A Novel Introducer for Ultrasound-Guided Cryoneurolysis Administration to Improve Patient Safety an d Functionality

2020 ◽  
pp. 217-220
Author(s):  
JOhn J. Finneran IV
Keyword(s):  
Peripheral Nerve ◽  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Improve Patient Safety ◽  
Femoral Nerve ◽  
Needle Insertion ◽  
Ultrasound Guided ◽  
Needle Pass ◽  
Time Required ◽  
Local Anesthetic Injection

Background: Percutaneous cryoneurolysis provides prolonged postoperative analgesia by placing a probe adjacent to a peripheral nerve and cooling the probe tip, inducing a reversible block that lasts weeks to months. Unfortunately, freezing the nerve can produce significant pain. Consequently, local anesthetic is generally applied to the nerve prior to cryoneurolysis, which, until now, required an additional needle insertion increasing both the risks and duration of the procedure. Case Presentation: Three patients underwent ultrasound-guided percutaneous cryoneurolysis of either the sciatic and saphenous nerves or the femoral nerve. In all patients, the local anesthetic injection and cryoneurolysis were accomplished with a single needle pass using the novel probe introducer. Conclusion: This introducer allows perineural local anesthetic injection followed immediately by cryoneurolysis, thereby sparing patients a second skin puncture, lowering the risks of the procedure, and decreasing the overall time required for cryoneurolysis. Key words: Cryoablation, cryoanalgesia, peripheral nerve block, postoperative analgesia, ultrasound

Anatomical basis of fascial plane blocks

2021 ◽  
Vol 46 (7) ◽  
pp. 581-599
Author(s):  
Ki Jinn Chin ◽  
Barbara Versyck ◽  
Hesham Elsharkawy ◽  
Maria Fernanda Rojas Gomez ◽  
Xavier Sala-Blanch ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Clinical Utility ◽  
Needle Insertion ◽  
Ultrasound Guided ◽  
Internal Organs ◽  
Paravertebral Space ◽  
Anatomical Basis ◽  
Local Anesthetic Injection ◽  
Visceral Innervation ◽  
Fascial Plane

Fascial plane blocks (FPBs) are regional anesthesia techniques in which the space (“plane”) between two discrete fascial layers is the target of needle insertion and injection. Analgesia is primarily achieved by local anesthetic spread to nerves traveling within this plane and adjacent tissues. This narrative review discusses key fundamental anatomical concepts relevant to FPBs, with a focus on blocks of the torso. Fascia, in this context, refers to any sheet of connective tissue that encloses or separates muscles and internal organs. The basic composition of fascia is a latticework of collagen fibers filled with a hydrated glycosaminoglycan matrix and infiltrated by adipocytes and fibroblasts; fluid can cross this by diffusion but not bulk flow. The plane between fascial layers is filled with a similar fat-glycosaminoglycan matric and provides gliding and cushioning between structures, as well as a pathway for nerves and vessels. The planes between the various muscle layers of the thorax, abdomen, and paraspinal area close to the thoracic paravertebral space and vertebral canal, are popular targets for ultrasound-guided local anesthetic injection. The pertinent musculofascial anatomy of these regions, together with the nerves involved in somatic and visceral innervation, are summarized. This knowledge will aid not only sonographic identification of landmarks and block performance, but also understanding of the potential pathways and barriers for spread of local anesthetic. It is also critical as the basis for further exploration and refinement of FPBs, with an emphasis on improving their clinical utility, efficacy, and safety.

Femoral Nerve Blockade

2010 ◽  
pp. 347-364
Author(s):  
Kimberly P. Wynd ◽  
Hugh M. Smith
Keyword(s):  
Side Effects ◽  
Peripheral Nerve ◽  
Postoperative Analgesia ◽  
Ultrasound Guidance ◽  
Insertion Site ◽  
Femoral Nerve ◽  
Needle Insertion ◽  
Clinical Applications ◽  
Nerve Blockade ◽  
Anterior Aspect

Blockade of the femoral nerve provides surgical anesthesia and postoperative analgesia to the anterior aspect of the thigh and knee. The following aspects of the procedure are reviewed: clinical applications, relevant anatomy, patient position, technique (including neural localization techniques, needle insertion site, and needle redirection cues), and side effects and complications. A discussion of ultrasound guidance and peripheral nerve catheters completes the chapter

scholarly journals Ultrasound Guided Femoral Nerve Block with Bupivacaine versus Bupivacaine and Tramadol for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty under Spinal Anesthesia

2021 ◽  
pp. 23-32
Author(s):  
Mohammad Mostafa Abo Farrag ◽  
Laila Elahwal ◽  
Hesham Mohammad Maroof ElDomairy ◽  
Mohammad Ibrahem Okab
Keyword(s):  
Total Knee Arthroplasty ◽  
Spinal Anesthesia ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Postoperative Analgesia ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Ultrasound Guided ◽  
Group I ◽  
Total Knee

Background: Effective pain control in Total knee arthroplasty (TKA) is important for optimizing the rehabilitation process in order to achieve patient satisfaction with a good functional outcome as well as reduce hospitalization duration and costs. Combined use of aesthetic with tramadol has been reported to achieve a longer duration of sensory and motor block. The aim of this study is to evaluate the quality and duration of postoperative analgesia produced by ultrasound guided femoral nerve block (FNB) by bupivacaine versus (bupivacaine & tramadol) in patients undergoing total knee arthroplasty under spinal anesthesia. Methods: This prospective randomized controlled double blinded study was carried out on 60 patients aged above 50 years; American Society of Anesthesiologists physical status (ASA) I-III scheduled for total knee arthroplasty under spinal anesthesia. Patients were randomized to one of two equal groups: Group I control (C): received FNB with 30 ml 0.25% bupivacaine. Group II tramadol (T): received FNB with 30ml 0.25% bupivacaine and 100 mg tramadol. Results: Postoperative heart rate was significantly increased in group C than group T at 8h, 12h, 16h and 24h. Postoperative mean arterial blood pressure was significantly increased in group C than group T at 6h, 8h, 12h, 16h and 24h. There were 30 (100%) patients required rescue analgesia in group C and 19 (63.33%) patients in group T which was increased significantly in group C than group T. The time to first analgesic requirement was significantly decreased in group C than group T. Total morphine consumption was increased significantly in group C than group T. VAS was increased significantly in group C than group T at 6, 8, 12, 16 and 24 hours. Adverse effects were insignificantly different between both groups. Conclusion: Adding tramadol (100 mg) to 0.25% bupivacaine (to a volume of 30 ml) during US guided FNB of TKA under spinal anesthesia was associated with better postoperative analgesia when compared with 0.25% bupivacaine alone.

Epipleural surgical block and ultrasound-guided erector spinae plane block for analgesia in VATS

2021 ◽  
Keyword(s):  
Postoperative Pain ◽  
Thoracic Surgery ◽  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Additional Method ◽  
Video Tutorial ◽  
Erector Spinae Plane Block ◽  
Severe Postoperative Pain

Thoracic surgery is still associated with severe postoperative pain. In this video tutorial, we present 2 techniques that could be used as an additional method in a multimodal postoperative analgesia strategy for video-assisted thoracic surgery. We present the combination of an epipleural surgical infiltration of a local anesthetic with an ultrasound-guided erector spinae plane block.

scholarly journals Ultrasound-Guided Continuous Femoral Nerve Block with Dexmedetomidine Combined with Low Concentrations of Ropivacaine for Postoperative Analgesia in Elderly Knee Arthroplasty

2019 ◽  
Vol 28 (5) ◽  
pp. 457-462 ◽  
Author(s):  
Xiao-Ying Zhao ◽  
Er-Fei Zhang ◽  
Xiao-Li Bai ◽  
Zi-Jian Cheng ◽  
Peng-Yun Jia ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Postoperative Analgesia ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Ultrasound Guided ◽  
Low Concentrations ◽  
Functional Exercise ◽  
Continuous Femoral Nerve Block

Objectives: This study aims to investigate the clinical effect of dexmedetomidine (DEX) combined with low concentrations of ropivacaine in ultrasound-guided continuous fem­oral nerve block for postoperative analgesia in elderly patients with total knee arthroplasty (TKA). Materials and Methods: Patients were divided into three groups: group C, group D1, and group D2. For postoperative analgesia, patients in group C were given 0.15% ropivacaine, patients in group D1 were given 0.15% ropivacaine + 0.02 μg × kg–1 × h–1 DEX, and patients in group D2 were given 0.15% ropivacaine + 0.05 μg × kg–1 × h–1 DEX. The visual analogue scores in the resting state, active state (AVAS), and passive functional exercise state (PVAS), degree of joint bending, and Ramsay scores were recorded. Results: The Ramsay scores were significantly higher, AVAS scores were significantly lower, PVAS scores were significantly decreased, the degree of joint bending was significantly higher, and the time to the first postoperative ambulation was shorter in groups D1 and D2 than group C. Furthermore, the time to the first postoperative ambulation was shorter in group D2 than in group D1, patients in groups D1 and D2 were more satisfied than patients in group C, and patients in group D2 were more satisfied than patients in group D1. Conclusion: The protocol of 0.05 μg × kg–1 × h–1 of DEX combined with 0.15% ro­pivacaine in ultrasound-guided continuous femoral nerve block for postoperative analgesia in elderly patients with TKA provides a better analgesic effect than without DEX performance.

scholarly journals A comparison of three techniques (local anesthetic deposited circumferential to vs. above vs. below the nerve) for ultrasound guided femoral nerve block

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Szilárd Szűcs ◽  
Didier Morau ◽  
Syed F Sultan ◽  
Gabriella Iohom ◽  
George Shorten
Keyword(s):  
Nerve Block ◽  
Local Anesthetic ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Ultrasound Guided
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