Faculty Bibliography

INTRODUCTION AND IMPORTANCE/UNASSIGNED:Patients with ventricular arrhythmias (VAs) refractory to medical treatment suffer high morbidity and mortality. The stellate ganglion block is an effective diagnostic and therapeutic tool for refractory VAs. CASE PRESENTATION/UNASSIGNED:After obtaining an informed consent, we describe a case of a 62-year-old female who suffered ventricular tachycardia refractory to pharmacologic and electrical management, resulting in pulseless ventricular tachycardia (pVT) arrest. The regional anesthesia team was unable to expose the neck and obtain adequate ultrasound visualization using the classic approach and therefore used alternative ultrasound-guided approaches with success. DISCUSSION/UNASSIGNED:We describe the performance of the stellate ganglion blocks with an out-of-plane needle approach on the left and a medial in-plane approach on the right. These approaches allowed us to successfully block the stellate ganglia bilaterally. CONCLUSION/UNASSIGNED:Refractory VA is associated with an increased cardiac sympathetic tone and has high morbidity and mortality. Stellate ganglion blocks can be used for diagnostic and therapeutic purposes. In-plane and out-of-plane techniques can be utilized.

The opioid epidemic in the United States has led to an increasing number of pregnant patients with opioid use disorder (OUD) presenting to obstetric units. Caring for this complex patient population requires an interdisciplinary approach involving obstetricians, anesthesiologists, addiction medicine physicians, psychiatrists, and social workers. The management of acute pain in the parturient with OUD can be challenging due to several factors, including respiratory depression, opioid tolerance, and opioid-induced hyperalgesia. Patients with a history of OUD can present in one of three categories: 1) those with untreated OUD; 2) those who are currently abstinent from opioids; 3) those being treated with medications to prevent withdrawal. A patient-centered, multimodal approach is essential for optimal peripartum pain relief and prevention of adverse maternal and neonatal outcomes. Medications for opioid use disorder (MOUD), previously referred to as medication-assisted therapy (MAT), include opioids like methadone, buprenorphine, and naltrexone. These are prescribed for pregnant patients with OUD, but appropriate dosing and administration of these medications are critical to avoid withdrawal in the mother. Non-opioid analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used in a stepwise approach, and regional techniques like neuraxial anesthesia and truncal blocks offer opioid-sparing options. Other medications like ketamine, clonidine, dexmedetomidine, nitrous oxide, and gabapentinoids show promise for pain management but require further research. Overall, a comprehensive pain management strategy is essential to ensure the well-being of both the mother and the fetus in pregnant patients with OUD.