Role of Regional Anesthesia in Orthopedic Trauma

Clark, Laura; Robinson, M.; Varbanova, Marina

doi:10.1016/j.anclin.2014.08.002

Cited by 15 publications

(7 citation statements)

References 54 publications

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“…As pain specialists, we also have a responsibility to keep our patients pain-free by selecting the most appropriate and safest analgesic protocol that must include RA as an essential ingredient. Incorporating the RA technique as an adjunct to MMA in any surgery has been proven multiple times to significantly reduce analgesic/opioid consumption and ultimately improve patient satisfaction by promoting enhanced recovery, early mobilization, and early discharge [25][26][27][28]. Such an inclusive approach helped us maintain our patients' overall satisfaction score of 4/5 (very good) at discharge with the existing analgesia protocol.…”

Section: Discussionmentioning

confidence: 99%

Resolving the Conflict Between Regional Analgesia and Developing Compartment Syndrome in Below-Knee Surgeries With the High-Volume Proximal Adductor Canal (Hi-PAC) Block: A Prospective Feasibility Study

Sonawane¹,

Shah²,

Balavenkatasubramanian³

2022

Cureus

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The consideration of regional analgesia (RA) in below-knee surgeries is always a controversial topic due to the fear of masking symptoms of developing compartment syndrome (CS) in the postoperative period. Compartment syndrome (CS) has been found frequently in below-knee surgeries, particularly among tibial diaphyseal fractures. Like any other surgery, below-knee surgeries have significant postoperative pain that requires effective postoperative analgesia protocol. The analgesia quality makes a big difference when compared with or without RA. Also, the presence or absence of RA cannot prevent or promote the development of CS. Therefore, patients should not be deprived of their right to remain pain-free in the postoperative period by compromising the analgesia protocol.The pain out of proportion to the surgery or injury is a typical symptom of developing CS, which can cause increased analgesic demands postoperatively. Timely diagnosis and treatment of CS require vigilant postoperative monitoring of the warning signs by trained staff. Avoiding RA for fear of presumed masking of symptoms and delaying CS diagnosis may not be a solution instead of choosing an appropriate RA with regular postoperative monitoring for such warning symptoms. The high-volume proximal adductor canal (Hi-PAC) block has been described as a procedure-specific and motor-sparing RA technique appropriate for below-knee surgeries.In this prospective study, we evaluated the analgesic efficacy of the Hi-PAC block in below-knee surgeries. We also observed the effect of the Hi-PAC block, due to proximal and distal drug distribution, on masking the symptoms of the developing CS during postoperative monitoring.We found the Hi-PAC block to be a safer and more effective RA alternative for below-knee surgeries with an added motor-sparing benefit that facilitated early mobility and discharge. Its property of not interfering with postoperative surveillance to detect the symptoms of CS and intervene in time helps deal with the anxiety of CS in below-knee surgeries.

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Section: Discussionmentioning

confidence: 99%

Resolving the Conflict Between Regional Analgesia and Developing Compartment Syndrome in Below-Knee Surgeries With the High-Volume Proximal Adductor Canal (Hi-PAC) Block: A Prospective Feasibility Study

Sonawane¹,

Shah²,

Balavenkatasubramanian³

2022

Cureus

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“…Regional anesthesia with the use of peripheral nerve blocks in the form of single injections or catheter placements with the option for prolonged infusions is becoming increasingly popular in orthopaedics. [56][57][58] Additionally, when surveyed, most orthopaedic surgeons are receptive to regional anesthesia for their patients. 56,59 Single injections or infusions are typically amide local anesthetics such as lidocaine, bupivacaine, or ropivacaine with additives to prolong the duration of blockade such as dexamethasone, clonidine, epinephrine, buprenorphine, tramadol, midazolam, and sodium bicarbonate.…”

Section: Postoperative Pain Management Regional Peripheral Anesthesiamentioning

confidence: 99%

Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting

Fanelli

2019

J Knee Surg

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The multiligament knee injury presents as a complex injury pattern that has substantial potential to cause long-term disability. Patients who sustain this injury pattern experience significant pain not only immediately following injury but also throughout the perioperative and postoperative period. Treating pain with major orthopaedic procedures is challenging but technical success of a surgical repair becomes trivial when pain is not effectively managed. This article will (1) provide an outline of the types of pain most often sustained in the multiligament knee injury, (2) outline the phases of pain management for this injury, and (3) provide an overview of persistent postoperative pain. The principles of multimodal analgesia in combination with effective regional anesthesia and attentive intraoperative management can position patients for successful rehabilitation and recovery.

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“…Lower extremity surgery can have moderate to severe pain, needing large doses of opioids and patients often become tolerant to these opioids. Surgeons prefer no regional anesthesia for lower extremity surgery due to risk of compartment syndrome because of the tight muscle compartments in thigh and calf [18].…”

Section: Introductionmentioning

confidence: 99%

Once-Weekly Nocturnal Ocular Choroidal Vascular Decongestion by Topical Long-acting Timolol Ophthlamic Solution Applied to Headache-Ipsilateral eye to Prevent Weekend-Migraine Attacks: Smartphone-app

Gupta¹

2021

JNNS

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This clinical study evaluates over medium-to-long term the hypothesis that intermittent spontaneous ocular choroidal vasculature-related congestive and nociceptive corneoscleral envelope distention have a pathogenetic role in genesis of episodic lateralizing migraine headache attacks. No neuro-anatomic or -physiologic difference prevails between the three divisions of the trigeminal nerve, but migraine dominantly affect the ophthalmic division. Use of topical ophthalmic solution for managing acute headache attacks of migraine has given contradictory results in controlled trials. I report the distribution of weekend-migraine headache attacks on a single‐participant (N=1) level for 2 patients over a 3-year period (2017-2020) without misuse of any recreational drug other than caffeine on week-days. After a run-in basal period of 6-months recorded on their Smartphones app, with their informed consent, a trial was carried out with topical long-acting β-blocker timolol maleate 0.5% w/v ophthalmic solution once weekly on Saturday night just before sleeping with no other advice to promote nocturnal sleeping or early awakening the next morning; only alcohol binge was proscribed. No week-end attacks of lateralizing migraine headache were reported in the 2 patients over a period of 3- years, a long-term consistent response. The biologically-plausible and defensible mechanistic link between migraine, intraocular pressure, ocular choroidal vasculature, nociceptive corneoscleral envelope aberration, and the pharmacologic basis for therapeutic ocular hypotension for prophylaxis of migraine headache attacks is elucidated for the first time in migraine literature.

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Role of Regional Anesthesia in Orthopedic Trauma

Cited by 15 publications

References 54 publications

Resolving the Conflict Between Regional Analgesia and Developing Compartment Syndrome in Below-Knee Surgeries With the High-Volume Proximal Adductor Canal (Hi-PAC) Block: A Prospective Feasibility Study

Resolving the Conflict Between Regional Analgesia and Developing Compartment Syndrome in Below-Knee Surgeries With the High-Volume Proximal Adductor Canal (Hi-PAC) Block: A Prospective Feasibility Study

Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting

Once-Weekly Nocturnal Ocular Choroidal Vascular Decongestion by Topical Long-acting Timolol Ophthlamic Solution Applied to Headache-Ipsilateral eye to Prevent Weekend-Migraine Attacks: Smartphone-app

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