Peripheral nerve blocks of the face in children

The sensory innervation of the face is provided by the three major nerves, emerging from trigeminal nerve: the ophthalmic, maxillary and mandibular nerve. Nerve blocks of the face or head are not widely used in practice in France. However, regional anaesthesia has shown its value in terms of quality of analgesia and perioperative opioid economy in children and adults. Facial peripheral nerve blocks are divided into two categories: superficial trigeminal nerve blocks and deeper blocks such as the mandibular or suprazygomatic maxillary block. The performance of these blocks is simple provided the usual safety rules are followed. As for other peripheral nerve blocks, ultrasound guidance has shown its interest for the realization of facial nerve blocks to identify anatomical structure and to locate the spread of the injected local anaesthetic.     

Evaluation of postoperative analgesia with continuous iliofascial nerve sheath block after total hip arthroplasty replacement: a pilot study

Objective

To assess the analgesic efficiency of a continuous iliofascial nerve sheath block after total hip arthroplasty replacement (RPTH).

Study design

open and prospective pilot study.

Patients and methods

Before induction of general anaesthesia (GA), an iliofascial catheter was inserted (group KT, n = 11) or not (group NKT, n = 10). In the KT group, 30 ml of ropivacaïne 4,75 mg/ml (maximum dose) were injected, and 14 mg/h of ropivacaïne 2 mg/ml were infused during the first 48 postoperative hours. All patients underwent a standardized GA and a multimodal postoperative analgesia with a intravenous PCA morphine, paracetamol and tramadol during the first 48 hours. Postoperative pain assessment which was achieved using visual analogic scores (VAS) at rest (EVAr) and on movement (EVAm), total morphine consumption, and side effects were collected during the first 48 hours. Statistical analysis was performed using a Mann and Whitney test for the quantitative values and a chi 2 exact test for the qualitative values. Data are expressed as median [interquartile range].

Results

Total morphine consumption was lower in the KT group with a total amount of 26 mg [11–48] versus 77.5 mg [55–91] (p = 0.007) at h48. EVAr and EVAm were lower in the KT group at h4, h8, h24, h36 for the EVAr and during the 48 postoperative hours for EVAm. Three patients experienced nausea and/or vomiting in the KT group versus 6 in the NKT group (p = 0.05).

Conclusion

After RPTH surgery, continuous iliofascial block reduces morphine consumption; provide a better pain relief at rest and on movement than IV multimodal analgesia alone.     

超声引导下胸椎旁神经阻滞对胸腔镜手术患者苏醒质量及术后镇痛的影响

目的评估超声引导下胸椎旁神经阻滞(thoracic paravertebral nerve block, TPVB)复合全麻对胸腔镜下肺叶切除术患者苏醒质量及术后镇痛的影响。方法择期行胸腔镜下肺叶切除术患者52例,男34例,女18例,年龄25～65岁,BMI 19～28 kg/m~2, ASAⅠ或Ⅱ级。按随机数字表法分为胸椎旁神经阻滞联合全麻组(观察组)和单纯全麻组(对照组),每组26例。麻醉诱导前观察组在超声引导下行单次椎旁神经阻滞,注射0.375%罗哌卡因25 ml;对照组不做任何处理。两组麻醉诱导后均采用全凭静脉麻醉,术后给予患者静脉自控镇痛。记录自主呼吸恢复时间、苏醒时间、拔管时间、术后镇静-躁动评分(SAS),记录术后1、6、12、24、48 h静息及咳嗽时VAS评分,记录镇痛药物使用及恶心呕吐、瘙痒、尿潴留、嗜睡、呼吸抑制和低血压等不良反应的发生情况。结果两组自主呼吸恢复时间、苏醒时间、拔管时间差异无统计学意义。两组术后不同时点静息时VAS评分差异无统计学意义。与对照组比较,观察组术后SAS评分、术后1、6、12 h的咳嗽时VAS评分明显降低(P0.05),术后48 h内镇痛泵有效按压次数明显减少(P0.05)。两组不良反应差异无统计学意义。结论 TPVB联合全麻镇痛效果确切,术后苏醒质量高,可安全有效地用于胸腔镜下肺叶切除术患者。     

Motivations and impact of international rotations in low- and middle-income countries for orthopaedic surgery residents: Are we on the same page?

BackgroundDespite interest among North American orthopaedic residents to pursue rotations in resource-limited settings, little is known regarding resident motivations and impact on host surgeons.MethodsSurveys were distributed to North American orthopaedic surgeons and trainees who participated in international rotations during residency to assess motivations for participation and to orthopaedic surgeons at partnering low- and middle-income country (LMIC) institutions to assess impact of visiting trainees.ResultsResponses were received from 136 North American resident rotators and 51 LMIC host surgeons and trainees. North American respondents were motivated by a desire to increase surgical capacity at the LMIC while host surgeons reported a greater impact from learning from residents than on surgical capacity. Negative aspects reported by hosts included selfishness, lack of reciprocity, racial discrimination, competition for surgical experience, and resource burdens.ConclusionsThe motivations and impact of orthopaedic resident rotations in LMICs need to be aligned. Host perceptions and bidirectional educational exchange should be incorporated into partnership guidelines.