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Analgesia And Anesthesia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Michele Mele, Valentina Bellussi, Laura Felder
The epidural space is identified with the loss-of-resistance technique. A spinal needle is then introduced into the intrathecal space. An intrathecal dose of local anesthetic and opioid is injected through the spinal needle, which is then removed, leaving the epidural needle in place. An epidural catheter is inserted, and an epidural local anesthetic and opioid infusion is started. The intrathecal dose generally lasts about 2 hours, after which the epidural catheter will provide continuous analgesia.
Translating the Medical Record
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Cerebrospinal fluid (CSF) is obtained by lumbar puncture, which involves insertion of a spinal needle between the fourth and fifth lumbar vertebrae (lower bones of the spine) into the space surrounding the spinal cord. A manometer is then attached to record the opening CSF pressure. This may reflect an increased intracranial pressure (ICP). The fluid may show xanthochromia (xanth = yellow, chrom = color), denoting some type of infection or possible drug interference.
Anticoagulation in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Rachel A. Newman, Ather Mehboob, Judith H. Chung
There is an absence of high-quality evidence regarding the best postpartum prophylactic anticoagulation regimen. For patients who have been on UFH prophylaxis, the first dose may be administered 1 hour after the spinal needle was placed or the epidural catheter has been removed [31,82]. If LMWH has been used for prophylaxis, the CMQCC Maternal VTE Task Force and ASRA recommends that a minimum of 12 hours elapse between removal of the epidural catheter or spinal needle placement and administration of LWMH.
Efficacy of ultrasound-guided transversus abdominis plane block versus erector spinae plane block for postoperative analgesia in patients undergoing emergency laparotomies: A randomized, double-blinded, controlled study
Published in Egyptian Journal of Anaesthesia, 2022
Abeer Ahmed Mohammed Hassanin, Nagy Sayed Ali, Hassan Mokhtar Elshorbagy
Patients with TAPB were positioned in supine posture. To properly identify the transversus abdominis fascial plane and conduct posterior TAP, the anesthesiologist cautiously moved the ultrasound probe (linear multi-frequency 6–13 MHz transducer) (SONOSITE M-TURBO, USA) posterolaterally after placing it between the iliac crest and the costal border on the mid-axillary line of the abdominal wall. A 90-mm 22-gauge spinal needle (GMS, Egypt) was placed in-plane at a 30°–40° angle from medial to lateral under aseptic circumstances. The exact needle tip location was checked by hydro-dissection with 2–3 mL of isotonic saline before the anesthetist administered 10 mL of 0.25% bupivacaine in the fascial plane. The subcostal TAP block was accomplished similarly with the ultrasonic probe in position beneath the costal margin, and the TAP on the other side was carried out using the same method.
The lateral arm device for mammographic breast procedures: overview of its uses, safety, and efficacy
Published in Expert Review of Medical Devices, 2021
Amy Kerger, Brandy Griffith, Mitva Patel, Jeffrey Hawley, Stephen P. Povoski
Complications of using the lateral arm device are similar to that of any breast biopsy including pain, infection, hematoma, inadequate sampling/undersampling, and bruising, all of which are similar in degree to the standard approach [10]. One potential disadvantage lies in the ability to provide adequate anesthesia in larger breasts. It is recommended to use a 18 G, 9 cm length spinal needle when placing local anesthetic; however, it is not the same length as the biopsy needle and in some patients is too short to reach the target site and provide appropriate anesthesia [10]. To ensure appropriate depth for numbing, one should look at the Z depth either by measuring it from the edge of the breast on the side of planned entrance to the lesion or by allowing the software to calculate the Z at the time of biopsy. If either of these calculations is greater than 9 cm, then proper anesthesia may not be obtained. Though clip and seed migration still occurs in the standard approach, it is thought to decrease with the lateral approach though still occurs (Figure 4). Many device companies state that the lateral approach decreases migration due to decreased accordion effect from the clip being placed in the same direction as the compression [10].
Does esmolol infusion have an adjuvant effect on transversus abdominis plane block for pain control in laparoscopic cholecystectomy? A randomized controlled double-blind trial
Published in Egyptian Journal of Anaesthesia, 2021
Fatma Ahmed Abdelfatah, Samar Rafik Amin
Following skin disinfection and covering of the ultrasound probe and cable with a sterile sheath, a broad linear array probe was placed transverse to the abdomen (horizontal plane) between the iliac crest and the costal margin in the mid-axillary line. Three muscle layers can be visualized in the image. A 20 Gauge 90 or 120 mm sharp ended spinal needle was used. The needle was introduced in a sagittal plane nearly 3–4 cm medial to the probe of ultrasound (in-plane technique). To follow the needle superficial course after skin puncture; the probe was moved slightly anterior, then gradually posteriorly to the mid-axillary line position until the needle settled in its right position in the TAP. A small volume of local anaesthetic (1 mL) was initially injected to open the plane then 20 mL of 0.25% bupivacaine was injected in each side. The local anaesthetic injectant appeared hypoechoic on ultrasound imaging. The surgery was started after completion of the block.