Passive manipulation for patients with frozen shoulder may enable fast recovery of shoulder symptoms. For the concern of many clinicians that deep anaesthesia and sedation for frozen shoulder manipulation may carry certain difficulty in identifying pericapsular structures damage during the procedure, we proposed a novel shoulder interfascial plane blocks for awake frozen shoulder manipulation.
Pemeriksaan penunjang ultrasonografi point-of-care (POCUS) jantung sangat berguna dalam memandu resusitasi pasien kritis dengan penyakit penyerta jantung. Namun, POCUS jantung memiliki keterbatasan dan harus tetap dipandu pemeriksaan fisis klinis. Seorang perempuan berusia 84 tahun, mendapatkan perawatan di ruang intensif atas indikasi hemodinamik tidak stabil pascaperdarahan akut gastrointestinal bawah. Pasien tampak somnolen, takipnea, hipotensi disertai distensi vena jugularis. Pemeriksaan laboratorium hanya menunjukkan tanda anemia akut, sedangkan pada rontgen toraks didapatkan kardiomegali dan pacu jantung-tanam. Pasien ditemukan di bangsal dalam kondisi hipotensi dan diberikan bolus cairan. Evaluasi pascabolus cairan, pasien menunjukkan tanda hemodinamik stabil yang transien akibat perdarahan yang terus menerus. Dengan kecurigaan awal bahwa terdapat gangguan fungsi jantung maka ekokardiografi digunakan untuk memandu resusitasi cairan. Pada pemeriksaan tidak didapatkan variasi left ventricular outflow tract velocity time integral (VTi) disertai regurgitasi aorta (AR) moderat dan parameter lain yang membatasi fungsi ultrasonografi POCUS jantung dalam memandu uji responsivitas cairan. Penulis akhirnya melakukan resusitasi cairan dengan panduan pemeriksaan klinis secara berulang semata disertai pemeriksaan ultrasonografi inferior vena cava (IVC). Pasien berhasil diresusitasi dengan bolus cairan intravena dalam jumlah besar tanpa komplikasi sekunder. Penilaian klinis tetap diperlukan terutama pada kondisi patologis tertentu yang membatasi utilisasi POCUS jantung.
Introduction. While interscalene brachial plexus block remains the gold standard of any shoulder procedure, including shoulder manipulation in patients with adhesive capsulitis, anesthesiologists are reluctant to face the risk of phrenic nerve paresis, especially in patients with preexisting pulmonary conditions. Hence, many studies have targeted specific regional anesthesia of the shoulder low enough by the blockade level, leaving phrenic nerve function intact but still providing satisfying anesthesia for shoulder procedures. Until recently, no comparison between these regional anesthesia techniques focusing on shoulder manipulation for adhesive capsulitis has been published. Case Report. We compared the profiles between suprascapular nerve block, shoulder interfascial plane block, and superior trunk block as the sole anesthesia technique in patients with adhesive capsulitis undergoing awake shoulder manipulation. Conclusion. This report descriptively signifies superior trunk block excellence among other regional anesthesia techniques in achieving complete anesthesia for awake shoulder manipulation in patients with adhesive capsulitis while sparing the phrenic-nerve function
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