Publications by authors named "Madan Narayanan"

Regional anaesthesia for shoulder surgery remains challenging in patients with pre-existing respiratory comorbidities. Various alternative phrenic sparing techniques have been described in the literature, but to our knowledge, none have explored the benefits of using short-acting local anaesthetics in combination to achieve surgical anaesthesia for awake surgery. This case report describes the successful use of the superior trunk block catheter, a relative phrenic sparing shoulder nerve block, and 2% chloroprocaine, a short-acting local anaesthetic, to provide surgical anaesthesia for awake shoulder surgery in a patient with severe respiratory disease.

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Study Objective: We report a novel block technique aimed to provide lumbosacral, abdominal, and hip analgesia: The quadro-iliac plane (QIP) block.

Design: A cadaveric examination that evaluates the spread of QIP block.

Setting: Cadaver laboratory.

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Background Acute moderate to severe pain after mastectomy is common and impedes patient recovery. Ambulatory serratus plane catheter with infusion pump (ASPIP) is a novel method to provide continuous delivery of local anaesthetic agents in the immediate postoperative period for extended analgesia, early mobility, and return to function after mastectomy. The aim of this project was to evaluate the introduction of ASPIP service and its effect on postoperative pain, opioid use, hospital stay, and recovery.

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The sine qua non of enhanced recovery after surgery protocols designed to improve the perioperative experiences and outcomes of patients is to determine the most appropriate analgesia management. Although many regional techniques have been tried over the years in this purpose, interfacial plane blocks have become more popular with the introduction of ultrasound technology into daily practice and they have great potential to support effective postoperative pain management in many surgeries. The current article focuses on the benefits, techniques, indications, and complications of interfascial plane blocks applied in cardiac, abdominal, and spine surgeries.

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Regional anesthesia has benefits beyond just treating acute postoperative pain. Interfascial plane blocks, which have been very popular with ultrasound in recent years, function primarily by administering a high volume of a local anesthetic to the fascial plane. Contrary to traditional peripheral nerve blocks, the targeted nerve or structure in interfacial plane blocks is not fully defined, and the indications have not been fully revealed yet.

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Chronic burn pain persists for 6 months or longer after the wound has healed, affecting the patient's quality of life and daily activities. Pharmacological treatments are essential in the treatment of chronic pain after burns, but interventional methods come to the fore in cases where there is no response to pharmacological treatments. Radiofrequency ablation is known as a safe, effective, and minimally invasive treatment for patients with intractable chronic pain.

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Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process.

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Article Synopsis
  • The study aims to standardize ultrasound identification of key anatomical structures for seven basic ultrasound-guided regional anesthesia (UGRA) blocks due to the lack of universally agreed criteria.
  • An international consensus was established using a modified Delphi process, allowing experts to anonymously refine a long-list of structures into strong and weak recommendations based on participant feedback.
  • Ultimately, strong recommendations were made for 35 structures during orientation scanning and 28 for the block view, while weak recommendations covered 36 and 20 structures, respectively, promoting consistent practice and education in UGRA.
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Proning intubated patients with acute respiratory distress syndrome (ARDS) is an established practice to improve oxygenation temporarily. We present two cases of patients on our intensive care unit with ARDS, on non-invasive ventilation (NIV), in whom proning improved oxygenation at a stage when intubation was the next step. We discuss the mechanisms by which proning improves oxygenation as well as the potential risks proning on NIV brings, for which we make specific recommendations.

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Amateur choral singing is a common pastime and worthy of study, possibly conferring benefits to health and social behaviour. Participants might be expected to possess musical ability and share some behavioural characteristics. Polymorphisms in genes concerned with serotonergic neurotransmission are associated with both behaviour and musical aptitude.

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