Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know

Kamel, Ihab R.; Ahmed, Muhammad F.; Sethi, Anish

doi:10.5312/wjo.v13.i1.11

Cited by 22 publications

(16 citation statements)

References 135 publications

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“…Regional anesthesia for lower limb surgeries is always an excellent option because of superior postoperative pain control, lesser opioid consumption and reduced opioidassociated side effects, and lesser risks for hypoxia, respiratory depression, and no airway manipulation compared with general anesthesia. 6 However, regional anesthesia in the form of neuraxial blocks is associated with increased risks in patients with coagulopathy. 7 Use of peripheral nerve blocks for above-and below-knee amputation can be a very good option in patients with multiple comorbidities because of lesser hemodynamic changes and better pain management intra-and postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Regional anesthesia for lower limb surgeries is always an excellent option because of superior postoperative pain control, lesser opioid consumption and reduced opioid‐associated side effects, and lesser risks for hypoxia, respiratory depression, and no airway manipulation compared with general anesthesia 6 . However, regional anesthesia in the form of neuraxial blocks is associated with increased risks in patients with coagulopathy 7 .…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound‐guided femoral and sciatic nerve block as an option for below‐knee amputation in an elderly patient: A case report

Devkota¹,

Thapa²

2023

Clinical Case Reports

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Peripheral nerve blocks can be a very safe option in elderlypatients with multiple comorbidities where spinal or general anesthesia may be associated with increased risks. We present a 67 years male taking antiplatelet drugs with deranged coagulation profile with bilateral pneumonia with diabetic foot with wet gangrene planned for emergency below knee amputation under ultrasound guided femoral and sciatic nerve block.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided femoral and sciatic nerve block as an option for below‐knee amputation in an elderly patient: A case report

Devkota¹,

Thapa²

2023

Clinical Case Reports

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“…Regional anesthesia with peripheral neuraxial blocks is commonly performed in pediatric orthopedic surgery [ 18 ]. They are associated with a very low risk of complications [ 19 , 20 ] and have the same effect regardless of the different types of regional anesthesia [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Factors for Prolonged Pain and Restriction of Movement Following Hemiepiphysiodesis Plating for the Correction of Lower Limb Malalignment in the Frontal Plane: An Explorative Analysis

et al. 2023

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The correction of valgus leg malalignment in children using implant-mediated growth guidance is widely used and effective. Despite the minimal invasive character of the procedure, a relevant number of patients sustain prolonged pain and limited mobility after temporary hemiepiphysiodesis. Our aim was to investigate implant-associated risk factors (such as implant position and screw angulation), surgical- or anesthesia-related risk factors (such as type of anesthesia, use, and duration), and pressure of tourniquet or duration of surgery for these complications. Thirty-four skeletally immature patients with idiopathic valgus deformities undergoing hemiepiphysiodesis plating from October 2018–July 2022 were enrolled in this retrospective study. Participants were divided into groups with and without prolonged complications (persistent pain, limited mobility of the operated knee between five weeks and six months) after surgery. Twenty-two patients (65%) had no notable complications, while twelve patients (35%) had prolonged complications. Both groups differed significantly in plate position relative to physis (p = 0.049). In addition, both groups showed significant differences in the distribution of implant location (p = 0.016). Group 1 had a shorter duration of surgery than group 2 (32 min vs. 38 min, p = 0.032) and a lower tourniquet pressure (250 mmHg vs. 270 mmHg, p = 0.019). In conclusion, simultaneous plate implantation at the femur and tibia and metaphyseal plate positioning resulted in prolonged pain and a delay of function. In addition, the amplitude of tourniquet pressure or duration of surgery could play a factor.

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“…In general, deep regional anesthetics should be treated like neuraxial procedures. According to the American Society of Regional Anesthesia and Pain Medicine Guidelines, 45,46 the bleeding risk is stratified by antiplatelet or anticoagulation agent and time of administration.…”

Section: Regional Anesthesia and Antithrombotic Therapymentioning

confidence: 99%

Perioperative Management of Oral Anticoagulants and Antiplatelet Therapy in Hand and Wrist Surgery

Gallant

Matzon

Beredjiklian

et al. 2023

J Am Acad Orthop Surg

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There is wide variability in the management of patients on antithrombotic therapy requiring surgery of the hand and wrist. There are no specific guidelines regarding whether to temporarily cease or continue oral anticoagulants and antiplatelet agents. Discontinuation of these medications before surgery can lead to perioperative thromboembolic or ischemic events. On the other hand, continuation can lead to intraoperative or postoperative bleeding complications. This review discusses various anticoagulants and antiplatelet agents with special considerations for their management, analyzes the current literature, summarizes current recommendations, and provides direction for additional research.

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Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know

Cited by 22 publications

References 135 publications

Ultrasound‐guided femoral and sciatic nerve block as an option for below‐knee amputation in an elderly patient: A case report

Ultrasound‐guided femoral and sciatic nerve block as an option for below‐knee amputation in an elderly patient: A case report

Factors for Prolonged Pain and Restriction of Movement Following Hemiepiphysiodesis Plating for the Correction of Lower Limb Malalignment in the Frontal Plane: An Explorative Analysis

Perioperative Management of Oral Anticoagulants and Antiplatelet Therapy in Hand and Wrist Surgery

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