ABSTRACT
INTRODUCTION: Pectoral Nerves Block (PECS) and Serratus Plane Block (SPB) have been used to treat persistent post-surgical pain after breast and thoracic surgery; however, they cannot block the internal mammary region, so a residual pain may occur in that region. Parasternal block (PSB) and Thoracic Transversus Plane Block (TTP) anaesthetize the anterior branches of T2-6 intercostal nerves thus they can provide analgesia to the internal mammary region. METHODS: We describe a 60-year-old man suffering from right post-thoracotomy pain syndrome with residual pain located in the internal mammary region after a successful treatment with PECS and SPB. We performed a PSB and TTP and hydrodissection of fascial planes with triamcinolone and Ropivacaine. RESULTS: Pain disappeared and the result was maintained 3 months later. DISCUSSION: This report suggests that PSB and TTP with local anaesthetic and corticosteroid with hydrodissection of fascial planes might be useful to treat a post thoracotomy pain syndrome located in the internal mammary region. SIGNIFICANCE: The use of Transversus Thoracic Plane and Parasternal Blocks and fascial planes hydrodissection as a novel therapeutic approach to treat a residual post thoracotomy pain syndrome even when already treated with Pectoral Nerves Block and Serratus Plane Block.
Subject(s)
Dissection , Fasciotomy , Nerve Block/methods , Pain, Postoperative/therapy , Thoracotomy/adverse effects , Anesthetics, Local/therapeutic use , Humans , Male , Middle Aged , Pain, Postoperative/etiology , Ropivacaine/therapeutic use , Thoracic NervesSubject(s)
Amides/therapeutic use , Anesthetics, Local/therapeutic use , Dexamethasone/therapeutic use , Nerve Block/methods , Pain, Postoperative/drug therapy , Thoracic Nerves/drug effects , Thoracic Surgery, Video-Assisted/adverse effects , Amides/administration & dosage , Anesthetics, Local/administration & dosage , Dexamethasone/administration & dosage , Humans , Male , Middle Aged , Pain, Postoperative/etiology , Ropivacaine , Thoracic Nerves/diagnostic imaging , Treatment Outcome , Ultrasonography, InterventionalSubject(s)
Foreign Bodies/surgery , Hypopharynx , Laryngoscopy/methods , Emergencies , Female , Humans , Middle Aged , Video RecordingABSTRACT
INTRODUCTION: Spinal anesthesia produces a profound and uniformly distributed sensory block with rapid onset and muscle relaxation, and results in complete control of cardiovascular and stress responses. Ketamine is an anesthetic agent that is widely used for pediatric sedations in settings where safety and efficacy of the agents are mandatory because of limited healthcare resources. The authors report on their experience in a refugee hospital located in Bol-la (Saharawi, Algeria). METHODS: Spinal anesthesia was performed for orthopedic surgery procedures in children. Before the spinal puncture, the patients were sedated with intramuscular ketamine followed by intravenous ketamine and midazolam. Boluses of midazolam were also administered throughout the surgery to keep the patients sedated; spinal anesthesia was performed with levobupivacaine 0.25 mg/kg. RESULTS: There were no intraoperative adverse events; vital signs were within the normal pediatric ranges during the procedures and there was no need to switch to general anesthesia. In the postoperative period, no symptoms of dural puncture headache or postoperative delirium or nightmares were reported. CONCLUSION: Based on the authors' experience, the combination of spinal anesthesia and sedation with midazolam and ketamine was found to be a safe approach for children undergoing orthopedic surgery in a low resources setting.
Subject(s)
Laryngeal Masks/adverse effects , Mediastinitis/etiology , Aged, 80 and over , Air Pressure , Anti-Bacterial Agents/therapeutic use , Axilla , Equipment Design , Fatal Outcome , Fever/etiology , Humans , Lymph Node Excision , Male , Mediastinitis/drug therapy , Meropenem , Pharynx/injuries , Spondylitis, Ankylosing/complications , Subcutaneous Emphysema/etiology , Thienamycins/therapeutic useSubject(s)
Airway Management/instrumentation , Airway Management/methods , Tracheostomy/instrumentation , Tracheostomy/methods , Aged , Blood Pressure/physiology , Bronchoscopy , Critical Care , Dilatation , Disposable Equipment , Female , Humans , Laryngeal Masks , Male , Middle Aged , Positive-Pressure RespirationSubject(s)
Nerve Block/methods , Thoracoscopy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Feasibility Studies , Humans , Middle Aged , Thoracic Vertebrae , Young AdultSubject(s)
Airway Management/instrumentation , Laryngoscopes , Child , Child, Preschool , Colombia , Developing Countries , Female , Humans , MaleSubject(s)
Anesthesia, General/instrumentation , Anesthesia, Obstetrical/instrumentation , Intubation, Intratracheal/instrumentation , Adult , Bradycardia/complications , Cesarean Section , Equipment Design , Female , Gels , Heart Rate, Fetal , Humans , Obesity, Morbid/complications , Pregnancy , Treatment Failure , Treatment OutcomeABSTRACT
An appropriate post operative analgesia after thoracotomies is mandatory to improve the patient's outcome, reduce complications rate, morbidity, hospital cost and length of stay. In this paper we review the evidences regarding the use of paravertebral block for thoracic surgery. In particular we examine the effect of paravertebral block compared to the other technique in four major issues: analgesia, complications rate, postoperative pulmonary function and transition from acute to chronic pain. We conclude that paravertebral block is superior to intravenous analgesia in providing pain control and preserving postoperative pulmonary function while it is equal to thoracic epidural analgesia regarding this two issues. Paravertebral block has a better safety profile when compared to intravenous and thoracic epidural analgesia. Its effect on chronic pain incidence still needs further studies.
