Popliteal sciatic nerve blocks after foot and ankle surgery: an adjunct to postoperative analgesia.

The use of sciatic popliteal nerve blocks in conjunction with common peroneal and saphenous nerve blocks can provide prolonged hours of analgesia after foot and ankle surgery. This adjunct to analgesia allows for reduced amounts of postoperative opioids and the undesirable and adverse effects associated with these drugs. The peripheral blocks are technically easy to perform and offer the surgical patient many hours of pain relief. Furthermore, when utilized preoperatively, a lighter depth of anesthesia can be maintained with little demand for opioids so that the postoperative recovery will be accelerated with fewer complications.     

Head and neck blocks in infants, children, and adolescents

This review will discuss the use of peripheral nerve blocks of the head and neck and its application to the practice of pediatric anesthesia using simple, landmark based approaches.     

Epidural buprenorphine or morphine for the relief of head and neck cancer pain.

We present three cases in which epidural buprenorphine or morphine was used for intractable cancer pain of the head and neck. Excellent pain relief and minimal side effects offered by epidural opioids were of significant benefit. The use of epidural opioids prior to the administration of high doses of oral morphine may be the treatment of choice for pain from malignancy of the head and neck, especially when there is tumor extension or distant metastasis.     

Adaptation of median partial sternotomy in head and neck surgery

Upper mediastinum involvement in diseases of the head and neck may require a sternal split. This study describes our adaptation of the upper median or "minimal" sternotomy technique for the treatment of head and neck pathologies. Between April 2002 and October 2005, 17 patients aged 4 to 82 years underwent minimal sternotomy in our institution for a variety of head and neck pathologies. The 17 patients included 11 adults with metastatic thyroid disease (six metastatic papillary thyroid carcinoma, two medullary carcinoma, and one Hiirthle cell carcinoma) and huge retrosternal goiter (n = 2), four adults with parathyroid disease (two primary parathyroid adenoma, one secondary hyperplasia, and one parathyroid carcinoma), and two children with lymphangioma and huge thymic cyst (one each). Average hospitalization was 8 days. Four patients needed a thoracic drain for 2 days, one had recurrent laryngeal nerve palsy, and one had phrenic nerve paresis. There were no postoperative deaths. Minimal sternotomy appears to be an excellent alternative for surgical exploration of the mediastinum and may be used in head and neck surgery for a range of indications.     

Complications of head and neck procedures

Head and neck blocks are valuable tools in the diagnosis and management of face, head, and neck pain. Clinicians should be familiar with the anatomy of the head and neck to avoid potential serious complications. Detailed informed consent is crucial before attempting such blocks, and meticulous attention should be paid to avoid intravascular injection and neurological injury.     

Occipital nerve blocks in postconcussive headaches: a retrospective review and report of ten patients

Headaches are common following traumatic brain injuries of all severities. Pain generators may be in the head itself or the neck. Headache assessment is discussed. Diagnosis and treatment of cervical headaches syndromes and, in particular, occipital neuralgia are reviewed. Finally, a retrospective study of 10 postconcussive patients with headaches who were treated with greater occipital nerve blocks is presented. Following the injection(s), 80% had a "good" response and 20% had a "partial" response. Occipital nerve block is a useful diagnostic and treatment modality in the setting of postconcussive headaches.     

The use of peripheral nerve blocks at the elbow for carpal tunnel release

This case report illustrates that median, radial, and ulnar nerve blocks at the elbow provides anesthesia for ambulatory carpal tunnel release surgery. This report discusses 3 patients with medical conditions, including vascular access problems and morbid obesity, which made nerve blocks at the elbow advantageous compared with other anesthetic techniques. Peripheral nerve blocks at the elbow were done before surgery in a block room, so the patients spent less time in the operating room. Nerve blocks at the elbow are effective anesthesia for hand procedures with no patient requiring further local anesthetic injection and opioids for pain or expressing any discomfort during surgery. The blocks are easy to perform and set up quickly, and using long-acting local anesthetics, elbow blocks provide postoperative pain control for approximately 10 hours. The nerve blocks at the elbow facilitate the perioperative process by being done out of the operating room and providing prolonged pain control without the need for opioids, so nausea may be avoided.     

Focused local anesthesia and analgesia for head and neck surgery

Facility in the use of head and neck regional blocks will provide excellent perioperative analgesia and patient satisfaction. The scope of ambulatory surgical care for head and neck surgery will undoubtedly increase as expertize in these blocks expand in the face of strict criteria for patient selection. Supplemental sedation will be more precise with the intended result of less hangover and nausea and vomiting.     

The use of cervical epidural nerve blocks in the management of chronic head and neck pain

Cervical epidural blocks were used as part of a comprehensive multimodal treatment programme for patients with chronic benign pain in the head and neck. Forty-five patients had 141 blocks without major complications. The indications and role of blocks in pain management are discussed.     

Continuous peripheral nerve blockade in lower extremity surgery

Peripheral nerve blocks afford numerous benefits for lower extremity surgery. There is growing interest in continuous peripheral nerve blocks, mainly for treatment of postoperative pain, a field that represents a challenge to the anaesthesiologist. This paper seeks to review the efficacy of continuous lower limb blocks for postoperative pain relief. Not only do continuous peripheral nerve blocks afford specificity of analgesic area but current research has shown that they enhance postoperative analgesia and patient satisfaction. New techniques and devices are increasingly appearing, and catheters are constantly being developed and improved; an example being the stimulating catheter, which represents one of the newest advances in this area. The above techniques show that continuous postoperative analgesia with catheters in the lower extremities is not only possible, but indeed provides sustained effective postoperative analgesia, reduces use of opioids, and improves rehabilitation and patient well-being with minimal side-effects. These techniques could prove an alternative to postoperative pain treatment following ambulatory surgery.     

Regional anesthesia in a very low-birth-weight neonate for a neurosurgical procedure

BACKGROUND AND OBJECTIVES: Peripheral nerve blocks can be successfully utilized in infants for neurosurgical procedures. Our objective was utilizing a series of peripheral nerve blocks for a neurosurgical procedure in a very low-birth-weight neonate. CASE REPORT: We report the use of supraorbital, great auricular, and greater occipital nerve block in a very low-birth-weight neonate (700 g) who was scheduled for a neurosurgical procedure. DISCUSSION: We were able to successfully utilize peripheral nerve blocks and were able to blunt physiologic responses to surgical stress without compromising hemodynamic stability using high-dose opioids.     

Actinomycotic granuloma masquerading as an infraorbital nerve neoplasm

Actinomycotic infections of the head and neck region are rare and frequently present a confusing clinical picture. We document a case of actinomycosis that simulated a neoplasm of the infraorbital nerve, both clinically and surgically. To the best of our knowledge, this is the first report of actinomycosis involving this nerve. Correct diagnosis of actinomycotic infection in the head and neck relies most heavily on clinical suspicion. It is, therefore, imperative for the head and neck surgeon to be familiar with the etiology of this infection and its various modes of presentation as well as its appropriate management.     

Pain relief after major ankle and hindfoot surgery with repetitive peripheral nerve blocks: A feasibility study

Background

Major ankle and hindfoot surgery (e.g., ankle, triple and subtalar arthrodesis) typically causes severe postoperative pain, especially the first two postoperative days. Current modalities of postoperative analgesic treatment often include continuous peripheral nerve blocks of the saphenous and sciatic nerves via catheters in order to extend the duration of pain- and opioid-free nerve blockade to 48 h. Unfortunately, the 48 h-efficacy of continuous infusion via a catheter is reduced by a high displacement rate. We hypothesised that one-time repetition of the single injection peripheral nerve blocks would provide effective analgesia with a low opioid consumption the first 48 postoperative hours.

Methods

Eleven subjects preoperatively received a popliteal sciatic and a saphenous single injection nerve block with a protracted local anaesthetic mixture. Surgery was performed under general anaesthesia. The one-time repetition of the single injection nerve block was carried out approximately 24 h after the primary nerve block. The main outcomes were pain and cumulative opioid consumption during the first 48 postoperative hours.

Results

Nine of the 11 (82%) patients had effective analgesia without opioids during the first 48 postoperative hours. Two patients each required a single dose of 7.5 mg of oral morphine equivalents after 43 h.

Conclusion

One-time repetition of single injection saphenous and sciatic nerve blocks consistently provided effective analgesia practically without opioids for 48 h after major elective ankle and hindfoot surgery.     

Anaesthetists as pain management consultants

Anaesthetists who manage acute and chronic pain need to be familiar with current research and practice guidelines in these areas. New local anaesthetics and new routes of administration for opioids and adjuvants may further improve our management of acute pain. The safety of epidural analgesia in combination with low molecular weight heparins and the role of the anaesthetist on the acute pain service are reviewed. Chronic pain disability is increasing, necessitating a re-evaluation of our approach to chronic pain. The limitations of nerve blocks are acknowledged and guidelines for managing chronic pain and opioids are available. Anaesthetists must recognize psychological difficulties as a significant perpetuating factor in chronic pain.     

Selected interventional methods for the treatment of chronic pain: Part 1: peripheral nerve block and sympathetic block

Approximately 5-8 million people in Germany suffer from chronic pain. Some patients can obtain relief from specific interventional techniques. In detail these are blocks of the sympathetic chain and peripheral nerve blocks, regional anesthetic techniques close to the spinal cord and neuromodulation. Part 1 of this article presents peripheral nerve blocks using the example of intercostal blocks and blocks of the sympathetic chain. Peripheral nerve blocks are important for postoperative pain treatment. Only a few methods are used for chronic pain and this applies primarily to the intercostal block which is used for the treatment of pain occurring after thoracotomy, intercostal neuralgia and pain associated with infiltration of cancer. Blocks of the vegetative nervous system are accomplished on the ganglions of the head and the sympathetic chain and are therefore most commonly applied to treat headache, neuropathic and sympathetic pain in the area of abdomen and the extremities.     

Small cell carcinoma of the head and neck

Treatment methods for patients with small cell carcinoma of the head and neck are changing. Increasing clinical experience with these tumors and a better appreciation of patterns of recurrence, the need for thorough tumor staging, and the importance of chemotherapy as a form of primary therapy have contributed to these changes. Current concepts regarding small cell carcinoma arising in the head and neck are reviewed. Reported results of treatment for a variety of head and neck sites and site-specific relapse rates are summarized. New cases of small cell carcinoma arising in the hypopharynx, paranasal sinus, and from an unknown primary are added to the reported experience in the literature.     

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.     

Ultrasound-guided combined femoral nerve and lateral femoral cutaneous nerve blocks for femur neck fracture surgery--case report

We report two cases of elderly patients who underwent ultrasound-guided combined femoral nerve and lateral femoral cutaneous nerve blocks for osteosynthesis of femur neck fracture. In both cases, neuraxial anesthesia was contraindicated due to coagulopathy, and severe restrictive ventilatory disorder was observed. The femoral nerve and lateral femoral cutaneous nerve blocks were performed with 20ml of 0.375% ropivacaine under ultrasonographic visualization using a high frequency linear probe. Ultrasonographic visualization was useful to identify the needle tip and to observe the spread of local anesthetics. Supplemental local infiltration of anesthetics and intravenous low-dose sedative drugs were administered during surgery. The perioperative course was uneventful in both cases. This combined block technique could be a choice for osteosynthesis of femur neck fracture especially in high-risk patients.