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Minerva Anestesiologica Oct 2009Pediatric regional anesthesia has attained wide use internationally because of its efficacy and safety; its use is supported by the existence of extensive data from the... (Review)
Review
Pediatric regional anesthesia has attained wide use internationally because of its efficacy and safety; its use is supported by the existence of extensive data from the international literature underlining the safety and efficacy of this technique. Safer drugs and dedicated pediatric tools are the keys to this success. Indeed, if we compare the drugs available to pediatric anesthesiologists for use in performing a block years ago with those in use today, it can be seen that progress in this area has been tremendous. The long journey began many years ago; at that time, pediatric regional anesthesia was seen as an extravagant and useless technique, used by only a few and opposed by many detractors. Despite its well-known benefits, clinical failures can occur during the application of regional anesthetic techniques. Neurovascular anatomy is highly variable, and presently available nerve localization techniques provide little or no information regarding the anatomical spread of local anesthesia; furthermore, traditional nerve localization techniques (nerve stimulation) rely on anatomical assumptions that may be incorrect. Modern imaging techniques, such as computed tomography scanning and ultrasound, are now available for improving these procedures. The ultrasound technique is now widely applied in children and many reports confirm the efficacy and advantages of this method. In children, ultrasound guidance has been shown to improve block characteristics, resulting in shorter block performance time, higher success rates, shorter onset, longer block duration, reduction in volume of local anesthetic agents required, and better visibility of neuraxial structures. Clinical studies in children suggest that ultrasound guidance has some advantages for regional block over more traditional nerve stimulation-based techniques. However, with the exception of ilio-inguinal blocks, the advantage of ultrasound guidance over traditional with respect to safety has not been adequately demonstrated in children, since there are only a limited number of randomized control trials in children comparing ultrasound-guided peripheral nerve block with other techniques. Real-time ultrasound guidance for peripheral regional anesthesia is not a foolproof technique. New data have emerged suggesting that the novice ultrasonographer may often commit repeated errors, the two most common being failure to visualize the needle during advancement and unintentional probe movement. For this reason, the American Society of Regional Anesthesia and the European Society of Regional Anesthesia created a Joint Committee, and a document was produced ''to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of ultrasound-guided regional anesthesia services".
Topics: Anesthesia, Conduction; Child; Humans; Nerve Block
PubMed: 19798014
DOI: No ID Found -
Cardiovascular Journal of Africa 2022
Topics: Anesthesia, Conduction; Humans
PubMed: 35904555
DOI: 10.5830/CVJA-2022-034 -
Minerva Anestesiologica Jan 2021Regional anesthesia has a very interesting long history, initially preferred over general anesthesia because of safety concerns, then for a period general anesthesia...
Regional anesthesia has a very interesting long history, initially preferred over general anesthesia because of safety concerns, then for a period general anesthesia became safer and was preferred. The use of innovative technologies such as ultrasound technology has made the blocks safer and successful by directly visualizing targeted nerves and the location of local anesthetics. With the wide use of ultrasound in the regional anesthesia field success rate of peripheral nerve blocks increased and novel blocks techniques developed. Moreover, new extended-release local anesthetic agents have begun to be promising time-efficient and longer duration of analgesia with a single injection. In this article, we attempt to summarize some of the novel block techniques, pharmacological agents, and new technologies in the field of regional anesthesia.
Topics: Analgesia; Anesthesia, Conduction; Anesthesia, Local; Anesthetics, Local; Humans; Nerve Block
PubMed: 32959636
DOI: 10.23736/S0375-9393.20.14791-6 -
Minerva Anestesiologica Sep 2005The introduction of low molecolar weith heparin (LMWE) and the strong antithromboembolic prophylaxis protocols used in the USA, underlined the risk of spinal hemorrhage... (Review)
Review
The introduction of low molecolar weith heparin (LMWE) and the strong antithromboembolic prophylaxis protocols used in the USA, underlined the risk of spinal hemorrhage in patients receveing a neuraxial blockade. On the other side, the efficacy of these techniques over general anesthesia doesn't allow the anesthesist to miss this pratice, where possible. So it's necessary to quantify the spinal hematoma risk in patients assuming these drugs. Unfortunately, routine investigations on coagulation factors and platelets count are not reliable if patients are receiving LMWE. Waiting for dynamic tests concerning the coagulative status such as thromboelastography (TEG), many hospitals follow many different guidelines. For these reasons peripherical nerve block techniques are a good alternative, since they are not influenced by the efficacy of the coagulation system.
Topics: Anesthesia, Conduction; Hemorrhage; Humans; Nerve Block; Thromboembolism
PubMed: 16166907
DOI: No ID Found -
Minerva Anestesiologica Nov 2014Regional anesthesia is associated with recognized physiological advantages; however trials evaluating its impact on postoperative outcomes have shown contrasting... (Review)
Review
Regional anesthesia is associated with recognized physiological advantages; however trials evaluating its impact on postoperative outcomes have shown contrasting results, probably because these effects have not been utilized in a multimodal perioperative care program. Enhanced recovery has attracted clinical interest because of its standardized, coordinated, multidisciplinary perioperative care plan that incorporates several evidenced-based interventions with positive influence on postoperative patient recovery. A critical analysis of the published evidence is here presented in order to understand the role of regional anesthesia and analgesia as part of the multidisciplinary components of the enhanced recovery program. Clearly, there are synergistic benefits derived from integrating specific regional anesthetic and analgesic techniques with other perioperative elements characteristic of a particular surgical procedure. This challenge requires a team approach in delivering such integrated care, ultimately providing the best cure for patient.
Topics: Anesthesia Recovery Period; Anesthesia, Conduction; Humans; Outcome Assessment, Health Care; Postoperative Period; Quality Improvement
PubMed: 24492666
DOI: No ID Found -
British Journal of Hospital Medicine... Oct 2022Peripheral regional blockade is a type of regional anaesthesia involving depositing local anaesthetics around a specific nerve or bundle of nerves that help transmit... (Review)
Review
Peripheral regional blockade is a type of regional anaesthesia involving depositing local anaesthetics around a specific nerve or bundle of nerves that help transmit nociceptive signals to higher centres, such as the thalamus and somatosensory cortex. It is not only a widely used technique that provides surgical anaesthesia, but also acts as an essential part of the armamentarium against postoperative pain and pain following major skeletal trauma. This article discusses the structure and function of peripheral nerves, the classification and pathophysiology of peripheral nerve injury and, finally, how practising anaesthetists are committed to maximising success and minimising harm when performing peripheral nerve blockade in the operating theatre.
Topics: Humans; Nerve Block; Anesthesia, Conduction; Anesthetics, Local; Pain, Postoperative; Anesthesia, Local; Peripheral Nerves
PubMed: 36322433
DOI: 10.12968/hmed.2022.0304 -
The British Journal of Surgery Sep 2021
Review
Topics: Anesthesia, Conduction; Humans; Pain, Postoperative; Surgical Procedures, Operative
PubMed: 34131701
DOI: 10.1093/bjs/znab214 -
Anesthesiology Nov 2010
Review
Topics: Anesthesia, Conduction; Animals; Eye; Humans; Intraoperative Complications; Ophthalmologic Surgical Procedures
PubMed: 20938330
DOI: 10.1097/ALN.0b013e3181f7a78e -
British Journal of Anaesthesia Apr 2021
Topics: Ambulatory Surgical Procedures; Anesthesia, Conduction; Humans; Nerve Block; Pain; Peripheral Nerves
PubMed: 33551124
DOI: 10.1016/j.bja.2020.12.034 -
Anaesthesia Feb 2014
Topics: Anesthesia, Conduction; Anesthetics, Local; Bupivacaine; Female; Humans; Nerve Block; Thoracic Wall; Ultrasonography, Interventional
PubMed: 24443871
DOI: 10.1111/anae.12584