Regional Anesthesia

Occipital Neuralgia and Greater Occipital Nerve Blocks

Occipital neuralgia is a cause of occipital headache and is amenable to nerve block techniques.

This article discusses the symptomatology and in particular the use of ultrasound in the use of occipital nerve block.

It concludes: “Ultrasound-guided occipital nerve blocks appear to be a relatively safe, effective, and easy procedure for both the diagnosis and treatment of occipital neuralgia…more targeted blocks and potentially allowing for denervation procedures in the future”

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Metaraminol use during spinal anaesthesia for caesarean section

Phenylephrine has recently displaced Ephedrine as the pressor of choice for spinal induced hypotension during Cesarean Section. However an older agent makes a comeback in this study, although it has remained popular in some countries.

Conclusions:Metaraminol appears superior to ephedrine for the prevention of feto-maternal complications.

Metaraminol is associated with better umbilical arterial pH values than phenylephrine.

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Neuraxial labour analgesia reduces risk of maternal depression at 2 years after childbirth

This prospective study suggests another potential advantage to neuraxial analgesia for vaginal delivery.

It concluded: “For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth.”

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Major Neurologic Complications Associated With Postdural Puncture Headache in Obstetrics

Sometimes considered a nuisance, this study reminds us of the potential serious ramifications of accidental post-dural puncture headache (PDPH) during epidural placement in obstetrics.

The incidence of complications was not negligible in this retrospective review, including: composite of cerebral venous thrombosis and subdural hematoma, bacterial meningitis, depression, headache, and low back pain. PDPH and complications were identified during the delivery hospitalization and up to 1 year post-delivery. 

Early recognition and management is therefore important.

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Peripheral Nerve Blocks for Ambulatory Shoulder Surgery

Nerve blocks are now almost universal during shoulder surgery for their superior analgesia. This study reviewed post-discharge outcomes.

A decrease in unplanned admissions was found. There was no improvement in other postoperative outcomes such as emergency department visits, readmissions, mortality, or practical costs.

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Cesarean Delivery and Neuraxial Opioids

This consensus statement from SOAP specifically addresses the use of neuraxial Morphine in Cesarean delivery and looks st dosing, safety and monitoring.

It clearly favours the use of neuraxial Morphine as part of a multimodal analgesia regime and how the benefits and risks may be addressed using appropriate monitoring.

It should be reviewed by all who provide Obstetric anesthesia.

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Mortality and major morbidity after hip fracture surgery and Anesthesia

This retrospective analysis doesn’t prove causality but findings were in keeping with prior work.

Spinal anesthesia was weakly associated with a lower 90-day mortality following hip fracture surgery, and also associated with improved morbidity evidenced by a lower rate of pulmonary embolism and major blood loss and a shorter hospital length of stay.

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Spinal anesthesia compared with general anesthesia for neonates with hypertrophic pyloric stenosis

This retrospective study surveyed general vs. spinal anesthesia for infants with pyloric stenosis. While it may not be in the comfort zone for some practitioners, it was shown that it was a viable alternative to general anesthesia, reducing the respiratory morbidity associated with the latter, significantly reducing apneic episodes and desaturation.

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Spinal Anesthesia Failure

This retrospective study analyzed the factors associated with spinal anesthesia failure in patients undergoing elective total hip or knee arthroplasty.

The factors associated with increased odds of spinal failure included younger age, lower BMI, hip arthroplasty vs. knee arthroplasty, needle insertion at L4-5 and L5-S1 vs. L2-3, 22-gauge needle size vs. 25-gauge needle, and hyperbaric bupivacaine vs. isobaric bupivacaine.

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Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty

This large national cohort “identified various modifiable risk factors (including anesthesia type and pharmaceutical agents) for postoperative delirium, demonstrating possible prevention pathways.”

Benzodiazepines and gabapentinoids were associated with higher odds of delirium, whereas lower risk of delirium was associated with neuraxial vs. general anesthesia, use of NSAIDs and COX2 Inhibitors, and high vs low opioid use specifically in the over 65 year olds.

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