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Anaesthesia Mar 2022Various techniques have been explored to prolong the duration and improve the efficacy of local anaesthetic nerve blocks. Some of these involve mixing local anaesthetics... (Review)
Review
Various techniques have been explored to prolong the duration and improve the efficacy of local anaesthetic nerve blocks. Some of these involve mixing local anaesthetics or adding adjuncts. We did a literature review of studies published between 01 May 2011 and 01 May 2021 that studied specific combinations of local anaesthetics and adjuncts. The rationale behind mixing long- and short-acting local anaesthetics to hasten onset and extend duration is flawed on pharmacokinetic principles. Most local anaesthetic adjuncts are not licensed for use in this manner and the consequences of untested admixtures and adjuncts range from making the solution ineffective to potential harm. Pharmaceutical compatibility needs to be established before administration. The compatibility of drugs from the same class cannot be inferred and each admixture requires individual review. Precipitation on mixing (steroids, non-steroidal anti-inflammatory drugs) and subsequent embolisation can lead to serious adverse events, although these are rare. The additive itself or its preservative can have neurotoxic (adrenaline, midazolam) and/or chondrotoxic properties (non-steroidal anti-inflammatory drugs). The prolongation of block may occur at the expense of motor block quality (ketamine) or block onset (magnesium). Adverse effects for some adjuncts appear to be dose-dependent and recommendations concerning optimal dosing are lacking. An important confounding factor is whether studies used systemic administration of the adjunct as a control to accurately identify an additional benefit of perineural administration. The challenge of how best to prolong block duration while minimising adverse events remains a topic of interest with further research required.
Topics: Analgesics, Opioid; Anesthesia, Conduction; Anesthesia, Local; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Drug Therapy, Combination; Humans; Magnesium; Nerve Block
PubMed: 34904711
DOI: 10.1111/anae.15641 -
Anaesthesia Jan 2021Regional anaesthesia in children has evolved rapidly in the last decade. Although it previously consisted of primarily neuraxial techniques, the practice now...
Regional anaesthesia in children has evolved rapidly in the last decade. Although it previously consisted of primarily neuraxial techniques, the practice now incorporates advanced peripheral nerve blocks, which were only recently described in adults. These novel blocks provide new avenues for providing opioid-sparing analgesia while minimising invasiveness, and perhaps risk, associated with older techniques. At the same time, established methods, such as infant spinal anaesthesia, under-utilised in the last 20 years, are experiencing a revival. The impetus has been the concern regarding the potential long-term neurocognitive effects of general anaesthesia in the young child. These techniques have expanded from single shot spinal anaesthesia to combined spinal/epidural techniques, which can now effectively provide surgical anaesthesia for procedures below the umbilicus for a prolonged period of time, thereby avoiding the need for general anaesthesia. Continuous 2-chloroprocaine infusions, previously only described for intra-operative regional anaesthesia, have gained popularity as a means of providing prolonged postoperative analgesia in epidural and continuous nerve block techniques. The rapid, liver-independent metabolism of 2-chloroprocaine makes it ideal for prolonged local anaesthetic infusions in neonates and small infants, obviating the increased risk of local anaesthetic systemic toxicity that occurs with amide local anaesthetics. Debate continues over certain practices in paediatric regional anaesthesia. While the rarity of complications makes comparative analyses difficult, data from large prospective registries indicate that providing regional anaesthesia to children while under general anaesthesia appears to be at least as safe as in the sedated or awake patient. In addition, the estimated frequency of serious adverse events demonstrates that regional blocks in children under general anaesthesia are no less safe than in awake adults. In infants, the techniques of direct thoracic epidural placement or caudal placement with cephalad threading each have distinct advantages and disadvantages. As the data cannot support the safety of one technique over the other, the site of epidural insertion remains largely a matter of anaesthetist discretion.
Topics: Adolescent; Anesthesia, Conduction; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Pediatrics
PubMed: 33426659
DOI: 10.1111/anae.15283 -
Anaesthesia May 1991
Topics: Amides; Anesthesia, Conduction; Anesthetics, Local; Animals; Humans; Ropivacaine
PubMed: 2035775
DOI: 10.1111/j.1365-2044.1991.tb09537.x -
International Journal of Molecular... Mar 2016This review summarizes current knowledge concerning incidence, risk factors, and mechanisms of perioperative nerve injury, with focus on local anesthetic-induced... (Review)
Review
This review summarizes current knowledge concerning incidence, risk factors, and mechanisms of perioperative nerve injury, with focus on local anesthetic-induced neurotoxicity. Perioperative nerve injury is a complex phenomenon and can be caused by a number of clinical factors. Anesthetic risk factors for perioperative nerve injury include regional block technique, patient risk factors, and local anesthetic-induced neurotoxicity. Surgery can lead to nerve damage by use of tourniquets or by direct mechanical stress on nerves, such as traction, transection, compression, contusion, ischemia, and stretching. Current literature suggests that the majority of perioperative nerve injuries are unrelated to regional anesthesia. Besides the blockade of sodium channels which is responsible for the anesthetic effect, systemic local anesthetics can have a positive influence on the inflammatory response and the hemostatic system in the perioperative period. However, next to these beneficial effects, local anesthetics exhibit time and dose-dependent toxicity to a variety of tissues, including nerves. There is equivocal experimental evidence that the toxicity varies among local anesthetics. Even though the precise order of events during local anesthetic-induced neurotoxicity is not clear, possible cellular mechanisms have been identified. These include the intrinsic caspase-pathway, PI3K-pathway, and MAPK-pathways. Further research will need to determine whether these pathways are non-specifically activated by local anesthetics, or whether there is a single common precipitating factor.
Topics: Anesthesia, Conduction; Anesthetics, Local; Caspases; Dose-Response Relationship, Drug; Neurotoxicity Syndromes; Perioperative Period; Signal Transduction; Time Factors
PubMed: 26959012
DOI: 10.3390/ijms17030339 -
Agri : Agri (Algoloji) Dernegi'nin... Oct 2023With the increase in ultrasound use, regional anesthesia practices have gained popularity and many novel techniques are being described. However, the rapidly increasing... (Review)
Review
With the increase in ultrasound use, regional anesthesia practices have gained popularity and many novel techniques are being described. However, the rapidly increasing number of new block techniques also led to confusion. Therefore, seven basic regional anesthesia techniques that are effective in most of the surgeries have been listed as 'Plan A Blocks.' The purpose of this review is to introduce the basic sono-anatomy and indications of Plan A blocks.
Topics: Humans; Nerve Block; Anesthesia, Conduction; Ultrasonography; Anesthesia, Local
PubMed: 37886870
DOI: 10.14744/agri.2022.02256 -
Minerva Anestesiologica Mar 2022
Topics: Anesthesia, Conduction; Humans; Ultrasonography; Ultrasonography, Interventional
PubMed: 35315626
DOI: 10.23736/S0375-9393.22.16465-5 -
Current Opinion in Anaesthesiology Aug 2008To review the recently published peer-reviewed literature involving regional anesthesia and analgesia in patients at home. (Review)
Review
PURPOSE OF REVIEW
To review the recently published peer-reviewed literature involving regional anesthesia and analgesia in patients at home.
RECENT FINDINGS
The potential benefits and risks of regional anesthesia and analgesia at home are pertinent queries, and increased data regarding these topics are rapidly becoming available. Of particular interest is the use of continuous peripheral nerve blocks at home and their potential effect upon hospitalization duration and recovery profile.
SUMMARY
Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the interscalene block provides effective analgesia with minimal complications, whereas the impact and risks of intraarticular injections remain unclear. Perineural catheters are an analgesic option that offer improved pain relief among other benefits. They are now being used at home in both adult and pediatric populations.
Topics: Ambulatory Care; Analgesia; Anesthesia, Conduction; Home Infusion Therapy; Humans; Nerve Block; Pain, Postoperative
PubMed: 18660659
DOI: 10.1097/ACO.0b013e328303bfb5 -
Minerva Anestesiologica May 2014Regional anesthesia has become a widely used method to provide intraoperative anesthesia, and postoperative analgesia. This review seeks to address the question whether... (Review)
Review
Regional anesthesia has become a widely used method to provide intraoperative anesthesia, and postoperative analgesia. This review seeks to address the question whether patient outcomes are improved to an extent that justifies using regional anesthesia as a routine method. During the past decade, a very critical appraisal of risks and benefits of regional anesthetic procedures has taken place. In general, the indications for epidural blockade have decreased, and are limited to individual high-risk patients, major upper abdominal and major vascular surgery, and thoracotomy. We review the changing role of central and peripheral regional anesthesia in the perioperative management of total knee arthroplasty. Immediate perioperative outcome after knee arthroplasty concerning function and pain is improved, and rehabilitation facilitated, by peripheral nerve blockade, but this does not translate into superior functional outcome one year later. A substantial share of the beneficial effects of regional anesthesia on the immune system, hemostasis, pain, and the duration of ileus can be duplicated using intravenous administration of local anesthetics. In general, the use of regional anesthesia should always be preceded by a weighing of potential risks and proven benefits. Regional anesthesia continues to play a major role in perioperative medicine, but its role keeps getting more defined and less non-committal.
Topics: Anesthesia, Conduction; Humans; Risk; Risk Assessment; Treatment Outcome
PubMed: 24193234
DOI: No ID Found -
Korean Journal of Anesthesiology Oct 2020Rebound pain after regional anesthesia can be defined as transient acute postoperative pain that ensues following resolution of sensory blockade, and is clinically... (Review)
Review
Rebound pain after regional anesthesia can be defined as transient acute postoperative pain that ensues following resolution of sensory blockade, and is clinically significant, either with regard to the intensity of pain or the impact on psychological well-being, quality of recovery, and activities of daily living. Current evidence suggests that it represents an unmasking of the expected nociceptive response in the absence of adequate systemic analgesia, rather than an exaggerated hyperalgesic phenomenon induced by local anesthetic neural blockade. In the majority of patients, it does not appear to significantly impact cumulative postoperative opioid consumption, quality of recovery, or patient satisfaction, and is not associated with longer-term sequelae such as persistent post-surgical pain. Nevertheless, it must be considered whenever regional anesthesia is incorporated into perioperative management. Strategies to mitigate the impact of rebound pain include routine prescribing of a systemic multimodal analgesic regimen, as well as patient education on appropriate expectations regarding block offset and expected surgical pain, and timely initiation of analgesic medication. Prolonging the duration of action of regional anesthesia with continuous catheter techniques or local anesthetic adjuncts may also help alleviate rebound pain, although further research is required to confirm this.
Topics: Anesthesia, Conduction; Combined Modality Therapy; Humans; Pain Management; Pain Measurement; Pain, Postoperative
PubMed: 32773724
DOI: 10.4097/kja.20436 -
Anaesthesia Jan 2021
Topics: Anesthesia, Conduction; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Nerve Block
PubMed: 33426654
DOI: 10.1111/anae.15321