UNASSIGNED: Regional anaesthesia can be an attractive alternative anaesthetic approach in clavicle surgery, but it requires the peripheral block of multiple cervical and brachial nerves that transmit nociceptive information. Deep cervical plexus blocks, as paravertebral nerve block, can lead to severe side effects, such as unilateral diaphragmatic paralysis.
UNASSIGNED: A 66-year-old male patient, American Society of Anesthesiologists physical status III, was scheduled for open reduction and internal fixation of the right clavicle with plates and screws after a high-energy trauma. Pre-anaesthetic evaluation revealed right hemopneumothorax and bilateral rib fractures. We decided to perform regional anaesthesia (superficial cervical plexus block and clavipectoral fascial plane block), combined with dexmedetomidine perfusion to avoid invasive mechanical ventilation and prevent additional pulmonary complications. The surgical procedure was successfully completed without any further anaesthesia requirements. The patient remained comfortable during the postoperative period.
UNASSIGNED: Regional anaesthesia for clavicle surgeries has the advantage of promoting non-opioid free anaesthesia. Effective pain control enhances patient satisfaction and reduces the length of stay in hospital. In our case report, a combined superficial cervical plexus block and clavipectoral fascial plane block was a safe and effective regional anaesthetic approach.

Sickle cell disease is characterised by episodes of vaso-occlusive crisis, a painful complication. Regional anaesthesia has shown promising results in reducing opioid consumption and pain scores. Patients with vaso-occlusive crises who underwent regional anaesthesia in the paediatric intensive care unit were studied. Data regarding pain location, regional analgesia technique, the local anaesthetic used and dose, daily opioid consumption, daily pain scores, use of adjuvants and complications were recorded. The primary outcome was to evaluate the effect of regional anaesthesia on opioid consumption. In this study, we describe 10 cases, referring to six paediatric patients with the vaso-occlusive crisis who underwent regional anaesthesia for severe pain and were unresponsive to increasing doses of opioids. Six cases received epidural analgesia, three continuous peripheral nerve blocks and one received both techniques. Opioid consumption was reduced (58%), and pain scores decreased (72%), both statistically significant reductions.

Facioscapulohumeral muscular dystrophy (FSHD) is a muscular dystrophy that can affect individuals of all age groups. Its prevalence is reported to be 0.4-1 in 10,000 people. Because of the low occurrence of FSHD, anaesthetic management is primarily based on expert opinions, case reviews, or brief series. Here, we present the case of a 72-year-old woman with FSHD who underwent hip fracture (HF) surgery. To prevent respiratory compromise due to FSHD, we opted for lumbar-sacral plexus block. To the best of our knowledge, there is no information in the literature regarding the use of combined lumbar-sacral plexus block in patients with FSHD undergoing HF surgery.

The serratus posterior superior intercostal plane (SPSIP) block is a novel technique recently described for thoracic analgesia. This study presents two cases using this technique for postoperative pain after mastectomy with axillary lymph node dissection. The SPSIP block was administered to the patients in the preoperative period as part of multimodal analgesia, and postoperative pain was monitored using the numeric rating scale (NRS). In both patients, the NRS pain scores were below 3/10. SPSIP provided adequate postoperative analgesia in these cases without the need for any opioid agents. Thus, an SPSIP block can be a valuable treatment option for postoperative pain after breast surgery.

Post-mastectomy pain syndrome (PMPS) is a type of chronic postsurgical pain that can be severe, debilitating and frequently encountered in clinical practice. Multiple studies have focused on prevention, identifying risk factors and treating this condition. Nonetheless, PMPS remains a complex condition to treat effectively. In this case report, we describe the use of percutaneous electrical nerve stimulation in a breast cancer patient who experienced PMPS refractory to conventional treatments.

Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a rare type of vasculitis with multisystemic involvement. Very few authors have described the anaesthesia technique in these patients. We present the first report on ambulatory surgery in a patient with EGPA. This case dispels concerns about the safety of day surgery and reports successful regional anaesthesia management in a patient with EGPA.

Thoracoabdominal nerves block through perichondrial approach (TAPA) is a novel block and provides abdominal analgesia. TAPA block targets the both anterior and the lateral branches of the thoracoabdominal nerves. Modified-TAPA (M-TAPA) was defined due to the need for blocking certain dermatomes depending on the surgical incision sites. In the literature, the knowledge about the efficiency and dermatomal coverage of M-TAPA is limited. In this case series, we want to report our experiences with this issue.

Fryns syndrome cases with variable characteristics require careful preoperative evaluation and have challenges for airway management. Craniofacial anomalies can complicate both ventilation and intubation. Extubation can also be problematic because of limited pulmonary reserves.

BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most widely practiced surgical procedures in abdominal surgery. Patients undergo LC during general anaesthesia; however, in recent years, several studies have suggested the ability to perform LC in patients who are awake. We report a case of awake LC and a literature review.
METHODS: A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional anaesthesia. We first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 level. The procedure was managed in total comfort for both the patient and the surgeon. The intra-abdominal pressure was 8 mmHg. The patient remained stable throughout the procedure, and the postoperative course was uneventful.
CONCLUSIONS: Evidence has warranted the safe use of spinal and epidural anaesthesia, with minimal side effects easily managed with medications. Regional anaesthesia in selected patients may provide some advantages over general anaesthesia, such as no airway manipulation, maintenance of spontaneous breathing, effective postoperative analgesia, less nausea and vomiting, and early recovery. However, this technique for LC is not widely used in Europe; this is the first case reported in Italy in the literature. Regional anaesthesia is feasible and safe in performing some types of laparoscopic procedures. Further studies should be carried out to introduce this type of anaesthesia in routine clinical practice.

We report our clinical experience with the external oblique intercostal block in three consecutive adult patients who underwent liver surgery for resection of metastases. Enhanced recovery guidelines for liver surgery recommend intrathecal opioids and peripheral regional anaesthetic techniques in the context of multimodal analgesia to achieve adequate postoperative analgesia and early functional recovery. However, both laparoscopic and open approaches to liver surgery involve incisions in the upper abdomen, an anatomical area not well covered by previously described peripheral regional anaesthetic techniques. The external oblique intercostal block is a novel motor- and opioid-sparing technique which blocks both the anterior and lateral cutaneous branches of the thoracoabdominal nerves which innervate the upper abdominal quadrant. In all cases in this series, we performed the blocks in a short period of time and without complications. All patients remained pain- and opioid-free in the postoperative period and achieved enhanced recovery outcomes early. We found the external oblique intercostal block to be a simple, convenient, effective and opioid-sparing regional anaesthetic technique for postoperative analgesia after liver surgery. By minimising opioid use and by obviating the need for central neuraxial anaesthesia techniques in the postoperative period, this block could be incorporated into enhanced recovery protocols for hepatobiliary surgery.