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This case report describes the approach and use of an ultrasound-guided pudendal nerve block in dogs. The technique was first performed in the cadaver of a 14 kg male castrated Miniature Australian Shepherd dog. The ultrasound probe was placed in transverse orientation on midline between the anus and ischiatic arch. Methylene blue (0.05 mL kg−1) was injected around the pudendal nerves bilaterally via an in-plane technique, with the following landmarks identified: urethra, perineal arteries, and internal obturator, bulbospongiosus and retractor penis muscles. Postinjection dissection revealed diffuse staining of the ischiorectal fossae and staining of an approximately 25 mm length of each pudendal nerve. A 1-year-old castrated male Labradoodle dog presented for urethral resection and anastomosis due to necrotic prolapse of the distal urethra. An ultrasound-guided pudendal nerve block was performed with 0.5% bupivacaine (0.05 mL kg−1 per site) before surgery. The dog was premedicated with methadone [0.3 mg kg−1 intravenously (IV)] and dexmedetomidine (2 μg kg−1 IV), and general anesthesia was induced with ketamine (1 mg kg−1 IV) followed by propofol (titrated to effect; total 1.4 mg kg−1 IV). The trachea was intubated and anesthesia maintained with isoflurane carried in oxygen. The dog was given carprofen (2.2 mg kg−1 subcutaneously) on extubation. The dog did not require intra- or postoperative rescue analgesic interventions in the 18 hours after surgery until hospital discharge. This technique appeared successful in desensitizing the distal urethra. Further investigation of this locoregional technique is warranted. [ABSTRACT FROM AUTHOR]

Background/Objectives: There is an ongoing debate about the most advantageous anesthesia technique for carotid endarterectomy (CEA). From an anesthesiologic perspective, locoregional anesthesia (LRA) appears to offer significant benefits. However, the learning curve and complication rates for anesthesiologists newly performing ultrasound-guided LRA for CEA remain unclear and are to be examined in greater detail in this study. Methods: This retrospective, single-center study included all consecutive LRA administrations for CEA following the introduction of this procedure at a district hospital in Germany from November 2013 to November 2017. Nine board-certified anesthesiologists, initially inexperienced in LRA for CEA but with prior experience in other ultrasound-guided peripheral nerve blocks (PNBs), received theoretical training and supervision during their first six combined deep and superficial cervical plexus blocks under ultrasound guidance. The primary endpoint was the incidence of insufficient block quality, indicated by pain and restlessness or the additional need for analgesics. Secondary endpoints included LRA-associated complications. Patients were divided into four groups based on the number of previously performed LRA procedures by the attending anesthesiologist. Results: In 83 patients, LRA was performed by initially inexperienced anesthesiologists. Group A (patients managed by anesthesiologists performing their 1st to 3rd cervical plexus blockades) included 21 patients, Group B (blockades 4–6) included 12 patients, Group C (blockades 7–9) included 9 patients, and Group D (≥10 blockades) included 41 patients, respectively. The overall complication rate was 22% (18/83). Insufficient block quality occurred in 18.1% of patients (15/83), resulting in three conversions to general anesthesia (3.6%). Additional complications included dysphagia (n = 2) and Horner's syndrome (n = 1). The incidence of insufficient block quality was significantly reduced (p = 0.008) after performing the first three blockades. Conclusions: Ultrasound-guided cervical plexus block for CEA appears to be a rapidly learnable anesthesia technique for anesthesiologists experienced in other ultrasound-guided PNBs, with a low risk of complications. After three supervised blockades, the failure rate of LRA decreases significantly. [ABSTRACT FROM AUTHOR]

Francesco Coppolino, Simona Brunetti, Leonardo Maria Bottazzo, Gianluigi Cosenza, Pasquale Sansone, Marco Fiore, Maria Beatrice Passavanti, Vincenzo Pota, Maria Caterina Pace Department of Women, Children and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, ItalyCorrespondence: Simona Brunetti, Department of Women, Children and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia N.2, Naples, 80134, Italy, Tel +393492424108, Email simona.brunetti@studenti.unicampania.itPurpose: Thoracic surgery often results in severe chronic postoperative pain. Current evidence favors two locoregional techniques. Thoracic Epidural Anesthesia (TEA), the gold standard, and Thoracic Paravertebral Block (TPVB), which is associated with fewer side effects but is limited by short duration of action of local anesthetics (LA) and potential failure due to improper drug distribution. This study investigates the use of dexmedetomidine (DEX) as adjuvant to prolong the effects of LA in TPVB, with methylene blue used for visual confirmation of accurate injectate spread.Patients and Methods: We observed 6 patients undergoing Video-Assisted Thoracoscopy (VATS) lobectomy who received TPVB with ropivacaine, DEX and methylene blue. The primary endpoint was postoperative pain recorded at 1, 12, 24, 48 hours using Numeric Rating Scale (NRS); the secondary endpoints were cumulative opioid consumption in the first 24 hours in Milligram Morphine Equivalents (MME); adverse events: occurrence of bradycardia, hypotension, Postoperative Nausea and Vomiting (PONV); length of hospital stay. All patients completed the study.Results: Our results showed optimal pain scores, with NRS scores always below 4, decreased need for opioids, and prolonged analgesia. None of the patients had bradycardia nor PONV, but two patients experienced acute and self-limited hypotension following TPVB.Conclusion: Thoracic Paravertebral Block with Dexmedetomidine and methylene blue was effective and safe in controlling postoperative pain. Methylene blue could help improving knowledge on anesthetics distribution to reduce failure rates.Keywords: locoregional anesthesia, paravertebral block, post-operative pain, thoracic surgery

Abstract Background Despite advances in pain management, cancer-related pain remains a critical issue for many patients. In recent years, there has been a growing interest in the use of fascial plane blocks, such as the Erector Spinae Plane Block (ESPB), for managing chronic pain, including in the oncology field. We conducted a systematic review to synthetize existing evidence on the use of ESPB for cancer pain management. Methods We selected studies published between January 2016 to April 2024. A systematic search in Pubmed and Embase databases was performed. The search strategy included the following keywords and/or MeSH terms according to the controlled vocabulary of the databases sought: ((erector spinae plane block) OR (ESP block) OR (ESPB) AND ((cancer pain). We considered eligible Randomized, nonrandomized studies, case series and case reports reporting data on the use of ESPB in patients with cancer pain. Results The search revealed 34 studies. Among these, we found one RCT, three retrospective studies, two case series, and 28 case reports for a total of 135 patients. Studies included described the use of ESPB for the management of various types of cancer pain across different conditions, including chronic thoracic cancer-related pain, abdominal visceral pain and pain related to bone metastases. Single-shot ESPB was performed in 26 studies while continuous ESPB and the use of a peripheral nerve catheter for continuous analgesia were described in 8 studies. Neurolytic ESPB was performed in 6 studies for a total of 10 patients There was a high clinical heterogeneity in terms of technique, drugs, and use of adjuvants. The lack of comparators was a major flaw, together with the low level of evidence in the majority of the included studies. Conclusions The evidence supporting the use of ESPB for cancer pain management is currently scarce, heterogeneous, and of low quality. To better understand its potential and provide robust clinical guidance, future research needs to focus on rigorous comparative studies, standardization of techniques and larger sample sizes.

Background: Despite advances in pain management, cancer-related pain remains a critical issue for many patients. In recent years, there has been a growing interest in the use of fascial plane blocks, such as the Erector Spinae Plane Block (ESPB), for managing chronic pain, including in the oncology field. We conducted a systematic review to synthetize existing evidence on the use of ESPB for cancer pain management. Methods: We selected studies published between January 2016 to April 2024. A systematic search in Pubmed and Embase databases was performed. The search strategy included the following keywords and/or MeSH terms according to the controlled vocabulary of the databases sought: ((erector spinae plane block) OR (ESP block) OR (ESPB) AND ((cancer pain). We considered eligible Randomized, nonrandomized studies, case series and case reports reporting data on the use of ESPB in patients with cancer pain. Results: The search revealed 34 studies. Among these, we found one RCT, three retrospective studies, two case series, and 28 case reports for a total of 135 patients. Studies included described the use of ESPB for the management of various types of cancer pain across different conditions, including chronic thoracic cancer-related pain, abdominal visceral pain and pain related to bone metastases. Single-shot ESPB was performed in 26 studies while continuous ESPB and the use of a peripheral nerve catheter for continuous analgesia were described in 8 studies. Neurolytic ESPB was performed in 6 studies for a total of 10 patients There was a high clinical heterogeneity in terms of technique, drugs, and use of adjuvants. The lack of comparators was a major flaw, together with the low level of evidence in the majority of the included studies. Conclusions: The evidence supporting the use of ESPB for cancer pain management is currently scarce, heterogeneous, and of low quality. To better understand its potential and provide robust clinical guidance, future research needs to focus on rigorous comparative studies, standardization of techniques and larger sample sizes. [ABSTRACT FROM AUTHOR]

To develop an ultrasound (US)-guided ventral approach to the brachial plexus (BP) and evaluate nerve anatomy and staining in barred owl cadavers. Prospective, cadaveric study. Eleven adult male and female barred owl cadavers with a body mass of 0.43–0.98 kg. Eleven frozen cadavers were thawed for 48 hours, weighed and assigned a body condition score. Ten cadavers were placed in dorsal recumbency with wings abducted. US-guided visualization of the BP was achieved by placing a 13-6 MHz linear probe over the ventral aspect of the scapulohumeral joint, parallel to the sternum. A 22 gauge, 50 mm insulated needle was advanced in-plane in a caudal-to-cranial direction. In each owl, injection targeting one BP was performed with 0.4 mL kg–1 of a 1:1 0.5% ropivacaine and 1% methylene blue solution. Dissection was performed 15 minutes postinjection. Nerve staining was deemed successful if ≥ 1 cm of circumferential staining was achieved. The eleventh owl cadaver was injected with a 1:1 solution of 1% methylene blue and 74% ioversol contrast into both wings, and computed tomography (CT) was performed just before and 15 minutes after injection. The BP was clearly identified ultrasonographically in cadavers weighing > 0.5 kg. An injectate volume of 0.4 mL kg–1 provided complete staining of the BP branches in all cadavers. CT scan revealed no contrast within the coelomic cavity. The US-guided BP injection using a ventral approach was easily performed in barred owl cadavers weighing > 0.5 kg. The injection of 0.4 mL kg–1 of a ropivacaine–dye solution resulted in complete staining of the BP branches in all wings, suggesting that this technique could provide analgesia for structures distal to the scapulohumeral joint. Clinical studies are necessary to confirm the safety and efficacy of this technique in barred owls and other bird species. [ABSTRACT FROM AUTHOR]

Simple Summary: In human medicine, catheter implantation for local anesthetic administration in the quadratus lumborum (QL) inter-fascial plane (IFP) has been reported to extend the duration of a single-shot block's effect in the postoperative period of patients undergoing abdominal surgeries. In the first phase of this study, we described an ultrasound-guided technique for placing catheters in the QL IFP in canine cadavers and assessed the spread of 0.3 versus 0.6 mL kg−1 per side of contrast media solution injected through the catheters using computed tomography (CT). The second phase described the outcomes of five dogs undergoing open cholecystectomy or adrenalectomy, in which QL catheters were used for postoperative pain management. CT scan images showed that using a higher volume of injectate resulted in a significantly higher number of vertebral bodies stained by the contrast solution between the QL and psoas minor muscles. Results of the second phase of the study suggest that ropivacaine 0.5% injected uni- or bilaterally every eight hours through QL catheters could be safely implemented in a multimodal analgesic approach during the postoperative period in dogs subjected to abdominal surgeries. This study aimed to describe an ultrasound-guided technique for implanting catheters for local anesthetic administration into the quadratus lumborum (QL) inter-fascial plane in canine cadavers and assessing the spread along the vertebral bodies (VBs) by computed tomography (CT). Phase 1: eight canine cadavers received one catheter per hemiabdomen, followed by injection of contrast media solution [low volume (LV) 0.3 mL kg−1 or high volume (HV) 0.6 mL kg−1]. Phase 2: postoperative pain of five dogs was managed by injecting 0.3 mL kg−1 of ropivacaine 0.5% through QL catheters every eight hours, up to 72 h after abdominal surgery. Pain was assessed using the Short Form of the Glasgow Composite Measure Pain Scale, and methadone 0.2 mg kg−1 was administered intravenously when the pain score was ≥6. The number of VBs stained by the contrast solution between the QL and psoas minor muscles was significantly higher in group HV than group LV. The catheter tip was visualized in the retroperitoneal space in 1/16 and 2/10 hemiabdomens in phases 1 and 2, respectively. Rescue analgesia was required in 3/5 dogs during the postoperative period. The QL catheter placement technique appears feasible and may be included in a multimodal analgesic approach for dogs undergoing abdominal surgeries. [ABSTRACT FROM AUTHOR]

Para evaluar la aplicabilidad de la técnica LANT (Local Anesthesia No Tourniquet) en la osteosíntesis de fracturas del radio distal (FRD), se diseñó un ensayo clínico aleatorizado que comparó los resultados a corto plazo entre pacientes tratados con anestesia local sin isquemia (LANT) y aquellos operados con anestesia locorregional (AR) y manguito de isquemia. Las principales variables del estudio fueron el dolor, la tumefacción y la satisfacción del paciente. También se analizaron el sangrado de la herida quirúrgica, la movilidad, la dificultad técnica percibida por el cirujano, la insuficiencia anestésica y las complicaciones.

Abstract In recent years, there has been a growing awareness of the limitations and risks associated with the overreliance on opioids in various surgical procedures, including cardiothoracic surgery. This shift on pain management toward reducing reliance on opioids, together with need to improve patient outcomes, alleviate suffering, gain early mobilization after surgery, reduce hospital stay, and improve patient satisfaction and functional recovery, has led to the development and widespread implementation of enhanced recovery after surgery (ERAS) protocols. In this context, fascial plane blocks are emerging as part of a multimodal analgesic in cardiac surgery and as alternatives to conventional neuraxial blocks for thoracic surgery, and there is a growing body of evidence suggesting their effectiveness and safety in providing pain relief for these procedures. In this review, we discuss the most common fascial plane block techniques used in the field of cardiothoracic surgery, offering a comprehensive overview of regional anesthesia techniques and presenting the latest evidence on the use of chest wall plane blocks specifically in this surgical setting.

In recent years, there has been a growing awareness of the limitations and risks associated with the overreliance on opioids in various surgical procedures, including cardiothoracic surgery. This shift on pain management toward reducing reliance on opioids, together with need to improve patient outcomes, alleviate suffering, gain early mobilization after surgery, reduce hospital stay, and improve patient satisfaction and functional recovery, has led to the development and widespread implementation of enhanced recovery after surgery (ERAS) protocols. In this context, fascial plane blocks are emerging as part of a multimodal analgesic in cardiac surgery and as alternatives to conventional neuraxial blocks for thoracic surgery, and there is a growing body of evidence suggesting their effectiveness and safety in providing pain relief for these procedures. In this review, we discuss the most common fascial plane block techniques used in the field of cardiothoracic surgery, offering a comprehensive overview of regional anesthesia techniques and presenting the latest evidence on the use of chest wall plane blocks specifically in this surgical setting. [ABSTRACT FROM AUTHOR]

This study aimed to describe an ultrasound-guided technique for implanting catheters for local anesthetic administration into the quadratus lumborum (QL) inter-fascial plane in canine cadavers and assessing the spread along the vertebral bodies (VBs) by computed tomography (CT). Phase 1: eight canine cadavers received one catheter per hemiabdomen, followed by injection of contrast media solution [low volume (LV) 0.3 mL kg−1 or high volume (HV) 0.6 mL kg−1]. Phase 2: postoperative pain of five dogs was managed by injecting 0.3 mL kg−1 of ropivacaine 0.5% through QL catheters every eight hours, up to 72 h after abdominal surgery. Pain was assessed using the Short Form of the Glasgow Composite Measure Pain Scale, and methadone 0.2 mg kg−1 was administered intravenously when the pain score was ≥6. The number of VBs stained by the contrast solution between the QL and psoas minor muscles was significantly higher in group HV than group LV. The catheter tip was visualized in the retroperitoneal space in 1/16 and 2/10 hemiabdomens in phases 1 and 2, respectively. Rescue analgesia was required in 3/5 dogs during the postoperative period. The QL catheter placement technique appears feasible and may be included in a multimodal analgesic approach for dogs undergoing abdominal surgeries.

Simple Summary: The quadratus lumborum (QL) block is an ultrasound-guided locoregional anesthetic technique which aims to provide analgesia to the abdomen. Previous studies in dog cadavers have shown that a dorsal injection point, between the psoas minor muscle and the vertebral body of L1, is able to stain the truncus sympathicus and the T13–L3 rami ventrales, potentially providing analgesia to the abdominal wall and viscera. This dorsal approach could be feasible in cats and is probably able to offer similar results to those in canine cadavers. To assess this objective, 10 cat cadavers were used, and a mixture of methylene blue and iopromide (0.4 mL kg−1) was injected dorsal to the QL muscle in the abovementioned location. Computerized tomography and anatomical dissection were employed to evaluate the injectate spread. Our results showed the feasibility of this approach in cat cadavers as a consistent staining of the truncus sympathicus (T13–L3) and the rami ventrales of the spinal nerves (T13–L3) was observed. These results are compatible with the induction of somatic and visceral analgesia of the abdomen, although the cranial abdominal wall may not be covered. The quadratus lumborum (QL) block is an ultrasound-guided locoregional anesthesia technique which aims to provide analgesia to the abdomen. The main objective of this study was to assess a modified ultrasound-guided dorsal QL block in cat cadavers. For this purpose, a volume of 0.4 mL kg−1 of a mixture of iopromide and methylene blue was administered between the psoas minor muscle and the vertebral body (VB) of the first lumbar vertebra, and its distribution was assessed in thirteen cat cadavers. We hypothesized that this injection point would be feasible, offering a more cranial distribution of the injectate and a more consistent staining of the truncus sympathicus. The study was divided into two phases. Phase 1 consisted of an anatomical study (three cadavers were dissected). Phase 2 consisted of the ultrasound-guided administration of the injectate and the assessment of its distribution by computed tomography and anatomical dissection. The results showed a consistent distribution of contrast media within five (4–8) VBs from T10 to L5. Methylene blue stained three (2–6) rami ventrales, affecting T11 (10%), T12 (20%), T13 (60%), L1 (85%), L2 (95%) and L3 (65%). The truncus sympathicus was dyed in all cadavers with a spread of five (3–7) VBs. Finally, the splanchnicus major nerve was stained in all cadavers (100%). These results suggest that this technique could provide analgesia to the abdominal viscera and the abdominal wall, probably with the exception of the cranial aspects of the abdominal wall. [ABSTRACT FROM AUTHOR]

Abstract Background The gold standard anesthesiologic procedure for urgent femur fracture surgery is Spinal Anesthesia. It is not always feasible because of patients' severe comorbidities and difficulties in optimizing drug therapy in the appropriate time frame such as discontinuation of anticoagulant drugs. The use of four peripheral nerve blocks (tetra-block) can be a winning weapon when all seems lost. Case presentation We present, in this case series, three Caucasian adult femur fractures (an 83-year-old woman, a 73-year-old man, and a 68-year-old woman) with different and major comorbidities (cardiac or circulatory disorders on anticoagulants therapy that were not discontinued on time; breast cancer and others) underwent the same anesthesiologic approach in the urgent setting. Ultrasound peripheral nerve blocks, that is femoral, lateral femoral cutaneous, obturator, and sciatic with parasacral approach were successfully performed in all patients who underwent intramedullary nailing for intertrochanteric fracture. We evaluated the adequacy of the anesthesia plane, postoperative pain control with the VAS scale, and the incidence of postoperative side effects. Conclusions Four peripheral nerve blocks (Tetra-block) can be alternative anesthesiologic management in urgent settings, in patients where drug therapy cannot be optimized, as in antiplatelet and anticoagulant therapy.

Simple Summary: The quadratus lumborum (QL) block is an ultrasound-guided regional anesthesia technique that aims to provide analgesia to the abdomen. Previous studies show that this technique may fail to provide analgesia in the cranial abdominal wall in dogs. The QL block is a difficult technique with the risk of damaging vital structures. The objective of this study is to assess a new latero-ventral approach to the QL (LVQL), which could be easier and safer to perform than the interfascial approach (IQL) widely reported. Another objective is to evaluate the distribution of high-volume injections (0.6 mL/kg) of dye/contrast achieved by both approaches. Six thawed dog cadavers were used to randomly perform the LVQL in one hemiabdomen and the IQL in the other. Distribution of the injectate throughout the ventral branches of the spinal nerves from T10 to L4 and the sympathetic trunk (CT and dissection) was assessed. The two approaches consistently stained L1-L3 ventral branches, which is compatible with obtaining somatic analgesia in the middle and caudal abdominal wall. The administration of high-volume injections did not result in a more cranial distribution of the injectate compared to previous studies. The sympathetic trunk was more consistently stained by the IQL, therefore, the LVQL may not promote visceral desensitization of the abdomen. The QL block is a high-level locoregional anesthesia technique, which aims to provide analgesia to the abdomen. Several approaches of the QL block have been studied to find out which one allows a greater distribution of the injectate. The aim of this study is to compare the traditional interfascial QL block (IQL) with a new latero-ventral approach (LVQL). We hypothesize that this new approach could be safer and easier to perform, since the injectate is administered more superficially and further away from vital structures. Our second objective is to assess whether a higher volume of injectate (0.6 mL/kg) could reach the ventral branches of the last thoracic nerves, leading to a blockade of the cranial abdomen. Six thawed canine cadavers (12 hemiabdomens) were used for this purpose. Both approaches were performed in all cadavers. A combination of methylene blue/iopromide was administered to each hemiabdomen, randomly assigned to the LVQL or IQL. No differences were found regarding the ease of perform the LVQL with respect to IQL. The results show that both techniques reached the ventral branches from L1 to L3, although only the IQL consistently stained the sympathetic trunk (5/6 IQL vs. 1/6 LVQL). The use of a higher volume did not enhance a more cranial distribution of the injectate. [ABSTRACT FROM AUTHOR]

Background: The gold standard anesthesiologic procedure for urgent femur fracture surgery is Spinal Anesthesia. It is not always feasible because of patients' severe comorbidities and difficulties in optimizing drug therapy in the appropriate time frame such as discontinuation of anticoagulant drugs. The use of four peripheral nerve blocks (tetra-block) can be a winning weapon when all seems lost. Case presentation: We present, in this case series, three Caucasian adult femur fractures (an 83-year-old woman, a 73-year-old man, and a 68-year-old woman) with different and major comorbidities (cardiac or circulatory disorders on anticoagulants therapy that were not discontinued on time; breast cancer and others) underwent the same anesthesiologic approach in the urgent setting. Ultrasound peripheral nerve blocks, that is femoral, lateral femoral cutaneous, obturator, and sciatic with parasacral approach were successfully performed in all patients who underwent intramedullary nailing for intertrochanteric fracture. We evaluated the adequacy of the anesthesia plane, postoperative pain control with the VAS scale, and the incidence of postoperative side effects. Conclusions: Four peripheral nerve blocks (Tetra-block) can be alternative anesthesiologic management in urgent settings, in patients where drug therapy cannot be optimized, as in antiplatelet and anticoagulant therapy. [ABSTRACT FROM AUTHOR]

Background: Cesarean section (CS) is the most frequently performed obstetric procedure globally, and postoperative pain remains a prominent concern. This study aimed to evaluate the effectiveness of the bilateral transversus abdominis plane (TAP) block in addressing this issue. Methods: We performed a randomized trial in women with term pregnancies who underwent elective CS with spinal anesthesia. The women were randomized (1:1) to receive bilateral TAP or postoperative systemic analgesics (control group). The primary outcome was the effect on postoperative pain assessed using the numeric rating score (NRS) at 2, 6, 12, and 24 h in the postoperative period. Results: At 2 and 6 h after the surgical procedure, there was a significant reduction in both resting (rNRS p = 0.004) and movement-related pain (dNRS p = 0.0001, p = 0.001 respectively). However, at 12 h, a reduction of dNRS was demonstrated (p = 0.0001), while no benefit was observed at rest. The percentage of women with NRS ≤ 4 was higher after the block at 2 h for both resting and movement-related pain (rNRS p = 0.010; dNRS p = 0.0001); at 6 and 12 h, it was only significant for dNRS (p = 0.002). Rescue doses of analgesics were significantly higher in the control group at 2, 6, and 12 h (p = 0.01, p = 0.0383, p = 0.0003 respectively). No complications with the procedure were recorded. Conclusion: Bilateral TAP block has the potential to alleviate postoperative pain and reduce the need for additional analgesics after CS. Trial registration: This study is registered with ClinicalTrials.gov, number (NCT02801968), registered 28 May 2016, https://clinicaltrials.gov/ct2/show/NCT02801968?term=NCT02801968&draw=2&rank=1 [ABSTRACT FROM AUTHOR]

The erector spinae plane block remains a divisive regional technique which has split the regional anesthesia community into believers and non-believers. Its main mechanism of action remains controversial and this has been pivotal in the controversy. We explore our current understanding of fascial plane blocks and erector spinae blocks as well as explore the gaps in knowledge. This opinion paper is meant to give a balanced view of the current state of this block in regard to guidelines, research and future. The viewpoint of the authors may not necessarily align with current ideas, however, hopefully will guide subsequent trials to more robust evidence. [ABSTRACT FROM AUTHOR]

Major trauma is bound to be managed in highly specialized centers. Due to logistics needs or due to an initial clinical stabilization, these patients happen to be managed in hospitals that are not fully equipped for trauma. We handled a patient, major trauma to dynamics following a high-speed collision between two cars in which she was behind the wheel. The patient was also complex due to cardiovascular and respiratory comorbidities. After ‘ABCDE’ and radiological evaluation, the patient was managed in our hospital with ICU recovery and multiple orthopedic interventions to which she was subjected with neuraxial and peripheral regional anesthesia. The patient was managed successfully and with excellent pain control. The risks associated with her comorbidities were limited to a minimum and she was discharged for rehabilitation 5 days after the operations.

Background: The use of local anesthetics (LA) in individuals with Brugada syndrome (BrS) remains a subject of debate due to the lack of large-scale studies confirming their potential risks. This study primarily aimed to evaluate the incidence of new malignant arrhythmias or defibrillation events in patients diagnosed with BrS during the perioperative period, following the administration of local anesthetics, and within 30 days postoperatively. The secondary objective was to analyze the occurrence of adverse effects during hospitalization, as well as 30-day readmission and mortality rates., Methods: A retrospective cohort study was performed on patients with BrS who underwent locoregional anesthesia between January 1, 1996, and September 30, 2020. Anesthetic records and electronic medical records were thoroughly reviewed for up to 30 days following each administration of local anesthetics., Results: A total of 47 procedures involving patients with BrS who underwent locoregional anesthesia were analyzed. The patients were categorized into three groups: 27 in the peripheral nerve block (PNB) group, 13 in the epidural anesthesia group, and 9 in the spinal anesthesia group. One patient in the PNB group experienced intraoperative ventricular fibrillation following the administration of ajmaline. No other adverse events were observed., Conclusion: In this retrospective study, our findings do not indicate an increased arrhythmogenic risk or a higher incidence of adverse events associated with the administration of local anesthetics in patients with BrS. However, the available data are insufficient to confirm the safety of local anesthetic use in this population. Enhanced vigilance is recommended when administering local anesthetics to individuals with BrS. Prospective studies are necessary to further evaluate and establish the safety profile of local anesthetics in this patient group., (© 2025 Acta Anaesthesiologica Scandinavica Foundation.)

The management of postoperative pain in pediatric patients undergoing emergency surgical procedures, particularly in non-pediatric hospitals, presents significant challenges due to the unique physiological requirements of children. The utilization of opioid analgesia may result in severe complications, necessitating a transition toward multimodal analgesia, which integrates various pain management strategies to enhance effectiveness while mitigating adverse effects. Locoregional anesthesia techniques, such as fascial plane blocks, provide targeted pain alleviation, reducing dependence on opioids. Recent advancements in ultrasound-guided methodologies have markedly improved safety and precision in this context. This report presents two cases involving pediatric patients aged eight and 12 years who underwent urgent posttraumatic open splenectomy. Both patients exhibited stable hemodynamic parameters and had no significant prior medical history. Following surgery, they received an ultrasound-guided rectus sheath block (RSB) and dynamic transversus abdominis plane blocks (TAPBs) utilizing a mixture of ropivacaine, dexamethasone, and clonidine. Fentanyl was administered before and during the surgical procedures, which lasted approximately 75 minutes. Upon regaining consciousness, both patients indicated a visual analog scale (VAS) pain score of 0. They required only a single dose of intravenous acetaminophen for pain relief, demonstrating effective opioid-free pain management and achieving a high level of parental satisfaction. Combined RSB and TAPB provide adequate and safe postoperative pain management for pediatric patients undergoing emergency splenectomy in a non-pediatric hospital setting. This approach can reduce opioid dependence and improve patient outcomes. Further research is warranted to explore the broader application of locoregional anesthesia techniques for pediatric emergency surgery in non-pediatric settings., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gentili et al.)

Introduction: Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has been widely used in hand surgery, but there are few prospective data on its use in forefoot surgery., Hypothesis: The WALANT technique reduces pain compared to general anesthesia for bone surgery on the first ray of forefoot., Methods: This was a prospective, longitudinal, comparative, non-randomized cohort study in adult patients undergoing bone surgery on the first ray of forefoot. The primary objective was the level of pain (0-10 visual analogic scale) 4 h after the procedure with WALANT technique versus general anesthesia supplemented by ropivacaine infiltration., Results: A total 37 patients were analyzed in the WALANT group and 24 in the general anesthesia group (women, 90.2%; mean age, 51.3 years; hallux valgus, 85.2%; first metatarsal osteotomy, 80.3%). After generalized linear regression adjusted on a priori defined factors, there was no statistically difference for pain ≤3 at 4 h in WALANT vs. general anesthesia (odds-ratio 1.66; 95% CI, 0.17-20.49; p = 0.2548). At 24 h, pain level was also comparable in the two groups. Time spent in operating room was significantly shorter with WALANT (40.8 vs. 49.7 min; p = 0.0001). Mean length of stay in the recovery room was also significantly shorter with WALANT (4.4 vs. 75.6 min; p < 0.0001). Anxiety before/after surgery, uptake of analgesic/anti-inflammatory drugs and quality of life were comparable in the two anesthesia groups., Conclusion: Postoperative pain with WALANT technique or general anesthesia was comparable. Time spent in the operating room and in recovery room was significantly shorter with WALANT technique., Level of Evidence: III; prospective non-randomized comparative study., (Copyright © 2024. Published by Elsevier Masson SAS.)

IntroductionSurgical umbilical hernia repair is a frequent procedure in newborn calves, requiring mandatory pain management. This study aimed to develop an ultrasound-guided rectus sheath block (RSB) and to evaluate its clinical efficacy in calves undergoing umbilical herniorrhaphy under general field anesthesia.MethodsGross and ultrasound anatomy of the ventral abdomen and the diffusion of a new methylene blue solution after injection within the rectus sheath were described in seven fresh calf cadavers. Then, fourteen calves undergoing elective herniorrhaphy were randomly assigned to receive either bilateral ultrasound-guided RSB with 0.3 mL/kg of bupivacaine 0.25% and 0.15 µg/kg of dexmedetomidine or 0.3 mL/kg of 0.9% NaCl (control). Intraoperative data included cardiopulmonary variables and anesthetic requirements. Postoperative data included pain scores, sedation scores and peri-incisional mechanical threshold assessed by force algometry at specific time points after anesthetic recovery. Treatments were compared using Wilcoxon rank-sum, Student's t-test, and Cox proportional hazard model as appropriate. Mixed effect linear models on rank, with random effect calf; fixed effects time, treatment, and their interaction were used to compare pain scores and mechanical thresholds over time. Significance was set at p = 0.05.Results and DiscussionCalves receiving RSB recorded lower pain scores between 45 – 120 minutes (p < 0.05) and at 240 min after recovery (p = 0.02). And they recorded higher mechanical thresholds between 45 and 120 min after surgery (p < 0.05). Ultrasound-guided RSB provided effective perioperative analgesia in calves undergoing herniorrhaphy under field conditions.

Opioid-based analgesia is often used in the management of postoperative pain in arthroplasty cases. This article analyses the safety of single-shot peripheral nerve block (PNB) and potential analgesic benefits in patients undergoing lower limb free flap reconstruction. A retrospective review including all patients undergoing lower limb reconstruction with free flaps between October 2017 and April 2020 was performed. Patients were divided into two groups based on PNB utilization. The use of oral opioids, post-operative pain scores, flap-related outcomes, patient morbidity, and length of hospital stay (LOS) were compared between groups. Thirty-one patients who underwent lower limb reconstruction with free flaps, were finally included in the study. Preoperative PNB was performed on 14 patients, while 17 patients received general anesthesia (GA) alone. Pain at rest, measured using the visual analog scale (VAS) score, was significantly lower (2.2 ± 1.7 vs. 4.9 ± 1.7) in the PNB group on postoperative day 1 (POD). The mean [median]±SD amounts of opioids consumed in morphine milligram equivalent (MME) were significantly lower in the PNB group on both POD1 (33.5 [22.5] ± 33.9 vs. 61.6 [48.0] ± 39.0), POD2 (29.0 [15.0] ± 29.2 vs. 58.0 [52.5] ± 37.0) and cumulatively over 7 days (164.0 [197.0] ± 132.8 vs. 315.4 [225] ± 203.2). Complication rates and LOS were not statistically different between groups, although trending toward lower take-back procedures and major complications in the PNB group. Preoperative single-shot PNB significantly reduced postoperative opioid use and patient-reported pain severity and was not associated with an increase in complication rates. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve implantation (TAVI) has become the treatment of choice for the most fragile patients with severe aortic stenosis. The transfemoral route is preferred as the simplest and safest. The aim of our study was to compare the efficacy, tolerance and safety of local vs. locoregional anesthesia in trans-femoral TAVI procedures. This was a single-center retrospective study. Patients treated with femoral TAVI between February 25 and November 15, 2022 at the University Hospital of Reims were included, and two groups (local and locoregional anesthesia) were compared. TAVI success rate (92.9%), death rate (3.0%) and procedure duration (90.5 ± 13.5 minutes) did not differ between groups (p = 0.18, 0.15 and 0.55 respectively). For intra- and post-procedural treatments, the use of sedation, analgesics and benzodiazepines did not differ between groups. The cumulative dose of Remifentanil used per-procedure was lower in the local anesthesia group than in the locoregional anesthesia group (148.6 ± 71.9 mcg vs. 208.9 ± 110.0 mcg; p = 0.025). In this non-randomized retrospective study, local and locoregional anesthesia had comparable safety and efficacy in transfemoral TAVI procedures. In a constrained context and with a view to simplification, these results encourage transfemoral TAVIs to be performed under local anaesthesia, and to consider a "PCI-like" approach, without the presence of an anaesthetist, for selected patients without respiratory, musculoskeletal or agitation disorders, or vascular approach difficulties. [ABSTRACT FROM AUTHOR]

Margaretha B Breebaart,1,2 Jordi Branders,2 Luc Sermeus,3 Sultan Termurziev,2 Helene Camerlynck,2 Lennert Van Putte,1 Marnik Van Putte Minelli,1 Stefan De Hert4 1Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium; 2Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium; 3Department of Anesthesiology, St. Luc University Hospital, Brussels, Belgium; 4Department of Anesthesia and Perioperative Medicine, Ghent University Hospital, Ghent, BelgiumCorrespondence: Margaretha B BreebaartDepartment of Anesthesia, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, BelgiumTel +32 486911691Email Margaretha.breebaart@uza.bePurpose: Continuous sciatic nerve blocks have proven benefits for postoperative analgesia after foot surgery. However, the optimal mode of administration remains a point of debate. Ultrasound guided subparaneural injection accelerates onset time and increases duration after a single shot sciatic nerve block. This double blind prospective randomized trial compares the 48-hour local anesthetic (LA) dose consumption of an automated intermittent bolus technique to a continuous infusion regimen in a subparaneural sciatic nerve catheter after hallux valgus surgery.Patients and Methods: Patients scheduled for hallux valgus surgery were randomized to receive either a continuous infusion of levobupivacaine 0.125% at 5mL/h (group A) or an intermittent automated bolus of 9.8 mL every 2 hours with a background of 0.1 mL/h (group B), both with a PCA bolus of 6 mL and lockout of 30 minutes. The 48 hour LA consumption, PCA boluses, Numeric Rating Scale (NRS), satisfaction and return of normal sensation were recorded.Results: Sixteen patients were excluded because of protocol violation or technical problems and 42 patients remained for analysis. The 48 hour ropivacaine consumption was higher in group A (293 ± 60 mL) than group B (257± 33 mL). The median and highest NRS scores and patient satisfaction were not statistically different between groups. Normal sensation returned after 75 ± 22 hours (group A) and 70 ± 17 hours (group B).Conclusion: Programmed bolus administration in subparaneural sciatic nerve catheters reduces LA consumption 48 hours after surgery with equal analgesia and patient satisfaction. Return of sensation is variable and can last more than 75 hours.Keywords: locoregional anesthesia, sciatic nerve block, postoperative pain, local anesthetics, levobupivacaine, orthopedic surgery

To develop an ultrasound-guided interfascial plane technique for injection of the pudendal nerve near its sacral origin in cats. Prospective, randomized, anatomical study. A group of 12 feline cadavers. Gross and ultrasound anatomy of the ischiorectal fossa, the pudendal nerve relationship with parasacral structures, and the interfascial plane were described. Computed tomography was employed to describe a cranial transgluteal approach to the pudendal nerve. Bilateral ultrasound-guided injections were performed in eight cadavers using low [(LV) 0.1 mL kg–1] or high volume [(HV) 0.2 mL kg–1] of ropivacaine–dye solution. Dissections were performed to determine successful staining of the pudendal nerve (>1 cm) and inadvertent staining of the sciatic nerve, and any rectal, urethral, or intravascular puncture. Pudendal nerve staining in groups LV and HV were compared using Fisher's exact and Wilcoxon rank-sum test as appropriate (p = 0.05). The pudendal nerve and its rectal perineal and sensory branches coursed through the ischiorectal fossa, dorsomedial to the ischiatic spine. The pudendal nerve was not identified ultrasonographically, but the target plane was identified between the sacral transverse process, the ischiatic spine, the pelvic fascia and the rectum, and it was filled with dye solution. Both branches of the pudendal nerve were completely stained 75% and 87.5% in groups LV and HV, respectively (p = 1.00). The dorsal aspect of the sciatic nerve was partially stained in 37% of injections in group HV. Rectal or urethral puncture and intravascular injection were not observed. In cats, ultrasound-guided cranial transgluteal injection successfully stained the pudendal nerve in at least 75% of attempts, regardless of injectate volume. Group HV had a greater probability of sciatic nerve staining. [ABSTRACT FROM AUTHOR]

To investigate the epidural administration of combinations of ropivacaine, morphine and xylazine in bitches undergoing unilateral mastectomy. Prospective, randomized, blinded, clinical study. A total of 22 bitches scheduled to undergo unilateral mastectomy for mammary tumor excision. Dogs were anesthetized with acepromazine (0.02 mg kg–1) and morphine (0.3 mg kg–1) intramuscularly, propofol intravenously (IV) and isoflurane. Prior to the beginning of surgery, dogs were randomly administered one of three epidural treatments: ropivacaine (0.75 mg kg–1) with morphine (0.1 mg kg–1) (group RM, n = 7); ropivacaine with xylazine (0.1 mg kg–1) (group RX, n = 8); or ropivacaine with morphine and xylazine (group RMX, n = 7). Cardiopulmonary variables and the expired concentration of isoflurane (F e ′Iso) were recorded intraoperatively. Meloxicam (0.1 mg kg–1) was administered IV during skin closure. Postoperative pain scores were evaluated with the Glasgow composite measure pain scale short form for 24 hours, and rescue analgesia with morphine (0.5 mg kg–1) was administered intramuscularly when pain scores were ≥ 6/24. F e′ Iso was significantly higher in group RM than in groups RX and RMX. Heart rate decreased significantly in groups RX and RMX, but blood pressure remained within acceptable values. The number of dogs administered rescue analgesia within 24 hours was significantly higher in group RX (seven dogs, 87.5%) than in groups RM (one dog, 14.3%; p = 0.01) and RMX (two dogs, 28.6%; p = 0.04). Time to standing was significantly longer in group RX than in group RM. All epidural treatments provided adequate antinociception with minimal cardiovascular adverse effects during mastectomy. The inclusion of morphine (groups RM and RMX) provided the best postoperative analgesia. Owing to the undesirable effect of xylazine on ambulation, the combination ropivacaine–morphine appeared to provide greater benefits in bitches undergoing unilateral mastectomy. [ABSTRACT FROM AUTHOR]

Infra-clavicular brachial plexus block (ICB),h as been feared and hardly used by most anest hetists because of the proximity of the pleura. To-day, the use of ultrasound in anesthesia has reinstituted this block as a valid therapeutic option. The aim of this study was to present the value of ultrasound-guided ICB in upper limb anesthesia, its advantages and disadvantages compared to other types of block. We conducted a prospective descriptive study over a period of nine months (March to December 2020) in the anesthesia and intensive care unit of the medical center of the General Aboubacar Sangoulé Lamizana Camp (CMCGASL) in Ouagadougou. All the patients who had upper limb surgery performed under ultrasound-guided ICB without neurostimulation were included in the study. Thirty-eight (38) infra-clavicular blocks were performed during the study period. The average age of our patients was 35.34 years +/- 10. The site of surgery was the forearm in 27 cases (72%), the hand in 8 cases (21%), the elbow in 2 cases (5%) and the lower extremity of the arm in only one case (2%). The lenght of the ICB procedure was averagely 8.86 minutes +/- 4 minutes. The local anesthetic used was a mixture of ropivacaine and xylocaine. The average volume of local anesthesic administered was 19 ml +/- 2.21 ml. Sensory block was effective in 36 cases (94.7%). There were two block failures (5.3%). The average duration of the sensory block was 494 minutes (8 hours 15 minutes). After the surgery the complications sought for were pneumothorax and paresthesia. No patient presented this type of complication. Ultrasound-guided ICB is an efficient and safe block as are supra clavicular and axillary block in upper limb surgery. The position required for its realisation gives it a clear advantage over axillary and humeral canal block. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study aimed to compare rates of perioperative mortality and morbidity, especially pulmonary complication, between endovascular aneurysm repair (EVAR) performed under general anesthesia (GA) and under fascia iliaca block (FIB)., Methods: Patients diagnosed with infrarenal abdominal aortic aneurysm (AAA) who were treated with EVAR were included. Retrospective review of electronic medical records was performed. Patient characteristics, operative details, and postoperative results including mortality and morbidity within 30 days were collected. Statistical analysis to compare postoperative outcomes between EVAR under FIB and EVAR under GA was performed. A univariate analysis was conducted to identify factors associated with increased 30-day mortality., Results: This study included 119 patients, 75 in the FIB group and 44 in the GA group. Most patients were male, with 62 (82.5%) in the FIB group and 31 (70.2%) in the GA group, and most patients were hypertensive, with 57 (76%) in the FIB group and 36 (81.8%) in the GA group. Smoking and coronary artery disease (CAD) was more prevalent in the FIB group, p < .05. Thirty-day mortality was not significantly different between the FIB group and the GA group (1 (1.3%) vs 2 (4.5%), p = .554). Pulmonary complication was lower in the FIB group than in the GA group (1.3% vs 11.4%, p = .026). ICU stay was shorter in the FIB group than in the GA group (0.2 vs 4.5 days, p = .012). Univariate analysis showed that chronic obstructive pulmonary disease (COPD) was associated with higher 30-day mortality., Conclusions: Endovascular aneurysm repair under FIB was feasible. Compared to GA, this approach resulted in lower postoperative pulmonary complications and shorter ICU stay., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Epidural anesthesia minimizes perioperative pain in dogs. It is considered that epidural solution dispersion in cadavers is similar to alive dogs. The objective of the anatomical study was to compare the dispersion of 0.2 mL/kg 0.25% bupivacaine and iohexol via lumbar epidural (L1–L2) under fluoroscopic guidance in 10 thawed cadavers (GC) and 13 female dogs (G0.25) (5–15 kg; body score 4/5). The objective of the clinical study was to evaluate postoperative analgesic consumption and sedation for 6 h after extubation of dogs submitted to ovariohysterectomy when using 0.25% (G0.25; n = 10) bupivacaine with the intraoperative use of fentanyl (GF; n = 10). Parametric data were compared by the t-test and non-parametric data by the Mann Whitney test. Pain and sedation scores were evaluated over time by the Friedman test, followed by the Dunn test. Alive dogs presented greater epidural dispersion (17 ± 3 vertebrae) than thawed cadavers (11 ± 4 vertebrae; p = 0.002). All dogs treated with fentanyl and only one dog treated with 0.25% epidural bupivacaine presented pain scores above the cut-off point of the Glasgow Composite Measure Pain Scale Short-Form (GCMPS-SF) and required postoperative rescue analgesia up to 6 h after extubation. The sedation score was higher at all postoperative moments compared to preoperative moments in the G0.25 and GF, except for evaluations performed at 5 and 6 h after extubation in the GF. Greater sedation was observed immediately after extubation in the GF compared to the G0.25, and there was greater sedation in the G0.25 compared to the GF from 3 to 6 h after extubation. The conclusion of the anatomical study was that L1–L2 epidural bupivacaine dispersion is lower in canine thawed cadavers than in alive dogs. Conclusion of the clinical study was that lumbar epidural anesthesia improved postoperative analgesia and produced longer postoperative sedation when compared to fentanyl.

Little information is available regarding ultrasound-guided locoregional anesthesia in non-domestic species. Locoregional techniques have been shown to reduce intraoperative anesthetic requirements and provide postoperative pain relief. Decreasing dosage of general anesthetics allows more stable cardiopulmonary function during anesthesia and reduces the probability of side effects. An 11-week-old African leopard (Panthera pardus) was referred for treatment of a malunion angular limb deformity secondary to a tibial and fibular fracture. The animal was scheduled to undergo angular correction of the tibia via closing wedge osteotomy and fixation with a locking plate system. Following preanesthetic medication and induction of general anesthesia, a saphenous nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed under ultrasound guidance and a sciatic nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed using ultrasound and a peripheral nerve stimulator. Intraoperative anesthetic plane was considered light, yet no abrupt cardiocirculatory changes were seen, nor was rescue analgesia required. This case report suggests that sciatic and saphenous blockade could therefore be recommended as part of a multimodal plan of analgesia for orthopedic surgeries in pediatric exotic felids.

To compare the perioperative use of analgesics and complication rates in dogs administered an erector spinae plane (ESP) block or a traditional opioid-based (OP) treatment as part of analgesic management during hemilaminectomy. Retrospective cohort study. Medical records of 114 client-owned dogs. General data included demographics, duration of procedure, number of laminae fenestrated, perioperative use of steroid and non-steroidal anti-inflammatory drugs. Intra- and postoperative analgesics used in 48 hours and complications rates were compared between groups. Opioid use was expressed in morphine equivalents [ME (mg kg−1)]. Continuous data were compared using the Mann–Whitney U test and incidence of events with a Fisher's exact tests. Multiple linear regression was used to evaluate association between perioperative ME consumption (dependent variable) with other independent variables. Data are presented as median (range). Differences were considered significant when p < 0.05. Group ESP comprised 42 dogs and group OP 72 dogs. No differences were observed in the general data. Intraoperative ME was 0.65 (0.20–3.74) and 0.79 (0.19–5.60) mg kg−1 in groups ESP and OP, respectively (p = 0.03). Intraoperative infusion of lidocaine was administered intravenously (IV) to 23.8% and 68% of groups ESP and OP, respectively (p < 0.0001). Intraoperative infusion of ketamine was administered IV to 21% and 40% of groups ESP and OP, respectively (p = 0.04). Regression analysis revealed the ESP block as the only independent variable affecting the perioperative ME consumption. Pharmacological intervention to treat cardiovascular complications was administered to 21.4% and 47.2% of dogs in groups ESP and OP, respectively (p = 0.008). There were no differences in postoperative complication rates. ESP block was associated with reduced perioperative opioid consumption, intraoperative adjuvant analgesic use and incidence of pharmacological interventions to treat cardiovascular complications in dogs undergoing hemilaminectomy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Over the ongoing pandemic of coronavirus disease 2019 (COVID-19), the demand for critical care beds among medical services has rapidly exceeded its supply. Elective surgery has comprehensively been drastically limited and allocating intensive care beds to emergency cases or to high risk scheduled elective cases has become an even more difficult task. Here we present our experience which could help to handle undelayable surgical procedures during this emergency. PATIENTS AND METHODS: In 2019, eight patients (4 men, 4 women) with a mean age of 88 years, needing emergency abdominal surgery underwent awake open surgery at our Department of Surgery. All of them were identified as fragile patients at preoperative evaluation by the anesthesiologist. In all cases, locoregional anesthesia (spinal, epidural or combined spinal- epidural anesthesia) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. RESULTS: None of the patients was intubated. Mean operative time was 80 minutes (minimum 30 minutes, maximum 130 minutes). Intraoperative and postoperative pain were both well controlled. None of them required postoperative intensive care support. No perioperative complications were observed. CONCLUSIONS: Based on our preliminary case series, awake open surgery has resulted feasible and safe. This approach has allowed to perform undelayable major abdominal surgeries on fragile patients when intensive care beds were not available. Surely, it represents a helpful alternative in the COVID-19 era. A streamlining of workflows would fast-track both fragile patients management, as well as healthcare workers' tasks and activity. [ABSTRACT FROM AUTHOR]

The quadratus lumborum (QL) block targets the fascial plane surrounding the QL muscle providing abdominal somatic and visceral analgesia. The extension of its analgesic effects is a subject of research, as it could not cover areas of the cranial abdomen in dogs. This study assesses in eight thawed canine cadavers, the distribution of high-volume injections (0.6 mL kg−1 of a mixture of methylene blue and iopromide) injected between the psoas minor muscle and the vertebral body of L1. Anatomical features of the area of interest were studied in two cadavers. In another six dogs, QL blocks were performed bilaterally under ultrasound-guidance. The distribution of contrast was evaluated by computed tomography (CT). Hypaxial abdominal muscles were dissected to visualize the dye spread (spinal nerves and sympathetic trunk) in 5 cadavers. The remaining cadaver was refrozen and cross-sectioned. CT studies showed a maximum distribution of contrast from T10 to L7. The methylene blue stained T13 (10%), L1 (100%), L2 (100%), L3 (100%), L4 (60%) and the sympathetic trunk T10 (10%), T11 (20%), T12 (30%), T13 (70%), L1 (80%), L2 (80%), L3 (60%) and L4 (30%). These findings may suggest that despite the high volume of injectate administered, this modified QL block could not produce somatic analgesia of the cranial abdomen, although it could provide visceral analgesia in dogs.

Background: Rib fractures occur frequently following blunt chest trauma and induce morbidity and mortality. Analgesia is a cornerstone for their management, and regional analgesia is one of the tools available to reach this objective. Epidural and paravertebral blocks are the classical techniques used, but the serratus plane block (SPB) has recently been described as an effective technique for thoracic analgesia. Methods: This case series reported and analyzed 10 consecutive cases of SPB for blunt chest trauma analgesia in a level 1 trauma center from May to October 2018. SPB was performed with either a single shot of local anesthetic or a catheter infusion. Results: Ten patients were treated with 3 single shots and 7 catheter infusions (median length 3 days [interquartile range (IQR) 2.5 to 3.5]). The Median Injury Severity Score was 16 (IQR 16 to 23), and the number of broken ribs ranged from 3 to 22. Daily equivalent oral morphine consumption was significantly decreased after SPB from 108 mg (IQR 67 to 120) to 19 mg (IQR 0 to 58) (P = 0.015). The Numeric Pain Rating Scale (NPRS) score during cough was significantly decreased from 7.3 (IQR 5.3 to 8.8) to 4 (IQR 3.6 to 4.6) (P = 0.03). The NPRS score at rest remained unchanged. One complication occurred, due to a catheter section. Conclusions: The SPB technique (with or without catheter insertion) in 10 patients who had blunt chest trauma with rib fractures is effective for cough pain control, with a significant decrease in morphine consumption. [ABSTRACT FROM AUTHOR]

We present the clinical case of a 14-year-old girl with congenital insensitivity to pain and anhidrosis (CIPA) and a history of multiple fractures operated on in the right lower extremity. It was programmed for the removal of femorotibial osteosynthesis material and the intramedullary nail of the femur. The anesthetic strategy was: general anesthesia with spontaneous ventilation and locoregional anesthesia (three peripheral ultrasound-guided blocks: femoral, femorocutaneous and sciatic nerve), followed by muscle relaxation and orotracheal intubation for the rest of the procedure. Anesthetic maintenance without the need for opioids. The patient remained hemodynamically stable and without elevation of body temperature. No postoperative pain appeared, being discharged after 10 days. CIPA is a rare autosomal recessive disorder characterized by insensitivity to thermoalgesia, leading to multiple injuries and associated surgeries; anhidrosis with recurrent episodes of elevated body temperature and mental retardation. There is a failure in the nervous system through which thermoalgesia originates and in the autonomous reflex, which is why they present an interesting challenge in the anesthetic management. They have a higher risk of bronchoaspiration and hemodynamic instability due to dysautonomia; and of suffering hyperthermia, requiring an exquisite control of the intraoperative temperature. Although nociception has been abolished, they frequently have hyperesthesia, so a suitable degree of hypnosis is indicated, as well as certain analgesic techniques such as locoregional anesthesia. This case exposes the need to develop clinical guidelines for the management of CIPA, since its extraordinary rarity can make us doubt our anesthetic attitude. (DOLOR. 2019;34:137-41) [ABSTRACT FROM AUTHOR]

A significant problem in the dental medicine is pain alleviation. Many studies in the dental anesthesiology result in the production of new agents for locoregional anesthesia. Objective: This article aim to present the results of the last studies on the effect of the local anesthetics used in the oral surgery on patients with cardiovascular diseases. Material: A general review of the existing literature on the effect of the adrenaline, included as vasoconstrictor in the local anesthetics, used in patients with cardiovascular diseases is made. The benefits of vasoconstrictors for the quality of the anesthetic effect are proven. Conclusion: A small amount of adrenaline in the anesthetic solution does not result in complications development in patients with controlled cardiovascular diseases. Articaine is recommended agent of first choice for local anesthesia in the oral surgery.

Background: In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease., Case Summary: A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal-epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful., Conclusion: Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Mammary tumors are the most common neoplasms in female dogs. Surgical removal of the mammary gland chain is considered the standard treatment and is usually performed along with ovariohysterectomy (OH) to suppress ovarian hormonal influence. Mastectomies cause moderate to severe pain and require preferential multimodal analgesic protocols. The aim of this study was to compare the postoperative analgesic efficacy and the recovery times on female dogs undergoing mastectomies and OH between those treated with epidural levobupivacaine alone and those treated with associated doses of tramadol and anesthetized with propofol. Materials, Methods & Results: Eighteen female dogs were pretreated with acepromazine (0.03 mg/kg), using propofol (4 mg/kg) for induction and anesthesia maintenance. The dogs were randomly divided into three groups (n = 6) treated with epidural anesthesia with levobupivacaine alone at 1.5 mg/kg (GL) or associated with tramadol at doses of 2 mg/kg (GLT2) or 4 mg/kg (GLT4). After anesthesia, the mean propofol infusion rate for each group were calculed. During the postoperative period, the degree of analgesia according to the University of Melbourne Pain Scale for 6 hours were determined, considering seven time points for evaluation (M30, M60, M90, M120, M180, M240, and M360). Supplemental analgesia with morphine (0.5 mg/kg) to those dogs with scores ≥13 were provided. During the recovery period, the time intervals between the end of anesthesia, and the following events: extubation (EX), the first head movement (MC), and the establishment of sternal (PE) and quadrupedal (PQ) positions were measured. Data were subjected to the Friedman test for analysis of non-parametric variables within the same group and to the Mann-Whitney test for independent variables, comparing the mean scores between groups (statistical significance was set at P < 0.05). In the GL group, a higher mean propofol infusion rate than in either the GLT2 or GLT4 groups were found. The EX, PE, and PQ times were similar between the groups with a lower MC interval (P = 0.041) for dogs in the GLT2 group. The pain assessment revealed higher scores for dogs in the GL group than for those in the GLT4 group (M30 to M120 and M360). Over time, the initial scores increased after M90 (GL group) and after M120 (in all groups) and additional analgesia were required only in GL dogs. Discussion: Mammary tumors were more frequent in middle-aged and elderly female dogs, corroborating current literary data. Regarding anesthesia recovery, no differences in the time for extubation and sternal and quadrupedal positions were found, probably due to similar propofol infusion times and to similar metabolism among the dogs, independent of the higher mean infusion rates used in the group treated only with the local anesthetic. The post-surgical analgesic evaluation revealed lower pain scores in the groups in which tramadol was associated with levobupivacaine, in agreement with studies reporting its analgesic potential to approach surgical pain at doses ranging from 1 to 4 mg/kg. However, even lower scores with the highest dose of the proposed opioid were detected, suggesting improved effectiveness for occupying opioid and monoaminergic pathway receptors. Considering the results, epidural anesthesia with levobupivacaine and tramadol seems to provide adequate post-surgical analgesia for a minimum period of 6 h, and the best comfort is obtained with a dose of 4 mg/kg of opioid. [ABSTRACT FROM AUTHOR]

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Copyright of Arquivo Brasileiro de Medicina Veterinaria e Zootecnia is the property of Universidade Federal de Minas Gerais, Escola de Veterinaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)