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Neuraxial Blocks (neuraxial + block)

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Medical Sciences100%

Selected Abstracts

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010
H. BREIVIK
Background: Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks vary in their recommendations for safe practice. Methods: The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) appointed a task force of experts to establish a Nordic consensus on recommendations for best clinical practice in providing effective and safe CNBs in patients with an increased risk of bleeding. We performed a literature search and expert evaluation of evidence for (1) the possible benefits of CNBs on the outcome of anaesthesia and surgery, for (2) risks of spinal bleeding from hereditary and acquired bleeding disorders and antihaemostatic drugs used in surgical patients for thromboprophylaxis, for (3) risk evaluation in published case reports, and for (4) recommendations in published national guidelines. Proposals from the taskforce were available for feedback on the SSAI web-page during the summer of 2008. Results: Neuraxial blocks can improve comfort and reduce morbidity (strong evidence) and mortality (moderate evidence) after surgical procedures. Haemostatic disorders, antihaemostatic drugs, anatomical abnormalities of the spine and spinal blood vessels, elderly patients, and renal and hepatic impairment are risk factors for spinal bleeding (strong evidence). Published national guidelines are mainly based on experts' opinions (weak evidence). The task force reached a consensus on Nordic guidelines, mainly based on our experts' opinions, but we acknowledge different practices in heparinization during vascular surgery and peri-operative administration of non-steroidal anti-inflammatory drugs during neuraxial blocks. Conclusions: Experts from the five Nordic countries offer consensus recommendations for safe clinical practice of neuraxial blocks and how to minimize the risks of serious complications from spinal bleeding. A brief version of the recommendations is available on http://www.ssai.info. [source]

A review of pediatric regional anesthesia practice during a 17-year period in a single institution

PEDIATRIC ANESTHESIA, Issue 9 2007
ALAIN ROCHETTE MD
Summary Background:, There is anecdotal evidence of changes in pediatric regional anesthesia (RA) practice. We performed a retrospective review of prospective data on pediatric RA over 17 years in our institution. Methods:, Data were collected from an electronic database for every anesthetic performed between 1989 and 2005. Type of RA, if any, and age of the patient were noted. Patients were divided into two groups: ,4 years (younger group) and 5 years or older (older group). Results:, A total of 51 408 anesthetics were performed; 23 609 (46%) in the younger group. A total of 10 929 RA were performed. In the younger group, RA increased from 9.5% to 27.6% (P < 0.001). Neuraxial blocks decreased from 100% to 59.7% of RA. Caudals decreased in the late 1990s from 70% to 22% of RA and epidurals have decreased from 22% to 11% of RA since 2002. Neonatal spinals were introduced in 1990 and now reach 30% of RA. Peripheral blocks have increased up to 37% of RA since 1994. In the older group, RA increased from 9.2% to 23.3% (P < 0.001), less than in the younger (P < 0.01). Neuraxial blocks have decreased from 97% to 24.9% of RA (P < 0.001), more obviously than in the younger group (P < 0.001). Peripheral blocks emerged in 1994, outnumbering neuraxial blocks as early as 1995 and now account for 75% of RA. This increase is significantly more pronounced than in the younger group (P < 0.001). In both groups, peripheral blocks were distributed among plexus blocks (30%) and compartment/peripheral nerve blocks (70%). In the last 5 years, a perineural catheter was placed in 12.9% of peripheral blocks to ensure continuous postoperative analgesia. Conclusions:, In our hospital, there has been a dramatic increase in RA, mainly from 1989 to 1995. The most remarkable events in the last decade were: (i) the change in practice from neuraxial to peripheral blocks and (ii) the emergence of continuous postoperative analgesia via perineural catheters. [source]

Scandinavian guidelines for neuraxial block and disturbed haemostasis: replacing wishful thinking with evidence based caution

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010
V. MOEN
No abstract is available for this article. [source]

Litigation related to regional anaesthesia: an analysis of claims against the NHS in England 1995,2007,

ANAESTHESIA, Issue 5 2010
K. Szypula
Summary We analysed 366 claims related to regional anaesthesia and analgesia from the 841 anaesthesia-related claims handled by the National Health Service Litigation Authority between 1995 and 2007. The majority of claims (281/366, 77%) were closed at the time of analysis. The total cost of closed claims was £12 724 017 (34% of the cost of the anaesthesia dataset) with a median (IQR [range]) of £4772 (£0,28 907 [£0,2 070 092]). Approximately half of the claims (186/366; 51%) were related to obstetric anaesthesia and analgesia and of the non-obstetric claims, the majority (148/180; 82%) were related to neuraxial block. The total cost for obstetric closed claims was £5 433 920 (median (IQR [range]) £5678 (£0,27 690 [£0,1 597 565]) while that for non-obstetric closed claims was £7 290 097 (£3337 (£0,31 405 [£0,2 070 062]). Non-obstetric claims were more likely to relate to severe outcomes than obstetric ones. The maximum values of claims were higher for claims related to neuraxial blocks and eye blocks than for peripheral nerve blocks. Despite many limitations, including lack of clinical detail for each case, the dataset provides a useful overview of the extent, patterns and cost associated with the claims. [source]

Motor block in regional anaesthesia

ANAESTHESIA, Issue 12 2001
apparatus
A device based on a load cell was constructed to measure the strength of foot dorsiflexion and plantarflexion. Performance of the device was evaluated for both movements. The influence of foot position within the device, its use over a 30-min period at 30-s intervals and the effect of the removal and reapplication of the device on measured force of dorsiflexion and plantarflexion was studied in six volunteers. Both dorsiflexion and plantarflexion are suitable movements on which to base a device to quantify the density of motor block during the onset and offset of neuraxial block. Dorsiflexion has a number of advantages: muscle strength is independent of knee position, and therefore a below-knee device can be constructed; strength of dorsiflexion is less affected by the foot position; we found the device easier to apply using dorsiflexion as the heel tended to self-locate; innervation of the muscles responsible for dorsiflexion involves fewer spinal segments. [source]

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010
H. BREIVIK
Background: Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks vary in their recommendations for safe practice. Methods: The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) appointed a task force of experts to establish a Nordic consensus on recommendations for best clinical practice in providing effective and safe CNBs in patients with an increased risk of bleeding. We performed a literature search and expert evaluation of evidence for (1) the possible benefits of CNBs on the outcome of anaesthesia and surgery, for (2) risks of spinal bleeding from hereditary and acquired bleeding disorders and antihaemostatic drugs used in surgical patients for thromboprophylaxis, for (3) risk evaluation in published case reports, and for (4) recommendations in published national guidelines. Proposals from the taskforce were available for feedback on the SSAI web-page during the summer of 2008. Results: Neuraxial blocks can improve comfort and reduce morbidity (strong evidence) and mortality (moderate evidence) after surgical procedures. Haemostatic disorders, antihaemostatic drugs, anatomical abnormalities of the spine and spinal blood vessels, elderly patients, and renal and hepatic impairment are risk factors for spinal bleeding (strong evidence). Published national guidelines are mainly based on experts' opinions (weak evidence). The task force reached a consensus on Nordic guidelines, mainly based on our experts' opinions, but we acknowledge different practices in heparinization during vascular surgery and peri-operative administration of non-steroidal anti-inflammatory drugs during neuraxial blocks. Conclusions: Experts from the five Nordic countries offer consensus recommendations for safe clinical practice of neuraxial blocks and how to minimize the risks of serious complications from spinal bleeding. A brief version of the recommendations is available on http://www.ssai.info. [source]

Are peripheral and neuraxial blocks with ultrasound guidance more effective and safe in children?

PEDIATRIC ANESTHESIA, Issue 2 2009
KASIA RUBIN MD
Summary Background and aims:, The efficacy and safety of ultrasound guided (USG) pediatric peripheral nerve and neuraxial blocks in children have not been evaluated. In this review, we have looked at the success rate, efficacy and complications with USG peripheral nerve blocks and compared with nerve stimulation or anatomical landmark based techniques in children. Methods:, All suitable studies in MEDLINE, EMBASE Drugs and Cochrane Evidence Based Medicine Reviews: Cochrane Database of Systemic Reviews databases were identified. In addition, citation review and hand search of recent pediatric anesthesia and surgical journals were done. All three authors read all selected articles independently and a consensus was achieved. All randomized controlled trials (RCTs) comparing USG peripheral and neuraxial blocks with other techniques in children were included. Results:, Ultrasound guidance has been demonstrated to improve block characteristics in children including shorter block performance time, higher success rates, shorter onset time, longer block duration, less volume of local anesthetic agents and visibility of neuraxial structures. Conclusion:, Clinical studies in children suggest that US guidance has some advantages over more traditional nerve stimulation,based techniques for regional block. However, the advantage of US guidance on safety over traditional has not been adequately demonstrated in children except ilio-inguinal blocks. [source]

A review of pediatric regional anesthesia practice during a 17-year period in a single institution

PEDIATRIC ANESTHESIA, Issue 9 2007
ALAIN ROCHETTE MD
Summary Background:, There is anecdotal evidence of changes in pediatric regional anesthesia (RA) practice. We performed a retrospective review of prospective data on pediatric RA over 17 years in our institution. Methods:, Data were collected from an electronic database for every anesthetic performed between 1989 and 2005. Type of RA, if any, and age of the patient were noted. Patients were divided into two groups: ,4 years (younger group) and 5 years or older (older group). Results:, A total of 51 408 anesthetics were performed; 23 609 (46%) in the younger group. A total of 10 929 RA were performed. In the younger group, RA increased from 9.5% to 27.6% (P < 0.001). Neuraxial blocks decreased from 100% to 59.7% of RA. Caudals decreased in the late 1990s from 70% to 22% of RA and epidurals have decreased from 22% to 11% of RA since 2002. Neonatal spinals were introduced in 1990 and now reach 30% of RA. Peripheral blocks have increased up to 37% of RA since 1994. In the older group, RA increased from 9.2% to 23.3% (P < 0.001), less than in the younger (P < 0.01). Neuraxial blocks have decreased from 97% to 24.9% of RA (P < 0.001), more obviously than in the younger group (P < 0.001). Peripheral blocks emerged in 1994, outnumbering neuraxial blocks as early as 1995 and now account for 75% of RA. This increase is significantly more pronounced than in the younger group (P < 0.001). In both groups, peripheral blocks were distributed among plexus blocks (30%) and compartment/peripheral nerve blocks (70%). In the last 5 years, a perineural catheter was placed in 12.9% of peripheral blocks to ensure continuous postoperative analgesia. Conclusions:, In our hospital, there has been a dramatic increase in RA, mainly from 1989 to 1995. The most remarkable events in the last decade were: (i) the change in practice from neuraxial to peripheral blocks and (ii) the emergence of continuous postoperative analgesia via perineural catheters. [source]

Litigation related to regional anaesthesia: an analysis of claims against the NHS in England 1995,2007,

ANAESTHESIA, Issue 5 2010
K. Szypula
Summary We analysed 366 claims related to regional anaesthesia and analgesia from the 841 anaesthesia-related claims handled by the National Health Service Litigation Authority between 1995 and 2007. The majority of claims (281/366, 77%) were closed at the time of analysis. The total cost of closed claims was £12 724 017 (34% of the cost of the anaesthesia dataset) with a median (IQR [range]) of £4772 (£0,28 907 [£0,2 070 092]). Approximately half of the claims (186/366; 51%) were related to obstetric anaesthesia and analgesia and of the non-obstetric claims, the majority (148/180; 82%) were related to neuraxial block. The total cost for obstetric closed claims was £5 433 920 (median (IQR [range]) £5678 (£0,27 690 [£0,1 597 565]) while that for non-obstetric closed claims was £7 290 097 (£3337 (£0,31 405 [£0,2 070 062]). Non-obstetric claims were more likely to relate to severe outcomes than obstetric ones. The maximum values of claims were higher for claims related to neuraxial blocks and eye blocks than for peripheral nerve blocks. Despite many limitations, including lack of clinical detail for each case, the dataset provides a useful overview of the extent, patterns and cost associated with the claims. [source]

Regional anaesthesia for limb surgery: a review of anaesthetists' beliefs and practice in the Oxford region*

ANAESTHESIA, Issue 6 2008
N. M. Feely
Summary We conducted a postal survey of 210 anaesthetists in the Oxford region to determine their views and practice regarding the timing of regional anaesthesia when combined with general anaesthesia for adults undergoing limb surgery and to compare the results with those obtained in a similar survey conducted in 2001. Of the 151 respondents (72% response rate), 102 (68%) regularly combined regional and general anaesthesia for adult limb surgery. Over 80% believed that central neuraxial blocks should be performed before general anaesthesia. This matched their current practice, marking a change from 2001. Significantly fewer anaesthetists believed it necessary to perform peripheral nerve blocks before general anaesthesia than in 2001, marking another significant change in practice. Overall, the results indicate an increased popularity of regional blocks in combination with general anaesthesia when compared with 2001 practice, which we believe is related to high quality advanced training modules now on offer to senior trainees in the Oxford region. [source]