Use of Computer-Assisted Instrument Guidance Technology by Student Registered Nurse Anesthetists for Simulated Invasive Procedures.

This study was conducted to determine if computer-assisted instrument guidance (CAIG, Clear Guide Medical), with an optical tracking mechanism, enhances simulated transversus abdominis plane (TAP) block performance in a porcine model by novice student registered nurse anesthetists (SRNAs) compared with standalone ultrasonography (US). In a crossover design, 26 students were randomly assigned into 2 groups: US only and CAIG. Performance was assessed using a task-specific checklist survey tool and a global rating scale to assess performance. Time to hydrodissection and number of insertion attempts were recorded. A pre-procedure and postprocedure survey obtained participants' demographics and measured overall experience. Results revealed higher mean scores for all items in the global rating scale and overall performance (P = .010). The checklist survey results indicated no significant between-group differences. The CAIG group was observed to have significantly lower simulated block performance times (P = .037) and number of attempts (P = .002). The postprocedure survey results showed most participants (88%) reported an enhanced experience using the CAIG. Use of the CAIG showed favorable results in novice SRNAs performing the simulated block. Procedure performance, number of attempts, and time to complete were significantly lower, with a strong preference for the CAIG system.

Dental Pain Relief in the Age of ALTO.

The opioid public health crisis necessitates that health care providers seek alternatives to opioid pain control. For patients presenting with dental pain, a dental nerve block provides effective, long-lasting pain relief without the use of opioid pain medications. This article presents the techniques required to safely and effectively administer 3 types of dental nerve blocks, allowing the emergency nurse practitioner to provide effective pain control to patients with dental pain.

Prehospital administered fascia iliaca compartment block by emergency medical service nurses, a feasibility study.

INTRODUCTION: Patients with a proximal femur fracture are often difficult to evacuate from the accident scene. Prehospital pain management for this vulnerable group of patients may be challenging. Multiple co-morbidities, polypharmacy and increased age may limit the choice of suitable analgesics. The fascia iliaca compartment (FIC) block may be an alternative to intravenous analgesics. However this peripheral nerve block is mainly applied by physicians.In the Netherlands, prehospital emergency care is mostly provided by EMS-nurses. Therefore we examined whether well-trained EMS-nurses are able to successfully perform a FIC block in order to ensure timely and appropriate effective analgesia.The study was study was registered in the Netherlands Trial Register (NTR-nr 3824). METHODS: Ten EMS nurses were educated in the performance of a FIC-block. Indications, technique, side-effects and complications were discussed. Hereafter the trained EMS-nurses staffed ambulance teams were dispatched to patients with a suspicion for a proximal femur fracture. After confirmation of the diagnosis, the block was performed and 0.3 ml/kg lidocaine (10 mg/ml) with adrenaline 5 µg/ml was injected. The quality of pain relief, occurrence of complications and patient satisfaction were evaluated. RESULTS: In 108 patients a block was performed. One hundred patients could be included. Every EMS nurse performed at least 10 FIC blocks. The block was effective in 96 patients. The initial median (NRS)-pain score decreased after block performance to a score of 6 (after 10 minutes), 4 (after 20 minutes) and 3 (after 30 minutes). At arrival at the Emergency Department the median pain score was 3. Dynamic NRS-pain scores when transferring the patient from the accident scene to the ambulance stretcher, during transportation to the hospital and when transferring the patient to a hospital bed were, 4, 3 and 3.5 respectively. Patient satisfaction was very high. No complications were noted. CONCLUSION: Additional educated EMS-nurses are able to successfully perform a FIC-block for providing acute pain relief to patients with a suspected proximal femur fracture.

Transversus abdominis plane blocks: an overview of indication and nursing care.

Transversus abdominis plane (TAP) blocks are an evolving regional anesthesia technique used as part of postoperative pain management regimens after major abdominal surgery. This article reviews TAP block insertion techniques, commonly used local anesthetics, and recommends nursing care related to TAP blocks.

Use of digital nerve blocks to provide anaesthetic relief.

This article discusses the various techniques that nurses can use to perform digital nerve blocks, which are some of the most common procedures undertaken by emergency practitioners treating patients with finger injuries. In covering the advantages and disadvantages of each technique, it focuses primarily on the digits of the hand, but the techniques can also be performed on toes.

Spinal anesthesia for orthopedic surgery: a detailed video assessment of quality.

BACKGROUND: Subarachnoid blocks are considered routine anesthetic procedures important in the daily practices of most anesthesiologists. However, few data exist regarding modern failure rates or quality-compromising behaviors. METHODS: Sixty adult patients having orthopedic surgery under spinal anesthesia were enrolled in this prospective and observational video study. Through a detailed high definition video review, we aimed to define our subarachnoid block failure rate and identify associated quality-compromising behaviors. RESULTS: An intrathecal injection either failed to generate a surgical block or was aborted secondary to difficulty in 7 patients (11.6%). A procedurally difficult subarachnoid block occurred in 17 patients (29%). Eight patients required greater than 10 mins of needling to complete the subarachnoid block. Body mass index represented an independent risk factor for long procedure times. There were 27 incidences of quality-compromising behaviors that included likely violation of aseptic technique, hemorrhage, poor positioning, damaged needles, thecal sac transfixation, high-lumbar needle placement, repetition of previously failed maneuvers, failure to provide skin anesthesia, and prolonged procedure times. Certified registered nurse anesthetist status predicted a greater-than-4-fold risk of subarachnoid block failure. DISCUSSION: The failure rate and quality-compromising behaviors identified in this study challenge the generalized assumption that performing a subarachnoid block in the orthopedic population is a simple procedure. The number and nature of the combined failed and difficult subarachnoid blocks suggest the need for quality improvement. Further research is needed to assess whether the use of image guidance may be a possible solution to navigate difficult anatomical pathology and confirm correct needle and drug placement.

Combined spinal/general anesthesia with postoperative femoral nerve block for total knee replacement in a patient with familial hyperkalemic periodic paralysis: a case report.

Familial hyperkalemic periodic paralysis (HYPP) is a rare genetic disorder in which the sodium channels in skeletal muscle cells have altered structure and function. Small elevations in serum potassium lead to inactivation of sodium channels, causing episodic weakness or paralysis. Exposure to cold, anesthesia, fasting, emotional stress, potassium ingestion, and rest after exercise can stimulate an attack. This case report describes a 65-year-old man with HYPP who was admitted for a right total knee arthroplasty. He had a history of arteriosclerotic heart disease and stenting 8 years earlier, previous inferior wall myocardial infarction with ejection fraction of 65%, anxiety, degenerative joint disease, well-controlled type 2 diabetes mellitus, and a body mass index of 53.3 kg/m2. A combined spinal/general anesthetic with a femoral nerve block for postoperative pain control was chosen. Careful attention was given to monitoring and maintenance of core temperature, use of insulin and glucose to maintain normokalemia, and carbohydrate loading the night before surgery. The patient recovered from the anesthetic without complication and had pain relief for approximately 22 hours postoperatively because of the femoral nerve block. The patient was without weakness or paralysis related to HYPP in the postanesthesia care unit or throughout his hospitalization.

Patient outcomes comparing CRNA-administered peripheral nerve blocks and general anesthetics: a retrospective chart review in a US Army same-day surgery center.

We compared outcomes between patients receiving general anesthesia (GA) vs regional block (RB) in a military same-day surgery unit (SDSU), where Certified Registered Nurse Anesthetists (CRNAs) delivered all RBs and GA. All patient charts from 2003 through 2006 were reviewed. Patients were included if they were 18 years or older, had an ASA physical status I or II, and underwent a shoulder or knee arthroscopy that used either RB or GA. Overall, 342 patients met inclusion criteria: 161 GA and 181 RB. With GA, mean anesthesia time was shorter (109.6 vs 135.5 minutes, P < .001), but recovery times were longer (56.7 vs 36.4 minutes, P < .001). SDSU times were nearly identical (GA vs RB, 71.5 vs 72.8 minutes), resulting in a total hospital time that was not significantly different (352.7 vs 347.5). The GA group received more morphine equivalents of narcotic in the operating room (22.9 vs 15.1 mg, P < .001) yet still had higher pain scores postoperatively than the RB group (1.1 vs 0.3, P < .001). The GA group received a significantly greater number of antiemetic doses intraoperatively (0.58 vs 0.04, P < .001) but still had a higher, although nonsignificant, rate of emesis (15.5% vs 10.0%). Patients receiving RB had less pain and received less analgesia without any increase in postoperative nausea and vomiting, hospital time, or anesthesia-related complications.

Material para la anestesia regional / Nursing basics in anesthesia: material to carry out. Regional anesthesia technics

Enfermería tiende a una gran especialización en las distintas áreas asistenciales; por este motivo, la introducción de la figura de la enfermera de anestesia obliga a un conocimiento específico de todo cuanto influya en esta disciplina. La continua evolución de la tecnología aplicada al diseño de nuevas agujas, ecógrafos u otro tipo de aparataje para la realización de técnicas anestésicas regionales, hace imprescindible la actualización de nuestros conocimientos en este campo. Este artículo pretende mostrar al lector interesado (enfermeras que se dedican al campo de la anestesiología y profesionales que pueden verse vinculados en áreas quirúrgicas o de dolor) una visión actual sobre el material y otro aparataje que más se utiliza en la realización de los distintos tipos de bloqueos nerviosos en anestesia regional; siendo su objetivo proporcionar a quien se inicia en esta disciplina una herramienta útil y rápida de introducción a la anestesia regional, y a los profesionales más expertos una actualización contrastada. El trabajo se estructura de forma clásica: introducción, bloqueos centrales (subaracnoideo y epidural), blo-queos periféricos, anestesia regional intravenosa, bloqueo del ojo, asepsia y conclusiones(AU)

Nursing career tend to specialize more each time in the different specialties, for this reason the introduction of the specialist nurse in anaesthesia required a specific knowledge on this medical discipline. The evolution of technologies applied to the design of new needles, echography machines and other equipment for regional anaesthesia techniques make essential to update of our knowledge in this area. This piece of work pretend to show the readers (nurses working in anaesthesia and others practitioners involved in surgical areas or pain management) a current view about the material and other instruments, mostly used in the different types of nerve blocks in regional anaesthesia. The aim of this, is provided an easy introduction of the regional anaesthesia to the junior practitioners, and updated evidence to the senior practitioner. The work is structured in a classic way: introduction, central blocks (subarachnoid and epidural), peripheral blocks, regional intravenous anaesthesia, eye block, asepsis and conclusions(AU)

Will the addition of a sciatic nerve block to a femoral nerve block provide better pain control following anterior cruciate ligament repair surgery?

Two common forms of postoperative analgesia used in patients following an anterior cruciate ligament repair (ACLR) are the femoral nerve block (FNB) and the combined femoral-sciatic nerve block (FSB). The purpose of this study was to determine if the addition of the sciatic nerve block to the FNB is truly beneficial in ACLR patients requesting regional anesthesia for postoperative pain control. All subjects scheduled for an ACLR, requesting general anesthesia and preoperative placement of a peripheral nerve block (PNB), were randomized to receive an FNB or an FSB. Analgesic requirements, pain scores, and overall postoperative analgesic satisfaction were the primary outcomes measured. The data for 56 subjects (FNB, 27; FSB, 29) were used in analysis. Significantly higher analgesic requirements, pain scores, and lower satisfaction scores were noted in the FNB group compared with the FSB group (P < .05). No other differences were noted between groups in demographic data. Based on this investigation, we concluded that the FSB, compared with FNB alone, provides superior postoperative analgesia in patients receiving an ACLR and should be included in the anesthetic care plan in which a PNB is planned to facilitate postoperative analgesia.

[Thoracic paravertebral block]. / Thorakale Paravertebralblockade.

Thoracic paravertebral block for postoperative pain control has been introduced more than a century ago. It is currently gaining increasing popularity. This simple and safe technique can be used for postoperative analgesia, as well as sole anesthetic technique. When compared to epidural analgesia for postthoracotomy pain control, thoracic paravertebral analgesia provides comparable analgesic efficacy, but less side-effects. Regarding concomitant use of anticoagulants and antiplatelet drugs, paravertebral blockade is considered a central nerve block.

Femoral nerve blocks.

Femoral nerve blocks and indeed all peripheral nerve blocks have become a popular, safe and effective method of providing postoperative analgesia. The advantages of a femoral nerve block for lower limb surgery include good postoperative analgesia, a reduction in the need for opioids (thus reducing the associated complications of opioids such as nausea, vomiting, itching and confusion (Allen et al 1998, Wang et al 2002)) and the potential for earlier mobilisation and discharge from the hospital (Wang et al 2002, Ilfeld et al 2008).

A nurse-led service for pre-operative pain management in hip fracture.

This article follows an In-depth piece published in last week's issue, which explored issues around pain management in older people following fractured neck of femur. It also discussed using femoral nerve block for pain relief in this group of patients. This Changing Practice article outlines the establishment of a nurse-led service to improve pre-operative pain management using femoral nerve block.

The influence of spinal needle orientation during administration of subarachnoid blocks on discharge criteria in same-day surgical patients.

Cost containment is a critical factor in today's healthcare industry, so finding ways to decrease length of stay is essential in anesthesia practice. We rely on rapid induction, recovery, and discharge to control cost in outpatient surgery. Subarachnoid block (SAB) is an acceptable anesthetic choice for many outpatient procedures. It is often underused because it may result in delayed discharge. The purpose of this study was to determine if orientation of the spinal needle during administration of SAB affects the time required to meet discharge criteria in a same-day surgical unit. Patients undergoing surgical procedures deemed appropriate for short-acting lidocaine spinal anesthetic were recruited for this randomized, posttest, prospective study. All patients received a hyperbaric lidocaine spinal administered using a 25-gauge Whitacre needle. The needle was oriented in a cephalad (group A) or a lateral (group B) direction. Time to discharge was determined by calculating time elapsed between administration of the SAB and the time when the patient met discharge criteria. The statistical analysis included 50 patients (group A, n = 30; group B, n = 20). Demographics (except weight) were not statistically different between the groups. Total hospital time did not differ between the groups. Regardless of needle orientation, patients in both study groups achieved discharge criteria in similar amounts of time.

Pain management: setting up a nurse-led femoral nerve block service.

Managing pain following a fractured neck of femur is challenging for a number of reasons. This group of patients are typically older people and frail with multiple co-morbidities and are often on numerous medications. In addition to a hip fracture, they commonly present with acute medical problems. Fractures cause significant pain, which can be difficult to manage safely and effectively with the traditional analgesics. A femoral nerve block has been shown to be a safe and effective preoperative intervention for managing pain in this patient group while they wait for surgery. This article describes how an acute pain team have developed protocols and training to establish a nurse-led service for providing preoperative femoral nerve blocks to patients with fractured neck of femur.