Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach: a two-centre prospective observational study.

The aim of this prospective, double-centre, observational study performed in 116 patients was to describe a new anterior approach of ultrasound-guided intermediate cervical plexus block for carotid endarterectomy. The median (IQR [range]) volume of ropivacaine 0.5% administered was 30 (25-30 [20-45]) ml. Supplemental local anaesthesia (infiltration and topical) was needed in 66 (57%) patients. Overall, 41 (35%) patients needed additional sedation (18 midazolam; 23 remifentanil). There was no intra-operative complication or systemic toxicity of ropivacaine. One regional anaesthesia procedure was converted to general anaesthesia because of patient agitation. Adverse effects were of short duration and did not affect surgery. Satisfaction scores were high for 92 (79%) patients (63 satisfied; 29 very satisfied) and 104 (90%) surgeons (51 satisfied; 53 very satisfied). This study shows that the ultrasound-guided intermediate cervical plexus block using an anterior approach is feasible and provides similar results to other regional techniques during carotid endarterectomy.

[Right thyroidectomy under ultrasound-guided anterior superficial cervical plexus in a patient with severe pulmonary hypertension]. / Lobo-isthmectomie droite chez une patiente atteinte d'une HTAP idiopathique sévère sous bloc intermédiaire échoguidé bilatéral antérieur du plexus cervical superficiel.

We report a case of partial thyroidectomy under ultrasound-guided regional anesthesia, according a new anterior approach, in a patient with a severe primitive pulmonary hypertension.

[TAP block analgesia after iliac bone surgery]. / Bloc dans le plan du muscle transverse de l'abdomen pour l'analgésie de la chirurgie du bassin antérieur.

We report two cases of iliac bone surgery (repair of a symphysis disjunction and fixation of a fracture of the iliac ala) where TAP blocks were effective for postoperative analgesia. In the first case, we performed a bilateral block, and only a unilateral block in the second case. We discuss possible mechanisms to explain the efficacy of the TAP blocks in such surgeries. As for the femoral nerve block in major knee surgery, we think that blocking the parietal pain from skin and blocking parietal muscles contracture, can reduce postoperative pain in such surgeries.

Increase in optic nerve sheath diameter induced by epidural blood patch: a preliminary report.

BACKGROUND: Post-dural puncture headache (PDPH) might be related to cerebrospinal fluid hypotension. Studies in brain-injured patients have shown a good relationship between optic nerve sheath diameter (ONSD) measured by ocular sonography and invasively measured intracranial pressure (ICP). The aim of this study was to evaluate changes in ONSD after lumbar epidural blood patch (EBP). METHODS: Consecutive subjects receiving an EBP for PDPH were included. ONSD and pain measurements were performed before (T(0)), 10 min (M(10)), 2 h (H(2)), and 20 h (H(20)) after the EBP. RESULTS: Ten subjects were included. ONSD [median (inter-quartile range)] increased with time after EBP, from 4.8 mm (4.5-5.1) at T(0) to 5.2 mm (4.9-5.7) at M(10) (P=0.005 vs T(0)), 5.5 mm (5.1-6.0) at H(2) (P=0.007 vs T(0)), and 5.8 mm (5.2-6.3) at H(20) (P=0.02 vs T(0)). EBP was clinically successful in nine of 10 subjects. In subjects in whom EBP was successful, ONSD significantly increased at M(10) and T(2) compared with T(0) (P=0.004 and 0.008, respectively) but did not reach statistical significance at H(20) (P=0.06). In the subject in whom EBP failed, a small increase in ONSD was observed over time. CONCLUSIONS: In this preliminary report, EBP was followed by ONSD enlargement in subjects with successful EBP, but not in the subject with EBP failure. Since ONSD is a surrogate marker of ICP, this suggests that a sustained increase in ICP is associated with successful EBP.

[TAP block and blocks of the abdominal wall]. / TAP bloc et blocs de la paroi abdominale.

Since the revolution of ultrasound in regional anesthesia, new techniques have arisen. The "transversus abdominis plane" block or TAP block is one of them. The benefits of a TAP block for postoperative analgesia have been shown mostly after laparotomy. Because this block seems to be technically easy, many anesthesiologists have quickly adopted it. However, the TAP block presents some technical specificities and knowledge of the anatomy is required. This article reviews the anatomy of the abdominal wall, the different blocks, the indications, the complications, and highlights the many unanswered questions left. This review proposes a new vision of the abdominal wall blocks based on a new understanding of the anatomy of the abdominal wall associated with an ultrasound technique.

[Bilateral catheter for continuous TAP block and postoperative pain relief after gynecologic surgery]. / TAP block avec pose bilatérale d'un cathéter pour analgésie postopératoire après chirurgie gynécologique.

We describe the case of two patients who had undergone gynecologic surgery and in whom a continuous ropivacaine infusion was administered through a catheter placed on each abdominal side, using the technique of ultrasound-guided TAP block. Postoperative analgesia was of excellent quality with almost no morphine requirement. No side effects were encountered.

[Fascia iliaca block for femoral bone fractures in prehospital medicine]. / Bloc iliofascial en médecine préhospitalière pour les fractures du fémur.

OBJECTIVE: The aim of this study was to assess the feasibility and efficacy of fascia iliaca compartment bloc (FIB) in prehospital care performed by emergency physicians. STUDY DESIGN: Prospective observational study. PATIENTS AND METHODS: Fifty-two patients victim of a femoral bone fracture were included consecutively. All FIB had been performed by emergency physicians trained to the technique. Lidocaine 1.5% with epinephrine has been used. Block efficacy was assessed by testing sensitive block in the anterior, lateral and medial part of the thigh. Pain levels were noted using a simplified numeric scale (SNS). RESULTS: No complete was reported. Ninety-four percent of blocks were successful. SNS values significantly decrease 10 minutes after block performance. CONCLUSION: Emergency medicine physicians trained to the technique can perform FIB with a high success rate.

Lateral approach to the sciatic nerve in the popliteal fossa.

UNLABELLED: We describe a modification of the sciatic nerve (SN) block in the popliteal fossa through the lateral approach. After a brief anatomic study using previously reported landmarks, we propose a new needle orientation associated with a double injection technique after identification of the tibial and the common peroneal nerve. Thirty-four patients undergoing ankle or foot surgery were enrolled in this study. With patients in the supine position, the upper edge of the patella and the groove between the posterior border of the vastus lateralis and the anterior border of the tendon of the biceps femoris were identified. The needle was directed posteriorly with a 20-30 degrees angle relative to the horizontal plane and slightly caudal. Both nerves were individually located with a nerve stimulator and blocked with a mixture of lidocaine-bupivacaine and clonidine. In all but one case, the two nerves were easily located, and no vascular puncture was evident. Effective analgesia was obtained for a minimum of 15 h (first analgesic demand). We conclude that this technique, with a modified direction of the needle and a double stimulation, provides a very high rate of success for SN blockade in the popliteal fossa. IMPLICATIONS: We describe a new lateral approach to the sciatic nerve in the popliteal fossa. The needle was directed caudad and posteriorly while seeking with a nerve stimulator for the tibial and the peroneal nerves, which were blocked separately. This technique was very successful.