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Acute Pain Management Protocol in Major Vascular Procedures

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Abstract

Aortic aneurysm and dissection repair are common major vascular surgeries. Management of aortic aneurysm and dissection has changed from open to endovascular aortic repair (EVAR) given the lower morbidity and mortality compared to open repair. This chapter will thus review the clinical classification for abdominal aortic aneurysm, thoracoabdominal aortic aneurysm, and thoracic aortic dissection. Pre-operative assessment and modification for risk factors will be included. Surgical intervention for aortic aneurysm or dissection in terms of open, endovascular, and hybrid repair will be discussed as well as surgical approach and incision for open aortic aneurysm or dissection repair. Primary anesthesia for EVAR in terms of general anesthesia (GA), combination of sedation and regional anesthesia (RA), and combination of sedation and local infiltration will also be assessed in detail. Lastly, regional anesthesia techniques for post-operative analgesia in open aortic aneurysm or dissection repair and the literatures for benefits and risks of RA, in terms of neuraxial and peripheral nerve block with or without catheter placement and continuous wound infiltration, will be reviewed.

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Zhang, A., Xu, J.L. (2023). Acute Pain Management Protocol in Major Vascular Procedures. In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-21291-8_32

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