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Erector Spinae Plane Block For Mastectomy And Reconstructive Surgery
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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 SINGLE SHOT ERECTOR SPINAE PLANE BLOCK (ESPB) VERSUS CATHETER FOR ONCOPLASTIC RECONSTRUCTIVE BREAST SURGERY WITH LATISSIMUS DORSI FLAP by : Rajendrasingh Patil
Download or read book SINGLE SHOT ERECTOR SPINAE PLANE BLOCK (ESPB) VERSUS CATHETER FOR ONCOPLASTIC RECONSTRUCTIVE BREAST SURGERY WITH LATISSIMUS DORSI FLAP written by Rajendrasingh Patil and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:Erector spinae block has emerged as a simple, suitable alternative for analgesia of the entire hemithorax, in comparison to central neuraxial blocks with similar pain relief and potentially lesser side effects. We studied single shot ESPB versus ESP catheter in reconstructive breast surgery with a latissimus dorsi flap.Methods:Five patients of ASA 1 or 2 posted for breast reconstruction surgery with a latissimus dorsi flap were randomly chosen to have either the catheter or single shot ESPB block postoperatively. 0.2 % Ropivacaine 20ml instilled under ultrasound guidance in both groups and catheters were inserted in 2 patients. Amongst these, 2 received catheters (C) whereas 3 others received single shot (S) blocks. The VAS scores, time to request of first analgesic, number of rescue analgesics and hospital stay noted.ResultsThe surgery duration in all cases was comparable at an average of 3.5 hours. The pain relief over 36 hours was comparable. VAS scores at 0,3,6,12,18 and 24 hours were comparable (VAS
Book Synopsis ERECTOR SPINAE PLANE BLOCK (ESPb) FOR AWAKE BREAST SURGERY IN YOUNG PREGNANT PATIENT. A CASE REPORT by : Luca Aiello
Download or read book ERECTOR SPINAE PLANE BLOCK (ESPb) FOR AWAKE BREAST SURGERY IN YOUNG PREGNANT PATIENT. A CASE REPORT written by Luca Aiello and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and aims:ESPb was described in thoracic neuropathic pain(1).It is not clear data over its analgesic range.ESPb prevents visceral and somatic pain including breast surgery(2).Here,we present a successful ESPb in awake anaesthesia for radical mastectomy.Methods:a 31year old pregnant patient was scheduled for nipple-areola complex sparing total mastectomy with axillary clearance of lymph nodes and expander positioning.Cardiotocographic control was carried out before and after surgery.ESPb was performed in sitting position at T4 transverse process level using 10-MHz linear ultrasound probe.Ropivacaine 0.5%,20ml was used.After confirming that successful blockade from T2-T8 was achieved in 30 min, propofol (target effect site concentration;1 u03bcg/ml) was infused to achieve a Ramsay sedation score of 4.No opioids were needed throughout surgery that lasted about 180 minutes.Results:her vital signs were stable during surgery.The patient experienced very good analgesia and described NRS pain score 0-2 up to 18 hours after ESPb.After 18hours and only once in the next 12 hours,the patient requested u201con demandu201d pain medication (Paracetamol 1 gr).The patient experienced no nausea or vomiting, and she was easily mobilized.Conclusions:ESPb is a simple and safe block,avoid opioid use.Our experience demonstrates that ESPb with sedation is a suitable option for awake radical mastectomy and reduce risk of PONV.REFERENCES:1)M. Forero,S.D. Adhikary,H. Lopez.C. Tsui,K. J. Chin.The Erector Spinae Plane Block A Novel Analgesic Technique in Thoracic Neuropathic Pain.Regional Anesthesia and Pain Medicine,2016:41;5,1-72)Ohgoshi Y,Ikeda T,Kurahashi K.Continuous erector spinae plane block provides effective perioperative analgesia for breast reconstruction using tissue expanders:a report of two cases. JClinAnesth.2018;44:1u20132.
Book Synopsis Continuous Erector Spinae Plane Block in Breast Cancer Surgery by : Pamela Maru00eda Clusella
Download or read book Continuous Erector Spinae Plane Block in Breast Cancer Surgery written by Pamela Maru00eda Clusella and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and AimsErector spinae plane (ESP) block has recently been reported for thoracic wall procedures. We describe three cases of continuous ESP block in breast cancer surgery. MethodsThree patients (37, 42, and 47 years-old) underwent breast cancer surgery (mastectomy and sentinel lymph node dissection, mastectomy and lymphadenectomy and tumorectomy and lymphadenectomy, respectively). ESP block was performed at T2 level with ropivacaine 0.35% (30 mL) plus catheter insertion with sedation with midazolam. General anesthesia was maintained with propofol (7mg/Kg/h) and low-dose remifentanil (0.05 mcg/Kg/minute). A single dose of fentanyl (2 mcg/Kg) was used in the induction. All patients received intraoperative antiemetic prophylaxis, dexketoprofen and paracetamol. Continuous ESP block with ropivacaine 0.2% infusion (10mL/h), paracetamol and dexketoprofen were administered for postoperative pain control. Pain was measured with VAS score (0-10) when patients arrived at the post-anesthesia care unit (PACU), when they left PACU and 24 hours after surgery. ResultsPatients reported VAS of 0-1 at all endpoints without requiring any additional analgesia. After ESP catheter infusion was stopped the analgesia lasted 6-8 hours. ConclusionsESP block provides anesthesia at multi-dermatomal levels across posterior, lateral and anterior thoracic wall, making this technique suitable for breast cancer surgery. The main advantage of this block is that it may cover a greater area of the breast and the axilla. Continuous infusion ensures optimal postoperative pain control. In conclusion, we present 3 cases of complex breast cancer surgery where continuous ESP block led to an optimal perioperative pain control with a minimum use of opioids and other analgesics.
Book Synopsis Continuous Erector Spinae Plane Block in Breast Cancer Surgery by : Pamela Maria Celdrán-Clusella
Download or read book Continuous Erector Spinae Plane Block in Breast Cancer Surgery written by Pamela Maria Celdrán-Clusella and published by . This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and AimsErector spinae plane (ESP) block has recently been reported for thoracic wall procedures. We describe three cases of continuous ESP block in breast cancer surgery. MethodsThree patients (37, 42, and 47 years-old) underwent breast cancer surgery (mastectomy and sentinel lymph node dissection, mastectomy and lymphadenectomy and tumorectomy and lymphadenectomy, respectively). ESP block was performed at T2 level with ropivacaine 0.35% (30 mL) plus catheter insertion with sedation with midazolam. General anesthesia was maintained with propofol (7mg/Kg/h) and low-dose remifentanil (0.05 mcg/Kg/minute). A single dose of fentanyl (2 mcg/Kg) was used in the induction. All patients received intraoperative antiemetic prophylaxis, dexketoprofen and paracetamol. Continuous ESP block with ropivacaine 0.2% infusion (10mL/h), paracetamol and dexketoprofen were administered for postoperative pain control. Pain was measured with VAS score (0-10) when patients arrived at the post-anesthesia care unit (PACU), when they left PACU and 24 hours after surgery. ResultsPatients reported VAS of 0-1 at all endpoints without requiring any additional analgesia. After ESP catheter infusion was stopped the analgesia lasted 6-8 hours. ConclusionsESP block provides anesthesia at multi-dermatomal levels across posterior, lateral and anterior thoracic wall, making this technique suitable for breast cancer surgery. The main advantage of this block is that it may cover a greater area of the breast and the axilla. Continuous infusion ensures optimal postoperative pain control. In conclusion, we present 3 cases of complex breast cancer surgery where continuous ESP block led to an optimal perioperative pain control with a minimum use of opioids and other analgesics.
Book Synopsis 6 - COMPARISON OF ERECTOR SPINAE PLANE BLOCK AND PARAVERTEBRAL BLOCK FOR BREAST SURGERY: A RETROSPECTIVE ANALYSIS by : Aumjit Wittayapairoj
Download or read book 6 - COMPARISON OF ERECTOR SPINAE PLANE BLOCK AND PARAVERTEBRAL BLOCK FOR BREAST SURGERY: A RETROSPECTIVE ANALYSIS written by Aumjit Wittayapairoj and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:Thoracic paravertebral block (PVB) is an established technique for perioperative pain management for breast surgery. However, since this block is technically challenging, it has not been widely used. Recently introduced erector spinae plane block (ESPB) requires less technical expertise and may be an alternative to PVB. However, the two blocks have not been fully compared. The present study retrospectively analyzed data saved in our registry to compare the two blocks in patients undergoing breast surgery. Methods: After IRB approval, we extracted data for breast surgery patients receiving either PVB or ESPB under ultrasound guidance from June 2018 to March 2019. We compared intra and postoperative data. The primary outcome was visual analogue pain scores (VAS) at rest at 12 h after block. The secondary outcome included scanning and performing time for block, dermatomal sensory blockade, and postoperative fentanyl consumption for 24 h. Results: Twenty-six PVB and 25 ESPB patients were evaluated. Patient demographics were comparable. VAS at rest at 12 h was similar [PVB 13 (0-30) vs ESPB 25 (12-40), P=0.069] [median (IQR)]. However, VAS at rest at 6 h was lower after PVB [10 (0-24)] than after ESPB [25 (18-40)] (P
Book Synopsis The Ultrasound-guided Erector Spinae Plane Block Allows Opioid Free Anesthesia in the Modified Radical Mastectomy with Axillary Dissection: a Pilot Study about 14 Cases by : El Ahmadi Brahim
Download or read book The Ultrasound-guided Erector Spinae Plane Block Allows Opioid Free Anesthesia in the Modified Radical Mastectomy with Axillary Dissection: a Pilot Study about 14 Cases written by El Ahmadi Brahim 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 modified radical mastectomy with axillary dissection is usually carried out under balanced general anesthesia using opiates, it is a source of moderate to severe postoperative acute pain. Opioid-free anesthesia (OFA) aims to reduce the undesirable effects of opioids while ensuring optimal anesthesia and analgesia perioperatively. we report 14 cases of ultrasound-guided Erector Spinae Plane Block (ESPB) to perform surgery using OFA.Methods:We recruited patients presenting no contraindications to the anesthetic technique. The OFA protocol included a general anesthesia with no opioids and an ultrasound-guided erector spinae plane block with bupivacaine at T4 level. Prior to incision, patients received a bolus of Ketamine, Ketoprofen, dexamethasone IV . Maintenance of anesthesia was performed by sevoflurane at 1 MAC. In case of haemodynamic repercussions related to nociception, a bolus of fentanyl at 1 u03bcg / kg was administered.ResultsAfter the approvel of the ethic comitee we included 14 consenting patients. Hemodynamic variations were all less than 20% of baseline. No patient had any intraoperative opiate injection. Upon waking, patients had a median visual analogical scale (VAS) less than 3. During the first 24 hours, the VAS was less than 3. Only one patient received a bolus of 3 mg morphine IV as part of the catch-up postoperative analgesia. After 24 h, all patients had no resting pain.Conclusions:OFA, is used to avoid short-term and long-term adverse effects of opioids, such as: nausea, postoperative hyperalgesia, chronic pain and tumor recurrence. The ESPB allows to practice anesthesia and analgesia in a safe way.
Book Synopsis ESP BLOCK FOR ONCOLOGIC BREAST SURGERY: CAN IT BE USED AS A REGIONAL ANESTHESIA TECHNIQUE? by : Eduardo Allu00f3
Download or read book ESP BLOCK FOR ONCOLOGIC BREAST SURGERY: CAN IT BE USED AS A REGIONAL ANESTHESIA TECHNIQUE? written by Eduardo Allu00f3 and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: ESP BLOCK FOR ONCOLOGIC BREAST SURGERY: CAN IT BE USED AS A REGIONAL ANESTHESIA TECHNIQUE?Juan Carlos Sosa Nicora, Adriana Inu00e9s Acosta, Eduardo Allu00f3Background and Aims:The Erector Spinae Plane (ESP) is a promising block whose mechanisms are not yet fully understood. 1 Since the ESP was first described by Mauricio Forero in 20162, many case reports have been published. Most of them have proven to be useful as part of mutimodal approach in analgesia. 3,4 Only a couple of case reports are available that describe the use of ESP without general anesthesia.5,6 In this case series we present the ESP technique with a continous catheter (E-Cathu00ae - Pajunk, 2018)7 as a standalone option in oncologic breast surgery.Methods:Patient Selection:Thirteen consecutive patients that were suspected or diagnosed with breast cancer determined by clinical features, physical examination, image studies and/or fine needle aspiration studies and were scheduled to undergo surgical intervention during april 2018 and april 2019 were candidates for this study according to the inclusion and exclusion criteria shown in Table 1. Thirteen patients recieved the ESP block along with complementary endovenous sedation in five different hospitals. Same surgical team undertook all of these surgeries. The technique was explained to the patient by the anesthesiologist before the intervention and Informed Consent was signed by both. Primary outcome was set as the need to convert to general anesthesia. The ESP was performed according to Forerou00b4s2 description; localization of T5 transverse process, with the patient in the sitting position under ultrasound guidance by single shot injection of 20 ccu00b4s of 2% lidocaine followed by continous plexus catheter placement. An aditional bolus of 10 cc was administered during surgery if procedure aproximated 60 minutes of duration.Time latency of between 10 and 30 minutes after full dose administration was allowed before skin incision. During this time patient was kept awake and monitored for systemic toxicity of local anesthesic. After latency period, surgery was initiated with an intermitent tegumentary testing incision with the patient sedated. If surgeon needed to administer additional local anesthesic at any point during skin incision, this was noted. Deep plane anesthesia was also noted.After surgery concluded, patient was awakened and asked to move the ipsilateral arm to rule out motor blockade. For post operative analgesia, either a bolus of 10 ccu00b4s of levobupivacaine 0,25% or ropivacaine 0,2% with 0,1 mgr/cc of dexamethasone was administered.Final duration of surgical intervention was noted and patient was taken to the PACU for 20 minutes and later to the ward. Patient recieved ketorolac 30 mgr IV or methamizole 2 Gr. IV TID and tramadol PRN. Hospital discharge was planed 24 hs after the procedure and number of administered rescue doses were noted.Funding of this study was provided by the surgical team if not covered by the patientu00b4s private health insurance company.Results:Twelve women and one man wtih a mean age of 64 (36-87) underwent surgical interventions of the breast and axilar region (Table 2). Latency time averaged 23 minutes (15-30). Lower latency times were related with use of local anesthesic by the surgeon (4 cases in superficial skin plane). Average intervention time was 70 minutes (45-120) and additional bolus of intraoperative lidocaine was administered in 7 patients.No patient required conversion to general anesthesia nor rescue analgesia in the post operative period. The last patient in the series was a high risk patient (severe valvulopathy, high ELVDP and CKD ) so she recieved analgesia through an elastomeric pump and NSAIDs were spared. All patients were discharged after 24 hours without complications.Conclusions:ESP block can be used as local anesthesia for oncologic breast surgery using a continuos catheter . This technique can provide good post operative analgesia and can be used as the sole strategy for post operative analgesia . Further studies are needed to evaluate overall safety for this procedure since high doses of Local Anesthesics are required.References:1.- Erector spinae plane block: an innovation or a delusion?Korean J Anesthesiol. 2019;72(1):1-3. Published online January 31, 2019DOI: https://doi.org/10.4097/kja.d.18.00359 2.- Forero M, Adhikary SD, Lopez H, Tsul C, Chin KJ. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. Reg Anaesth Pain Med. 2016;41:621u201373.- Kwon WJ, Bang SU, Sun WY. Erector spinae plane block for effective analgesia after total mastectomy with sentinel or axillary lymph node dissection: a report of three cases. J Korean Med Sci 2018; 33: e291.u20284.- Altu0131parmak B, et al. Ultrasound guided erector spinae plane block for postoperative analgesia after augmentation mammoplasty: case series. Rev Bras Anestesiol. 2019. https://doi.org/10.1016/j.bjane.2018.12.008 5.-Kimachi PP, Martins EG, Peng P, Forero M. The erector spinae plane block provides complete surgical anesthesia in breast surgery: a case report. A A Pract. 2018;11:186u20138. u20286.- De Cassai A, Marchet A, Ori C. The combination of erector spinae plane block and pectoralis blocks could avoid general anesthesia for radical mastectomy in high risk patients. Minerva Anestesiol. 2018; 84:1420-14217.- Ip V. H. Y. et al. The catheter-over-needle assembly offers greater stability and less leakage compared to the traditional counterpart in continuous interscalene nerve blocks: a randomized, patient-blinded study, Can. J. Anesth. 2013; 60: 1272u20131273Table 1a. Inclusion CriteriaMinimum age, 18 yearsSuspected or Diagnosed Breast Nodule, Tumor or Lymph Nodes Scheduled for Non-Reconstructive Oncologic Breast Surgery Table 1b. Exclusion CriteriaAbnormal Coagulation TestsKnown or suspected history of allergic reactions to Local Anesthesics Patient Refusal.
Book Synopsis BILATERAL ERECTOR SPINAE PLANE BLOCK FOR SURGERY ON THE POSTERIOR ASPECT OF THE NECK: A CASE REPORT by : Gavin Leslie
Download or read book BILATERAL ERECTOR SPINAE PLANE BLOCK FOR SURGERY ON THE POSTERIOR ASPECT OF THE NECK: A CASE REPORT written by Gavin Leslie and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUNDThe erector spinae plane (ESP) block is an interfascial plane block. Local anaesthetic is injected within the plane deep to the erector spinae muscle and superficial to the transverse process. It spreads craniocaudally leading to a multi-dermatomal sensory block. Its mechanism of action is still debated despite extensive cadaveric and radiological examination1, 2. To date, the ESP block has been used to provide analgesia in thoracic, abdominal and lumbar regions. It has even been used to provide complete surgical anaesthesia for mastectomy and axillary dissection3. We present the first case of the ESP block being used to provide complete surgical anaesthesia in the cervical region.HISTORY OF CASE REPORTA 50-year-old male with a large infected sebaceous cyst overlying the C2-4 spinous processes was admitted under the general surgeons. His numeric rating scale pain score was 7 at rest and 10 on movement despite paracetamol and oral morphine. Antibiotics yielded no improvement. The surgeon abandoned incision and drainage under local anaesthetic tissue infiltration because the patient could not tolerate it. He had multiple risk factors for a general anaesthetic including obstructive sleep apnoea, a BMI of 50 and a predicted difficult airway.CLINICAL PROCEDUREBilateral ultrasound-guided ESP blocks were performed at the level of the second thoracic vertebra with a curvilinear probe. 20mL of ropivacaine 0.375%, lignocaine 1% and adrenaline 1:400,000 was injected on each side.Testing after 15 minutes revealed loss of cold sensation over the C4 to T4 dermatomes. Midazolam 0.5mg and 20-30mg boluses of ketamine (totalling 120mg) given pre-emptively provided mild sedation. The patient remained in verbal communication and fully cooperative throughout. He tolerated the procedure well and he remained comfortable without further opiates until discharge.SUMMARYThe ESP block is an increasingly popular regional anaesthetic technique. It is easy, safe and quick to perform. This case contributes to the ever-expanding applications of this novel technique.
Book Synopsis Regional Anaesthesia Can Play An Important Role In Multimodal Analgesia For Mastectomy And Breast Reconstructive Surgery by : Boyne Bellew
Download or read book Regional Anaesthesia Can Play An Important Role In Multimodal Analgesia For Mastectomy And Breast Reconstructive Surgery 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 Aims:Reconstructive surgery is discussed with the majority of women in the UK undergoing mastectomy either as an immediate or a delayed procedure. Acute postsurgical pain is commonly associated with both mastectomies and reconstructions. Risk of chronic pain is increased with inadequate pain management in the immediate post-operative period. Post-mastectomy pain syndrome is associated with severe pain after mastectomy and adds to an already psychologically devastating experience and negatively impacts the womanu2019s quality of life. The American Society of Anesthesiologists Task Force recommends use of multimodal analgesic strategies including regional blockade.Methods:A 62-year old female presented for mastectomy and immediate reconstruction with a deep inferior epigastric perforator (DIEP) free flap. She had bilateral erector spinae plane (ESP) nerve block catheters sited and right-sided Serratus Anterior block (SAP) prior to TIVA general anaesthesia.ResultsIntraoperatively she received standard protocol analgesia. In the post-operative recovery area she was comfortable requiring no further analgesia. Post-operative analgesia included paracetamol, naproxen & pregabalin. The ESP catheters were bolused at midnight on the day of surgery, 6am and noon the next day with 20ml 0.125% bupivacaine with 1:400,000 adrenaline. Both catheters were removed following final bolus. No rescue analgesia was required until day 2 postoperatively.Conclusions:ESP nerve block catheters, SAP nerve block, together with multimodal analgesia is a useful post-operative analgesic strategy for mastectomy and DIEP reconstruction. This patient had a 50% reduction in opiate requirement and we plan to undertake a larger case series using this strategy to refine our centeru2019s analgesic protocols for this patient group.
Book Synopsis THE ULTRASOUND-GUIDED MULTIPLE-INJECTION COSTOTRANSVERSE BLOCK FOR POSTOPERATIVE PAIN MANAGEMENT WITH MAJOR BREAST CANCER SURGERY: CASE REPORTS. by :
Download or read book THE ULTRASOUND-GUIDED MULTIPLE-INJECTION COSTOTRANSVERSE BLOCK FOR POSTOPERATIVE PAIN MANAGEMENT WITH MAJOR BREAST CANCER SURGERY: CASE REPORTS. written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The ultrasound-guided multiple-injection costotransverse block for postoperative pain management with major breast cancer surgery: case reports.Background and aimThe multiple-injection costotransverse block (MICB)1 combines the positive mechanism of action from the thoracic paravertebral block with a reduced risk profile and we have, with success, obtained postoperative pain management with MICB for both unilateral mastectomy with sentinel node biopsy and bilateral mastectomy with primary reconstructive surgery (BMPR). We present three pilot cases (patientsu2019 oral and written informed consent obtained).MethodsufeffPreoperative multimodal analgesic regime for all patients consisted of Acetaminophen 1g, Celecoxib 400mg, Gabapentin 600mg, Dexamethasone 8mg and Dextromethorphan 30mg. The MICB was successfully applied preoperatively at levels T2, T4, T6 and 30min. prior to emergence 10u03bcg Sufentanil was administered (case C 12u03bcg Sufentanil)Case A: A 56-year-old woman, weight 68kg (body mass index, 24.1kg/m2) with a history of thrombocytopenic purpura, hypertension and poor morphine tolerance (syncope), scheduled for unilateral mastectomy and sentinel node biopsy due to breast cancer. MICB: Ropivacaine 0.5%, 3x10ml respectively. A PECS1 block2 using Ropivacaine 0.375% 10ml block was added.ufeffCase B: A 67-year-old woman, weight 55kg (body mass index, 23.2kg/m2) with a history of chronic obstructive pulmonary disease scheduled for BMPR due to breast cancer. Bilateral MICB: Ropivacaine 0.375% 6x10ml supplemented with 60u03bcg Dexmedetomidine.Case C: A 51-year-old woman, weight 57kg (body mass index, 21.5kg/m2) with a history of migraine and gastroesophageal reflux scheduled for UMPR with a sub-pectoral implant due to breast cancer. MICB: Ropivacaine 0.75% 3x7ml.ResultsCase A: Oral Tradolan 100mg was administered within the first 24hrs. Reported diplopia 12hrs. postoperative; presumably from sympathetic block. Case B: Sufentanil 10u03bcg and Morphine 5mg was administered within the first 24hrs. (all in the post anaesthesia care unit). Left surgical field was completely pain free.Case C: In the PACU the patient received 5mg morphine and 5mcg Sufentanil. No opioids were administered within 48 hrs. of discharge from the PACU. The patient reported no adverse effects in regards to the MICB.ConclusionThe MICB is effective as postoperative pain management in regards to major breast cancer surgery. In a forthcoming RCT we aim to use Ropivacaine 0.5% 3x10ml at levels T2, T4, T6 respectively and 0.2mcg Sufentanil/kg body weight 30 min. prior to emergence vs. placebo (saline) in 36 UMPR patients.1. Nielsen M V, Moriggl B, Hoermann R, Nielsen TD, Bendtsen TF, Bu00f8rglum J. Are Single-injection Erector Spinae Plane Block and Multiple-injection Costotransverse Block Equivalent to Thoracic Paravertebral Block? Acta Anaesthesiol Scand. 2019;Accepted:In press.
Book Synopsis Ultrasound for Interventional Pain Management by : Philip Peng
Download or read book Ultrasound for Interventional Pain Management written by Philip Peng and published by Springer Nature. This book was released on 2019-09-05 with total page 360 pages. Available in PDF, EPUB and Kindle. Book excerpt: Due to a wide-spread developing interest in ultrasound-guided pain intervention by clinicians, the demand for a practical reference material on this topic has grown simultaneously. This book thoroughly satisfies the need for such a reference, as it contains text written by experts in the field and a multitude of unique, educational illustrations. Spinal pain, the musculoskeletal system, and peripheral structures function as the fundamental items of discussion across three divided sections. In order to augment the reader’s learning experience, the high-quality images found within each chapter provide step-by-step guidance on the various ultrasound scanning procedural processes. Additionally, tips and pearls for scan and injection supplement each chapter conclusion. Ultrasound for Interventional Pain Management: An Illustrated Procedural Guide is a pragmatic, indispensable resource that helps interested clinical practitioners enhance their visual memory and overall understanding of this method.
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 Operative Dictations in Plastic and Reconstructive Surgery by : Tuan Anh Tran
Download or read book Operative Dictations in Plastic and Reconstructive Surgery written by Tuan Anh Tran and published by Springer. This book was released on 2016-12-30 with total page 583 pages. Available in PDF, EPUB and Kindle. Book excerpt: This text provides a comprehensive overview of operative dictations in plastic, aesthetic, and reconstructive surgical procedures, which will serve as a valuable resource for residents, fellows, and practicing surgeons. The book provides step-by-step operative details regarding all indexed plastic surgery cases that a resident is expected to be thoroughly acquainted with for his or her daily practice and examinations. Each case is preceded by a list of common indications, covering most of the situations in which particular procedures will be used, as well as a list of essential steps. Operative Dictations in Plastic and Reconstructive Surgery will serve as a very useful resource for physicians dealing with, and interested in the field of plastic surgery. It will also provide the related data for the newly minted practicing plastic surgeons. All chapters are written by authorities in their fields and include the most up-to-date scientific and clinical information.
Book Synopsis Textbook of Plastic and Reconstructive Surgery by : Deepak K. Kalaskar
Download or read book Textbook of Plastic and Reconstructive Surgery written by Deepak K. Kalaskar and published by UCL Press. This book was released on 2016-08-02 with total page 491 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written by experts from London’s renowned Royal Free Hospital, Textbook of Plastic and Reconstructive Surgery offers a comprehensive overview of the vast topic of reconstructive plastic surgery and its various subspecialties for introductory plastic surgery and surgical science courses. The book comprises five sections covering the fundamental principles of plastic surgery, cancer, burns and trauma, paediatric plastic surgery and aesthetic surgery, and covers the breadth of knowledge that students need to further their career in this exciting field. Additional coverage of areas in which reconstructive surgery techniques are called upon includes abdominal wall reconstruction, ear reconstruction and genital reconstruction. A chapter on aesthetic surgery includes facial aesthetic surgery and blepharoplasty, aesthetic breast surgery, body contouring and the evolution of hair transplantation.The broad scope of this volume and attention to often neglected specialisms such as military plastic surgery make this a unique contribution to the field. Heavily illustrated throughout, Textbook of Plastic and Reconstructive Surgery is essential reading for anyone interested in furthering their knowledge of this exciting field. This book was produced as part of JISC's Institution as e-Textbook Publisher project. Find out more at https://www.jisc.ac.uk/rd/projects/institution-as-e-textbook-publisher
Book Synopsis Pain Control in Ambulatory Surgery Centers by : Kanishka Rajput
Download or read book Pain Control in Ambulatory Surgery Centers written by Kanishka Rajput and published by Springer Nature. This book was released on 2021-03-08 with total page 429 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a comprehensive review of the challenges, risk stratification, approaches and techniques needed to improve pain control in ambulatory surgery centers (ASCs). It addresses not only the management of acute perioperative pain but also describes modalities that could potentially reduce the risk of evolution of acute pain into chronic pain, in addition to weaning protocols and follow ups with primary surgical specialties and pain physicians as needed. Organized into five sections, the book begins with the foundations of managing ASCs, with specific attention paid to the current opioid epidemic and U.S. policies relating to prescribing opioids to patients. Section two and three then explore facets of multimodal analgesia and non-operating room locations, including the use of ultrasounds, sedation in specific procedures, regional anesthesia, ketamine infusions, and the management of perioperative nausea and intractable pain in outpatient surgery. Section four examines the unique challenges physicians face with certain patient demographics, such as the pediatric population, those suffering from sleep apnea, and those with a history of substance abuse. The book closes with information on discharge considerations, ambulatory surgery protocols, recovery room protocols, and mandatory pain management services. An invaluable reference for all health personnel and allied specialties, Pain Control in Ambulatory Surgery Centers (ASCs) meets the unmet need for a resource that covers optimum pain control in patients undergoing outpatient surgery as well as the urgent ASCs challenges that are presented on an immense scale with national and international impact.
Book Synopsis Perioperative Pain Management by : Felicia Cox
Download or read book Perioperative Pain Management written by Felicia Cox and published by John Wiley & Sons. This book was released on 2009-03-17 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Handbook of Perioperative Pain Management is an up-to-date evidence-based guide to the effective management of perioperative pain even in the most challenging situations. It provides readers with an understanding of the physiology, pharmacology and psychology of acute pain together with guidelines for best practice. Examples of assessment documentation and guidelines for specific patient sub-groups are reproduced throughout the text.
