We describe the case of a 28-year-old man with Brugada syndrome who received single-shot adductor canal and sciatic nerve blocks for the management of post-operative pain related to extensive orthopedic injuries. Low-dose ropivacaine with glucocorticoid additives was administered without any EKG changes, arrhythmias, or syncopal sensations. The patient experienced pain relief for over 24 h and was monitored on telemetry with defibrillator pads as a cardiac precaution. This case adds a valuable data point in the limited canon of information on the safety and efficacy of regional anesthesia in Brugada syndrome for the perioperative physician.

BACKGROUND: Pain is a common experience in people living with cancer. Concerns around opioid prescribing have seen a move toward a multi-modality management approach, which includes interventional pain procedures.
OBJECTIVE: In this paper we discuss the interventional pain procedures used to treat cancer pain at two major tertiary centers in Australia.
RESULTS: This expert review provides practical insights on cancer pain management from healthcare providers in different specialties. These insights can be used to guide the management of a wide range of cancer pain types.
CONCLUSIONS: Furthermore, this review identifies the need for a systematic and comprehensive approach to the management of cancer pain that is broader than that of a single specialty. With recent advances in pain management procedures, an interdisciplinary approach is essential in order to provide an up to date, patient tailored approach to pain management. This review will help inform the development of a cancer pain intervention registry.

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Multi-modal analgesic strategies, including regional anesthesia techniques, have been shown to contribute to a reduction in the use of opioids and associated side effects in the perioperative setting. Consequently, those so-called multi-modal approaches are recommended and have become the state of the art in perioperative medicine. In the majority of intensive care units (ICUs), however, mono-modal opioid-based analgesic strategies are still the standard of care. The evidence guiding the application of regional anesthesia in the ICU is scarce because possible complications, especially associated with neuraxial regional anesthesia techniques, are often feared in critically ill patients. However, chest and abdominal wall analgesia in particular is often insufficiently treated by opioid-based analgesic regimes. This review summarizes the available evidence and gives recommendations for peripheral regional analgesia approaches as valuable complements in the repertoire of intensive care physicians\' analgesic portfolios.

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UNASSIGNED: The epidural injections used to treat lumbar radiculopathy are potentially associated with serious complications like neurological injuries and epidural abscess. The nociceptors have the unique property of being pseudo-unipolar, as its both ends are expected to be functionally same. We have hypothesized that peripheral nerve blocks given at the distal site should be able to provide pain relief. This prospective study was planned to assess the efficacy of peripheral nerve blocks in lumbar radiculopathy.
UNASSIGNED: Thirty-four patients who fit the eligibility criteria were included in this open labeled prospective preliminary study. They were administered peripheral nerve blocks at ankle level with 4 ml of 0.25% bupivacaine and 40 mg of triamcinolone.
UNASSIGNED: The outcomes measured at 15 days, 1 month, 2 months, and 3 months after the intervention were the pain intensity (Numerical Rating Scale), the Global Perceived Effect, functional status (Roland Morris Disability Questionnaire), Beck\'s Depression Inventory score, employment status, and analgesic intake.
UNASSIGNED: At 15 days, 1 month, and 2 months, 88% of the patients reported a ≥50% decrease in their pain scores and a GPE ≥6, while at 3 months 85% of the patients reported a significant decrease in their pain scores and a GPE ≥6.
UNASSIGNED: Peripheral nerve blocks are effective in the management of pain in patients with chronic lumbosacral radiculopathy. The ability to administer it in an outpatient setting, without image guidance and the absence of debilitating side effects, makes it an attractive treatment option.

UNASSIGNED: Handheld ultrasound devices have become popular among clinicians due to their affordability and compatibility with tablets and smartphones. Several handheld ultrasound devices have the capability to construct three-dimensional (3D) images using a traditional two-dimensional (2D) ultrasound transducer.
UNASSIGNED: The current study aimed to construct 3D images of common peripheral nerve and fascial plane blocks using a handheld ultrasound device with a 2D ultrasound probe.
UNASSIGNED: A total of 10 patients who were scheduled to receive ultrasound-guided peripheral nerve blocks for outpatient surgery and classified as the American Society of Anesthesiologists physical status I or II with a body mass index of ≤ 30 kg/m2 were included in the study. Patients who presented with anatomical variations during the initial ultrasound scanning were excluded.
UNASSIGNED: This study successfully constructed 3D images of 10 peripheral nerve blocks. The average time to complete each 3D scan was less than 5 seconds per attempt, with fascial plane blocks requiring twice the amount of time to complete. All the nerve blocks provided effective postoperative analgesia without complications. The 3D images were successfully captured in all patients.
UNASSIGNED: The 3D images provide clinicians with valuable information on the anatomical boundaries of the injectate that can further direct needle direction and placement of local anesthetic to achieve visual confidence of anesthetic spread.

OBJECTIVE: Rebound pain (RP) is a common occurrence after peripheral nerve block placement, especially when blocks are used for orthopedic surgery. This literature review focuses on the incidence and risk factors for RP as well as preventative and treatment strategies.
RESULTS: The addition of adjuvants to a block, when appropriate, and starting patients on oral analgesics prior to sensory resolution are reasonable approaches. Using continuous nerve block techniques can provide extended analgesia through the immediate postoperative phase when pain is the most intense. Peripheral nerve blocks (PNBs) are associated with RP, a frequent phenomenon that must be recognized and addressed to prevent short-term pain and patient dissatisfaction, as well as long-term complications and avoidable hospital resource utilization. Knowledge about the advantages and limitations of PNBs allows the anesthesiologists to anticipate, intervene, and hopefully mitigate or avoid the phenomenon of RP.

Patients with burns suffer from excruciating pain, thus presenting unique challenges to the hospital staff involved in their care. Any hospital system may be involved in managing smaller and less serious burns, but patients with more complicated issues are often transferred to a burn center. This article will review the pathophysiological evolution of pain immediately after burn injury to emphasize the role of complex inflammatory pathways involved in the progression of burn pain. This review also focuses on managing acute pain using a combined multimodal and regional pain management approach. Finally, we attempt to address the continuum from acute to chronic pain management and the strategies used to minimize and manage the progression to chronic pain. Chronic pain remains a debilitating outcome of burn injury, and this article discusses efforts to mitigate this complication. Available options for pain treatment are important to discuss, as current drug shortages may limit medications that can be used.

This meta-analysis aimed to determine whether peripheral nerve blocks (PNB) reduce postoperative delirium (POD) in elderly patients undergoing hip surgery. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022328320). The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomized controlled trials (RCTs) on 26 April 2022. A total of 19 RCTs with 1977 participants were included. Perioperative PNB lowered the POD incidence on the third postoperative day (OR: 0.59, 95% CI [0.40 to 0.87], p = 0.007, I2 = 35%), in patients without underlying cognitive impairment (OR: 0.47, 95% CI [0.30 to 0.74], p = 0.001, I2 = 30%), and when a fascia iliaca compartment block (OR: 0.58, 95% CI [0.37 to 0.91], p = 0.02, I2 = 0%) or a femoral nerve block (OR: 0.33, 95% CI [0.11 to 0.99], p = 0.05, I2 = 66%) were performed. The pain score was also reduced (SMD: -0.83, 95% CI [-1.36 to -0.30], p = 0.002, I2 = 95%) after PNB. Perioperative PNB can lower the POD incidence and pain scores up to the third postoperative day. However, considering the wide variety of PNBs performed, more trials are needed to identify the effects of each PNB on POD.