Anaesthesia

Intraoperative Placement of Paravertebral Catheters to Manage Postoperative Pain in Opioid-Dependent Patients After Thoracolumbar Spine Fusion Surgery: A Case Report We introduce a regional technique that involves the intraoperative placement of bilateral paravertebral catheters under direct visualization. The patient had stage IV lung cancer and was on chronic oxycodone therapy. He presented with a T10 metastatic lesion, and underwent spinal decompression with T7–L1 fusion and T10 corpectomy. Before fascial closure, catheters were advanced into the T10 paravertebral space under direct visualization by the surgeon bilaterally. Postoperatively, his pain was well controlled, and narcotic requirements were decreased. Our case report demonstrates that for patients undergoing posterior spine surgery, intraoperative placement of bilateral paravertebral catheters can be used to help manage postoperative pain. Accepted for publication June 17, 2019. Funding: None. The authors declare no conflicts of interest. The authors declare no conflicts of interest., Address correspondence to Kelly Y. Chen, MD, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Gray-Bigelow 444, Boston, MA 02114. Address e-mail to kychen1@mgh.harvard.edu. © 2019 International Anesthesia Research Society

A Guide for Submitting a Manuscript That Is Aligned With the Mission of Anesthesia & Analgesia Practice Anesthesia & Analgesia (A&A) Practice is a journal for clinicians worldwide. It is aligned with the educational mission of its parent organization, the International Anesthesia Research Society. A&A Practice is an online-only companion journal of A&A. A&A Practice seeks to publish short yet informative, peer-reviewed, PubMed indexed articles that offer a solution to a perioperative care or patient safety conundrum or a health management issue, which is communicated as one of the several manuscript types. We herein provide authors with a guide to assist them toward a successfully published manuscript in A&A Practice. Accepted for publication June 5, 2019. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Address correspondence to BobbieJean Sweitzer, MD, FACP, Department of Anesthesiology, Northwestern University, Chicago, IL. Address e-mail to bobbiejean.sweitzer@nm.org. © 2019 International Anesthesia Research Society

Abdominal Surgery With Bilateral Rectus Sheath Block: A Case Report A 44-year-old man, American Society of Anesthesiologists physical status class IV, presented for fulguration of anal condyloma and diverting colostomy. The patient's medical history includes World Health Organization (WHO) class I pulmonary hypertension (PH), right heart failure, and bilateral lower extremity paralysis due to Pott's disease. The patient was not a candidate for neuraxial anesthesia due to sacral decubitus ulcers, and alternative options to general anesthesia (GA) were considered to avoid the high risk of right ventricular (RV) failure and ensuing complications. The case was successfully performed under sedation with dexmedetomidine infusion and bilateral rectus sheath blocks for surgical anesthesia. Accepted for publication May 16, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Elizabeth W. Duggan, MD, Department of Anesthesiology, Emory University Hospital, 1364 Clifton Rd, Office C-238, Atlanta, GA 30322. Address e-mail to ewdugga@emory.edu. © 2019 International Anesthesia Research Society

Neuropathic Pain due to Neurofibromatosis Treated With Transcutaneous Electrical Nerve Stimulation in a Pregnant Patient: A Case Report A patient with neurofibromatosis type 1 presented to the pain clinic with neuropathic pain. Thoracolumbar magnetic resonance imagining revealed meningocele T12–L2 with cauda equina distortion. After becoming pregnant, the patient interrupted opioid treatment, refusing pharmacological treatment until the pain became unbearable. Transcutaneous electrical nerve stimulation (TENS) was proposed. The patient used this treatment from the first trimester until month 6 postpartum, achieving good analgesia without any adverse effects for the mother or child. TENS may be a viable treatment for neuropathic pain (NP) during pregnancy. However, more data are needed due to the difficulty of conducting clinical trials in this population. Accepted for publication June 20, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Victor Caño Silva, MD, Department of Anesthesiology, Critical Care and Pain Clinics, L'Hospitalet de Llobregat, Av Feixa Llarga s/n, Barcelona 08907, Spain. Address e-mail to victorc@bellvitgehospital.cat. © 2019 International Anesthesia Research Society

Continuous Intravenous Lidocaine as an Effective Pain Adjunct for Opioid-Induced Bowel Dysfunction: A Case Report This case study describes a patient with suspected opioid-induced bowel dysfunction who had improved pain control when treated with intravenous (IV) lidocaine. An 80-year-old man with failed back surgery syndrome managed with an intrathecal (IT) pump presented with protracted abdominal pain. The acute pain service initiated a lidocaine infusion at 1 mg·min−1, and the patient reported significant pain relief. The patient experienced refractory abdominal pain with 3 attempts to wean the lidocaine infusion. Eventually, a successful transitional regimen was achieved with methylnaltrexone and transdermal lidocaine patches. Lidocaine infusions may be an effective and underutilized multimodal adjunct for nonsurgical pain conditions. Accepted for publication June 17, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Bryant W. Tran, MD, Department of Anesthesiology, Virginia Commonwealth University Medical Center, 1200 E Broad St, Box 980695, Richmond, VA 23298. Address e-mail to bryant.tran@vcuhealth.org. © 2019 International Anesthesia Research Society

Erector Spinae Plane Blocks in Major Hepatopancreaticobiliary Surgery: A Case Series Hepatopancreaticobiliary (HPB) surgery is major upper abdominal surgery with considerable risk of pulmonary complications related to postoperative pain. While epidural analgesia remains an effective analgesic technique for upper abdominal surgery, HPB surgery poses challenges to its use due to coagulopathy. Erector spinae plane (ESP) blocks are a promising alternative to epidurals. Injection of local anesthetic deep to the erector spinae muscle plane and placement of a catheter for prolonged effect provide both somatic and visceral analgesia for both thoracic and abdominal surgery. We describe a series of 3 cases that illustrate the efficacy of ESP blocks after major HPB surgery. Accepted for publication June 20, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Shrijit Nair, FCAI, Department of Anesthesia and Intensive Care Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Address e-mail to drshrijitnair@yahoo.com. © 2019 International Anesthesia Research Society

Total Hip Replacement in a Patient With a Fontan Circulation: A Case Report Anesthetic management of the adult patient with a Fontan circulation is complex and requires understanding of the specific physiology of the individual patient. Long-term survival in this cohort has increased to the point where patients are presenting for noncardiac surgery related to degenerative diseases of aging. We describe the perioperative management of a patient with a Fontan circulation undergoing total hip arthroplasty using combined spinal–epidural anesthesia and discuss the issues requiring special consideration for this surgical procedure in this group of patients. Accepted for publication June 9, 2019. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Address correspondence to Nicholas D. Black, MBBCh, BAO (Hons), Department of Anesthesia, Toronto Western Hospital, 399 Bathurst St, Toronto, ON, Canada. Address e-mail to nicholasdavidblack@hotmail.com. © 2019 International Anesthesia Research Society

Retained Perineural Catheter: A Sentinel Case Report We report the rare complication of a retained peripheral nerve block catheter (PNBC). A 45-year-old man with intractable postamputation phantom limb pain was treated with continuous infusions via femoral and sciatic peripheral nerve catheters. The catheters were removed by an emergency department physician 2 days after placement. Five months later, the patient presented with a discharging sinus from the sciatic nerve catheter site. Magnetic resonance imaging (MRI) was inconclusive. Surgical exploration showed 15 cm of retained peripheral nerve catheter, which was removed. Accepted for publication June 12, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Alparslan Turan, MD, Outcomes Research Department, Cleveland Clinic, Cleveland, OH 44195. Address e-mail to turana@ccf.org. © 2019 International Anesthesia Research Society

Intravenous Ketamine as an Adjunct for Pachyonychia Congenita–Associated Pain: A Case Report Pachyonychia congenita (PC) is a rare, inherited disorder of keratin filaments characterized by palmoplantar hyperkeratosis, keratoderma, and extreme pain. Management is largely symptomatic and typically involves multimodal pain control strategies. Here, we report the treatment of one 21-year-old man's refractory neuropathic PC pain with a 4-day inpatient ketamine infusion. Within 1 night of beginning treatment, his pain diminished to a 0/10 without any adverse effects, with effects lasting 2 weeks. No reported PC pain regimens have made use of intravenous ketamine; thus, we suggest recurrent ketamine infusions as an additional option in the multimodal pain regimen for patients with PC. Accepted for publication June 17, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Xiang Qian, MD, PhD, Stanford University School of Medicine, Pain Management Center, 450 Broadway St, Pavilion A, 1st Floor MC5340, Redwood City, CA 94063. Address e-mail to xqian@stanford.edu. © 2019 International Anesthesia Research Society

A Case Report of Surgical Entrapment and Catheter Embolization: A Rare Complication of Peripherally Inserted Central Catheters Peripherally inserted central catheters (PICCs) are a feasible alternative to conventional central venous access. PICCs are often used perioperatively for central venous pressure monitoring and administration of vasoactive drugs especially in cancer patients. Catheter breakage and embolization are rare but potentially fatal complications, and most of the reported literature pertains to pediatric patients after medium- to long-term use. In this report, we describe a rare scenario of catheter breakage, entrapment, and embolization in a patient caused by inadvertent surgical clip and suture placement. Accepted for publication May 30, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Seema Mishra, MD, Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi 110029, New Delhi. Address e-mail to seemamishra2003@gmail.com. © 2019 International Anesthesia Research Society

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
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alsfakia@gmail.com