Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years

Abstract

The majority of peripheral regional anaesthetic techniques have been shown to produce benefits for patients and hospital efficiency. Further interventional trials are required to clarify such benefits for supraclavicular block and transversus abdominis plane block and to ascertain any longer-term benefits for almost all of the blocks reviewed. Permanent complications of peripheral regional anaesthetic blocks are rare but accurate estimates of their incidence are yet to be determined.

Regional anesthesia in pain management

“…This is confirmed by a recent metaanalysis, which found marginal postoperative analgesic efficacy of transversus abdominis plane block after abdominal laparotomy/laparoscopy and cesarean delivery [10]. Consistent with the aforementioned study by the multisociety panel [7 && ], the review [9] found that the evidence for the impact of peripheral nerve blocks on longer-term outcomes was inadequate to inform clinical decision-making.…”

“…The main advantages over neuraxial analgesia are the avoidance of potentially catastrophic neurologic complications associated with spinal procedures, the higher hemodynamic stability and the lesser impairment of motor function. A recent narrative review based on a systematic literature search and prospectively defined appraisal criteria came to the conclusion that the majority of peripheral regional anesthetic techniques produce benefits for patients and hospital efficiency: they reduce postoperative pain and opioid consumption and/or increase patient satisfaction; for selected surgical procedures, the use of blocks can avoid general anesthesia and is associated with increased efficiency of the surgical pathway [9]. An exception is the transversus abdominis plane block, where the evidence for efficacy was conflicting.…”

WFH Musculoskeletal Congress 2015 Abstracts

“…Biomarkers related to active synovitis are also investigated. In this respect, it is demonstrated that plasma levels of vascular endothelial growth factor (VEGF), matrix metalloprotease (MMP)-9 [3] and osteopontin are increased in patients with synovitis compared to controls [4]. These studies indicate that biomarkers are a promising tool in detecting the destructive properties of joint damage.…”

“…To address these issues a meeting of experts in the field, including hematologists, orthopedic surgeons and physical therapists was held in Toronto, Canada in October 2014. The World Health Organization (WHO) International Classification of Function and Disability (ICF) model was used as a frame work to discuss the potential for developing a "core" set of outcome measures for use in persons with hemophilia treated with prophylaxis (3) ; a systematic review of selected outcome measures is in progress (4) . The results of this systematic review will identify areas that require further work including translation and culture adaptation of selected outcome measures for use globally.…”

“…A relatively small number of intra-articular bleeds are massive bleeds with a huge amount of intra-articular blood that could be aspirated. Moreover, the procedure is usually not practical, it should be performed enough early (<12-24 h from bleeding onset) in order to avoid the formation of a loose fibrin grid that can render aspiration more difficult and not resolutiv3 (4). Although the procedure is quite safe, minimal factor coverage should be given in order to ensure a plasmatic clotting activity of at least 30-50%, for the 48-72 h following the procedure.…”