RESUMO
We present a case of a four-year-old male with a history of giant omphalocele who underwent ultrasound-guided Botox injection to bilateral anterior abdominal wall musculature in preparation for definitive repair. Botox administration was successfully combined with preoperative subfascial tissue expanders to achieve definitive midline closure of the anterior abdominal wall defect. Our experience suggests that Botox can be safely used as part of the treatment plan for giant omphalocele repair.
RESUMO
We describe the case of a 30-year-old woman with chronic hip pain secondary to avascular necrosis. She received preoperative L1-L2 paravertebral block for postoperative pain control after arthroscopic hip surgery. Preoperative paravertebral block at the level of L1-L2 provided an effective postoperative analgesia for hip arthroscopy when used in a multimodal approach.
Assuntos
Analgesia/métodos , Anestésicos Locais/uso terapêutico , Artroscopia , Quadril/cirurgia , Vértebras Lombares , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Feminino , Humanos , Cuidados Pré-OperatóriosRESUMO
BACKGROUND: We hypothesized that blocking the tibial and common peroneal nerves individually using ultrasound distal to sciatic bifurcation would decrease time to complete block compared with a block proximal to the bifurcation. METHODS: Seventy-six patients undergoing foot or ankle surgery received a sciatic nerve block either proximal or distal to the point of bifurcation. A mixture of 28 mL 1.5% mepivacaine with 100 microg clonidine and 1 mL 8.4% sodium bicarbonate for a total of 30 mL was used. Ultrasound was used to guide needle adjustments to achieve circumferential spread. Block success was defined as a loss of sensation to pinprick in both nerve distributions within 46 minutes. RESULTS: Patients in the tibial-peroneal group had significantly faster time to complete block than the sciatic group (19.2 vs 26.1 minutes; P = 0.006). CONCLUSIONS: Blocking the tibial and common peroneal nerves in the popliteal fossa separately provides for a faster onset than a prebifurcation sciatic block.
