UNASSIGNED: During electrochemotherapy (ECT), a chemotherapeutic drug is injected into the tumor and then an electroporation is provided. In horses, ear manipulation may be very painful, and combining a loco-regional technique with sedation might be a good option to avoid anesthesia-related risks. A two-injection-point block of the internal and external pinna and acoustic meatus was described in horse cadavers, and it permitted complete stain of all three branches of the great auricular nerve (GAN), internal auricular nerve branch (IAB), lateral auricular branch (LAB), and caudal auricular nerve (CAN), suggesting a lower risk of intra-parotid injection during the IAB and LAB block.
UNASSIGNED: An 8-year-old Italian jumping gelding presented for ECT to treat a fibroblastic sarcoid in the left medial pinna. After intravenous sedation with acepromazine, romifidine, and butorphanol, a two-injection-point block was provided as previously described. The block of the GAN was blind, whereas an electrical nerve locator was used for the IAB, LAB, and CAN. A total of 12 ml of 0.5% ropivacaine was injected. The ECT was safely performed without any difficulties. The horse well tolerated the procedure and completely recovered 75 minutes after sedation. No complications were detected.
UNASSIGNED: The described approach seems feasible and suitable for the blockade of the sensory innervation of the equine ear in the case of ECT.

Failure of sub-arachnoid block (SAB), due to resistance to bupivacaine after a recent scorpion sting can lead to multiple block attempts and subsequent conversion to general anaesthesia. We report this case series of 10 patients with successful SAB with newly launched 0.75% hyperbaric ropivacaine, in patients with recent scorpion sting. Thus, intrathecal hyperbaric ropivacaine may be considered as the local anaesthetic agent of choice in patients with scorpion sting to prevent failure of SAB.

Ropivacaine is an amide local anesthetic with rare reports of anaphylaxis. To our knowledge, this is the first report of delayed nonimmune anaphylaxis induced by ropivacaine. A 70-year-old man underwent general anesthesia with a nerve block for a total knee arthroplasty. The patient developed symptoms of anaphylaxis 3.5 hours after receiving ropivacaine for femoral and tibial nerve blocks. A basophil activation test (BAT) revealed ropivacaine as the causative agent. Notably, anaphylaxis can be caused by medications even hours after their administration, and all administered drugs should be suspected of potentially causing anaphylaxis.

Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression.
A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset.
This case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required.

A 74-year-old male was diagnosed with osteomyelitis of the left mandible requiring marginal mandibulectomy under general anesthesia. However, the patient\'s pulmonary function tests demonstrated findings consistent with severe chronic obstructive pulmonary disease, classified as stage III. The consulting pulmonologist explained the increased risk of respiratory complications associated with general anesthesia and advised against its use. Therefore, we opted to perform the surgery under moderate sedation using 0.2% ropivacaine administered via bilateral ultrasound-guided inferior alveolar nerve blocks (UGIANBs) and an indwelling catheter with a pump for continuous perioperative local anesthesia and prolonged postoperative analgesia. This approach delivered excellent local anesthetic effects without any need for rescue medications or complications. Use of UGIANBs along with an indwelling catheter and pump may provide adequate local anesthesia and postoperative analgesia in patients with contraindications for general anesthesia.

UNASSIGNED: Bilateral Paravertebral block has been used successfully for postoperative pain relief in thoracic, abdominal, and pelvic regions. Despite the need for relatively large doses of local anaesthetics, there are few reports of systemic toxicity. Here we reported a case of local anaesthetic toxicity after ultrasound-guided bilateral thoracic paravertebral block before general anaesthesia leading to mental. To our knowledge, the onset of this patient has never been reported previously, and we will discuss the potential risk factors and preventive measures for such patients in the future.
UNASSIGNED: A 38-year-old female patient presented for elective open resection of liver tumor, when bilateral 7th thoracic (T7) paravertebral blocks were performed under the guidance of ultrasound with 0.5% ropivacaine (3 mg/kg) in the anesthesia preparation area. After 20 minutes, the patient suddenly became extremely excited and requested to suspend the operation, because Guanyin Bodhisattva just told her that the operation would put her life in danger.
UNASSIGNED: Although the dose of ropivacaine was up to 3 mg/kg for lumbar epidural, or 4.3 mg/kg for major nerve block based on the manufacturer\'s recommendation, we believe that the bolus dosage of 0.5% ropivacaine 3 mg/kg was high for bilateral thoracic paravertebral block in this patient.

Etomidate is an ultra-short-acting anesthetic agent derived from imidazole that can only be administered intravenously. Etomidate has excellent hemodynamic properties in inducing anesthesia, making it an ideal choice for patients with shock, hypovolemia, or significant cardiovascular disease, with minimal reduction in blood pressure. We report a case of a female patient who was given accidental etomidate intrathecally instead of ropivacaine because of its similar appearance, which led to a slight decrease in blood pressure and no change in the pulse rate. The patient had stable vital signs and no neurological complications.

We report a case of ultrasound-guided craniocervical nerve blocks performed with ropivacaine for perioperative local/regional anesthesia in a patient who underwent right partial maxillary resection and neck dissection under general anesthesia. The patient was an 85-year-old woman with multiple medical comorbidities in whom analgesia using nonsteroidal anti-inflammatory drugs and opioids was expected to increase the risk of postoperative complications. Bilateral ultrasound-guided maxillary (V2) nerve blocks and a right superficial cervical plexus block were performed, which provided adequate perioperative anesthesia and avoided postoperative complications. The use of ultrasound-guided craniocervical nerve blocks with ropivacaine can be an effective approach for providing prolonged perioperative local anesthesia and analgesia, minimizing the need for other potentially problematic analgesics.

In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space. We propose that a continuous costoclavicular block with a retrograde stimulating catheter is a feasible alternative regional anesthesia technique for postoperative analgesia in shoulder surgery.

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