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The Role of Intravenous Lidocaine in Preventing Chronic Post-Operative Pain
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Abstract [+]
Background and Goal of Study
Chronic post-operative pain (CPOP) is an increasing public health issue considering its impact on the patients quality of life and and the associated costs for the healthcare system. The incidence of CPOP can be as high as 75%, depending on the surgical procedure and other factors. Lidocaine is a local anesthetic with anti-inflammatory, analgesic and antihyperalgesic properties. Several studies have shown its use in controlling acute post-operative pain when used intravenously. The goal of this study was to define the role of intravenous lidocaine in preventing CPOP.
Materials and Methods
The PubMed database was searched from 2006 and 2019 with the keywords: “Chronic post-operative pain” or “Chronic post-surgical pain” or “Chronic pain” and “Intravenous lidocaine”. Adequate papers for the purpose of this study were selected.
Results and Discussion
Three randomized controlled trials that met criteria were obtained: two on breast surgery and the other on open nephrectomy. All trials used intravenous lidocaine during surgery, suspending the infusion up to the first 24-hours of the post-operative period. All three of them showed a significant decrease on the incidence of CPOP. There was a 20-fold decrease six months after breast
surgery.
Conclusion
Intravenous lidocaine seems to decrease the incidence of CPOP however, there is limited evidence. More trials are necessary to define the efficacy and safety of intravenous lidocaine. A generally accepted definition of CPOP is needed.
Keywords
Chronic pain; Chronic post-operative pain; Chronic post-surgical pain; Intravenous lidocaine.
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Current Issue
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Cranial and Spinal Subdural Hygroma Following Lumbar Epidural for Labour Analgesia
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Intracranial hygroma is a rare and probably missed complication of epidural analgesia secondary to accidental dural breech. The patient presented had a presumed spinal cerebrospinal fluid leak with symptoms of intracranial hypotension. Unusually the patient had both an intracranial subdural hygroma and rarely reported extensive spinal intradural (extra-arachnoid) collection following a lumbar epidural, administered in labour. Given the potential for progression to symptomatic neurological deficits, anesthetists should consider subdural hygroma when encountering patients with features of intracranial hypotension, or altered neurology following epidural. Pathophysiology, imaging and management are discussed.
Keywords
Subdural hygroma; Epidural; Dural puncture.
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Anesthetic Considerations in Bilateral Congenital Anophthalmia: A Rare Clinical Entity
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Congenital anomalies planned for ocular surgeries range from the rare to atypical to common. Many of this rare ophthalmopathy are associated with clinical syndromes and have important anesthetic implications. Not only is it important to know the syndrome we are dealing with, but it’s also the more important to understand the systems that are involved, the extent of involvement, potential anesthetic complications, right from the cerebrovascular, cardiovascular, endocrine, metabolic, neuromuscular, genitourinary systems to airway. Understanding these aspects becomes more important in rare clinical scenarios as it helps to plan the case, anticipate and treat the complications. Congenital anophthalmia is one of the rare conditions with an incidence of <3/1000 with microphthalmia reported in up to 11% of blind children, hence we report a rare case of bilateral congenital anophthalmia planned for excision of right ocular swelling.
Keywords
Ophthalmopathies; Congenital anophthalmia; Microophthalmia; Ocular surgery.
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Hardware Causing Hard Times: Use of the SuperNO2VA™ Nasal PAP Device to Address Airway Challenges Caused by Eroding Mandibular Hardware
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Background
Maintenance of the airway and adequate ventilation are essential for the anesthetized patient and may be compromised in patients with pan-facial trauma, abnormal dentition, abnormal mandibular space, or presence of dental hardware. We present an unusual case of a patient with a lack of natural mandibular structure and exposed mechanical hardware with fistula complicating intubation and ventilation prior to surgery.
Case Presentation
A 35-year-old male with a history of a self-inflicted gunshot to the left submandibular region approximately 6 years prior was scheduled for urgent mandibular hardware removal, closure of left facial fistula, and removal of several teeth. Pre-oxygenation and ventilation were complicated by extruding hardware and eroded skin, causing interference with a conventional facemask seal. The patient was pre-oxygenated using the SuperNO2VA™ nasal mask with which an adequate seal was achieved without use of a nasal trumpet and with a modified grip. Tracheal intubation via oral video laryngoscopy was successful, and the case proceeded uneventfully.
Conclusion
Adequate ventilation and airway maintenance can be difficult to achieve in patients with abnormal facial structure or mandibular mechanical hardware using conventional methods. The SuperNO2VA™ nasal mask can address airway issues for these patients peri-operatively.
Keywords
Anesthesiology; Airway management; Difficult airway; Airway devices; Difficult intubation; Ventilation; Oxygenation; Facial trauma; Mask ventilation.
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Pneumocephalus Caused by an Epidural Ozone Injection for Treatment of Disc Prolapse
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Pneumocephalus is a complication seen either after head trauma or post-neurosurgical procedure. It can be life-threatening if it turns into tension pneumocephalus. The presence of intracranial air indicates the presence of an open communication of cerebrospinal fluid. Air enters dura matter even without connection. Thin air flows upstream along the cerebrospinal fluid (CSF) pathway. Herein, we report a case of pneumocephalus in a 62-year-old female after epidural injection of Bupivacaine and Ozone for the treatment of a prolapsed disc. She was shifted to our hospital post-epidural injection for the management of severe headache. Though it is a rare complication, keeping this in mind will help to quickly diagnose, if need arises.
Keywords
Pneumocephalus; Head trauma; CT; Thunderclap headache.
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Transcatheter Arterial Embolization in Postpartum Hemorrhage: A Case Report
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Background
Postpartum haemorrhage is the leading cause of maternal mortality and morbidity. The significant impact of postpartum haemorrhage (PPH) on maternal mortality can be reduced if timely measures are implemented. Transcatheter arterial embolisation (TAE) is an alternative therapeutic strategy for PPH.
Case report
We report a case of postpartum haemorrhage which was managed by transcatheter arterial embolization in lieu of hysterectomy to preserve fertility and menstruation in a 27-year-old patient.
Conclusion
The critical role of obstetrician, anaesthesiologist and interventional radiologist as a team, improve the quality of care and patient safety.
Keywords
Postpartum hemorrhage (PPH); Peripartum hysterectomy; Transarterial embolisation.
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An Observational Study to Evaluate Infection Risk in Two Staff Warming Devices and a Review of Current Literature into Thermal Comfort in the Operating Room and Beyond
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Objective
To compare the degree of bacteria dissemination using two currently available operating room (OR) personnel warming devices. The “off-label” use of 3MTM’s Bair HuggerTM vs. a fairly new device, worn around the torso and under a scrub warm-up jacket or surgical gown, the OPERATIONHEATJAC® transformer only (TRO) powered by a transformer and controlled by a 4-level controller, and best for anesthesia providers and perfusionists.
Methods
Initially, staff members in scrubs sat in a room for 3 and 6-hours with agar plates placed in various positions throughout the room. Then staff members sat in the same room under the same conditions for 3 and 6-hours, and placed the hose from 3M’s Bair Hugger under their scrubs. Agar plates were positioned in the room in the same positions as in the control. Then staff members sat in the same room under the same conditions for 3 and 6-hours, wearing the OPERATIONHEATJAC® TRO over their scrub shirt and under a scrub warm-up jacket. Agar plates were again positioned in the room in the same positions as in the control. Bacteria colony counts were compared.
Results
The bacteria colony counts were 43.78% and 46.18% higher at 3 and 6-hours respectively from placement of the hose from 3MTM’s Bair HuggerTM under scrubs vs. the control. There was no significant difference in bacteria colony counts with using the OPERATIONHEATJAC® TRO vs. the control.
Conclusion
ORs are maintained cold, mostly for surgeon comfort. In an attempt to keep comfortable in this environment, peripheral OR staff opt for the “off-label” use of 3M’s Bair Hugger hose placed under scrubs. An increased spread of bacteria throughout the OR can result from this practice. Currently, there are now safer OR personnel warming devices available. In addition, this paper reviews the significance and benefits of keeping staff warm and comfortable.
Keywords
Warming devices; OPERATIONHEATJAC®; surgical site infections (SSIs); Operating room (OR); Temperature.
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Anticipated Difficult Intubation Due to Polypoidal Squamous Cell Carcinoma on Posterior One Third of Tongue
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SuperNOVA Nasal Mask Ventilation Maintains Oxygenation during Deep Sedation in High-Risk Patients: A Case Series
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Post intubation Pharyngolaryngeal Pain in Otorhinolaryngology Surgery: Efficiency of Intra cuff and Extra cuff Lidocaine
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Previous Issue
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Effect of the Irrigation Fluid Temperature on Core Temperature in Transurethral Resection of Prostate Patients Under Spinal Versus General Anaesthesia
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Anticipated Difficult Intubation Due to Polypoidal Squamous Cell Carcinoma on Posterior One Third of Tongue
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SuperNOVA Nasal Mask Ventilation Maintains Oxygenation during Deep Sedation in High-Risk Patients: A Case Series
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Post intubation Pharyngolaryngeal Pain in Otorhinolaryngology Surgery: Efficiency of Intra cuff and Extra cuff Lidocaine
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Associate Editors
Fayaz Mohammed Khazi, MD
Consultant Cardiothoracic Anesthetist Dubai Hospital Dubai Health Authority Al-Barah, Dubai, UAE
Uma Hariharan, MBBS, DNB, PGDHM
Assistant Professor Fellowship Onco-Anesthesia and Advanced Regional Anesthesia. Dr Ram Manohar Lohia Hospital Post Graduate Institute of Medical Education and Research Central Health Services, Teaching Cadre New Delhi (Central Health Services), Govt. of India
Hugh A. Cassiere, MD, FCCP, FACP
Associate Professor Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Uniondale, NY 11549, USA
Robert E. Wright, MD, DABPM, FIPP
Sydney Pain Management Centre New South Wales. Australia