Madan Narayanan

Frimley Park Hospital NHS Foundation Trust · Department of Anaesthetics

Study objective We report a novel block technique aimed to provide lumbosacral, abdominal and hip analgesia: The Quadro-iliac plane (QIP) block. Design A cadaveric examination that evaluates the spread of QIP block. Setting Cadaver laboratory. Patients One unembalmed cadaver. Interventions Bilateral ultrasound-guided QIP blocks on cadavers with...

Regional anaesthesia for shoulder surgery remains challenging in patients with pre-existing respiratory comorbidities. Various alternative phrenic sparing techniques have been described in the literature, but to our knowledge, none have explored the benefits of using short-acting local anaesthetics in combination to achieve surgical anaesthesia for...

Please confirm that an ethics committee approval has been applied for or granted Not relevant (see information at the bottom of this page) Background and Aims Triple monitoring (TM) involves the use of a nerve stimulator, ultrasound imaging and a pressure limiting device (PLD), particularly when performing plexus blocks and peripheral nerve blocks...

Application for ESRA Abstract Prizes I apply as an Anesthesiologist (Aged 35 years old or less) Background and Aims Oncological breast surgery is associated with significant postoperative pain. PROSPECT guidelines recommend regional anaesthesia for postoperative pain management following mastectomy [1]. Single shot blocks with standard local anaes...

Please confirm that an ethics committee approval has been applied for or granted Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Background and Aims Liposomal bupivacaine (LB) may provide analgesia up to 96 hours following single shot injection. Its role in perioperative pain management regimen is still...

Regional anesthesia has benefits beyond just treating acute postoperative pain. Interfascial plane blocks, which have been very popular with ultrasound in recent years, function primarily by administering a high volume of a local anesthetic to the fascial plane. Contrary to traditional peripheral nerve blocks, the targeted nerve or structure in int...

Chronic burn pain persists for six months or longer after the wound has healed, affecting the patient's quality of life and daily activities. Pharmacological treatments are essential in the treatment of chronic pain after burns, but interventional methods come to the fore in cases where there is no response to pharmacological treatments. Radiofrequ...

Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of...

Sedatives are frequently administered to critically ill patients to relieve anxiety, reduce the stress of being mechanically ventilated, and prevent agitation-related harm [1]. However these medications may predispose patients to prolonged ventilation, delirium or other morbidities [2, 3].

Background and Aims Pain associated with major breast surgery can be severe. Recent PROSPECT guidelines recommend regional anaesthesia (RA) for postoperative pain management¹ but single shot blocks are limited in duration (<24 hours). We have introduced a continuous ambulatory local anaesthestic (LA) infusion through serratus plane catheters (SPC)...

Background and Aims The erector spinae plane (ESP) block is safe and effective following traumatic rib fracture¹. The optimal regimen for local anaesthetic (LA) administration remains unknown. At our institution patients receive either a continuous infusion of 0.125% bupivacaine (up to 10 ml/h, 20 ml boluses 6 hourly as required), or a patient cont...

Patients suffering from cancer often require admission to intensive care unit (ICU) either primarily due to the malignancy, to the treatment of the primary condition (surgery, chemotherapy) or complications either of the primary disease process (e.g., metastasis) or treatment (e.g., pulmonary complications, neutropenic sepsis, drug toxicity).

There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought thr...

Proning intubated patients with acute respiratory distress syndrome (ARDS) is an established practice to improve oxygenation temporarily. We present two cases of patients on our intensive care unit with ARDS, on non-invasive ventilation (NIV), in whom proning improved oxygenation at a stage when intubation was the next step. We discuss the mechanis...

Serratus anterior plane blocks may provide analgesia for rib fractures, thoracic surgery and breast surgery. There remains uncertainty regarding the location of injection, be it superficial or deep to the serratus anterior muscle. We describe the case of a 63‐year‐old ASA physical status 3 woman undergoing a wire‐guided wide local excision of a rig...

The erector spinae plane block is an easy-to-perform regional anaesthesia technique with a wide range of clinical applications. Most of the current research has focused on its use in thoracic and trunk surgery. Many experts now consider the erector spinae plane block an alternative analgesic option to thoracic epidural analgesia and paravertebral b...

Background and aims First described in 2018, the PENG block is gaining popularity for its provision of targeted anaesthesia of the articular branches of the hip. Our aim was to evaluate its perioperative analgesic efficacy in patients undergoing surgical fixation of neck of femur fractures. Methods With local audit committee authorisation, data wa...

Background and aims The ultrasound guided transversus abdominis plane (TAP) block was first described in 2007 by Hebberd, providing analgesia for the abdominal wall between T7-T11 depending on approach. Prolonging the duration of the local anaesthetics (LA) in patients undergoing abdominal surgery is desirable as severe pain can develop on the firs...

Around 5500 lower limb amputations are performed in England every year, with best practice guidelines advocating processes to ensure the patient has a pain free limb with optimal potential for prosthesis 1 2 However, pain management is often difficult owing to the nociceptive and neuropathic elements Optimizing control of acute pain may have wide r...

Use of Perineural (Femoral/Sciatic catheters) for pain management after lower limb amputation.

Use of Rectus sheath catheters for analgesia after emergency abdominal aortic aneurysm surgery

Our Trust is a Regional vascular centre with a dynamic regional anaesthesia service. Our standard analgesia for laparotomies is bilateral rectus sheath catheters (RSC), these are also now being used for elective open AAA (OAAA) surgery. We evaluated our current practice with regard to type of post-operative analgesia provided, worst pain scores and...

Brief article of how to avoid knottting/entrapment of perineural or fascial plane catheters and how to rescue them

At our hospital, we have a growing regional anaesthesia service providing over 400 peripheral nerve or fascial plane catheters so far in 2017. We have recently had 2 episodes where rectus sheath catheters, which are our first line pain management for midline laparotomies, have become knotted whilst in situ and therefore been difficult to remove. On...

Background and Aims: Rectus sheath catheters (RSC) are a feasible and effective opioid sparing postoperative pain management technique for laparotomies. There is significant heterogeneity in nomenclature and location of catheter placement, the most effective location being above the posterior rectus sheath. The audit was conducted to identify the...

Objectives: Sternal fractures occur after deceleration injuries such as falls and road traffic accidents. Recovery from isolated fractures is excellent, but mortality increases dramatically with concurrent chest injuries such as rib fractures and soft tissue injuries. Short-term complications include chest pain, which prevents patients from taking...

Background: The Serratus anterior muscle plane (SAP) block has recently been described for the purpose of perioperative pain management following cases of trauma and breast surgery. It might prove a safer alternative to the other regional thoracic paravertebral and central neuraxial blockade techniques. There are no descriptive cadaveric studies i...

Inherited bleeding (haemostatic) and clotting (thrombotic) disorders are rare but sometimes encountered by anaesthetists during emergency or elective surgeries. The perioperative management of these uncommon conditions can be challenging. In this article, we discuss the most common inherited coagulation disorders, their pathophysiology, and periope...

This small multicentre randomised study supports the early institution of CPAP in individuals with cardiogenic pulmonary oedema (CPE). Those in whom CPAP was started alongside medical treatment in a pre-hospital setting were less likely to deteriorate in the first 48 hours when compared with medical treatment alone. Level of evidence: 2B (CEBM 2011...

Amateur choral singing is a common pastime and worthy of study, possibly conferring benefits to health and social behaviour. Participants might be expected to possess musical ability and share some behavioural characteristics. Polymorphisms in genes concerned with serotonergic neurotransmission are associated with both behaviour and musical aptitud...

The composition and performance of “Allele”. (DOC)

Text: Background and aims: Ultrasound Guidance for Regional Anaesthesia (UGRA) has revolutionised the practice of regional anaesthesia. We aimed to find out the training opportunities available in the UK through our national survey. Methods: Trainees were sent an online questionnaire through their deaneries containing 16 questions pertaining to per...

Text: Background and aims: Ultrasound Guidance for Regional Anaesthesia (UGRA) has revolutionised the practice of regional anaesthesia. We aimed to find out the training opportunities available in the UK through our national survey. Methods: Trainees were sent an online questionnaire through their deaneries containing 16 questions pertaining to per...

Background and aims: One of the limitations of using a tourniquet in awake patients is the development of tourniquet pain. Blocking the musculocutaneous and radial nerves has been advocated to decrease the incidence of tourniquet pain during surgery under axillary brachial plexus blocks. We report the incidence of tourniquet pain in awake patients...

Text: Background and aims: Laparoscopic cholecystectomy is increasingly being performed as a day case procedure. The anaesthetic aim is to achieve rapid recovery by using multimodal analgesia, thereby minimizing the opioid use and reduction of post-operative nausea & vomiting (PONV). Anaesthetic techniques vary and there is no optimal technique. In...

Introduction: Oesophagectomy is commonly performed for oesophageal malignancies. The conventional approach is by open surgery. Advancements in endoscopic surgery gave birth to minimally invasive oesophagectomy (MIO) which is associated with reduced length of ITU stay and complication rates.1 Methods: Retrospective audit of patients undergoing oesop...

The following day, the patient had oedema and dark discoloration in his left hand and distal forearm. Doppler ultrasonography revealed thrombotic occlusion of the brachial vein. Magnetic resonance angiography, performed to rule out any other venous compression of the left upper extremity, was normal. Low molecular weight heparin was commenced. Pre-...

INTRODUCTION: Ehlers Danlos syndrome(EDS)is an inherited connective tissue disorder caused by the production of abnormal collagen. The major manifestations of EDS are skin fragility, skin hyper extensibility, and joint hypermobility (1).EDS typeIV can present as a surgical emergency with organ or arterial rupture. We present the spontaneous occurre...

The occurrence of unilateral pulmonary oedema in post operative patients is very uncommon (11). It has been described in urological (8) and cardiothoracic surgery (13) but to the best of our knowledge it has not been reported following orthopaedic surgery. Pulmonary oedema can occur due to congestive cardiac failure, its unilateral presentation bei...