Search

Pain management is extremely important in day surgery, and it is one of the limiting factors for this type of procedures. Locoregional anesthesia is strongly recommended for day surgery; nevertheless, it could be very difficult to localize nerve position especially in obese patients. Furthermore, a complete nerve blockade could result in a delayed discharge. We present a case of analgesic ultrasound-guided block of tibial and common peroneal nerves in the popliteal fossa without any motor function involvement in an obese patient undergoing debridement of an infected lower limb ulcer; all previous attempts of surgical debridement in day surgery with topical anesthetics had failed because of discomfort due to pain. Our aim was to ensure an optimal degree of analgesia and, at the same time, to save motor function in order to make early discharge possible. We used 15 mL ropivacaine 0.375% to obtain a differential block, taking advantage of sensitive fibers selectivity of ropivacaine. Surgical debridement was performed successfully. Our peripheral blockade was able to provide significantly prolonged analgesia without motor block that guaranteed a safe and early discharge according to the Post Anesthetic Discharge Scoring System. The satisfaction expressed by the patient and her comfort during the procedure support the choice of this approach for intractable painful ulcers of lower limb., (© The Author(s) 2016.)

To assess the efficacy of transversus abdominis plane (TAP) block as anesthesia method for retroperitoneal varicocele repair and to evaluate its postoperative analgesic effectiveness. Thirty-three consecutive male patients undergoing retroperitoneal varicocele repair (Palomo technique) were enrolled in this study. Patients were randomly allocated to undergo ultrasound-guided TAP block anesthesia (case group), or conventional spinal anesthesia (control group). The primary outcome was the evaluation of the proportion of patients achieving an adequate anaesthesia (as evaluated by prinprick sensation test and by the need of analgosedation). We have also evaluated pain during the intervention and pain on movement, pain at rest, rescue analgesia need, nausea, and satisfaction at different time-points (6, 12, and 24 h after surgery). The proportion of patients achieving adequate anesthesia was not different between the groups (p = 0.1). In the post-operative evaluation, patients enrolled in the case group expressed significantly less pain on VAS score at rest and on movement at 6 (p = 0.001 and p = 0.001) and at 12 h (p = 0.004 and p = 0.01). Moreover, the need of rescue analgesia resulted significantly higher in the control group (p = 0.03). This is the first study showing that TAP block could be employed as an effective and feasible anesthesia method for the retroperitoneal varicocelectomy. Moreover, our results demonstrate that this method is more effective than spinal anesthesia in the pain control after varicocele repair.

The treatment of degenerative hip joint disease involves modern operative techniques and the use of prosthetic devices individualized on each patient. Being a surgery of considerable importance, great attention is always given by the anaesthesiologist to postoperative analgesia. In general, our goal is to limit the doses of NSAIDs, known to be associated with haemostasis interference and alteration of gastrointestinal apparatus; component of our baseline analgesic protocols after arthroplasty is morphine given parenterally. In order to steadily improve analgesic techniques, which directly impact on patient outcome, we experimented the use of a continuous infusion of magnesium sulphate during subarachnoid anaesthesia. Magnesium sulphate is the drug of choice in case of eclampsia, and pre-eclampsia (for the risk of evolution in eclampsia). According to the most recent findings, this drug has also analgesic properties: its use as an adjunct to analgesia is based on a non-competitive antagonism towards the NMDA receptor and on the blocking of calcium channels: these properties prevent the mechanisms of central sensitization due to nociceptive stimulation of peripheral nerves.

In 1970, Winnie proposed the brachial plexus block as an alternative and effective anaesthesia technique for shoulder surgery. From that date, several techniques have been developed to approach the brachial plexus: the use of a nerve stimulator and, more recently, the ultrasound guided nerve blockade have made the procedure easier and more effective; the availability of the new drugs demonstrates some major advantages due to the application of peripheral blocks. Nowadays the attention has been focused on postoperative pain control: although many techniques have been proposed, the application of a continuous infusion of local anaesthetics through an interscalene catheter seems the best available technique to achieve pain relief after shoulder surgery. Advantages ad disadvantages of regional anaesthesia and adverse events associated with interscalene brachial plexus blockade are reviewed.

Aim: The technique of ultrasound-guided subclavian cannulation was evaluated in our experience assessing the real effectiveness of such procedure., Methods: We have evaluated 297 subclavian cannulation, performed for the placement of central venous catheter both with landmark method (176 patients) and ultrasound guided technique (121 patients) to assess the real effectiveness of the ultrasound-guided technique to reduce the mechanical complication of the subclavian vein puncture., Results: A total of 23 mechanical complications were identified. Of these, 8 were pneumothorax and 15 arterial puncture. Such cases were identified from the pool of patients who had undergone subclavian venous cannulation with landmark method. However these complications occurred only in difficult venous access and teaching procedure performed with landmark method., Discussion: An ultrasound-guided recent technique for the placement of central venous access should be adopted since such technique seems to reduce the incidence of failure and mechanical complications. However it is worth notice that the clinical effect of using ultrasound guidance technique seems to be more significant when the internal jugular vein rather than the subclavian vein is cannulated., Conclusion: Our experience demonstrate that, both in no difficult cases and in no teaching procedures, central venous catheterization using landmark technique seems to be acceptable on both clinical and medico-legal grounds. However the ultrasound guided technique is necessarily required to achieve the reduction of complications in difficult venous access.