Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach: a two-centre prospective observational study.

The aim of this prospective, double-centre, observational study performed in 116 patients was to describe a new anterior approach of ultrasound-guided intermediate cervical plexus block for carotid endarterectomy. The median (IQR [range]) volume of ropivacaine 0.5% administered was 30 (25-30 [20-45]) ml. Supplemental local anaesthesia (infiltration and topical) was needed in 66 (57%) patients. Overall, 41 (35%) patients needed additional sedation (18 midazolam; 23 remifentanil). There was no intra-operative complication or systemic toxicity of ropivacaine. One regional anaesthesia procedure was converted to general anaesthesia because of patient agitation. Adverse effects were of short duration and did not affect surgery. Satisfaction scores were high for 92 (79%) patients (63 satisfied; 29 very satisfied) and 104 (90%) surgeons (51 satisfied; 53 very satisfied). This study shows that the ultrasound-guided intermediate cervical plexus block using an anterior approach is feasible and provides similar results to other regional techniques during carotid endarterectomy.

Increase in optic nerve sheath diameter induced by epidural blood patch: a preliminary report.

BACKGROUND: Post-dural puncture headache (PDPH) might be related to cerebrospinal fluid hypotension. Studies in brain-injured patients have shown a good relationship between optic nerve sheath diameter (ONSD) measured by ocular sonography and invasively measured intracranial pressure (ICP). The aim of this study was to evaluate changes in ONSD after lumbar epidural blood patch (EBP). METHODS: Consecutive subjects receiving an EBP for PDPH were included. ONSD and pain measurements were performed before (T(0)), 10 min (M(10)), 2 h (H(2)), and 20 h (H(20)) after the EBP. RESULTS: Ten subjects were included. ONSD [median (inter-quartile range)] increased with time after EBP, from 4.8 mm (4.5-5.1) at T(0) to 5.2 mm (4.9-5.7) at M(10) (P=0.005 vs T(0)), 5.5 mm (5.1-6.0) at H(2) (P=0.007 vs T(0)), and 5.8 mm (5.2-6.3) at H(20) (P=0.02 vs T(0)). EBP was clinically successful in nine of 10 subjects. In subjects in whom EBP was successful, ONSD significantly increased at M(10) and T(2) compared with T(0) (P=0.004 and 0.008, respectively) but did not reach statistical significance at H(20) (P=0.06). In the subject in whom EBP failed, a small increase in ONSD was observed over time. CONCLUSIONS: In this preliminary report, EBP was followed by ONSD enlargement in subjects with successful EBP, but not in the subject with EBP failure. Since ONSD is a surrogate marker of ICP, this suggests that a sustained increase in ICP is associated with successful EBP.

[Fascia iliaca block for femoral bone fractures in prehospital medicine]. / Bloc iliofascial en médecine préhospitalière pour les fractures du fémur.

OBJECTIVE: The aim of this study was to assess the feasibility and efficacy of fascia iliaca compartment bloc (FIB) in prehospital care performed by emergency physicians. STUDY DESIGN: Prospective observational study. PATIENTS AND METHODS: Fifty-two patients victim of a femoral bone fracture were included consecutively. All FIB had been performed by emergency physicians trained to the technique. Lidocaine 1.5% with epinephrine has been used. Block efficacy was assessed by testing sensitive block in the anterior, lateral and medial part of the thigh. Pain levels were noted using a simplified numeric scale (SNS). RESULTS: No complete was reported. Ninety-four percent of blocks were successful. SNS values significantly decrease 10 minutes after block performance. CONCLUSION: Emergency medicine physicians trained to the technique can perform FIB with a high success rate.

Influence of timing on the analgesic effect of intravenous ketorolac after orthopedic surgery.

This study evaluated the pre-emptive analgesic effect of intravenous (i.v.) ketorolac (KET) for total hip replacement (THR). Sixty patients who underwent surgery for THR under general anesthesia were randomly allocated to 3 groups. Two i.v. injections were administered: one before induction and one after surgery. The patients were studied prospectively in a double-blind manner. The control group (CONT; n = 20) received 2 ml of normal saline (NS) for both injections. The pre-operative KET group (PRE; n = 20) received 60 mg of KET and then 2 ml of NS. The postoperative KET group (POST; n = 20) received 2 ml of NS and then 60 mg of KET. General anesthesia was standardized with a intra-operative cumulated dose of fentanyl limited to 4 micrograms/kg. In the recovery room (RR), pain was controlled with an i.v. tritration of morphine; thereafter, on the surgical ward, patients used a patient-controlled analgesia (PCA) pump (Abbott). Pain was evaluated with a visual analogue scale (VAS) at rest and movement in the RR, then every hour for 6 h and every 6 h for 5 days. The side effects monitored were: sedation, respiratory depression, nausea, perioperative bleeding. The patients and surgery were similar for the 3 groups. Upon arrival in the RR, VAS scores taken at rest and at movement were lower for the PRE group than for the CONT and POST groups. Otherwise, VAS scores were similar in all 3 groups. The cumulative dose of morphine in the PRE group was lower than that for the CONT and POST groups from 0 to 6 h.(ABSTRACT TRUNCATED AT 250 WORDS)

[The truncal blocks of the foot]. / Les blocs tronculaires du pied.

Among the five branches of principal nerves trunks supplying the ankle and foot, only the tibial nerve is sometimes difficult to block at the ankle, at the border of the medial malleolus. Using new landmarks at the level of the sustentaculum tali overcomes this problem. Blocking these five nerves make possible all surgical procedures on the foot and provide excellent postoperative analgesia. Only tourniquet is a limit for these blocks.

[Truncal and peripheral blocks of the arm]. / Blocs tronculaires et périphériques du membre supérieur.

Blocking the median, the radial, the ulnar and the musculo-cutaneous nerves, alone or all together provide sufficient anaesthesia for hand and forearm surgery. Because of frequent anatomical variations and the possibility of a double nerve supply in some territories, blockade must be extended to the adjacent nerves. Tourniquet over the elbow is the only limit for these blocks, but they are useful to provide per and postoperative analgesia during general anaesthesia, and in some cases to improve the efficiency of brachial plexus block.

[Block of the lumbar plexus]. / Les blocs du plexus lombaire.

Lumbar plexus block is indicated in anesthesia and analgesia of the proximal part of the lower limb. Several techniques, two via the anterior approach and at least three via a posterior paravertebral approach have been described. All these techniques are not equivalent in terms of technical facilities or difficulties, efficacy, success or failure rates and postoperative analgesia. The best choice must be done keeping in mind all advantages or disadvantages of each technic.

[Sciatic nerves block]. / Blocs des nerfs sciatiques.

Sciatic nerve block is considered difficult to perform, but very useful for lower limb anaesthesia and analgesia. The use of a nerve stimulator makes the technique easier. Functionally, it is better to consider that there are three independent sciatic nerves, namely, the posterior cutaneous nerve, the tibial nerve and the common peroneal nerve. Searching for blocking these three nerves and especially the latter two, specifically improve the reliability and quality of blockade.

[Right thyroidectomy under ultrasound-guided anterior superficial cervical plexus in a patient with severe pulmonary hypertension]. / Lobo-isthmectomie droite chez une patiente atteinte d'une HTAP idiopathique sévère sous bloc intermédiaire échoguidé bilatéral antérieur du plexus cervical superficiel.

We report a case of partial thyroidectomy under ultrasound-guided regional anesthesia, according a new anterior approach, in a patient with a severe primitive pulmonary hypertension.

[TAP block analgesia after iliac bone surgery]. / Bloc dans le plan du muscle transverse de l'abdomen pour l'analgésie de la chirurgie du bassin antérieur.

We report two cases of iliac bone surgery (repair of a symphysis disjunction and fixation of a fracture of the iliac ala) where TAP blocks were effective for postoperative analgesia. In the first case, we performed a bilateral block, and only a unilateral block in the second case. We discuss possible mechanisms to explain the efficacy of the TAP blocks in such surgeries. As for the femoral nerve block in major knee surgery, we think that blocking the parietal pain from skin and blocking parietal muscles contracture, can reduce postoperative pain in such surgeries.

[TAP block and blocks of the abdominal wall]. / TAP bloc et blocs de la paroi abdominale.

Since the revolution of ultrasound in regional anesthesia, new techniques have arisen. The "transversus abdominis plane" block or TAP block is one of them. The benefits of a TAP block for postoperative analgesia have been shown mostly after laparotomy. Because this block seems to be technically easy, many anesthesiologists have quickly adopted it. However, the TAP block presents some technical specificities and knowledge of the anatomy is required. This article reviews the anatomy of the abdominal wall, the different blocks, the indications, the complications, and highlights the many unanswered questions left. This review proposes a new vision of the abdominal wall blocks based on a new understanding of the anatomy of the abdominal wall associated with an ultrasound technique.

[Bilateral catheter for continuous TAP block and postoperative pain relief after gynecologic surgery]. / TAP block avec pose bilatérale d'un cathéter pour analgésie postopératoire après chirurgie gynécologique.

We describe the case of two patients who had undergone gynecologic surgery and in whom a continuous ropivacaine infusion was administered through a catheter placed on each abdominal side, using the technique of ultrasound-guided TAP block. Postoperative analgesia was of excellent quality with almost no morphine requirement. No side effects were encountered.