ABSTRACT
Chronic pain is a common, pervasive, and often disabling medical condition that affects millions of people worldwide. According to the Global Burden of Disease survey, painful chronic conditions are causing the largest numbers of years lived with disability worldwide. In America, more than one in five adults experiences chronic pain. Erector spinae plane block is a novel regional anesthesia technique used to provide analgesia with multiple possible uses and a relatively low learning curve and complication rate. Here, we review the erector spinae plane block rationale, mechanism of action and possible complications, and discuss its potential use for chronic pain with possible future directions for research.
ABSTRACT
PURPOSE: Adequate patient positioning is of paramount importance in neurosurgery. Complications related to the position are common and make up for more than 16% of the claims towards anaesthesiologists and neurosurgeons. This paper aims to provide the anaesthesiologist with a practical guide to avoid common pitfalls related to the patient positioning process. METHOD: We performed a systematic review of the medical literature for the identification, screening, and inclusion of articles. The bibliographic search was conducted on June 1st, 2021 by two of the authors. In this review, we included articles indexed by MEDLINE, Cochrane Library, or Google Scholar. RESULTS: We retrieved a total of 5706 unique papers from our initial search. However, after the initial screening, 5363 papers were removed is not related to our research leaving a total of 343 papers. We examined the full text of all the 343 articles including 68 of them in the final qualitative analysis. DISCUSSION: In this review we examine the most common neurosurgical positions: supine, sitting, lateral, park-bench, prone, jack-knife, and knee-chest. For each of them, the proper positioning and related complications are described. Particular attention is given to the prevention and management of these complications, providing a practical guide for clinicians.
Subject(s)
Neurosurgery , Humans , Neurosurgical Procedures/adverse effectsABSTRACT
INTRODUCTION: People are not able to anticipate unexpected events. Inattentional blindness is demonstrated to happen not only in naïve observers engaged in an unfamiliar task but also in field experts with years of training. Anaesthesia is the perfect example of a discipline which requires a high level of attention and our aim was to evaluate if inattentional blindness can affect anesthesiologists during their daily activities. MATERIALS AND METHODS: An online survey was distributed on Facebook between May 1, 2021 and May 31, 2021. The survey consisted of five simulated cases with questions investigating the anesthetic management of day-case surgeries. Each case had an introduction, a chest radiography, an electrocardiogram, preoperative blood testing and the last case had a gorilla embedded in the chest radiography. RESULTS: In total 699 respondents from 17 different countries were finally included in the analysis. The main outcome was to assess the incidence of inattentional blindness. Only 34 (4.9%) respondents were able to spot the gorilla. No differences were found between anesthesiologists or residents, private or public hospitals, or between medical doctors with different experience. DISCUSSION: Our findings assess that inattentional blindness is common in anesthesia, and ever-growing attention is deemed necessary to improve patient safety; to achieve this objective several strategies should be adopted such as an increased use of standardized protocols, promoting automation based strategies to reduce human error when performing repetitive tasks and discouraging evaluation of multiple consecutive patients in the same work shifts independently of the associated complexity.