Background and Aims:Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries.Material and Methods:A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal.Results:Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively.Conclusion:This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information.
Objective: To assess the safety and effectiveness of peripheral nerve blocks using ultrasound.
Methods: All patients who received peripheral nerve blocks (PNB) as a part of their anaesthesia care, in two years were analysed retrospectively. The data included outcomes of PNB effectiveness, complications and limb conditions after block. PNB effectiveness was assessed by monitoring pain scores at rest and on movement and the requirement of co- analgesia. Complications like numbness, motor block, metallic taste, hypotension, respiratory depression were also assessed.
Results: A total of 299 patients received ultrasound guided peripheral nerve blocks. Most common block performed was transversus abdominus plane block (TAP) block (46.5%) followed by supraclavicular block (16.7%). Most common complication observed in the recovery room after PNB was numbness 6.2%. Approximately 70% patients remained pain free; however 16% of the patients had moderate pain on movement at 12 hour post-operatively. Sedation score, sensory block and skin conditions were observed to be normal.
Conclusion: This study shows that the complications associated with ultrasound guided regional anaesthesia (UGRA) are very few. With advancements in ultrasound guided technique, further studies are required to evaluate benefits and complications in comparison to conventional techniques.
Keywords: Regional anesthesia, ultrasound guided blocks, peripheral nerve blocks
Continuous....
Forty one year old female known case of Kleine-Levin Syndrome, admitted for elective total abdominal hysterectomy. There is no literature describing the anaesthesia technique in these patients, we tried to avoid all known factors which could trigger the disease so we used central neuraxial anesthesia in the form of combined spinal-epidural block. Procedure was done successfully without any complication and patient remained pain free postoperatively.
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