Perioperative management in complex spine surgery.

The last two decades have seen a significant increase in the number of spine surgical procedures performed worldwide. This type of surgery includes a wide variety of procedures, from mini-invasive discectomies to multilevel spinal arthrodesis and osteotomies. Moreover, different surgical approaches are described at different spine levels: the anesthesiologist should be aware of the potential benefits and risks for the patients and be prepared for their management.

The Role of Regional Anesthesia During the SARS-CoV2 Pandemic: Appraisal of Clinical, Pharmacological and Organizational Aspects.

The severe acute respiratory syndrome coronavirus SARS-CoV2 is spreading over millions of people worldwide, leading to thousands of deaths, even among the healthcare providers. Italy has registered the deaths of 337 physicians and more than 200 nurses as of March 14, 2021. Anesthesiologists are at higher risk as they are the care providers in both ICU and operating rooms.

Spinal anaesthesia with Chloroprocaine HCl 1% for elective lower limb procedures of short duration: a prospective, randomised, observer-blind study in adult patients.

Background: This prospective, randomised, observer-blinded study has been conducted in patients undergoing procedures of the lower extremities to evaluate the time to complete block resolution of 2-chloroprocaine 1% at three intrathecal doses (30, 40 and 50 mg).

Methods: After informed consent, we enrolled 45 male and female patients, aged 18-65 years, ASA score I-II, BMI 18-32 kg/m, undergoing elective lower limb procedures lasting ≤40 min and with a requested dermatomeric level of sensory block ≥ T12. The patients were randomised in a 1:1:1 ratio to receive Chloroprocaine HCl 1% at one of the three different intrathecal doses (Group 30 = 30 mg, Group 40 = 40 mg or Group 50 = 50 mg).

Non-invasive haemodynamic monitoring with Clearsight in patients undergoing spinal anaesthesia for total hip replacement. A prospective observational cohort study.

Background: Patients undergoing elective primary total hip replacement and spinal anesthesia may encounter significant hemodynamic instability Objective: The study is aimed at observing the haemodynamic modifications after spinal anaesthesia during total hip replacement in patients managed to "preload independence" with goal directed fluid therapy (GDFT) and monitored non-invasively with Clearsight.

Methods: Thirty patients, aged 50-80 years, with an American Society of Anaesthesiologists' (ASA) score II-III, undergoing elective primary total hip replacement and spinal anaesthesia were enrolled. Patients were monitored with the EV1000 platform and the Clearsight finger-cuff and managed with a goal directed fluid therapy.

Liver and skeletal muscle injury in a 12-year-old female patient after scoliosis correction in prone position: a case report.

We report the case of a 12-year-old female, otherwise healthy patient, who underwent surgery for scoliosis correction in prone position under total intravenous general anesthesia, with CardioQ and sensory-motor-evoked potentials for hemodynamic and neurological monitoring. The patient showed severe intraoperative hypotension, lactic acidosis, and complete abolition of motor-evoked potentials during the positioning of posterior corrective bars. During the postoperative period, the increase in muscle and liver enzymes indicated an abdominal organ damage and confirmed hypoperfusion of the lower limbs.

A randomized comparison between Accuro and palpation-guided spinal anesthesia for obese patients undergoing orthopedic surgery.

Background: Although obese patients benefit from neuraxial anesthesia, technical difficulties often discourage its use. The current randomized trial compared Accuro, a hand-held, battery-operated ultrasound (US) device, and conventional palpation for spinal anesthesia in obese patients undergoing orthopedic surgery. We hypothesized that Accuro would decrease the number of needle redirections.

Acute pancreatitis after major spine surgery: a case report and literature review.

Background: Acute pancreatitis has been described as potential complication of both abdominal and non-abdominal surgeries. The pathogenetic mechanism underlying acute pancreatitis in spine surgery may include intraoperative hemodynamic instability causing prolonged splanchnic hypoperfusion, as well as mechanical compression of the pancreas due to scoliosis correction, with a higher risk in cases of more extended fusions, especially in young adults with lower body mass index (BMI).

Case Presentation: We report here a case of postoperative acute pancreatitis with benign evolution in a young female patient after the first and second surgery of a two-stage correction of right thoracic idiopathic scoliosis.

Morphine sulfate abuse-deterrent formulations for the treatment of chronic pain.

Abuse-deterrent formulations have been developed to reduce inappropriate opioid use. The aim of this paper is to review existing literature about currently available morphine abuse-deterrent formulations. Areas covered: The US FDA has currently attributed an 'abuse-deterrent formulation' label to two different morphine compounds: an agonist/antagonist combination, and a morphine formulation with physical barrier.

Stimulating versus non-stimulating catheter for lumbar plexus continuous infusion after total hip replacement.

Background: This study was aimed to investigate whether stimulating catheters for continuous lumbar plexus block reduce local anesthetic consumption after hip arthroplasty if compared with traditional non-stimulating catheters.

Methods: Seventy-two ASA I-III, 18-82-year-old, undergoing primary hip replacement (THA) for osteoarthritis with spinal anesthesia were randomized into two groups: Stim group (stimulating catheter, N.=36) and Nonstim group (non-stimulating catheter, N.

Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications.

Observational studies and meta-analyses have shown that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), especially when prescribed at high doses for long periods of time, can potentially increase the risk of cardiovascular diseases. The increased thrombotic risk related to the use of NSAIDs is mainly due to their cyclooxygenase 2 selectivity. The dosage use, the formulation selected and the duration of the therapy are other factors that can significantly impact on the cardiovascular risk.

Continuous regional anesthesia: a review of perioperative outcome benefits.

Routine use of regional anesthesia for patients having surgery is supported by general safety and proven effectiveness as a targeted modality in the prevention and treatment of acute pain. Recently, perioperative physicians have become much more interested in improving long-term outcomes after surgery rather than focusing on the well-established short-term benefits of regional anesthesia. This interest has raised important questions regarding the potential influence of regional anesthesia on morbidity and mortality, persistent pain and cancer prognosis.

The use of vitamin B1 as a perineural adjuvant to middle interscalene block for postoperative analgesia after shoulder surgery.

Background: Perineural administration of thiamine, via axonal flow, could strenghthen synthesis of ACh in the dorsal horn inhibitory interneurons, thus potentiating analgesia. The purpose of the present retrospective analysis is therefore to investigate whether adding perineurally 2 mg/Kg of thiamine to 0.75% levobupivacaine in patients undergoing middle interscalene block may prolong the duration of analgesia.

Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Laparoscopic Hysterectomy: A Randomized, Controlled, Observer-Blinded Trial.

Background: In this randomized, controlled, observer-blinded study, we evaluated analgesia provided by transversus abdominis plane (TAP) block after elective total laparoscopic hysterectomy in terms of reduced postoperative morphine consumption as the primary end point.

Methods: Fifty-two patients were randomly divided into 2 groups: patients in group T (TAP, n = 26) received an ultrasound-guided bilateral TAP block with 40 mL of 0.375% levobupivacaine and morphine patient-controlled analgesia, whereas patients in group C (control, n = 26) received morphine patient-controlled analgesia.

Goal-Directed Fluid Therapy Based on Stroke Volume Variation in Patients Undergoing Major Spine Surgery in the Prone Position: A Cohort Study.

Study Design: A retrospective observational study.

Objective: The aim of this study was to test whether a goal-directed fluid therapy (GDFT) protocol, based on stroke volume variation (SVV), applied in major spine surgery performed in the prone position, would be effective in reducing peri-operative red blood cells transfusions.

Summary Of Background Data: Recent literature shows that optimizing perioperative fluid therapy is associated with lower complication rates and faster recovery.

An update around the evidence base for the lower extremity ultrasound regional block technique.

Ultrasound guidance currently represents the gold standard for regional anesthesia. In particular for lower extremity blocks, despite the heterogeneity and the lack of large randomized controlled trials, current literature shows a modest improvement in block onset and quality compared with other localization techniques. This review aims to present the most recent findings on the application of ultrasound guidance for each single lower extremity approach.

Lidocaine versus ropivacaine for postoperative continuous paravertebral nerve blocks in patients undergoing laparoscopic bowel surgery: a randomized, controlled, double-blinded, pilot study.

Background And Objectives: Lidocaine could provide many advantages in continuous regional anesthesia techniques, including faster onset, greater titratability, and lower cost than long-acting local anesthetics. This prospective, randomized, double-blinded, pilot study is therefore intended to compare lidocaine to ropivacaine in bilateral continuous paravertebral blocks using a multimodal approach for postoperative pain management following laparoscopic bowel surgery.

Methods: Thirty-five ASA I-III consecutive patients undergoing elective laparoscopic bowel surgery and bilateral thoracic paravertebral continuous blocks were analyzed: bilateral thoracic paravertebral infusions of ropivacaine 0.

Use of ultrasound for lower extremity.

Purpose Of Review: To explore the recent advances in the use of ultrasound for lower extremity blocks, including approaches to the lumbar and sacral plexus blocks.

Recent Findings: Procedures of the lower extremity often require blocks of the lumbar and sacral plexuses. The use of ultrasound offers some advantages, including the possibility to directly visualize the distribution of local anesthetics.

Is spinal anaesthesia a suitable technique for ultra-short outpatient procedures?

Spinal anaesthesia is an easy and reliable technique. Factors limiting its use in the ambulatory setting include delayed ambulation, risk of urinary retention and pain after block regression. On the contrary, general anaesthesia with fast-acting drugs provides a fast recovery that facilitates an early discharge.

Nonsteroideal Anti-inflammatory Drugs (NSAIDs) in clinical practice: managing gastric and cardiovascular risks.

For many years, non-steroidal inflammatory drugs (NSAIDs) were commonly used in the treatment of acute pain due to inflammation.With the arrival on the market of NSAIDs with selective action on COX-2 there was a reduction of side effects in the stomach, but not eliminating the possible cardiovascular complications. The availability of NSAIDs such self-medication can aggravate this type of problem, it is therefore the clinician a fair and accurate assessment of the risk \ benefit based on the characteristics of the individual patient.

Does continuous sciatic nerve block improve postoperative analgesia and early rehabilitation after total knee arthroplasty? A prospective, randomized, double-blinded study.

Introduction: The aim of this prospective, randomized, double-blind study was to evaluate whether continuous sciatic nerve block can improve postoperative pain relief and early rehabilitation compared with single-injection sciatic nerve block in patients undergoing total knee arthroplasty (TKA) and lumbar plexus block.

Methods: After ethical committee approval and written informed consent, 38 patients with ASA physical status I to II were enrolled. The first group received continuous sciatic and continuous lumbar plexus blocks (group regional or R, n = 19), whereas the second group received a single sciatic nerve block followed by saline infusion through the sciatic catheter and continuous lumbar plexus block (group control or C, n = 19).

A prospective, double-blinded, randomized, clinical trial comparing the efficacy of 40 mg and 60 mg hyperbaric 2% prilocaine versus 60 mg plain 2% prilocaine for intrathecal anesthesia in ambulatory surgery.

Background: In this prospective, double-blind, randomized trial we compared 60 mg and 40 mg of 2% hyperbaric prilocaine with 60 mg of 2% plain prilocaine for spinal anesthesia in terms of sensory block onset in outpatients undergoing elective short-duration (<60 minutes) surgery under spinal anesthesia.

Methods: Ninety patients were enrolled and randomly allocated to receive 1 of the 3 treatments. Times to sensory and motor block onsets, time to the maximum sensory block level, readiness for surgery, time to first urinary voiding, time to Bromage's score 0, and side effects were registered blindly.

The effects of ultrasound guidance and neurostimulation on the minimum effective anesthetic volume of mepivacaine 1.5% required to block the sciatic nerve using the subgluteal approach.

Background: We tested the hypothesis that ultrasound (US) guidance may reduce the minimum effective anesthetic volume (MEAV(50)) of 1.5% mepivacaine required to block the sciatic nerve with a subgluteal approach compared with neurostimulation (NS).

Methods: After premedication and single-injection femoral nerve block, 60 patients undergoing knee arthroscopy were randomly allocated to receive a sciatic nerve block with either NS (n = 30) or US (n = 30).

The efficacy of a resistive heating under-patient blanket versus a forced-air warming system: a randomized controlled trial.

Background: We compared temperature changes in patients undergoing hip replacement during warming with a resistive heating blanket or air-forced system.

Methods: Fifty-six patients were enrolled. Patients were randomly allocated to the "forced-air group" (forced-air system) or to the "heating-blanket group" (resistive heating under-patient blanket).