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      Advances in regional anaesthesia: A review of current practice, newer techniques and outcomes

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          Abstract

          Advances in ultrasound guided regional anaesthesia and introduction of newer long acting local anaesthetics have given clinicians an opportunity to apply novel approaches to block peripheral nerves with ease. Consequently, improvements in outcomes such as quality of analgesia, early rehabilitation and patient satisfaction have been observed. In this article we will review some of the newer regional anaesthetic techniques, long acting local anaesthetics and adjuvants, and discuss evidence for key outcomes such as cancer recurrence and safety with ultrasound guidance.

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          Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis?

          Aristomenis K. Exadaktylos, Donal J Buggy, Denis Moriarty … (2006)
          Regional anesthesia is known to prevent or attenuate the surgical stress response; therefore, inhibiting surgical stress by paravertebral anesthesia might attenuate perioperative factors that enhance tumor growth and spread. The authors hypothesized that breast cancer patients undergoing surgery with paravertebral anesthesia and analgesia combined with general anesthesia have a lower incidence of cancer recurrence or metastases than patients undergoing surgery with general anesthesia and patient-controlled morphine analgesia. In this retrospective study, the authors examined the medical records of 129 consecutive patients undergoing mastectomy and axillary clearance for breast cancer between September 2001 and December 2002. Fifty patients had surgery with paravertebral anesthesia and analgesia combined with general anesthesia, and 79 patients had general anesthesia combined with postoperative morphine analgesia. The follow-up time was 32 +/- 5 months (mean +/- SD). There were no significant differences in patients or surgical details, tumor presentation, or prognostic factors. Recurrence- and metastasis-free survival was 94% (95% confidence interval, 87-100%) and 82% (74-91%) at 24 months and 94% (87-100%) and 77% (68-87%) at 36 months in the paravertebral and general anesthesia patients, respectively (P = 0.012). This retrospective analysis suggests that paravertebral anesthesia and analgesia for breast cancer surgery reduces the risk of recurrence or metastasis during the initial years of follow-up. Prospective trials evaluating the effects of regional analgesia and morphine sparing on cancer recurrence seem warranted.
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            Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery.

            R. Blanco, M. FAJARDO, T. Parras Maldonado (2012)
            The Pecs block (pectoral nerves block) is an easy and reliable superficial block inspired by the infraclavicular block approach and the transversus abdominis plane blocks. Once the pectoralis muscles are located under the clavicle the space between the two muscles is dissected to reach the lateral pectoral and the medial pectoral nerves. The main indications are breast expanders and subpectoral prosthesis where the distension of these muscles is extremely painful. A second version of the Pecs block is described, called "modified Pecs block" or Pecs block type II. This novel approach aims to block at least the pectoral nerves, the intercostobrachial, intercostals III-IV-V-VI and the long thoracic nerve. These nerves need to be blocked to provide complete analgesia during breast surgery, and it is an alternative or a rescue block if paravertebral blocks and thoracic epidurals failed. This block has been used in our unit in the past year for the Pecs I indications described, and in addition for, tumorectomies, wide excisions, and axillary clearances. The ultrasound sequence to perform this block is shown, together with simple X-ray dye images and gadolinium MRI images to understand the spread and pathways that can explain the benefit of this novel approach. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.
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              Clinical uses of alpha2 -adrenergic agonists.

              T Kamibayashi, M Maze (2000)
              Article 0 comments Cited 142 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Anaesth
                Journal ID (iso-abbrev): Indian J Anaesth
                Journal ID (publisher-id): IJA
                Title: Indian Journal of Anaesthesia
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0019-5049
                ISSN (Electronic): 0976-2817
                Publication date (Print): February 2018
                Volume: 62
                Issue: 2
                Pages: 94-102
                Affiliations
                [1]Department of Anesthesiology, Division of Regional Anesthesia and Pain Management, Veterans Affairs Medical Center, Duke University School of Medicine, North Carolina, USA
                Author notes
                Address for correspondence: Dr. Srinivas Pyati, Department of Anesthesiology, Division of Regional Anesthesia and Pain Management, Duke University School of Medicine, Veterans Affairs Medical Center, Durham 27710, North Carolina, USA. E-mail: Srinivas.pyati@ 123456duke.edu
                Article
                Publisher ID: IJA-62-94
                DOI: 10.4103/ija.IJA_433_17
                PMC ID: 5827494
                PubMed ID: 29491513
                SO-VID: 505a4ccb-ad85-4e19-9898-0264e9bd838a
                Copyright © Copyright: © 2018 Indian Journal of Anaesthesia
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Categories
                Subject: Review Article

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: adjuvants,erector spinae block,pectoral nerves block,quadratus lumborum block,regional anaesthesia,transversus abdominis block,ultrasound-guided
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: adjuvants, erector spinae block, pectoral nerves block, quadratus lumborum block, regional anaesthesia, transversus abdominis block, ultrasound-guided

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