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Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Background and AimsThere are well established procedures for obtaining and documenting informed consent for surgical procedures. Anaesthetic procedures, lack the same standardized approach. This has safety implications for patients and clinicians. We sought to evaluate the patient experience of those who underwent regional anaesthesia (RA) within our department.MethodsFollowing approval from our audit committee, we conducted a twelve-part telephone survey with thirty patients regarding their experience of RA.The survey explored the circumstances under which patients were consented, and their recall of the information provided.ResultsOf the total number of patients interviewed (n=30), seventy percent (21) believed the NB was compulsory. Sixty percent (18) could not recall any of the possible advantages of receiving a NB and eighty percent (24) could not recall any risks. Sixty-six percent (20) of patients were consented for a NB in the holding bay. Sixteen percent (5) were consented in the induction room. Sixty percent (20) of patients said they would have valued written information regarding the NB. A majority (17) felt they did not have adequate time to consider the NB.Currently there is no formalized process that exists within our department for documentation of the risks and benefits discussed with patients. The practise of which can therefore vary greatly amongst practitioners.ConclusionsOur results demonstrate a paucity of information that is either delivered to, or retained by, our patients with regards to receiving RA. We aim to distribute a Patient information leaflet to better achieve informed consent from our patients.

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Background and AimsThe Erector Spinae Plane (ESP) block is paraspinal fascial plane block that targets both ventral and dorsal rami of the thoracic and abdominal spinal nerves. It has been used to provide analgesia for a range of surgical procedures and painful conditions. Spontaneous cough-induced rib fractures are a rare but recognised phenomenon in term parturients. Patients who experience rib fractures near term often undergo elective caesarean delivery, due to the recognition that thoracic pain may limit patient effort in the second stage of labour. We present a case of ESP catheter managed rib fracture pain, facilitating labour and vaginal delivery in a term parturient with a cough-induced rib fracture.MethodsA 38-year-old woman, para 1, presented at 37+6 weeks gestation with left-sided pleuritic chest pain, following a lower respiratory tract infection, which was associated with intense bouts of coughing. The presumptive diagnosis was an atraumatic rib fracture and she was initially discharged with analgesia. She re-presented the following day with 10/10 pain despite paracetamol, oxycodone and a lidocaine patch. A mid-thoracic ESP catheter was inserted under ultrasound guidance with immediate relief. She received 4-hourly clinician administered boluses of 20ml of 0.125% levobupivacaine for 5 days with a maximum pain score of 4 on coughing.ResultsWith adequate analgesia attained and following multi-disciplinary input, she underwent induction of labour, resulting in an instrumental vaginal delivery undercombined ESP and epidural analgesia.ConclusionsESP blocks could be considered for pregnant patients presenting with rib fracture pain near term, who wish to attempt labour and vaginal delivery.

In recent anesthetic practice, peripheral nerve blocks (PNBs) are used extensively for surgical anesthesia and nonsurgical analgesia. PNBs offer many benefits over other anesthetic techniques in a certain population of patients, and in some specific clinical setting, that may contribute to faster and safer pain relief, increased patient satisfaction, reduced hospital stay, and decreased overall healthcare cost. The technique involves the injection of the anesthetic in the vicinity of a specific nerve or bundle of nerves to block the sensation of pain transmitting to a specific portion of the body. However, the length of analgesia when a single anesthetic is used for PNB may not last long. Therefore, the practice of adding an additional agent called adjuvant has been evolved to prolong the analgesic effect. There are many such adjuvants available that are clinically being used for this purpose imparting great efficacy and safety to the anesthetic process. The adjuvants molecules are generally classified as opioids, alpha-2 agonist, steroids, etc. Most of them are safe to use and show little or no adverse event related to neurotoxicity and tissue damage. Although there is extensive use of such adjuvants in the clinical field, none of the molecules is approved by the FDA and is used as an off-label drug. The risk to benefit ratio must be assessed while using such an agent. This review will try to delineate the basic need of adjuvant in peripheral nerve block and will discuss the advantages and limitations of using different adjuvants and will discuss the future prospect of such application.

Background: Addition of dexmedetomidine to ropivacaine for peripheral nerve blocks has shown to improve the efficacy of ropivacaine by prolonging the duration of analgesia. This study was undertaken to evaluate the effects of ropivacaine alone and in combination with dexmedetomidine in the axillary block. Materials and Methods: A total of 80 patients belonging to American Society of Anesthesiologists physical status I, II, and III, scheduled for elective forearm and/or hand surgeries were randomly allocated into one of the two groups to receive either 39 ml of 0.375% ropivacaine and 1 ml normal saline (Group R) or 39 ml of 0.375% ropivacaine and 1 μg/kg dexmedetomidine diluted to 1 ml with normal saline (Group RD). Results: There was a significant early the onset of sensory and the motor block in Group RD. Duration of sensory block in Group RD was 677.25 ± 99.64 min and in Group R was 494.38 ± 70.64 min and the difference was clinically significant (P < 0.001). Duration of motor block in Group RD was 712.88 ± 89.32 min and in Group R was 526.25 ± 70.229 min and was clinically significant. Duration of analgesia in Group RD was 764.38 ± 110.275 min and that in Group R was 576.88 ± 76.306 min and was clinically significant. There was a significant alteration in hemodynamics in Group RD when compared to Group R without any side effects. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine provides quicker onset of anesthesia, longer duration of analgesia. It offers convenient, simple, effective mode of anesthesia, and postoperative analgesia for forearm and/or hand surgeries.

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Background and AimsAortic-bifemoral bypass is a surgery chosen for patients with Leriche syndrome or severe peripheral arteriopathy. This procedure implies a laparotomy supra and infraumbilical. That translates into a severe pain during postoperative period. Therefore, pain management becomes a key pilar for early recovery. Cardiovascular anesthesiologists usually choose low thoracic epidural to control pain. However, the circumstances of some patients make it a non-feasible technique. In those cases, abdominal wall blocks are a valid alternative reducing pain, morbidity and the length of stay in hospital.MethodsWe expose a case in which a bilateral transverse abdominis block with a single shot technique was performed on a patient who was elected for aortic-bifemoral bypass.ResultsA woman 61 years old is elected for aortic-bifemoral bypass due to Leriche syndrome. In our hospital our gold-standard technique is thoracic epidural at a t10-t11 level. However, in this case she had systemic sclerosis, so we decided to perform a bilateral transverse abdominis block with a posterior approach at the level of Petit´s triangle. We administered levobupivacaine 0,25% with a volume of 40 ml in total. During the first 48 hours in the ICU, she received an elastomeric pump consisting of dexketoprofen, metamizole and ondansetron. She didn’t have irruptive pain either she got any opioid rescue analgesia.Abstract #36493 Figure 1Transverse abdominis plane block with a posterior approach towards the Petit´s triangleConclusionsBilateral transverse abdominis plane block is a valid alternative to thoracic epidural in aortic-bifemoral bypass. Transverse abdominis plane block with a posterior approach can give a sensory block from T7 until L1.

Background and AimsThere is no evidence on analgesia or sedation concepts during pre-operative placement of peripheral nerve block. Aim of our RCT pilot trial was to estimate the best practice approach for analgosedation for regional anaesthesia.Methods50 patients participated the study from 08/2020–12/2020. Computer-based randomization was performed to one of five treatment concept groups:Remifentanyl-Infusion (no bolus, 6–9 mcg/kg/h i.v.),Fentanyl-Bolus (100 mcg i.v. for BW>50 kg and 50 mcg for BW< 50 kg),Clonidine 150 mcg bolus i.v.,Lidocaine/Prilocaine topical cream 30 min prior to the puncture,Placebo.Pain intensity at skin puncture with 22-G 50 mm and 21-G 100 mm needles was the main outcome, assessed by a numeric rain scale (NRS) at the time of a needle insertion, as well as patients’ satisfaction and wellbeing (Anaesthesiological Questionnaire).(Ethical Committee No. 31–255 ex18/19)ResultsThere were no statistical differences between the baseline charakteristics. No significant difference in favour of any analgosedation concept regarding pain reduction or wellbeing. Remifentanil infusion provided the lowest experienced pain levels (NRS 2,0 [1,5–3,0]) followed by Lidocaine/Prilocaine creme (NRS 2,5 [1,25–4,0]) and Placebo (NRS 2,5 [1,25–4,5]). No adverse effects (e.g. nonresponsiveness or drop in oxygen saturation or blood pressure, nerve injury) were revealed.Abstract B58 Table 1ConclusionsFurther issue to investigate are, whether it is reasonable to reduce the pain intensity at the price of patients’ vigilance. Analgosedation with remifentanil seems to provide the lowest pain while best ensuring patients’ wellbeing. Optimal approach has to be adjusted according to the patient needs, medical personnel expertise and a hospital’s logistics.

Background and AimsHip has a complex innervation and therefore it is a challenge to anesthetize it solely with peripheral nerve blocks. There are just a few cases described in literature where PENG block was used with anaesthetic goals and, as far as we know, there is no description of the association of blocks here described.MethodsWe describe a female 82 year old patient, 72kg, with previous systemic hypertension and heart failure NHYA III with a femur fracture for an intramedullary nail. After monitoring, the following ultrasound guided nerve blocks were performed: PENG block (20 mL 0.5% Ropivacaine), Lateral Cutaneous Femoral Nerve (5 mL 0.5% Ropivacaine) and Obturator nerves at subpectineus plane (15 mL 0.5% Ropivacaine). Additional light sedation was achieved with dexmedetomidine IV (0,5mcg/kg/h) and ketamine (0,5mg/kg).ResultsSurgery underwent smoothly without the need of any other anaesthetic drugs, patient sedated in RASS -3.In the following 24h after surgery, there was no pain complaints or need of opioids.ConclusionsThe anterior capsule of the hip is innervated by the lumbar plexus and the posterior capsule by the sacral plexus. The lateral side of the thigh is innervated by the lateral femoral cutaneous nerve, also part of lumbar plexus. Studies showed that the nociceptors concentrate mainly on the anterior capsule, thus the lumbar plexus is the main responsible for hip anaesthesia.In this particular case, it was chosen to focus on lumbar plexus blocks through blocks mentioned previously.By choosing this technique, we aimed to avoid approaching neuroaxial techniques or general anaesthesia preventing haemodynamic changes.

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Background and AimsBuerger’s disease is a non-arteriosclerotic segmental inflammatory occlusive vasculitis of small vessels, typically affecting the extremities. The main goal of treatment is to improve blood flow to the affected tissues, which can be achieved by reducing the activity of the sympathetic nervous system. One effective method for achieving this is through the use of brachial plexus block, which blocks sympathetic fibers and promotes vasodilatation.Methods36-year-old man, complaining of pain and trophic lesions in the extremities of the first and second fingers of the right hand with 1 month of evolution. Upon admission he reports pain 10/10 on the numerical rating scale, which has prevented him from sleeping for the last few days. We performed a brachial plexus block, supraclavicular approach and started patient controlled regional analgesia with Ropivacaine 0.2% 15ml every 4hours, 10ml bolus with 1hour lockout. He also started Alprostadil and Enoxaparin.ResultsPatient always reported intensity less than 2/10 and he mentioned that since we performed theblock he was able to sleep again. Seven days after the treatment initiation, the signs attributed to poor perfusion in fingers regressed significantly and on the 14th day, no signs of poor perfusion were observed.ConclusionsWe concluded that the brachial plexus block ensured the return of the patient‘s quality of life by greatly reducing the intensity of the pain and providing him with the possibility of being able to sleep. Furthermore, we believe that the contribution of the brachial plexus block was decisive for the success of the treatment.

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA PrizesBackground and AimsThe 2021 curriculum for anaesthetists in training in the United Kingdom recognises the importance of regional anaesthesia. All anaesthetists in training are now expected to be able to perform regional anaesthesia to the abdominal wall, chest wall, lower limb and upper limb independently by the end of their training . The Regional Anaesthesia UK (RA-UK) Plan A blocks documents provide a framework for regional anaesthetic techniques covering each region of the body. We wanted to assess the readiness of our department to be able to perform and/or teach these skills.MethodsWe designed an anonymous questionnaire to assess the readiness of permanent staff members within our department to perform and teach each technique listed in the RA-UK plan A blocks, including catheter techniques.Results62 responses were received. Of these, 47 were from consultants or locally employed doctors who would be expected to supervise trainees during their daily work. Table 1 demonstrates that, In our institution we identified a high proportion of permanent staff members able to teach the upper and lower limb plan A blocks, but a much lower confidence level with trunk blocks.ConclusionsThis survey demonstrates the need to focus on training of the permanent staff body in plan A trunk blocks in particular before we can reliably teach anaesthetists in training. 92% respondents felt future departmental teaching/sessions on scanning and teaching on Plan A blocks would be helpful for their development, including the use of perineural/fascial plane catheter techniques.AttachmentPlan A blocks abstract.pdf

Background Total hip arthroplasty (THA) is one of the surgical procedures associated with severe postoperative pain. Appropriate postoperative pain management is effective for promoting early ambulation and reducing the length of hospital stay. Effects of conventional pain management strategies, such as femoral nerve block and fascia iliaca block, are inadequate in some cases. Case presentation THA was planned for 2 patients with osteoarthritis. In addition to general anesthesia, continuous pericapsular nerve group (PENG) block and lateral femoral cutaneous nerve (LFCN) block were performed for postoperative pain management. Numerical rating scale (NRS) scores measured at rest and upon movement were low at 2, 12, 24, and 48 h postoperatively, suggesting that the treatments were effective for managing postoperative pain. The Bromage score at postoperative days (POD) 1 and 2 was 0. Conclusion Continuous PENG block and LFCN block were effective for postoperative pain management in patients who underwent THA. PENG block did not cause postoperative motor blockade.