scholarly journals Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ariel Clare Johnson ◽  
Salih Colakoglu ◽  
Angela Reddy ◽  
Clara Marie Kerwin ◽  
Roland A Flores ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Enhanced Recovery ◽  
Anesthetic Technique ◽  
Single Shot ◽  
Nerve Blocks ◽  
Reconstruction Surgery ◽  
Opioid Medications

Context: High rates of mortality and chemical dependence occur following the overuse of narcotic medications, and the prescription of these medications has become a central discussion in health care. Efforts to curtail opioid prescribing include Enhanced Recovery After Surgery (ERAS) guidelines, which describe local anesthesia techniques to decrease or eliminate the need for opioids when used in a comprehensive protocol. Here, we review effective perioperative blocks for the decreased use of opioid medications post-breast reconstruction surgery. Evidence Acquisition: A comprehensive review was conducted using keywords narcotics, opioid, surgery, breast reconstruction, pain pump, nerve block, regional anesthesia, and analgesia. Papers that described a local anesthetic option for breast reconstruction for decreasing postoperative narcotic consumption, written in English, were included. Results: A total of 52 papers were included in this review. Local anesthetic options included single-shot nerve blocks, nerve block catheters, and local and regional anesthesia. Most papers reported equal or even superior pain control with decreased nausea and vomiting, length of hospital stay, and other outcomes. Conclusions: Though opioid medications are currently the gold standard medication for pain management following surgery, strategies to decrease the dose or number of opioids prescribed may lead to better patient outcomes. The use of a local anesthetic technique has been shown to reduce narcotic use and improve patients’ pain scores after breast reconstruction surgery.

scholarly journals NERVE BLOCKS FOR PEDIATRIC ACL RECONSTRUCTION: COMPARING FUNCTION, PATIENT-REPORTED OUTCOMES, AND EFFICIENCY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0012
Author(s):  
Tomasina M. Leska ◽  
Joshua T. Bram ◽  
Nicolas Pascual-Leone ◽  
Brendan A. Williams ◽  
Theodore J. Ganley
Keyword(s):  
Physical Function ◽  
Acl Reconstruction ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Tertiary Care ◽  
Isokinetic Strength ◽  
Single Shot ◽  
Nerve Blocks ◽  
Patient Reported

Background: Previous studies have compared the use of continuous nerve catheter versus single-shot nerve block approaches to regional anesthesia in ACL Reconstruction (ACLR), but they have primarily focused on adult populations. A paucity of data exists comparing these regional anesthesia techniques in children. Hypothesis/Purpose: To compare postoperative pain, strength, and functional outcomes between pediatric ACLR patients undergoing femoral nerve catheter (FNC) placement with single-shot sciatic block and those receiving femoral and sciatic single-shot nerve blocks (SSNB). Methods: Pediatric patients (≤18 years) undergoing primary ACLR between 1/2018-8/2019 at an urban tertiary care children’s hospital were identified. Patients were grouped based on regional anesthetic technique (FNC vs. SSNB). Emergency department (ED) visits, clinic visits, and calls for uncontrolled pain and narcotic refills were compared between these two groups. Outcomes including PROMIS scores, strength testing, and active range of motion (AROM) were also compared. Multiple imputation analysis was used to reduce bias as a result of missed follow-up. Results: 78 patients met inclusion criteria (FNC-36 patients, SSNB-42 patients). There were no differences in age, sex, BMI, or surgical technique between cohorts (Table I). Block preparation time (p<0.001) and surgical duration (p<0.001) were significantly longer for the FNC group. Ropivacaine dose (mg) of the sciatic nerve block was significantly higher in the SSNB group (35.0 ± 7.5 vs. 30.1 ± 4.1, p=0.001). All SSNB cases were performed at a satellite surgical center compared to 1 (2.8%) FNC case (p<0.001). There were no differences in uncontrolled pain or required narcotic refills between groups, and at 1 week follow-up, the proportion of patients with continued opioid consumption was not different (Table II). At 1 week, SSNB patients reported higher PROMIS physical function - mobility scores (25.5 ± 5.6 vs. 22.1 ± 4.9, p=0.009) with no difference in PROMIS pain interference scores. PROMIS scores were not different between cohorts at 6 weeks, 3 months or 6 months. AROM in extension and flexion also showed no difference between groups. SSNB was associated with a higher hamstrings to quadriceps ratio (quadriceps deficit) at 3 months (77.4 ± 23.8 vs. 66.2 ± 18.0, p=0.028), but there were no differences in isokinetic strength at 6 months. Conclusion: SSNB was associated with shorter operative times and better PROMIS physical function – mobility scores at 1 week compared to FNC. No other differences were observed in post-operative pain management, and cohorts were without differences in AROM and isokinetic strength by 6 months. Tables/Figures: [Table: see text][Table: see text]

scholarly journals National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092934
Author(s):  
Nicholas A. Trasolini ◽  
Ioanna K. Bolia ◽  
Hyunwoo P. Kang ◽  
Anthony Essilfie ◽  
Erik N. Mayer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Shoulder Arthroscopy ◽  
Labral Repair ◽  
Future Research ◽  
Single Shot ◽  
Nerve Blocks ◽  
Opioid Prescription ◽  
National Trends

Background: There are few large database studies on national trends in regional anesthesia for various arthroscopic shoulder procedures and the effect of nerve blocks on the postoperative rate of opioid prescription filling. Hypothesis: The use of regional nerve block will decrease the rate of opioid prescription filling after various shoulder arthroscopic procedures. Also, the postoperative pattern of opioid prescription filling will be affected by the preoperative opioid prescription-filling history. Study Design: Cohort study; Level of evidence, 3. Methods: Patient data from Humana, a large national private insurer, were queried via PearlDiver software, and a retrospective review was conducted from 2007 through 2015. Patients undergoing arthroscopic shoulder procedures were identified through Current Procedural Terminology codes. Nerve blocks were identified by relevant codes for single-shot and indwelling catheter blocks. The blocked and unblocked cases were age and sex matched to compare the pain medication prescription-filling pattern. Postoperative opioid trends (up to 6 months) were compared by regression analysis. Results: We identified 82,561 cases, of which 54,578 (66.1%) included a peripheral nerve block. Of the patients who received a block, 508 underwent diagnostic shoulder arthroscopy; 2449 had labral repair; 4746 had subacromial decompression procedure; and 12,616 underwent rotator cuff repair. The percentage of patients undergoing a nerve block increased linearly over the 9-year study period ( R 2 = 0.77; P = .002). After matching across the 2 cohorts, there was an identical trend in opioid prescription filling between blocked and unblocked cases ( P = .95). When subdivided by procedure, there was no difference in the trends between blocked and unblocked cases ( P = .52 for diagnostic arthroscopies; P = .24 for labral procedures; P = .71 for subacromial decompressions; P = .34 for rotator cuff repairs). However, when preoperative opioid users were isolated, postoperative opioid prescription filling was found to be less common in the first 2 weeks after surgery when a nerve block was given versus not given ( P < .001). Conclusion: An increasing percentage of shoulder arthroscopies are being performed with regional nerve blocks. However, there was no difference in patterns of filled postoperative opioid prescriptions between blocked and unblocked cases, except for the subgroup of patients who had filled an opioid prescription within 1 to 3 months prior to shoulder arthroscopy. Future research should focus on recording the amount of prescribed opioids consumed in national databases to reinforce our strategy against the opioid epidemic.

Automated text messaging follow-up for patients who receive peripheral nerve blocks

2021 ◽  
pp. rapm-2021-102472
Author(s):  
Daniel Gessner ◽  
Oluwatobi O Hunter ◽  
Alex Kou ◽  
Edward R Mariano
Keyword(s):  
Regional Anesthesia ◽  
Nerve Block ◽  
Text Messaging ◽  
Low Cost ◽  
Automated System ◽  
Phone Call ◽  
Nerve Blocks ◽  
Patient Response ◽  
Patient Reported

BackgroundRoutine follow-up of patients who receive a nerve block for ambulatory surgery typically consists of a phone call from a regional anesthesia clinician. This process can be burdensome for both patients and clinicians but is necessary to assess the efficacy and complication rate of nerve blocks.MethodsWe present our experience developing an automated system for completing follow-up via short message service text messaging and our preliminary results using it at three clinical sites. The system is built on REDCap, a secure online research data capture platform developed by Vanderbilt University and currently available worldwide.ResultsOur automated system queried patients who received a variety of nerve block techniques, assessed patient-reported nerve block duration, and surveyed patients for potential complications. Patient response rate to text messaging averaged 91% (higher than our rates of daily phone contact reported previously) for patients aged 18 to 90 years.ConclusionsGiven the wide availability of REDCap, we believe this automated text messaging system can be implemented in a variety of health systems at low cost with minimal technical expertise and will improve both the consistency of patient follow-up and the service efficiency of regional anesthesia practices.

Cervical Intra-Articular Facet Injection: Computed Tomography

2016 ◽  
Author(s):  
Amaresh Vydyanathan ◽  
Karina Gritsenko ◽  
Samer N. Narouze ◽  
Allan L. Brook
Keyword(s):  
Pain Relief ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Facet Joint ◽  
Medial Branch ◽  
Nerve Blocks ◽  
Articular Facet ◽  
Short And Long Term ◽  
Joint Injections

Intra-articular facet joint injections commonly refer to the injection of a contrast media and local anesthetic solution, with or without corticosteroids, directly into the facet joint space. The purpose of this procedure is pain relief as well as to establish an etiological diagnosis for surgical interventions such as joint denervation or radiofrequency ablation. Medial branch block, or facet nerve block, refers to injection of local anesthetic and possible corticosteroids along the medial branch nerve supplying the facet joints. Cervical intra-articular and facet nerve block injections are often part of a work-up for general or focal neck pain, headaches, or cervical muscle spasms. There is limited evidence for short- and long-term pain relief with cervical intra-articular facet joint injections. Cervical medial branch nerve blocks with local anesthetics demonstrate moderate evidence for short- and long-term pain relief with repeat interventions, and strong evidence exists for long-term pain relief following cervical radiofrequency neurotomy.

scholarly journals Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost

2015 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Brendan Carvalho ◽  
Romy D. Yun ◽  
Edward R. Mariano
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Single Injection ◽  
Clinical Care ◽  
Personnel Cost ◽  
Additional Time ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Physician Time

Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a “block room” model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p<0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusion: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.

scholarly journals Severe Brachial Plexopathy after an Ultrasound-guided Single-injection Nerve Block for Total Shoulder Arthroplasty in a Patient with Multiple Sclerosis

2008 ◽  
Vol 108 (2) ◽  
pp. 325-328 ◽  
Author(s):  
Matthew D. Koff ◽  
Jeffrey A. Cohen ◽  
John J. McIntyre ◽  
Charles F. Carr ◽  
Brian D. Sites
Keyword(s):  
Multiple Sclerosis ◽  
Nervous System ◽  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Brachial Plexopathy ◽  
Nerve Blocks ◽  
Peripheral Nerve Blockade

DESPITE the known benefits of regional anesthesia for patients undergoing joint arthroplasty, the performance of peripheral nerve blocks in patients with multiple sclerosis (MS) remains controversial. MS has traditionally been described as an isolated disease of the central nervous system, without involvement of the peripheral nerves, and peripheral nerve blockade has been suggested to be safe. However, careful review of the literature suggests that MS may also be associated with involvement of the peripheral nervous system, challenging traditional teachings. There is a paucity of evidence with regard to safety in using peripheral nerve regional anesthesia in these patients. This makes it difficult to provide adequate "informed consent" to these patients. This case report describes a patient with MS who sustained a severe brachial plexopathy after a total shoulder arthroplasty during combined general anesthesia and interscalene nerve block.

Anesthetic Principles

2020 ◽  
Author(s):  
Britlyn D. Orgill ◽  
Douglas L. Helm
Keyword(s):  
General Anesthesia ◽  
Local Anesthetic ◽  
Enhanced Recovery ◽  
Physical Status ◽  
Preoperative Risk ◽  
Nerve Blocks ◽  
Surgical Emergencies ◽  
Post Operative Pain ◽  
Joint Decisions ◽  
Selection Of

Advances in anesthesia have expanded the field of plastic surgery by allowing more procedures to be done, while also increasing the safety of the patient. Anesthesia is a spectrum ranging from local anesthetic injected by the surgeon, to regional and neuraxial blocks or general anesthesia with an anesthesia team. Anesthesiologists work with the surgeon to assess a patient’s preoperative risk and make joint decisions to determine if additional medical optimization is needed prior to surgery. New peripheral blocks allow alternatives to general anesthesia or serve as adjuncts to improve post-operative pain. Selection of drugs used to induce and maintain anesthesia are changing with the advent of Enhanced Recovery After Surgery Protocols and emphasis on decreasing opioids. Teamwork and excellent communication are imperative to navigate anesthetic and surgical emergencies.  This review contains 3 figures, 4 tables, and 29 references. Keywords: sedation, general anesthesia, regional anesthesia, peripheral nerve blocks, local anesthetic toxicity syndrome, ASA physical status, preoperative fasting guidelines, opioids, multi-modal analgesia, ERAS, crisis checklists

The Treatment of Rib Fractures

2020 ◽  
Vol 86 (9) ◽  
pp. 1144-1147
Author(s):  
Paige Farley ◽  
Parker R. Mullen ◽  
Catherine N. Taylor ◽  
Yannleei L. Lee ◽  
Charles C. Butts ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Injury Severity ◽  
Intercostal Nerve ◽  
Rib Fractures ◽  
Hospital Length Of Stay ◽  
Intercostal Nerve Block ◽  
Nerve Blocks ◽  
Multiple Rib Fractures

Background Rib fractures are a major problem characterized by pain, increased length of stay, and respiratory complications. Treatments include fixation, management with opiates, paraspinous local anesthetic pumps, and intercostal nerve blocks. The aim of this study was to evaluate the use of treatment options and compare clinically relevant outcomes. Methods Patients admitted to a Level 1 trauma center with multiple rib fractures between 2015 and 2019 were screened. We included all participants treated with surgical fixation and/or intercostal nerve block or local anesthetic pump. Patients were case-matched 1:2 by Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) Chest and Head, age, and number of rib fractures. Outcomes assessed were hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, pneumonia, and tracheostomy rates. Results We identified 25 patients who received rib fixation and intercostal analgesia. Of these, 14 cases were treated with liposomal bupivaicaine nerve block and 11 by paraspinous catheter block. Fifty control cases treated with opiates were identified. All patients survived to discharge. Cases and controls were approximately equivalent in age, ISS, number of fractured ribs, chest AIS, and head AIS. Rib-plated patients had a lower rate of pneumonia (OR 0.2029, 95% CI 0.0242, 0.09718), decreased average ICU LOS (10.62 vs 6.64, P = .018), and decreased average ventilator days (5.44 vs 1.68, P = .003). Discussion Findings suggest more aggressive treatment of rib fractures may decrease ICU LOS, ventilator days, and pneumonia in patients with multiple rib fractures. These findings are in line with current literature; however, more research is needed in this area.

scholarly journals Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review

2019 ◽  
Vol 16 (18) ◽  
pp. 3257 ◽  
Author(s):  
Olufunke Dada ◽  
Alicia Gonzalez Zacarias ◽  
Corinna Ongaigui ◽  
Marco Echeverria-Villalobos ◽  
Michael Kushelev ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Opioid Consumption ◽  
Orthopedic Procedures ◽  
Negative Consequences ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
The Impact

Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions may reduce the burden of rebound pain. Additionally, patient education regarding the possibility of rebound pain is paramount to ensure appropriate use of prescribed pre-emptive analgesics and establish appropriate expectations of minimized opioid requirements. Understanding the impact of rebound pain and strategies to prevent it is integral to effective utilization of regional anesthesia to reduce negative consequences associated with long-term opioid consumption.

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