I have had 5 LAST reactions. One in my arm, 4 at the dentist. It was terrifying. Only the last reaction involved my heart, as far as I know. Are some people prone to this reaction or is it always the guy with the syringe? Is General anaesthesia the answer? I present with intense confusion, I can’t hear or process what is said and I am unable to make words or connect to my mouth. Tears run down my face and I feel buzzing all over. I apparently turn very pale. I am not at all afraid if needles, or "just anxious" as previous providers suggested. I have been numbed several times without this reaction. And here's the kicker- none of the doctors knew what happened! They just moved on.
@emmanuelkweka9575Күн бұрын
Beautifully explained ❤
@weima8564 күн бұрын
omg the puns, i love this man so much
@haroldocosta59254 күн бұрын
😊
@haroldocosta59254 күн бұрын
Legal
@haroldocosta59254 күн бұрын
Bom
@user-wm3of1pt9w5 күн бұрын
Su voz irreemplazanle..transmite una nota unica e inigualable. Siempre vivirás en nuestros corazones❤
@haroldocosta59256 күн бұрын
Muito bom
@gaylengurr39117 күн бұрын
we use exparel (adductor along with surgeon injections) for our tka's. total dose is 20 cc 1.3% exparel with 30 cc .25% marcaine. this seems to be the max recommended dose of local. another 20 cc for the genicular blocks would exceed recommended max mounts.
@thevascularguy10 күн бұрын
This has one of the best ultrasound/tissue diagram I've ever seen! I'm speaking on applied anatomy for vascular access. Do you mind if I use a section of it for a presentation?
@regionalanesthesiology6 күн бұрын
Of course! Thanks for watching!
@thevascularguy6 күн бұрын
@@regionalanesthesiology 🙏🙏🙏
@jakub37911 күн бұрын
do we finally know the answer: can be done billateraly? in the most literature indication is thyroid surgery or paratyhroid surgery , my concern : for this surgery we have to do bilaterall intermidiate cervical plexus block, what about a risk of blocking phrenic nerve , recurent laryngeal nerve?? can somebody please answer this?
@jodahurt483711 күн бұрын
When if ever would you recommend the PENG over SIFI? Or does it simply fall to provider comfort level?
@juanestebanhernandezsantam443512 күн бұрын
excelente video... mucho mejor abordaje comparado a la fluoroscopia
@giganadiradze13 күн бұрын
why do we see as a hypo-echoic and not hyper-echoic circles? 😳
@mfcoelho415 күн бұрын
Why is Epinephrine is used as a marker for detecting intravascular injection? I mean if the pacient is monitorized you can see the heart rate rising instantly but if it’s just a local injection how it helps?
@prestonooi16 күн бұрын
That was an excellent video. Thank you for the clear and detailed explanation!
@Jyunyudi17 күн бұрын
Great video! Without the nerve stimulator (not every service has it), how can you do this? Try and error?
@enricolazzarini229818 күн бұрын
Amazing!
@asimmahmood39719 күн бұрын
Do you do bilateral block for bilateral mastectomy?
@drreferee839421 күн бұрын
Amazing.. Thank you so much.. ❤
@aucoin200828 күн бұрын
This is awesome 🎉
@dhandapani9870Ай бұрын
You’re such a blessing. Thank you 😊
@rajanarsapur.6072Ай бұрын
It is very dangerous procedure negative aspirations will not guaranty one is not in vessel. Most importantly being very close to heart drug act more rapidly than Intravenous. The author has about 45 Yeats of Exeperince in Regional Anesthesia
@paanmelakaАй бұрын
thank you
@srinivasht3720Ай бұрын
Hi,Great video, can we ablate these nerves along with genicular nerves for pain relief in Knee OA patients? Will it provide better pain relief?
@regionalanesthesiologyАй бұрын
Typically we don't ablate these at the mid-thigh. The infra-patellar branch of the saphenous is often ablated (or treated with cryo-analgesia) on the medial side of the knee joint. I'd be concerned about ablating the nerve to vastus medialis...while it doesn't seem to contribute much to gross motor power in postop patients for a few days, I wouldn't want to knock it out for several months. Thanks for watching!
@Focklala1Ай бұрын
Para os brasileiros, é mais fácil entender o inglês do que o português de Portugal
@charesepelham7682Ай бұрын
Well done.
@regionalanesthesiologyАй бұрын
Thanks for watching!
@charesepelham7682Ай бұрын
@@regionalanesthesiology I’m quite experienced and comfortable with the “standard” blocks, and place multiple blocks daily, but I had never before placed IPACK. I looked at multiple IPACK videos. To me, your video seemed clearest and safest. It resonated with me. Soooo-after informed consent-in which I explained the previous information to the patient-and patient requested block-For postop pain, I used your video to place an IPACK in addition to an adductor canal block. The patient was thrilled. Said it’s the first time pain-free since knee injury! Today-patient still happy he had the block. I added dexamethasone and stayed low dose as you recommended and all is well. Thank you!
@rusthoАй бұрын
There is almost no surgeon agreeing to injecting in the vicinity of the knee joint before an endoprothetic kneearthroplasty. In our clinic there is either regional anesthesia or LIA. maybe combining the adductor canal block combined with a dose attentive LIA is a way to go
@regionalanesthesiologyАй бұрын
There are certainly different ways to get the same result. We do genicular blocks because it’s an image-guided, consistent, reproducible way to block those nerves at the knee, and we get excellent results. Obviously we take care to use aseptic technique. Surgeons infiltrating blindly is…just ok. It’s notoriously inconsistent, is operator-dependent, and they frequently miss things. I do appreciate that some centers get good results combining approaches as you suggest. I’m quite biased, but my personal take is let the surgeons cut bone, and leave the analgesia and local anesthetic use to the experts. 😊
@rusthoАй бұрын
@@regionalanesthesiologyIm very pleased for your answer. Im from germany and follow you intensively and appreciate your take on the subject. your participation in the pajunk videos were very stimulating and most of the information that i share with residents derive from your knowledge. maybe one time we meet to share our passion for regional anesthesia. BUT unfortunately surgeons are a very sensitive kind and endoprothetic infections renders most operators superstitious to practices on the operating field. i dont have the capacities or backup to provide studies which compares combined focused genicular blocks by surgeons in combination with NVM and Saphenus nerve blocks respecting toxic LA levels. Maybe you re bringing insight inti this in the future. i d be very interested ☺️
@valdelicerezende9221Ай бұрын
Bloqueio desse nervo é necessário anestesia geral?
@regionalanesthesiologyАй бұрын
O plano anestésico dependerá do procedimento cirúrgico que você fará. Normalmente combinamos anestesia geral com bloqueios nervosos para manter os pacientes o mais confortáveis possível
@valdelicerezende9221Ай бұрын
Que devo fazer para fazer loqueio desse nervo
@regionalanesthesiologyАй бұрын
Eu perguntaria ao seu anestesista se é apropriado
@Diotallevi73Ай бұрын
Do you use a fresh needle for the opposite side?
@regionalanesthesiologyАй бұрын
Nope, if you keep the needle sterile you can prep the skin on both sides and use the same needle for both. Thanks for watching!
@armukАй бұрын
Excellent overview. Kudos for making this great resource
@regionalanesthesiologyАй бұрын
Thanks very much for watching!
@MaksimbaltaiАй бұрын
A very useful and informative video! Thank you very much!
@regionalanesthesiologyАй бұрын
Glad it was helpful, thanks for watching!
@BassGuyNLАй бұрын
Great video! Would you consider performing this block after induction of general anesthesia, prior to surgical incision?
@regionalanesthesiologyАй бұрын
Yes, I think that's a great way to do it. It's pretty quick to do so you're not going to take up a lot of surgical time, and it avoids the discomfort of needling the periosteum while awake. Thanks for watching!
@paanmelakaАй бұрын
thank you
@regionalanesthesiologyАй бұрын
Thanks for watching!
@khaledhbenhusainbenhusain404Ай бұрын
excellent presentation, very useful, practical tips..... thanks
@regionalanesthesiologyАй бұрын
Thanks for watching!
@drshivsingh1394Ай бұрын
Angels at work. keep it up👏
@regionalanesthesiologyАй бұрын
Thank you, more to come!
@nicolassaliba7205Ай бұрын
I got a sizable hematoma (tracking from the point of insertion to fill the space under the recti on each side of the lower abdomen) so clinician be aware.
@regionalanesthesiologyАй бұрын
Thanks for the comment. Yes, agree, something to watch for. The inferior epigastric vessels are surprisingly large (and therefore at risk) but can be missed on ultrasound. I always turn on the color Doppler to double-check before inserting the needle.
@samreenshaikh9160Ай бұрын
amazing
@regionalanesthesiologyАй бұрын
Thanks so much!
@knowyourenemy50Ай бұрын
it's nice that all of these knee blocks can potentially provide maximal sensory analgesia with minimal motor blockade, but how many patients would realistically tolerate this many needle sticks? 1 for adductor + AFCN. 3 for genicular blocks. 1 for iPACK. so 5 separate needle sticks at least?
@intestinomedicinoАй бұрын
I use them once spinal anesthesia has been applied or just before taking the patient to PACU; if under GA just after intubation or before waking up the patient, it all depends of how much time the surgeon leaves me alone doing my job; so far haven't have no single "ouch" from that many punctures.
@regionalanesthesiologyАй бұрын
Thanks for the questions--yes, it can be a number of pokes. The geniculars especially can be a little uncomfortable when the needle hits the periosteum, but a little sedation/analgesia goes a long way. I personally like to do my spinal FIRST in preop, then immediately do the adductor, ipack and genics (I'm also now doing anterior femoral cutaneous nerve blocks too for the skin). The whole thing (spinal plus blocks) can be done in less than 10-15 min once you're up to speed, and well tolerated after the spinal goes in. We had to get our preop nurses comfortable with the idea of a patient getting a spinal out of the OR, but were able to show them it's safe and effective. Good luck!
@adziuba122 ай бұрын
Just when I thought there could be no more blocks to describe... you guys bring the knowledge. Appreciate it!
@btd8362 ай бұрын
I much prefer doing this block out of plane on patients in the lateral position. It is more comfortable for awake patients with OOP, in my experience. OOP the needle trajectory is easier to pop into the sheath without contacting either nerve. With IP you're always pointed slightly at one nerve or another, like in the video.
@cumingsca2 ай бұрын
Depends on TYPE of probe covers. Some are 20 feet long, very thick, and not appropriate for regional probe usage. However this is what some hospitals provide. The likelihood of infection is multifactorial: comorbidities, plus /minus catheter/location/ diabetes, etc. if it was strict sterile technique only that prevents infection, central lines would never be infected.
@morphine2312 ай бұрын
Amazing
@joestevenson55682 ай бұрын
Where you finding pre-folded probe covers?
@No-xh2cs2 ай бұрын
Those people feel that 20 secs is worth the increased risk of infection with the potential morbidity/mortality associated with it.
@Idsapthatt2 ай бұрын
Thanks for the video, my and my colleagues success rate of finding the “bat sign” is essentially 0/10. Any advice on it. I followed the tips in the video
@natepoulson59872 ай бұрын
Start on what you think is the midline with the probe in the saggital orientation. You’re looking for the spinous process as you see the images in this video. Once you find the spinous process, rotate your probe 90 degrees and tilt slightly superior, or adjust slightly superior. That’ll show you the “bat sign”
@regionalanesthesiologyАй бұрын
You're not alone...it's sometimes tricky. Play with the tilt of the probe--try angling it slightly towards the head and then slide up or down several millimeters. Also, those spaces also get smaller as we age and the discs compress. While you're getting used to the technique, try scanning younger people to get used to their juicy anatomy, then as you get more confident you'll be better with the oldies. I brought my teenage kids in on a weekend and scanned their backs and it was amazingly different (and rewarding!). Good luck!
@doctorbius2 ай бұрын
Total 80 mls LA?
@hafizah-xn3mh2 ай бұрын
soothing voice
@tulsidas71592 ай бұрын
do u feel only adductor canal block is sufficient for TKR? along with block I ask my surgeon to infiltrate posteriorly capsule also