Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations

Saranteas, Theodosios; Koliantzaki, Iosifina; Savvidou, Olga D.; Tsoumpa, Marina; Eustathiou, Georgia; Kontogeorgakos, Vasileios; Souvatzoglou, Rizos

doi:10.23736/s0375-9393.19.13145-8

“…Many of the strategies discussed herein for inpatient postoperative patients may also be applied to various special populations, including trauma/emergent surgical patients, the elderly, the obese, obstetric populations, and pediatrics, as discussed in more detail elsewhere [293,300,[365][366][367][368][369][370][371][372][373][374][375][376][377].…”

Section: Postoperative Phasementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Hyland

¹

,

Brockhaus

²

,

Vincent

³

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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“…With the help of ultrasound guidance, nerve block can accurately locate the anesthesia site and clarify the paths of drug diffusion, which may end up with optimal anesthesia effect and decrease in unnecessary injury. In recent years, ultrasound-guided nerve block is increasingly used in fracture surgery, especially in elderly patients [ 9 – 11 ]. However, as described in previous studies, nerve block might lead to block failure or incomplete block.…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Impacts of Ultrasound‐Guided Nerve Block Combined with General Anesthesia with Laryngeal Mask on the Patients with Lower Extremity Fractures

Yang

¹

,

Bao

²

,

Gong

³

et al. 2022

Journal of Environmental and Public Health

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Objective. Surgical reduction is the leading approach to patients with lower extremity fractures. The options of anesthetic drugs during surgery are of great significance to postoperative recovery of patients. There is no consensus on the optimum anesthesia method for patients undergoing lower extremity fracture surgery. Our study is aimed at investigating the impacts of nerve block combined with general anesthesia on perioperative outcomes of the patients. Methods. In this retrospective study, 48 patients experienced general anesthesia only, and 42 patients received never block combined with general anesthesia. The perioperative hemodynamics was recorded, including mean arterial pressure (MAP), oxygen saturation of blood (SpO2), and heart rate (HR). Visual analogue scale (VAS) and Montreal Cognitive Assessment (MoCA) were carried out to evaluate postoperative pain and cognitive status. Furthermore, adverse reactions and recovery condition were observed between the patients receiving different anesthesia methods. Results. At 15 minutes and 30 minutes after anesthesia, as well as 5 minutes after surgery, significant lower MAP was observed in the patients treated with general anesthesia ( 83.04 ± 8.661 , 79.17 ± 9.427 , 86.58 ± 8.913 ) compared to those receiving never block combined with general anesthesia ( 90.43 ± 4.618 , 88.74 ± 6.224 , 92.21 ± 4.015 ) ( P < 0.05 ), and compared with general anesthesia group ( 68.5 ± 7.05 , 69.63 ± 7.956 , 72.75 ± 8.446 ), the combined anesthesia group ( 73.52 ± 9.451 , 74.17 ± 10.13 , 77.62 ± 9.768 ) showed obvious higher HR ( P < 0.05 ). No significant difference in SpO2 was found between the two groups at multiple time points ( P > 0.05 ). As for the score of VAS and MoCA, remarkably lower VAS and higher MoCA at 6 h, 12 h and 24 h after surgery were presented in the combined anesthesia group compared to general anesthesia group ( P < 0.05 ). At 24 h after surgery, the two groups showed normal cognitive function ( 26.33 ± 0.7244 vs. 28.55 ± 0.7392 ). Incidence of nausea and vomiting in the combined anesthesia group was lower than that of the general anesthesia group ( P < 0.05 ). The time to out-of-bed activity and hospital stay were shorter in the combined anesthesia group compared with general anesthesia ( P < 0.05 ). Conclusion. The application of never block combined with general anesthesia contributed to the stability of hemodynamics, alleviation of postoperative pain and cognitive impairment, along with decrease in adverse reactions and hospital stay in the patients with lower extremity fractures.

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“…There were two cases of hematoma and two cases of pneumothorax in the blind detection group. This is attributed to the fact that the blind detection operation lacks sufficient precision in control of the needle tip and requires repeated puncture to induce brachial plexus irritation, which causes damage to blood vessels, pleura and nerves ( Saranteas et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Establishment of ultrasound-guided stellate ganglion block in rats

Lin

¹

,

Chen

²

,

Tang

³

et al. 2023

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BackgroundA novel protocol for accurate stellate ganglion block under ultrasound guidance was designed in rats. This technique raises the success rate of stellate ganglion block and reduces the incidence of brachial plexus and vagus nerve block.MethodsFifty-six Sprague-Dawley were randomly divided into an ultrasound-guided group (n = 28) and a blind technique group (n = 28). The rats in the blind technique group were injected with 1.5% lidocaine mixed with methylene blue after signs of brachial plexus stimulation were elicited. The lateral side of the cephalic brachial vein was located under the first rib, where lidocaine was injected into the rats in the ultrasound-guided group. The up-and-down sequential method of Dixon was used to determine the minimum effective volume for stellate ganglion block in rats. Furthermore, we calculated the required operative duration of the two methods and observed the difference in the lidocaine diffusion range between the two groups.ResultsThe minimum effective volume for stellate ganglion block in the ultrasound-guided group was 0.040 ml, and the 95% CI was 0.026–0.052 ml. In the blind technique group, the minimum effective volume was 0.639 ml, and the 95% CI was 0.490–0.733 ml. Within the 95% CI of the lowest effective volume, the incidence of brachial plexus block as a complication of stellate ganglion block under ultrasound guidance was 10.00%.ConclusionStellate ganglion block under ultrasound guidance is more accurate than blind detection, which the incidence of complications of stellate ganglion block under ultrasound guidance was significantly lower than under blind detection; the rate of methylene blue staining in the vagus nerve was significantly lower under ultrasound guidance.

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Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations

Cited by 26 publications

References 66 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

[Retracted] Impacts of Ultrasound‐Guided Nerve Block Combined with General Anesthesia with Laryngeal Mask on the Patients with Lower Extremity Fractures

Establishment of ultrasound-guided stellate ganglion block in rats

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