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6 results

  • Regional anesthesia in Canadian emergency departments: Emergency physician practices, perspectives, and barriers to use

  • David Wiercigroch, Maxim Ben-Yakov, Danielle Porplycia, Steven Marc Friedman
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 22 / Issue 4 / July 2020
    Published online by Cambridge University Press:
    21 May 2020, pp. 499-503
    Print publication:
    July 2020
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  • Objectives

    Regional anesthesia has many applications in the emergency department (ED). It has been shown to reduce general anesthetic dose, requirement for post-procedural opioids, and recovery time. We sought to characterize the use of regional anesthesia by Canadian emergency physicians, including practices, perspectives and barriers to use in the ED.

    Methods

    A cross-sectional survey was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical response questions. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables.

    Results

    The survey was completed by 149/1144 staff emergency physicians, with a response rate of 13%. Respondents used regional anesthesia a median of 2 (IQR 0–4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of respondents, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). Respondents agreed that regional anesthesia is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had point of care ultrasound available, however less than half (49.0%) felt comfortable using it for RA. Respondents indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use of RA.

    Conclusion

    Canadian emergency physicians use regional anesthesia infrequently but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake.

  • Regional Nerve Blocks For Hip and Femoral Neck Fractures in the Emergency Department: A Systematic Review

  • Brandon Ritcey, Paul Pageau, Michael Y. Woo, Jeffrey J. Perry
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 18 / Issue 1 / January 2016
    Published online by Cambridge University Press:
    02 September 2015, pp. 37-47
    Print publication:
    January 2016
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  • Objectives

    Hip and femoral neck fractures are common in elderly patients, who are at an increased risk of complications if their pain is suboptimally managed. This systematic review seeks to determine if regional nerve blocks reduce pain, reduce the need for parenteral opiates, and reduce complications, compared to standard pain management with opiates, acetaminophen, or NSAIDs.

    Data sources

    Systematic review of MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials found 401 articles, of which nine were selected for inclusion.

    Study selection

    Randomized controlled trials including adult patients with a hip or femoral neck fracture (Population) who had a 3-in-1 femoral nerve block, traditional femoral nerve block, or fascia iliaca compartment block performed preoperatively (Intervention). Comparison must have been made with standard pain management with opiates, acetaminophen, or NSAIDs (Comparison) and outcomes must have included pain score reduction (Outcome).

    Data synthesis

    Eight out of nine studies concluded pain scores were improved with the regional nerve block compared to standard pain management. A significant reduction in parenteral opiate use was seen in five out of six studies. No patients suffered life-threatening complications related to the nerve block; however, more minor complications were under-reported. Most of the studies were at a moderate to high risk of bias.

    Conclusions

    Regional nerve blocks for hip and femoral neck fractures have a benefit in reducing pain and the need for IV opiates. The use of these blocks can be recommended for these patients. Further high-quality randomized controlled trials are required.

  • Chapter 13 - Anesthesia for endoscopic sinus surgery

  • from Section 2 - Anesthesia for nasal, sinus and pituitary surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 121-132

  • Summary

    The incidence of difficult airway is higher in patients undergoing ENT surgery and, specifically, in patients undergoing ENT cancer surgery. Even the process of topicalization with local anesthetic can precipitate loss of the airway, as can some of the complications associated with awake intubation (e.g. airway bleeding and laryngospasm). The preoperative interview should also address the possibility of events having occurred since the last anesthetic such as weight gain, laryngeal stenosis from previous airway intervention, airway radiation, facial cosmetic surgery, and worsening temporomandibular joint disorder or rheumatoid arthritis. Prior to awake intubation, premedication is commonly used to reduce secretions, enable adequate topicalization of the airway, reduce the risk of epistaxis, and protect against the risk of aspiration. Depending on the clinical circumstance, intravenous sedation may be useful in allowing the patient to tolerate awake intubation by providing anxiolysis, amnesia, and analgesia.

  • 17 - Management of spasticity

  • from Section B1 - Sensory and motor dysfunctions
  • Edited by Michael Selzer, University of Pennsylvania, Stephanie Clarke, Université de Lausanne, Switzerland, Leonardo Cohen, National Institute of Mental Health, Bethesda, Maryland, Pamela Duncan, University of Florida, Fred Gage, Salk Institute for Biological Studies, San Diego
  • Book:
    Textbook of Neural Repair and Rehabilitation
    Published online:
    04 August 2010
    Print publication:
    16 February 2006, pp 248-264

  • Summary

    This chapter reviews the pathophysiology of spasticity, and outlines the rationale for treatment and the development of treatment goals. Lesions of the brain and spinal cord that interfere with the descending motor pathways often result in spasticity. A number of neurotransmitters are involved in the sensory and motor pathways that regulate muscle tone. Spasticity can be evaluated at bedside during the physical examination. It can be more formally assessed using quantitative scales and laboratory measures. Orthotic devices are considered in the management of spasticity, to reduce tone, improve range of motion, prevent contractures, and reduce pain. Treatment for spasticity is generally initiated when the increase in muscle tone interferes with functional activities. The chapter discusses the pharmacologic and surgical management strategies. For focal spasticity, treatment with botulinum toxin or nerve blocks may of benefit. For severe refractory cases of spasticity neurosurgical procedures can be considered.

  • The use of combined suprascapular and circumflex (articular branches) nerve blocks in the management of chronic arthritis of the shoulder joint

  • R. N. Lewis
  • Journal:
    European Journal of Anaesthesiology / Volume 16 / Issue 1 / January 1999
    Published online by Cambridge University Press:
    16 August 2006, pp. 37-41
    Print publication:
    January 1999

  • Sixteen patients suffering from rheumatoid or osteoarthritis of the shoulder joint were studied. All patients complained of pain and limitation of active movement of the shoulder joint. Combined neural blockade of the suprascapular nerve (SSNB) and articular branches of the circumflex nerve (ACNB) was carried out using 4 mL of 1% prilocaine and 4 mL of 6% aqueous phenol. Following this procedure, the mean value for pain intensity decreased by 69% (VASP 2.7) and for abduction, adduction and flexion increased by 36–67% over a mean time of 13 weeks. Functional external and internal rotation of the shoulder joint also increased after neural blockade. These findings were significant (P<0.05). Further clinical evaluation of combined SSNB and ACNB in relation to previously reported methods of neural blockade of the shoulder joint is warranted using a randomized, controlled, comparative study. Conventional power calculations (80% power, 5% test) indicate that 17 patients per group would be necessary to detect one standard deviation (about 2 VASP) or 64 per group to detect a change of 0.5 standard deviations.