Users Online: 25 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to dranjugrewal@gmail.com preferably by 30th June 2019.

 

 
Table of Contents
LETTER TO EDITOR
Year : 2012  |  Volume : 28  |  Issue : 4  |  Page : 535-536

Regional blocks for pre-emptive anti-emesis


Department of Anesthesiology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA

Date of Web Publication4-Oct-2012

Correspondence Address:
Deepak Gupta
Department of Anesthesiology, Wayne State University, Box No 162, 3990 John R, Detroit, Michigan
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.101955

Rights and Permissions

How to cite this article:
Gupta D. Regional blocks for pre-emptive anti-emesis. J Anaesthesiol Clin Pharmacol 2012;28:535-6

How to cite this URL:
Gupta D. Regional blocks for pre-emptive anti-emesis. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2019 Jul 18];28:535-6. Available from: http://www.joacp.org/text.asp?2012/28/4/535/101955

Sir,

It was immensely interesting to read the original research article by Bansal et al. [1] that presents the critical and innovative perspective of peri-anesthesia management. It has been my subjective understanding based on my observations that the surgical handling and stimulation of the eye globe, breasts and testicles elicit nauseating responses in the patients. This leads to postoperative nausea and vomiting (PONV) in these patients in varying degrees depending on the pre-existent variable sensitivities of these organs in different individuals and the variable degrees of surgical handling-related stimulation based on the extent of the underlying anatomical disease as well as the proficiency of the surgical team. The existent facts that the incidence and severity of oculo-cardiac reflex are dependent on the variable and graded mechanical stimuli on the extra-ocular muscles [2] reaffirm that mechanical stimuli to these sensitive organs can only be modified but not completely prevented by the surgical team. It seems prudent to assume that these critical, exteriorized (superficial) and hence sensitive organs have evolutionary in-situ dual protective mechanisms: nausea with or without bradyarrhythmia, and pain in response to stimuli. However, there is one aspect that still remains to be investigated whether the afferent output from eyes, breasts and testes primarily elicit either nausea or pain as primary efferent phenomenon to incite individual's attention and protect themselves against unwarranted stimuli or injuries. Therefore, except for the pre-emptive regional blocks instituted universally for the eye, breast and testicular surgeries, there appears to be no other way to abolish the surgically stimulated reflexes: well-known oculo-cardiac as well as (in my words) unappreciated mammo-vagal [3] and orchio-vagal responses. Additionally, these responses cannot be blocked with postoperative regional blocks as the physiological changes and reflexive mechanisms have been initiated to varying degrees intraoperatively that will present as PONV in pre-emptively untreated patients. [1] As wound infiltrations and surgical field/incision local anesthetic blocks can only be accomplished at the end of the surgeries, the clinically significant pre-emptive anti-emesis can only be achieved with pre-incision paravertebral/epidural blocks for mastectomies and pre-incision caudal/epidural/spinal/spermatic cord blocks for adult or pediatric testicular surgeries; however, peri-bulbar/retro-bulbar blocks for eye-muscle surgeries may have a concern for counter-productive surgical results in terms of the inadequate corrections of heterotropia. In summary, the observations of Bansal et al. [1] present a landmark research that will instigate the initiatives for regional nerve blocks in high-risk surgeries as a pre-emptive anti-emetic technique relegating the analgesia achieved as a secondary gain from these blocks.

 
  References Top

1.Bansal P, Saxena KN, Taneja B, Sareen B. A comparative randomized study of paravertebral block versus wound infiltration of bupivacaine in modified radical mastectomy. J Anaesthesiol Clin Pharmacol 2012;28:76-80.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Khurana I, Sharma R, Khurana AK. Experimental study of oculocardiac reflex (OCR) with graded stimuli. Indian J Physiol Pharmacol 2006;50:152-6.  Back to cited text no. 2
[PUBMED]    
3.Mennella JA, Pepino MY. Breast pumping and lactational state exert differential effects on ethanol pharmacokinetics. Alcohol 2010;44:141-8.  Back to cited text no. 3
[PUBMED]    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed884    
    Printed54    
    Emailed0    
    PDF Downloaded238    
    Comments [Add]    

Recommend this journal