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Adapting Injection Techniques to Different Regions
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
There is no 100% safe injecting technique for the nose. Injectors have to be vigilant and always listen to the response of patients. There should be limited use of nerve block, local infiltration, or the procedure under general anesthesia or deep sedation. Softer gel without enough strength should be reserved for surface correction only or sidewall volume adjustment. Patients with past histories of trauma, surgery, implant, filler injection, or threading should be carefully handled because the pattern of vessel distribution and fibrotic tissue reaction could increase the risk of vessel injury (Figure 6.60).
The Spirits of Pain and Suffering
Published in Robert S. Holzman, Anesthesia and the Classics, 2022
Anesthesia is broadly considered to be the provision of pain relief, unconsciousness and motionlessness during surgery. Most surgical anesthetics are general anesthetics, but anesthetic techniques are much more extensive than that. They include regional (nerve block) anesthesia, the provision of pain relief through the use of local anesthetic blocking major nerves to the arms or legs, as well as spinal or epidural anesthesia, blocking spinal nerves, typically for obstetrical pain relief or extremity surgery. Pain treatment specialists perform specific nerve blocks for the treatment of cancer pain, trauma, inflammatory diseases, headache and other disorders that can be treated with such blocks. They will also employ multi-modal analgesic medications because of their expert understanding of the various kinds of nerves and neurotransmitters involved in different modalities of pain – the lancinating pain of trauma, the sharp, twinging of peripheral neuropathies such as diabetic neuropathy, and the burning of complex regional pain syndromes. Critical Care Medicine, a melting pot of medical specialties such as anesthesiology, surgery, pulmonary medicine and pediatrics, began in the back of the Recovery Room (now called the Post Anesthesia Care Unit, or PACU) with anesthesiologists, as specialists in cardiopulmonary support and mechanical ventilation.
Analgesia and Anaesthesia
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Direct trauma to nerves with a needle and/or injection of local anaesthetic directly into a nerve can cause neurological damage. Serious nerve injury is rare, and may be due to neuropraxia, which may improve with time, but permanent injury can occur. Short-bevelled needles designed specifically for regional anaesthesia should be used where possible. A conscious patient will complain of pain and paraesthesia if a nerve is penetrated while attempting a nerve block, and the needle should be withdrawn immediately.
Evaluating the perioperative analgesic effect of ultrasound-guided trigeminal nerve block in adult patients undergoing maxillofacial surgery under general anesthesia: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2023
Maha Misk, Abdelrhman Alshawadfy, Medhat Lamei, Fatma Khames, Mohamed Abd Elgawad, Hamdy A. Hendawy
The trigeminal nerve mediates both sensory and motor innervation to the maxillofacial region. It is divided into ophthalmic, maxillary, and mandibular branches. The sensory divisions of these branches travel to their cell bodies in the trigeminal or Gasserian ganglion found at the floor of the middle cranial fossa. From the Gasserian ganglion, the sensory nerve fibers synapse with the trigeminal nuclei in the brainstem [18,19]. Nader et al. [9] demonstrated that infusing just 2 mL of contrast dye into the pterygopalatine fossa under fluoroscopy guidance caused a backward flow of contrast into the middle cranial fossa and enabled the observation of the Gasserian ganglion. They attributed the dye’s retrograde spread to the small size of the pterygopalatine fossa and its connection to the middle cerebral fossa via the foramen rotundum. The USGTNB via pterygopalatine fossa was carried out in patients who had facial pain by injecting 4 ml of 0.25% bupivacaine [20]. The long acting anesthetic bupivacaine has been used for many years in nerve block procedures. Recent studies [21,22] have used bupivacaine alone to effectively manage trigeminal nerve pain. Nader and Kendall [23] assessed the effectiveness and safety of USGTNB using bupivacaine in patients with facial pain. Within 10 min of injection, 80% of the patients experienced complete sensory analgesia in one side of the face. In addition, the patients did not show any neurological adverse effects from the block after being observed for 6–12 months.
Comparison between pericapsular nerve group block and fascia iliaca compartment block for perioperative pain control in hip surgeries: A meta-analysis from randomized controlled trials
Published in Egyptian Journal of Anaesthesia, 2023
According to Table 1, the selected studies revealed both similarities and differences in several clinical aspects as follows: the sample sizes of all available literature were quite small, they ranged from 24 to 80 patients. All papers evaluated the analgesic efficacy of PENG compared to FICB in hip arthroplasty or hip fracture surgeries. PENG was given to the experimental groups, while FICB was given to the control groups. The dose and type of local anesthetics varied between articles. Preoperative nerve block was applied in eight studies (22,23,25,26,27,29,30,31), postoperative nerve block was used in two studies (24,27), and intra-operative nerve block was applied in one study (28). Nine studies (22,23,24,25,26,27,29,30,31)used spinal anesthesia (SA), and only one study (28) employed the general anesthesia. Participates in five studies (24,27,28,29,31) received patient-controlled analgesia (PCA) with opioids for acute pain management, while the remaining participants received IV analgesics at fixed time intervals with additional rescue opioid doses as needed. Pain intensity was expressed as a visual analog score or numeric rating score at different time points.
Postoperative analgesic effect of dexmedetomidine combined with TPVB applied to open gastrectomy for gastric cancer
Published in Immunopharmacology and Immunotoxicology, 2023
Weilan Wan, Zhiqi Hou, Qiuying Qiu
Afterwards, ultrasound-guided TPVB was performed by an experienced anesthesiologist that was blind to the group allocation. In brief, the patient was in lateral position, and the 8–9 spinous processes of thoracic vertebrae were determined first. Before puncture, 1% lidocaine was used for local infiltration anesthesia. The puncture point was 3 cm beside the upper edge of spinous process. In-plane puncture technique was used to puncture into thoracic paravertebral space. No blood and cerebrospinal fluid were drawn back. The catheter was implanted 2.5 cm and fixed. Fifteen milliliters 0.5% RO with 2 mL dexmedetomidine (1 μg/kg) was injected paravertebrally to the patients in RD group under ultrasound guidance. Patients in the RO group received 15 mL RO (0.5%) and 2 mL normal saline. The anesthetic effect was tested to determine that nerve block was successful.