional anaesthesia and intraoperative angiography in carotid endarterectomy - 16-year results of a consecutive single-centre series." European Journal of Vascular and Endovascular Surgery, October 2022. http://dx.doi.org/10.1016/j.ejvs.2022.10.002.

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Izard, P., J. Pouymayou, B. Chaminade, S. Pierre, and P. Rougé. "868 LONG LASTING LOCOREGIONAL ANAESTHESIA THROUGH INDWELLING CATHETER CONNECTED TO SUBCUTANEOUS PORT FOR CHRONIC CANCER PAIN RELIEF." European Journal of Pain 13, S1 (September 2009). http://dx.doi.org/10.1016/s1090-3801(09)60871-5.

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MS, Chaibou, Labo Madougou R, Daddy H, Dodo Siddo MN, Nanzir Sanoussi M, Gagara M, James Didier L, Younssa H, Sanoussi S, and Sani R. "Anaesthesia for thyroidectomy at the Niamey National Hospital." Anesthesia & Pain Research 5, no. 2 (December 30, 2021). http://dx.doi.org/10.33425/2639-846x.1057.

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Objectives: To describe anesthesiological management of thyroidectomy at Niamey National Hospital. Method: This was a prospective study conducted from, January 1st to June 30th 2018. Were been included all patients who underwent an anesthesiological procedure with a complete record for a thyroidectomy at the National Hospital of Niamey. The following variables were studied: age, sex, comorbidity, ASA class Status, Mallampati class, operative indication, anesthesia technique, anesthetic protocol, intraoperative anesthetic incidents and accidents, duration of surgery, duration of anesthesia, duration in resuscitation room, postoperative follow-up. The data were analyzed by the software Word 2013 and Epi Info 3.5.4. Results: The series included 33 patients, 28 women (84.84%) and 5 men (15.16%). The average age was 42 years ± 8.3 with extremes of 24 years to 78 years. The operative indications were dominated by multinodular goiter with 42.42%; the Mallampati 1 class was predominant with 51.51% of cases; the ASA 2 class status represent 54.54% of cases; difficult intubation involved 18.20% of patients. General anesthesia was the only technique used in all our patients. Hypotension was the major perioperative incident for 6 of 7 patients involved. Total thyroidectomy was the most performed procedure in 72.72% of patients. Postoperative analgesia was provided by paracetamol, NSAIDs, tramadol and nefopam with a predominance of paracetamol+tramadol combination in 66.60% of cases. The average duration of the surgery was 80 minutes with extremes of 36 minutes to 120 minutes. The operative follow-ups were simple in 97% of cases with a zero-mortality rate. The average hospital stay was 7 days with extremes of 3 days to 14 days. Conclusion: Thyroidectomy under general anesthesia is a well-understood procedure today in our context, but it is necessary to train teams in the practice of locoregional anesthesia adapted to our environment.

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Grott, Matthias, Martin Eichhorn, Florian Eichhorn, Werner Schmidt, Michael Kreuter, and Hauke Winter. "Thoracic surgery in the non-intubated spontaneously breathing patient." Respiratory Research 23, no. 1 (December 27, 2022). http://dx.doi.org/10.1186/s12931-022-02250-z.

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Abstract Background The interest in non-intubated video-assisted thoracic surgery (NIVATS) has risen over the last decade and numerous terms have been used to describe this technique. They all have in common, that the surgical procedure is performed in a spontaneously breathing patient under locoregional anaesthesia in combination with intravenous sedation but have also been performed on awake patients without sedation. Evidence has been generated favouring NIVATS compared to one-lung-ventilation under general anaesthesia. Main body We want to give an overview of how NIVATS is performed, and which different techniques are possible. We discuss advantages such as shorter length of hospital stay or (relative) contraindications like airway difficulties. Technical aspects, for instance intraoperative handling of the vagus nerve, are considered from a thoracic surgeon’s point of view. Furthermore, special attention is paid to the cohort of patients with interstitial lung diseases, who seem to benefit from NIVATS due to the avoidance of positive pressure ventilation. Whenever a new technique is introduced, it must prove noninferiority to the state of the art. Under this aspect current literature on NIVATS for lung cancer surgery has been reviewed. Conclusion NIVATS technique may safely be applied to minor, moderate, and major thoracic procedures and is appropriate for a selected group of patients, especially in interstitial lung disease. However, prospective studies are urgently needed.

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Vukusic, Sandra, Clarisse Carra-Dalliere, Jonathan Ciron, Elisabeth Maillart, Laure Michel, Emmanuelle Leray, Anne-Marie Guennoc, et al. "Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society." Multiple Sclerosis Journal, November 1, 2022, 135245852211294. http://dx.doi.org/10.1177/13524585221129472.

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Objective: The objective of this study was to develop evidence-based recommendations on pregnancy management for persons with multiple sclerosis (MS). Background: MS typically affects young women in their childbearing years. Increasing evidence is available to inform questions raised by MS patients and health professionals about pregnancy issues. Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and university databases (January 1975 through June 2021). The RAND/UCLA appropriateness method was developed to synthesise the scientific literature and expert opinions on healthcare topics; it was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence. Results: A strong agreement was reached for all 104 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, locoregional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses and disease-modifying treatments. Conclusion: The 2022 recommendations of the French MS society should be helpful to harmonise counselling and treatment practice for pregnancy in persons with MS, allowing for better and individualised choices.

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Tan, Y. N., PJ Vandekerckhove, and P. Verdonk. "The long road to recovery: at six months since the first COVID-19 wave, elective orthopedic care has still not fully recovered in Belgium." Journal of Experimental Orthopaedics 7, no. 1 (December 2020). http://dx.doi.org/10.1186/s40634-020-00316-9.

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Abstract Purpose The primary aim of our study was to investigate elective orthopaedic care during the first wave government-imposed COVID-19 lockdown and at four weeks and 21 weeks after resuming elective care. The secondary aim of our study was to evaluate the implementation of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) COVID-19 Guidelines and Recommendations for Resuming Elective Surgery in the clinical practice of Belgian knee surgeons. Methods We sent three anonymous online surveys to 102 Belgian Knee Society members (BKS) at times mentioned above. Addressed topics were: (1) participant demographics, (2) elective surgeries, (3) outpatient visits, (4) ESSKA Guidelines, (5) patient and surgeon safety. Results During the COVID-19 lockdown, there was a decrease of 97% in elective knee surgeries and 91% in outpatient visits. At four and 21 weeks after resuming elective care, volumes were respectively 67% and 89% for elective surgeries and 81% and 91% for outpatient visits. Regarding ESSKA guidelines, 91% of surgeons had no COVID-19 testing prior to resuming elective care. Ninety-two per cent reported preoperative (< 72 h) patient PCR testing, and 45% gave preference to young patients without comorbidities. Seventy-two per cent did not use additional personal protective equipment (PPE) if a patient PCR test was negative. Forty-nine per cent continued to give preference to general anaesthesia. Conclusion Our study shows that elective surgeries and outpatient visits were almost completely interrupted during the COVID-19 lockdown and were still below normal at four and 21 weeks after resuming elective care. Regarding ESSKA COVID-19 guidelines, our study observes good compliance in preoperative patient COVID-19 testing, but lower compliance for preoperative health care personnel testing, patient selection, use of PPE, and locoregional anaesthesia. Level of Evidence V

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Chiancone, Francesco, Marco Fabiano, Maria Ferraiuolo, Lucia de Rosa, Elena Prisco, Maurizio Fedelini, Clemente Meccariello, Giulio Visciola, and Paolo Fedelini. "Clinical implications of transversus abdominis plane block (TAP-block) for robot assisted laparoscopic radical prostatectomy: A single-institute analysis." Urologia Journal, September 18, 2020, 039156032095722. http://dx.doi.org/10.1177/0391560320957226.

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Introduction: The aim of this study was to evaluate the role of TAP block in improvement of anesthesiological management and perioperative surgical outcomes of robot-assisted laparoscopic radical prostatectomy (RALP). Methods: We consecutive enrolled 93 patients with prostate cancer whose underwent RALP at our department from January 2019 to December 2019. Group A included 45 patients who received bilateral TAP block, and Group B included 48 patients who did not received TAP block. TAP blocks were always performed by a single anesthesia team. An elastomeric pump device was used in all patients for post-operative pain management. TAP block was performed according to Rafi’s technique, with Ropivacaine 0.375% and dexamethasone 4 mg. Mean values with standard deviations (±SD) were computed and reported for all items. Statistical significance was achieved if p-value was ⩽0.05 (two-sides). Results: The two groups showed no difference in the most important demographics and baseline characteristics ( p > 0.05). Group A showed a significant longer time of anaesthesia. Moreover, Ketorolac doses (started dose plus continuous post-operative infusion via elastomeric pump) used in Group A were significantly lower than Group B. Despite this, Group B showed statistical significant higher value of NRS PACU and at 12, 24, 48, 72 h than Group A but not at 96 h. Rescue analgesic medication use was significantly higher in the Group B than Group A. Moreover, patency of the intestinal tract and time to ambulation was significantly lower in the Group A. Discussion: The use of TAP block during a RALP is a safe procedure that can be applied more appropriately to achieve better pain control. A multimodal protocol that includes locoregional anesthesia, reduction of intra and postoperative use of strong opiates, correct placing of the patient and the use of low pneumoperitoneum pressures should be implemented in order to reach a faster and better post-operative full recovery of patients whose underwent RALP.

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Sansone, Pasquale, Luca Gregorio Giaccari, Mario Faenza, Pasquale Di Costanzo, Sara Izzo, Caterina Aurilio, Francesco Coppolino, Maria Beatrice Passavanti, Vincenzo Pota, and Maria Caterina Pace. "What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction." BMC Anesthesiology 20, no. 1 (November 23, 2020). http://dx.doi.org/10.1186/s12871-020-01206-4.

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Abstract Background Breast surgery in the United States is common. Pain affects up to 50% of women undergoing breast surgery and can interfere with postoperative outcomes. General anesthesia is the conventional, most frequently used anaesthetic technique. Various locoregional anesthetic techniques are also used for breast surgeries. A systematic review of the use of locoregional anesthesia for postoperative pain in breast surgery is needed to clarify its role in pain management. Objectives To systematically review literature to establish the efficacy and the safety of locoregional anesthesia used in the treatment of pain after breast surgery. Methods Embase, MEDLINE, Google Scholar and Cochrane Central Trials Register were systematically searched in Mars 2020 for studies examining locoregional anesthesia for management of pain in adults after breast surgery. The methodological quality of the studies and their results were appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and specific measurement properties criteria, respectively. Results Nineteen studies evaluating locoregional anesthesia were included: 1058 patients underwent lumpectomy/mastectomy, 142 breast augmentation and 79 breast reduction. Locoregional anesthesia provides effective anesthesia and analgesia in the perioperative setting, however no statistically significant difference emerged if compared to other techniques. For mastectomy only, the use of locoregional techniques reduces pain in the first hour after the end of the surgery if compared to other procedures (p = 0.02). Other potentially beneficial effects of locoregional anesthesia include decreased need for opioids, decreased postoperative nausea and vomiting, fewer complications and increased patient satisfaction. All this improves postoperative recovery and shortens hospitalization stay. In none of these cases, locoregional anesthesia was statistically superior to other techniques. Conclusion The results of our review showed no differences between locoregional anesthesia and other techniques in the management of breast surgery. Locoregional techniques are superior in reducing pain in the first hour after mastectomy.

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Journal articles on the topic 'LOCOREGIONAL ANAESTHESIA'

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