PainExam Podcast

Blocks for Head, Neck, and Spinal Surgeries

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In this episode, we will explore the various regional anesthesia techniques used in neurosurgery, specifically focusing on blocks for head, neck, and spinal surgeries.

Segment 1: Blocks used in Head and Neck Surgeries

1. Scalp Block:

• The scalp block involves blocking six nerves that provide sensory innervation to the scalp.
• It is performed by subcutaneous infiltration of local anesthetics (such as bupivacaine, ropivacaine, or levobupivacaine) for each nerve.
• Ultrasound guidance has improved the precision of block administration.
• The main indication for a scalp block is awake craniotomy, but it is also used in other procedures like deep brain stimulation and cranioplasty surgery.
• Scalp block offers advantages such as accurate neurological evaluation, pre-emptive analgesia, and hemodynamic stability during surgery.
• It also reduces postoperative pain, the need for rescue analgesics, and pain scores in the early postoperative period.

1. Infraorbital Block (IOB):

• The infraorbital nerve block targets the infraorbital nerve, which supplies the skin and mucous membrane of the upper lip, lower eyelid, and cheek.
• The IOB can be performed using the classical landmark technique or ultrasound guidance.
• Ultrasound guidance provides real-time visualization and accurate needle placement.
• IOB combined with general anesthesia is beneficial for postoperative pain relief in procedures like endoscopic trans-nasal trans-sphenoidal (TNTS) approach for pituitary tumor excision.
• Other regional techniques like sphenopalatine ganglion block and maxillary nerve blocks have also been attempted for transsphenoidal surgeries.

1. Trigeminal Nerve Block:

• Trigeminal nerve block is used for patients unresponsive to medical management of trigeminal neuralgia.
• Traditionally performed using the paresthesia technique, ultrasound guidance allows real-time visualization and confirmation of local anesthetic spread.
• Ultrasound guidance helps locate the Gasserian ganglion and visualize the trigeminal ganglion, providing a safe and radiation-free procedure for pain relief.

Segment 2: Blocks used for Spinal Surgeries

1. Cervical Plexus Block (CPB):

• CPB is commonly used in carotid endarterectomy (CEA) and cervical spine surgery.
• Different levels of CPB can be performed depending on the depth of injection.
• Superficial CPB involves injecting local anesthetic superficially into the deep cervical fascia.
• Deep CPB requires depositing local anesthetic deep to the prevertebral fascia.
• CPB helps in monitoring cerebral blood flow during CEA and provides postoperative pain relief.
• Ultrasound guidance can be used for superficial CPB, ensuring accurate needle placement and local anesthetic spread.

1. Erector Spinae Block (ESB):

• ESB is used for pain control in spinal surgeries.
• It involves depositing local anesthetic in the plane between the erector spinae muscle and the transverse process.
• ESB provides effective postoperative analgesia and reduces opioid consumption.

Regional anesthesia techniques play a crucial role in neurosurgery, providing effective pain relief and improving patient outcomes. Blocks like scalp block, infraorbital block, trigeminal nerve block, cervical plexus block, and erector spinae block offer numerous advantages in specific procedures. Ultrasound guidance has enhanced the precision and safety of block administration. These techniques contribute to improved surgical outcomes and patient satisfaction in neurosurgical procedures.

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References Kaushal A, Haldar R. Regional Anesthesia in Neuroanesthesia Pr...

Biologics and the Peripheral Nerve. Claim CME The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/TgB18M Dr. Rosenblum discuss his upcoming talk at the Appalachian Region Spine and Pain Meeting: Incorporating Ultrasound into a Spine and Pain Practice on April 14-16 2023 and the topics he plans to include: Ultrasound Guided Knee therapies, cluneal nerve, caudal, brachial plexus and more! Today’s podcast (inspired by TOBI and Dr. Sudhir Diwan, Dr. Sheldon Jordon and Dr. Rikin Patel's ASIPP Lectures) focuses on the risk and benefits of performing PRP injection onto a nerve. Dr. Rosenblum discusses: Possible fibrosis of the ulna nerve after using PRP for partial ulnar collateral ligament tears Best Time for PRP Injection after Nerve Regeneration Alpha 2-macroglobulin (what is it?) PRP for moderate to severe carpal tunnel syndrome Featured Courses! May 25, 2023 Private Pain Group Ultrasound Course- NYC (Sold out) Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 Regenerative Pain Medicine Course NYC- May 13 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023 see the full schedule for our July and August US IPM Courses! References Robert G. Thompson, Kendall Bradley, Gary M. Lourie, Ulnar nerve dysfunction at the elbow after platelet-rich plasma treatment for partial ulnar collateral ligament injuries,JSES Reviews, Reports, and Techniques,Volume 1, Issue 1,2021,Pages 41-44,ISSN 2666-6391, Si-Ru Chen, Yu-Ping Shen, Tsung-Yen Ho, Tsung-Ying Li, Yu-Chi Su, Yu-Ching Chou, Liang-Cheng Chen, Yung-Tsan Wu,One-Year Efficacy of Platelet-Rich Plasma for Moderate-to-Severe Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial,Archives of Physical Medicine and RehabilitationVolume 102, Issue 5,2021, Pages 951-958,ISSN 0003-9993,https://doi.org/10.1016/j.apmr.2020.12.025. Rehman, A.A., Ahsan, H. and Khan, F.H. (2013), Alpha-2-macroglobulin: A physiological guardian. J. Cell. Physiol., 228: 1665-1675. https://doi.org/10.1002/jcp.24266 Muhammad Pandunugrahadi, Komang Agung Irianto, Oen Sindrawati, "The Optimal Timing of Platelet-Rich Plasma (PRP) Injection for Nerve Lesion Recovery: A Preliminary Study", International Journal of Biomaterials, vol. 2022, Article ID 9601547, 7 pages, 2022. https://doi.org/10.1155/2022/9601547

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PRP vs PRP Plus Hyaluronic Acid, and Cost Effectives Prior to TKA

NSYIPP, and NRAP Tampa Ultrasound Course...

Dr. Rosenblum reviews 2 articles- - PRP in the delaying of Total Knee Arthroplasty, - PRP vs. PRP with LMW Hyaluronic acid and HMW Hyaluronic Acid

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Podcast Resources:

G.Jacob, V.ShettyS.Shetty. A study assessing intra-articular PRP vs PRP with HMW HA vs PRP with LMW HA in early knee osteoarthritisJournal of Arthroscopy and Joint Surgery Volume 4, Issue 2, May–August 2017, Pages 65-71

Rajan, Prashant V. MD1; Ng, Mitchell K. BA1; Klika, Alison MS1; Kamath, Atul F. MD1; Muschler, George F. MD1; Higuera, Carlos A. MD1; Piuzzi, Nicolas S. MD1,a The Cost-Effectiveness of Platelet-Rich Plasma Injections for Knee Osteoarthritis, The Journal of Bone and Joint Surgery: September 16, 2020 - Volume 102 - Issue 18 - p e104 doi: 10.2106/JBJS.19.01446

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Journal Club Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis PainThe SPACE Randomized Clinical Trial Subscribe to our mailing list * indicates required Email Address * Erin E. Krebs, MD, MPH1,2; Amy Gravely, MA1; Sean Nugent, BA1; et alAgnes C. Jensen, MPH1; Beth DeRonne, PharmD1; Elizabeth S. Goldsmith, MD, MS1,3; Kurt Kroenke, MD4,5,6; Matthew J. Bair4,5,6; Siamak Noorbaloochi, PhD1,2 Author Affiliations Article Information JAMA. 2018;319(9):872-882. doi:10.1001/jama.2018.0899

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