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Erector Spinae Plane Block As An Alternative To Epidural Analgesia In Kidney Surgery A Case Report
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Book Synopsis ERECTOR SPINAE PLANE BLOCK AS AN ALTERNATIVE TO EPIDURAL ANALGESIA IN KIDNEY SURGERY : A CASE REPORT. by :
Download or read book ERECTOR SPINAE PLANE BLOCK AS AN ALTERNATIVE TO EPIDURAL ANALGESIA IN KIDNEY SURGERY : A CASE REPORT. written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: ETIENNE A. 1, BOSMAN F. 1, JORION J-L. 2, VANDER ESSEN L. 1, SAMOURI G. 1 1.tAnesthesiology department2.tUrology surgery departmentThe erector spinae plane (ESP) block was first described in 2016 by Forero et al. (1). It involves the injection of local anesthetic into the interfascial plane, deep to erector spinae muscle (ESM), allowing the blockade of the dorsal and ventral rami of the thoracic spinal nerves. It was initially proposed for analgesia of costal fractures and pulmonary lobectomy (1).We report the case of a left nephrectomy, performed in a 61 years old man. The plan combined general anesthesia with an epidural catheter. After several unsuccessful attempts to place the epidural catheter, we performed a left ESP block. The needle was advanced in plane, and we injected 20 cc of a solution (Levobupivacau00efne 0.25% with epinephrine 1 / 200.000 and clonidine 75 microgram) deep to ESM at the level of T12.Postoperative analgesia included paracetamol, and PCA piritramide IV pump. Piritramide is an opioid commonly used in Belgium, with an analgesic ratio 0.7 versus morphine.No opioid consumption on recovery room, only 11 mg on day one, and 9 mg on the day two. The PCA was removed at the beginning of the second day and analgesia was performed only with paracetamol and tradonal.Altought epidural remains the first choice for lombotomy, this reported case shows the potential interest of an ESP block when an epidural is difficult or impossible. ESP block is easy to learn and safe. It would be interesting to think about the insertion of a catheter which could extend the duration of the analgesia.Bibliography1.tForero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41:621u20137.
Book Synopsis 2 - ERECTOR SPINAE PLANE BLOCK FOR POSTOPERATIVE ANALGESIA AFTER VATS: A SAFE AND EFFECTIVE ALTERNATIVE TO EPIDURAL ANALGESIA. by :
Download or read book 2 - ERECTOR SPINAE PLANE BLOCK FOR POSTOPERATIVE ANALGESIA AFTER VATS: A SAFE AND EFFECTIVE ALTERNATIVE TO EPIDURAL ANALGESIA. written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Postoperative pain increases the morbidity and mortality after surgery. It gains importance in thoracic surgery, because the rehabilitation is essential in the initial postoperative period. For this reason, alternative analgesic techniques to the epidural are useful for cases in which epidural wasnu2019t possible.Case report: Fifty years old woman scheduled for right inferior lobectomy by VATS. In this case, epidural catheter couldnu2019t be possible due to a osteoporotic fracture at spinous process of the fifth and sixth thoracic vertebras. We performed an ESP blocks at the T5 level. About 3 centimeters lateral to the transverse process of T5 localizated the rhomboid, trapezius and erector spinal muscles. The inferior fascia of the erector muscle of the spine was located with a Tuhoy needle. We administrated 25cc of levobupivacaine 0.5% to dissect the interfascial space and placed a catheter at this level. We used analgesia by the catheter in the intraoperatory and first three postoperative days. Postoperative pain was less than 4 over 10 in VAS, during the postoperative period.Conclusions: The erector spinae plane block is a simple technique of postoperative analgesia, easily reproducible with an adequate safety profile that allows a good analgesic control in postoperative pain after videothoracoscopy.
Book Synopsis BILATERAL ERECTOR SPINAE PLANE BLOCKS AS AN ALTERNATIVE TO EPIDURAL IN A PATIENT ON CLOPIDOGREL by : Boyne Bellew
Download or read book BILATERAL ERECTOR SPINAE PLANE BLOCKS AS AN ALTERNATIVE TO EPIDURAL IN A PATIENT ON CLOPIDOGREL written by Boyne Bellew and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and aimsA 63 year old, ASA 4, female patient with a 12 cm abdominal aortic aneurysm due to type II and III endoleaks required a laparotomy via rooftop incision. She was bedbound with significant cardiac, respiratory and renal comorbidities and on clopidogrel for a coronary stent. Bilateral erector spinae plane catheters (ESPC) were used for analgesia in place of epidural to avoid the risk of epidural haematoma.MethodsFollowing general anaesthesia, bilateral ESPC were placed with ultrasound guidance. An initial bolus of 20mls 0.25% levobupivacaine was given bilaterally. Post-operatively, an infusion of plain 0.125% levobupivacaine was commenced at 10mls/hour through each catheter. She required multiple blood products including 28 units of packed red cells.ResultsOn day 2 post-operatively she was able to cough comfortably and was successfully extubated. The ESPC were removed on day 4 post surgery. ConclusionsThe addition of epidurals to general anaesthesia can reduce the 30-day mortality following high-risk surgery and provide excellent analgesia. However, these are contra-indicated in patients requiring some antiplatelet therapies. It is recognised that regional nerve blocks may provide a safer alternative. The ESPC has been shown to be efficacious for abdominal surgery. As this is relatively new, the risk of haemorrhagic complications is not described in current guidelines. We suggest that ESPC may provide a safer alternative to epidurals in patients on clopidogrel.
Book Synopsis CONTINUOUS ERECTOR SPINAE PLANE BLOCK WITH EPIDURAL CATHETER FOR POSTu2011OPERATIVE ANALGESIA FOLLOWING THORACIC SURGERIES: A CASE SERIES by : ALI RAZA KHAN
Download or read book CONTINUOUS ERECTOR SPINAE PLANE BLOCK WITH EPIDURAL CATHETER FOR POSTu2011OPERATIVE ANALGESIA FOLLOWING THORACIC SURGERIES: A CASE SERIES written by ALI RAZA KHAN and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background & Aims:Erector spinae plane block (ESPB) is a novel regional analgesia technique for thoracic and abdominal surgeries. It can be employed for analgesia as an alternative to epidural block in patients presenting for thoracic surgeries. ESPB provides adequate analgesia, is technically easier to perform, and safer due to lower risk of serious complications as compared to epidural block. We have illustrated this by presenting a case series of thoracic surgeries in which an ESPB catheter was used for postoperative analgesia. We reviewed our SOP regarding use of continuous ESPB use for thoracic surgeries.Methods:35 patients (ASA-III/IV) who underwent thoracic surgery (VATS, thoracotomy) under GA were included. Ultrasound-guided, 16-G epidural catheter was inserted at T5 level cephalo-caudally. 30 mL of 0.25% bupivacaine in ESPB administered prior to incision supplemented with Tramadol (1 mg/kg IV). Postoperatively ESPB infusion was started at 10 mL/h of 0.1% bupivacaine. The dose and catheter management in rooms/ward was done by anesthesia technicians. The outcomes assessed were number of hours in PACU stay, VAS 2 hourly in PACU and then 8 hourly in rooms/ward), safety profile and number of days of catheter in situ. Rescue analgesia was Tramadol 0.75 mg/kg IV SOS, Ketorolac 0.5 mg/kg IV BD (if not contraindicated) and Paracetamol 1 g IV TDS. The authors certify that appropriate consent were obtained from the patients and their identity is not been disclosed.Continuous Erector Spinae Plane block with epidural catheter for post-operative analgesia following thoracic surgeries.A case seriesResults:Patient stay in PACU was for 8u00b14 hours. Mean VAS 2 hourly in PACU was 3u00b12 while mean VAS 8 hourly in room/ward was 1u00b11. None of the patients had hypotension necessitating vasopressor support, and the catheter remained in situ for 4u00b12 days. 34.2% (N=12) patients who experienced VAS 5, required supplemental analgesia.Discussion:TEA and PVB are mostly chosen as the first line regional analgesic techniques in thoracic surgeries for the pain management.[1, 2] When there is a contraindication or failure of these blocks, intercostal nerve block remained as an alternative but necessitating multiple injections. ESP block can serve as an alternative either as a single dose or as a continuous catheter based infusion for post-thoracotomy pain. Forero et al.[3] demonstrated ESPB as rescue analgesia in thoracotomy after a failed epidural. They revealed comparable pain score between TEA and ESP block until 12 h postextubation. The VAS scores remained to be persistently u22644 until 48 h in either of the group.Conclusions:Our case series reflects that ESPB provides adequate postoperative analgesia with no hemodynamic compromise in patients undergoing thoracic surgeriesReferences1 Romero A, Et. al. The state of the art in preventing postt-horacotomy pain. Semin Thorac Cardiovasc Surg. 2013;25:116u201324.2 Yeung JH, Et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2:CD009121.3 Forero M, Et al. Continuous ESPB for rescue analgesia in thoracotomy after epidural failure. A Case Rep. 2017;8:254u20136.
Book Synopsis CATHETERIZED ERECTOR SPINAE PLANE BLOCK AS A PAIN MANAGEMENT FOR RIGHT PULMONARY BRONCHOGENIC CANCER PAIN, A CASE REPORT by : Aulia Nailufar
Download or read book CATHETERIZED ERECTOR SPINAE PLANE BLOCK AS A PAIN MANAGEMENT FOR RIGHT PULMONARY BRONCHOGENIC CANCER PAIN, A CASE REPORT written by Aulia Nailufar and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:Research has shown that Erector spinae plane (ESP) block can be used as safe analgesic technique for acute and chronic neuropathic pain. For recurrent pain, ESP block can be administered through a catheter giving a long term analgesic effect. We present a case of catheterized ESP block as a pain management modality for pulmonary bronchogenic cancer pain.Methods:A 46-years-old woman, diagnosed with pulmonary bronchogenic carcinoma, had severe stabbing neuropathic pain with a 9/10 severity on the numerical rating score (NRS). The pain didn't subside significantly even after we administered intravenous fentanyl 50mcg/hour, 1g paracetamol every 6 hours, and 12,5mg amitriptyline every 24 hours. We decided to use ESP block due to inadequate pain control for this patient. Using ultrasound guided technique, we inserted a catheter to the interfascial plane below the musculus erector spinae and injected local anesthetic periodically. We used 20cc bupivacaine 0.125% every 12 hours.ResultsThe patient had significant decrease of pain numerical rating scale from 5-6/10 at first 12 hours to 1-2/10 at 48 hours. We evaluated that satisfactory pain control was achieved and maintained after 48 hours after first local anesthetic administration.Conclusions:Periodical administration of ESP block can be used as an effective alternative pain intervention for patient with severe cancer pain with inadequate pain control by high dose opioid.
Book Synopsis CONTINUOUS ERECTOR SPINAE PLANE BLOCK FOR MULTIMODAL ANALGESIA AFTER WIDE MIDLINE LAPAROTOMY: A CASE REPORT. by :
Download or read book CONTINUOUS ERECTOR SPINAE PLANE BLOCK FOR MULTIMODAL ANALGESIA AFTER WIDE MIDLINE LAPAROTOMY: A CASE REPORT. written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The most commonly used regional techniques for analgesia following laparotomyu2e3athoracic epidural analgesia and paravertebral blocksu2e3aare technically difficult to perform and carry a risk of severe complications. Recently, the erector spinae plane block (ESPB) has been reported to effectively treat neuropathic pain. The ultrasound-guided ESPB is an easily performed fascial plane block that can provide sensory blockade from T2u20134 to T12u2013L1. Moreover, the ESPB reportedly blocks both the ventral rami of spinal nerves and the rami communicants, which contain sympathetic nerve fibers, through spread into the thoracic paravertebral space. Here, we report the case of a 35-year-old female patient who underwent excision of a larger ovarian mass via laparotomy with a wide, midline incision from the xiphoid process to the pubic tubercle. After the surgery, an ultrasound-guided continuous ESPB was performed with bilateral catheter placement at the level of T8. The first demand dose of fentanyl was administered at 9 h and 39 min after the surgery. There were no reported resting pain scores higher than 4, nor were any rescue analgesics needed during the first 5 postoperative days. Thus, a continuous ESPB provided highly effective analgesia after laparotomy with a wide midline incision.
Book Synopsis Continuous ERECTOR SPINAE PLANE BLOCK: First Choice in Perioperative Analgesia in Thoracotomy Surgery? by : Cristu00f3vu00e3o Tiago Pinto
Download or read book Continuous ERECTOR SPINAE PLANE BLOCK: First Choice in Perioperative Analgesia in Thoracotomy Surgery? written by Cristu00f3vu00e3o Tiago Pinto and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Backgroud and AimsThoracic epidural analgesia are currently the first line techniques for use in managing perioperative pain follow thoracotomy (1). Regional anesthetic techniques are strongly recommended primarily to reduce opioid use and the related adverse effects, including hypoventilation, sedation, nausea, and vomiting (2).In this way, continuous erector spinae plane (ESP) block is growing popularity because of its simplicity, safe and lesser side effects (1,2).We aim to present the result of the analgesic efficacy ofcontinuous ultrasound-guided ESP block in two cases of thoracotomy surgery.Case Report:65-year-old woman, presented for right inferior lobectomy (adenocarcinoma) and a 49-year-old woman, presented for left superior lobectomy (adenocarcinoma). Combined anesthesia (Balanced general anesthesia + continuous ESP) was performed. Before induction, the ultrasound-guided unilateral continuous ESP block was performed at the level of T5. 30 milliliters of ropivacaine 0,375% were administered.The multimodal approach for postoperative analgesia was: programmed intermittent mandatory boluses through the ESP catheter of ropivacaine 0,2% 8 ml/h + paracetamol 1g 8/8h + ketorolac 30mg 12/12h. Rescue analgesia with tramadol 100mg.The worst pain was 4 (numeric scale) 3 and 5 hours after surgery, respectively. At this time they both do tramadol 100mg. Beside this they donu00b4t need more rescue analgesia in the first 48 hours.ConclusionPain after thoracotomy can be difficult to control with a multimodal analgesia. Furthermor, thoracic epidural analgesia has potentially serious complications. Recently, ESP block has increased acceptance because it is a safe thoracic block with minor complications. With this two cases authors had shown that continuous ESP block provides effective post-operative analgesia follow thoracotomy with excellent pain control inside multimodal analgesic program with low opioids requirements.1- Forero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block: A novel analgesic technique in thoracic neuropatic pain. Regional Anesthesia and Pain Medicine. 2016 Sep u2013 Oct 41; 5: 621-27.2 - Forrero M, Rajarathinam M, Adhikary S, et Chin KJ. Continuous Erector Spinae Plane Block for Rescue Analgesia in Thoracotomy After Epidural Failure: ACase Report. . A & A Case Reports. MAY 15TH, 2017; 8(10):254u2013256.
Book Synopsis A NEW INDICATION OF ERECTOR SPINAE PLANE BLOCK FOR PERIOPERATIVE ANALGESIA IS PERCUTANEOUS NEPHROLITHOTOMY (PCNL) SURGERY: CASE SERIES. by :
Download or read book A NEW INDICATION OF ERECTOR SPINAE PLANE BLOCK FOR PERIOPERATIVE ANALGESIA IS PERCUTANEOUS NEPHROLITHOTOMY (PCNL) SURGERY: CASE SERIES. written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: A NOVEL APPLICATION OF ERECTOR SPINAE PLANE BLOCK - PERIOPERATIVE ANALGESIA FOR PERCUTANEOUS NEPHROLITHOTOMY (PCNL): CASE SERIESIntroduction and objective: PCNL is a surgical procedure commonly used to treat large kidney stones. The procedure is accompanied by severe pain, originating from the kidney and ureters (T10-L2) and somatic pain from the incision site (T8-12). Various analgesia techniques (neuraxial, systemic opioids and paravertebral/intercostal blocks) have been used for PCNL surgeries. ESP block is a simple, paraspinal, fascial block which blocks ventral, dorsal and rami communicates of spinal nerves to provide unilateral wide sensory and visceral analgesia. We present a series of 5 patients where ESP block was used along with general anaesthesia to provide perioperative analgesia. Material and methods: A series of 5 patients, undergoing PCNL surgery were included in the study. After induction of general anesthesia, patient was positioned prone and ultrasound guided ESP block( SINGLE SHOT) was given using 20ml 0f 0.375% ropivacaine plus 50micrograms of dexmedetomidine at lower thoracic level(T10-12). Additional requirement of intraoperative opioids, if any noted. Postop pain was assessed by VAS score 2 hourly for 24 hours. All patients received Inj. Paracetamol 1gm 8th hourly irrespective of VAS score. Any patient whose VAS score was u2265 4 was treated with Tramadol 100mg iv stat. Results and Discussion: None of the patients required additional opioids in the intraoperative period. 4 patients had VAS score of less than 3 and didnu2019t require any analgesics for 24 hours in the postoperative period. one patient had VAS score of 4 at 16 hours after surgery requiring 1 dose of Tramadol. Conclusion: ESP block is promising novel block to provide excellent intraoperative and postoperative analgesia for PCNL surgery.
Book Synopsis ERECTOR SPINAE PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN LAPAROSCOPIC HYSTERECTOMY U2013 A CASE REPORT by : Lara Ribeiro
Download or read book ERECTOR SPINAE PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN LAPAROSCOPIC HYSTERECTOMY U2013 A CASE REPORT written by Lara Ribeiro and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: ERECTOR SPINAE PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN LAPAROSCOPIC HYSTERECTOMY u2013 A CASE REPORTJ. Veiga1, R. Silva1, P. Almeida1, S. Oliveira1, L. Ribeiro1.1Hospital de Braga, Department of Anesthesia, Braga, Portugal.Background and Aims:The Erector Spinae Plane Block (ESP) was first described in 2016, and, since then, there has been growing interest and research about its potential as regional anesthetic/analgesic technique. With the present case we are interested in exploring the efficacy of ESP block as a postoperative analgesic method for laparoscopic hysterectomy.Methods:We describe a case of a 47-year-old female patient, ASA I scheduled for elective laparoscopic hysterectomy. A bilateral ultrasound-guided ESP block at T8 level was performed before general anesthesia induction. The anesthetic solution we used consisted of 20 ml Ropivacaine 0,5% (on each side). Systemic analgesia with Paracetamol 1g and Ketorolac 30mg was performed during the surgery and prescribed for 24h and after that u201con demandu201d.ResultsProcedure and recovery were uneventful with the patient experiencing good analgesia (NRS pain scale 0-2/10) 12 hours after block performance. No u201con demandu201d pain medication was requested by the patient during the hospital admission. The patient experienced no nausea or vomiting, was mobilized easily 6 hours after the block and was discharged 36 hours later.Conclusions:The ESP block applied to abdominal laparoscopic surgery has a relatively limited literature, particularly in laparoscopic hysterectomy. This is the reason we believe every new case is a valuable contribution. In this case report, the use of ESP block performed preoperatively dramatically reduced the amount of IV pain medication.The overall result was increased satisfaction of the patient, avoidance of opioid use and fast recovery.
Book Synopsis 30cm Length Subcostal Incision:Continuous ERECTOR SPINAE PLANE BLOCK was Truly Effective by : Cristu00f3vu00e3o Tiago Pinto
Download or read book 30cm Length Subcostal Incision:Continuous ERECTOR SPINAE PLANE BLOCK was Truly Effective written by Cristu00f3vu00e3o Tiago Pinto and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:Ultrasound-guided erector spinae plane (ESP) block is a regional anesthetic procedure originally described for thoracic analgesia when performed at the T5 transverse process1.However, if performed at lower thoracic levels, the ESP block can provide abdominal analgesia.A catheter inserted into this plane can extend analgesic duration and can be an alternative to epidural analgesia.2We aim to present the result of the analgesic efficacy of continuous ultrasound-guided ESP block at T8 level for a sub-costal incision for an open nephrectomy.Methods:65-year-old woman,presented for laparoscopic radical nephrectomy (giant tumor:17x12cm).A balanced general anesthesia was done.Due to laparoscopic technical difficulties, surgery was converted,requiring an antero-posterior subcostal incision (30cm length).Just before the awakening,an ultrasound-guided unilateral left continuous ESP block was performed at the level of T8.25 millilitres of ropivacaine 0,375% were administered.The multimodal approach for postoperative analgesia was:programmed intermittent mandatory boluses through the ESP catheter of ropivacaine 0,2% 8 ml/h + paracetamol 1g 8/8h + ketorolac 30mg 12/12h.Rescue analgesia with tramadol 100mg.ResultsDuring the 4 days of follow-up by the acute pain unit, there was no need for rescue analgesia. The maximum pain reported was 2 (Numeric scale). The ESP catheter was removed on the fourth day.Conclusions:Pain after subcostal incision presents a great challenge and was traditionally managed by placement of a thoracic epidural catheter. However, recently the ESP block has gained u201cpopularityu201d, even to abdominal analgesia.With this case,the authors showed that a lower continuous ESP block provides effective post-operative analgesia for sub-costal incision, and can be a valid option to integrate multimodal analgesia schemes.
Book Synopsis 5 - BILATERAL THORACIC CONTINOUS ERECTOR SPINAE BLOCK FOR PAIN RELIEF IN MULTIPLE BILATERAL RIB FRACTURES WITH FLAIL SEGMENT-A CASE REPORT by : Isaac Babu
Download or read book 5 - BILATERAL THORACIC CONTINOUS ERECTOR SPINAE BLOCK FOR PAIN RELIEF IN MULTIPLE BILATERAL RIB FRACTURES WITH FLAIL SEGMENT-A CASE REPORT written by Isaac Babu and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Rib fractures: relationship with pneumonia and mortality. Crit Care Med 2006; 34: 16422.Blanco R.The u2018pecsblocku2019: anovel techniquefor providing analgesia after breastsurgery.Anaesthesia2011;66:847u201383.Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block.Anaesthesia2013;68:1107u2013134.Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block. A novel analgesic technique in thoracic neuropathicpain.RegAnesthPainMed2016;41:621u201375. Ho AM, Karmakar MK, Critchley LA. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques.CurrOpinCritCare2011;17:323u201376. Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. Br J Anaesth 2017;118:474-5. 7. Steinthorsdottir KJ, Wildgaard L, Hansen HJ, Petersen RH, Wildgaard K. Regional analgesia for video-assisted thoracic surgery: A systematic review. Eur J Cardiothorac Surg 2014;45:959-66.8. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia 2017;72:452-60. AuthorsJesto Kurian , Isaac BabuAddress for correspondenceDr Jesto KurianConsultant AnaesthesiologistDepartment of anesthesiology,Rajagiri Hospital,Aluva ,KochiEmail: [email protected].
Download or read book Onco-critical Care written by Vinod Kumar and published by Springer Nature. This book was released on 2022-06-06 with total page 539 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides insights into the care of cancer patients in the intensive care unit in a comprehensive manner. It provides an evidence-based approach to practitioners and postgraduate students to understand about the critical care needs of the patients suffering from malignancies. It helps the readers to develop critical thinking and encourage discussion towards improving the overall care of the patients and their families as their optimal management requires expertise in oncology, critical care, and palliative medicine and there is a dearth of books explaining about the special requirements and critical care needs of cancer patients. Each chapter is prepared by an expert in the field and contains well-prepared illustrations, flowcharts and relevant images. Chapters include latest evidence-based information which is useful for the readers. The book is useful for residents, fellows and trainees in the field of onco-anaesthesia, onco-critical care, onco-surgery, critical care and anaesthesia; practitioners and consultants in anaesthesia and onco-anaesthesia as well as intensivist, critical care experts and postgraduates in nursing.
Book Synopsis Regional Anesthesia and Analgesia by : David Lee Brown
Download or read book Regional Anesthesia and Analgesia written by David Lee Brown and published by Saunders. This book was released on 1996 with total page 788 pages. Available in PDF, EPUB and Kindle. Book excerpt: This comprehensive, clinically oriented text can serve as either a stand-alone reference or as a companion to the ATLAS. Sections cover the development of regional anesthesia; basic science; induction of regional anesthesia; side effects, complications, and concurrent medical problems; and clinical applications. Each chapter features excellent illustrations and "clinical pearls."
Book Synopsis Erector Spinae Plane Block For Mastectomy And Reconstructive Surgery by :
Download or read book Erector Spinae Plane Block For Mastectomy And Reconstructive Surgery written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: Avoiding severe pain after mastectomy and reconstructive surgeries may prevent the development of chronic pain syndromes(1). Multimodal analgesic techniques including plane blocks like pectoral nerve (PEC), serratus or abdominal blocks are well described. Local anaesthetics (LA) placed in these planes may contaminate surgical sites. We describe a less invasive and simpler regional anaesthetic technique which provides extensive and prolonged analgesia with catheter placed in the erector spinae plane (ESP) at the relevent transverse processes(TP) (2) in three cases of mastectomy and reconstruction. This technique provided effective analgesia at both operative sites.Case Report:The first case involved a lady scheduled for left mastectomy with lateral intercostal perforator artery flap. She had ESP block performed at the T5 transverse process (TP5) as a rescue analgesia method four hours after standard PEC (1 and 2) and Serratus Anterior plane block and general anaesthesia. Her pain score decreased from 7/10 with coughing to 0/10 immediately after the rescue block. The second case had an ESP catheter sited at the level of TP3 to avoid contamination of the latissimus dorsi muscle flap with LA after induction. The patient reported a decrease of pain score from 6/10 to 0/10 immediately after a 10 ml 0.5% bolus of Ropivacaine the next day.The third case had bilateral ESP cathethers sited after induction for the right mastectomy, removal of pectoral muscle and implant and free flap from the contralateral thigh. The catheters were sited at the level of TP4 for the mastectomy and at TP9 for the donor site. The catheters were removed on post op day 3.Discussion: ESP catheter placement is a safe and simpler block that offers prolonged analgesia without hemodynamic compromise as compared to established epidural or paravertebral blocks. ESP cover extensive area with a single catheter sited between 2 distant sites. It is a useful addition to opioid sparing and multimodal analgesia method.
Book Synopsis ERECTOR SPINAE PLANE BLOCK: WHEN PARAVERTEBRAL BLOCK IS NOT AN OPTION by : Daniel da Melo
Download or read book ERECTOR SPINAE PLANE BLOCK: WHEN PARAVERTEBRAL BLOCK IS NOT AN OPTION written by Daniel da Melo and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:The accomplishment of paravertebral block requires integrity of the parietal pleura and it should be avoided in cases of pleural empyema due to the risk of dissemination of the infection to the central nervous system.We present a case in which the erector spinae plane block (ESPB) was chosen as ananalgesic alternative to videothoracoscopic pulmonary decortication.Methods:75 years old, male, 64kg, hypertensive and smoker, with pleural empyema was scheduled to perform videothoracoscopic pulmonary decortication. Considering the contraindications to execute the paravertebral block, the anesthetic team decided to perform an ESPB for postoperative analgesia.At the end of the surgical procedure, with patient still in lateral decubitus, under general anesthesia, ultrasound guided ESPB was performed at T5 level with 20 mL of Ropivacaine 0.375% plus 50 mcg of Clonidine.ResultsAfter extubation, the patient awoke without complaints and was referred to intensive care unit (ICU). After 3 hours in ICU, the patient assigned grade 2 on numerical scale of pain intensity. The first request for complementary analgesia occurred after 5 hours in ICU.Conclusions:In patients with contraindication to paravertebral block due to parietal pleural damage or empyema, ESPB represents a regional anesthesia alternative in postoperative analgesia for thoracic surgeries.
Book Synopsis ERECTOR SPINAE PLANE BLOCK AS PART OF AN OPIOID-SPARING ANAESTHETIC STRATEGY FOR BREAST QUADRANTECTOMY AND SENTINEL LYMPH-NODE EXCISION: A CASE-REPORT by : Lopes Luis
Download or read book ERECTOR SPINAE PLANE BLOCK AS PART OF AN OPIOID-SPARING ANAESTHETIC STRATEGY FOR BREAST QUADRANTECTOMY AND SENTINEL LYMPH-NODE EXCISION: A CASE-REPORT written by Lopes Luis and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:Breast surgery often requires post-operative opioid analgesia, which has been associated with treatment-resistant chronic pain syndromes, and been suggested as having cancer-spreading potential. Erector spinae plane (ESP) block is a novel approach to thoracic and abdominal pain management which has previously been described as successfully implemented perioperatively in various breast interventions. We hereby present our experience in the management of a quadrantectomy patient.Methods:An otherwise healthy 66-year old woman presented for right-lower quadrantectomy of the right breast with sentinel lymph node excision. An anaesthetic management plan consisting of combined general anaesthesia with right-sided ESP block was devised. Ultrasonography-guided injection of 20cc of 0,75% ropivacaine along the erector spinae fascial plane at the T5 spinal level was performed preoperatively. General anaesthesia was induced with fentanyl (100mcg) and propofol (120mg). After supraglottic device placement, maintenance was ensured with sevoflurane. Additional intravenous analgesia was provided with paracetamol(1g) and ketorolac(30mg). ResultsHaemodynamic stability was noted throughout surgery, with no response to skin incision or tissue dissection. The patient reported no significant pain upon waking or discharge, 24h later. No rescue analgesia was needed during that period and skin numbness representing no significant discomfort subsided over the next day.Conclusions:Our report of a successful implementation of nearly opioid-free anaesthesia in a quadrantectomy patient, by using the novel potential of the ESP-block, suggests that this might be an invaluably safe and effective strategy, not only for pain control, but also as an opioid and anaesthetic-sparing approach, plausibly increasingly useful in debilitated and physiologically fragile patients.
Author :Anesthesiology Vice Chair of Clinical Operations Nabil Elkassabany Publisher :Oxford University Press ISBN 13 :0197518516 Total Pages :617 pages Book Rating :4.1/5 (975 download)
Book Synopsis Regional Anesthesia and Acute Pain Medicine by : Anesthesiology Vice Chair of Clinical Operations Nabil Elkassabany
Download or read book Regional Anesthesia and Acute Pain Medicine written by Anesthesiology Vice Chair of Clinical Operations Nabil Elkassabany and published by Oxford University Press. This book was released on 2023-04-21 with total page 617 pages. Available in PDF, EPUB and Kindle. Book excerpt: Regional Anesthesia and Acute Pain Medicine: A Problem-Based Learning Approach provides a comprehensive review of regional anesthesia and acute pain medicine for medical learners to integrate theoretical knowledge into clinical practice. Its problem-based format incorporates a pool of multiple-choice questions for self-assessment. Each of its 50 case-based chapters is accompanied by questions and answers accessible online in a full practice exam. These chapters cover several areas such as pharmacology, obstetric and pediatric regional anesthesia, complex acute pain problems, anticoagulation, and regional anesthesia and complicated nerve blocks. The cases presented are also unique, as each chapter starts with a case description, usually a compilation of several actual cases, which branches out through case-based questions to increasingly complex situations. This structure is designed to create an authentic experience mirroring the nuances of a complicated clinical scenario. The discussion sections that follow offer a comprehensive approach to the chapter's subject matter, thus creating a modern, complete, and up-to-date medical review of the topic.
