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Norouzi A, Behrouzibakhsh F, Kamali A, Yazdi B, Ghaffari B. Short-term complications of anesthetic technique used in hip fracture surgery in elderly people. Eur J Transl Myol 2018; 28:7355. [PMID: 30344972 PMCID: PMC6176388 DOI: 10.4081/ejtm.2018.7355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 02/06/2023] Open
Abstract
Postoperative complications of fracture are one of the main problems in older patients with hip fracture. In this study, complications were observed 48 hours after surgery in different anesthetic procedures. This prospective cross sectional study was carried out over a 12-month period. All subjects over 55 years of age undergoing hip fracture surgery were selected for study with ASA class (American Society of Anesthesiology: one, two and three). After determining the vital signs in the operating room, anesthesia type (general, spinal and epidural) and various variables were recorded. It was observed that the spinal anesthesia method had the lowest level of postoperative disturbances of consciousness and had the shortest duration in terms of duration of time. On the other hand, general anesthesia was the least in terms of blood transfusion. Finally, epidural anesthetic method showed the least amount of pain 48 hours after operation and the least changes in blood pressure and heart rate.
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Affiliation(s)
- Afsaneh Norouzi
- Department of Anesthesiology, Arak University of Medical Sciences, Arak
| | | | - Alireza Kamali
- Department of Anesthesiology, Arak University of Medical Sciences, Arak
| | - Bijan Yazdi
- Department of Anesthesiology, Arak University of Medical Sciences, Arak
| | - Babak Ghaffari
- Department of Orthopedics, Arak University of Medical Sciences, Arak, Iran
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53
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Kahn RL, Ellis SJ, Cheng J, Curren J, Fields KG, Roberts MM, YaDeau JT. The Incidence of Complications Is Low Following Foot and Ankle Surgery for Which Peripheral Nerve Blocks Are Used for Postoperative Pain Management. HSS J 2018; 14:134-142. [PMID: 29983654 PMCID: PMC6031533 DOI: 10.1007/s11420-017-9588-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of neurologic complications from foot and ankle surgery utilizing regional anesthesia is not well established. QUESTIONS/PURPOSES The purpose of this study was to prospectively determine the incidence of neurologic and peripheral nerve block (PNB) site complications on a busy foot and ankle service that utilizes ankle blocks (ABs) and popliteal blocks (POPs). PATIENTS AND METHODS This prospective observational study included patients undergoing foot and ankle surgery with ABs or POPs. Block choice was determined by surgeon's preference. Patients were assessed for complications during postoperative visits at 2, 6, and 12 weeks. The relation of each complication to the block was scored by a surgeon and anesthesiologist. RESULTS From October 2012 to October 2014, 2516 patients underwent 2704 surgeries. There were 195 complications (7.2%) considered neurologic or at the PNB site. The incidence of serious complications was 0.7%. A higher complication rate was reported for POPs (8.8%) than for ABs (2.5%). However, when analysis was limited to forefoot surgery, this difference was not significant. Dexamethasone use was associated with increased complications for POPs. Only 5 of the 195 total complications, and 2 of 20 serious complications, were deemed to have been likely caused by the block by both the surgeon and anesthesiologist reviewer. CONCLUSIONS The incidences of neurologic or block-related complications and serious complications were 7.2 and 0.7%, respectively, most without a clear surgical vs. nerve block etiology. The higher complication rate for POPs using perineural dexamethasone should be interpreted cautiously in light of the lack of randomization and likely confounders.
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Affiliation(s)
- Richard L. Kahn
- 0000 0001 2285 8823grid.239915.5Department of Anesthesiology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Scott J. Ellis
- 0000 0001 2285 8823grid.239915.5Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY USA
| | - Jennifer Cheng
- 0000 0001 2285 8823grid.239915.5Department of Anesthesiology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Jodie Curren
- 0000 0001 2285 8823grid.239915.5Department of Anesthesiology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Kara G. Fields
- 0000 0001 2285 8823grid.239915.5Healthcare Research Institute, Hospital for Special Surgery, New York, NY USA
| | - Matthew M. Roberts
- 0000 0001 2285 8823grid.239915.5Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY USA
| | - Jacques T. YaDeau
- 0000 0001 2285 8823grid.239915.5Department of Anesthesiology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
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Kang C, Kim SB, Heo YM, Won YG, Oh BH, Jun JB, Lee GS. Comparison of Time to Operation and Efficacies of Ultrasound-Guided Nerve Block and General Anesthesia in Emergency External Fixation of Lower Leg Fractures (AO 42, 43, 44). J Foot Ankle Surg 2018; 56:1019-1024. [PMID: 28842086 DOI: 10.1053/j.jfas.2017.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 02/03/2023]
Abstract
The present randomized controlled trial evaluated the usefulness of ultrasound (US)-guided nerve block (NB) for emergency external fixation of lower leg fractures, by investigating the time required before surgery and the clinical results stratified by the anesthesia method (US-guided NB or general anesthesia [GA]). From June 2014 to April 2016, 40 patients who had undergone emergency surgery for external fixator application were enrolled in the present study. We measured the lead time before the start of surgery after the decision to perform emergency surgery in both groups. The US-guided NB group included 17 males (85%) and 3 females (15%), with a mean age of 55.6 (range 33 to 77) years. Of these 20 patients, 12 (60%) had comorbidities such as diabetes mellitus, hypertension, and kidney-related disease. Fracture type 42, 43, and 44 in the AO classification were observed in 3 (15%), 12 (60%), and 5 (25%) cases, respectively. The mean interval before emergency surgery was 4.3 (range 2 to 6.25) hours in the US-guided NB group. In the GA group (n = 20 patients), the mean interval before emergency surgery was 9.4 (range 3 to 14) hours, and this difference was statistically significant (p < .001). In the US-guided NB group, no cases of anesthesia failure or unstable vital signs occurred during surgery. Also, no postoperative complications related to the anesthesia method, such as aggravation of the general condition, developed. In contrast, 1 case of postoperative atelectasis occurred in the GA group. Emergency external fixation with US-guided NB in patients with lower extremity trauma can be implemented in less time, regardless of the preoperative preparation, which is a requirement for GA.
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Affiliation(s)
- Chan Kang
- Professor, Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejon, Korea
| | - Sang-Bum Kim
- Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Youn-Moo Heo
- Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - You-Gun Won
- Assistant Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Byung-Hak Oh
- Assistant Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - June-Bum Jun
- Orthopedist, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Gi-Soo Lee
- Assistant Professor, Department of Orthopedic Surgery, Konyang University College of Medicine, Daejon, Korea.
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Park YU, Cho JH, Lee DH, Choi WS, Lee HD, Kim KS. Complications After Multiple-Site Peripheral Nerve Blocks for Foot and Ankle Surgery Compared With Popliteal Sciatic Nerve Block Alone. Foot Ankle Int 2018; 39:731-735. [PMID: 29366344 DOI: 10.1177/1071100717753954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Single or combined multiple-site peripheral nerve blocks (PNBs) are becoming popular for patients undergoing surgery on their feet or ankles. These procedures are known to be generally safe in surgical settings compared with other forms of anesthesia, such as spinal block. The purposes of this study were to assess the incidence of complications after the administration of multiple PNBs for foot and ankle surgery and to compare the rates of complications between patients who received a single PNB and those who received multiple blocks. METHODS Charts were reviewed retrospectively to assess peri- and postoperative complications possibly related to the PNBs. The records of 827 patients who had received sciatic nerve blocks, femoral nerve blocks adductor canal blocks, or combinations of these for foot and/or ankle surgery were analyzed for complications. The collected data consisted of age, sex, body mass index, presence of diabetes mellitus, smoking history, tourniquet time, and complications both immediately postoperatively and 1 year later. RESULTS Of these 827 patients, 92 (11.1%) developed neurologic symptoms after surgery; 22 (2.7%) of these likely resulted from the nerve blocks, and 7 (0.8%) of these were unresolved after the patients' last follow-up visits. There were no differences in complication rates between combined blocks and single sciatic nerve blocks. CONCLUSION There were more complications, both transient and long term, after anesthetic PNBs than previous literature has reported. Combined multiple-site blocks did not increase the rate of neurologic complications. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Young Uk Park
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Jae Ho Cho
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Doo Hyung Lee
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Wan Sun Choi
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Han Dong Lee
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Keun Soo Kim
- 1 Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
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Risk Factors for Neurological Injury After Reverse Total Shoulder Arthroplasty. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2018. [DOI: 10.1097/bte.0000000000000103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tseng KY, Wang HC, Chang LL, Cheng KI. Advances in Experimental Medicine and Biology: Intrafascicular Local Anesthetic Injection Damages Peripheral Nerve-Induced Neuropathic Pain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1099:65-76. [PMID: 30306515 DOI: 10.1007/978-981-13-1756-9_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Peripheral nerve blockade (PNB) is advantageous for patients undergoing surgery to decrease the perioperative opioid consumptions and enhance recovery after surgery.Inadvertent local anesthetic (LA) administration into nerve fiber intrafascicularly easily results in unrecognized nerve injury. Using nerve block guidance either by ultrasound, electrical nerve stimulator, or using pressure devices does not prevent nerve damage, even though most of the nerve injury is transiently. The incidence of neurologic symptoms or neuropathy is in the range of 0.02-2.2%, and no significant difference of postoperative neurologic symptoms is found as compared with using ultrasound or guided nerve stimulator technique. However, intrafascicular lidocaine brought about macrophage migration into the damaged fascicle, Schwann cell proliferation, increased intensity of myelin basic protein, and shorten withdrawal time to mechanical stimuli. In dorsal root ganglion (DRG), intrafascicular LA injection increased the activated transcriptional factor 3 (ATF-3) and downregulated Nav1.8 (Nav1.8). In spinal dorsal horn (SDH), the microglia and astrocytes located in SDH were activated and proliferated after intrafascicular LA injection and returned to baseline gradually at the end of the month. This is a kind of neuropathic pain, so low injection pressure should be maintained, the correct needle bevel used, nerve stimulator or ultrasound guidance applied, and careful and deliberately slow injection employed as important parts of the injection technique to prevent intrafascicular LA administration-induced neuropathic pain.
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Affiliation(s)
- Kuang-Yi Tseng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chen Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lin-Li Chang
- Department of Microbiology and Immunology, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Zhang J, Yuan Y, Zhang Y, Wang Y. Clinical effects of single femoral nerve block in combination with general anesthesia on geriatric patients receiving total knee arthroplasty. Pak J Med Sci 2018; 34:43-48. [PMID: 29643876 PMCID: PMC5857026 DOI: 10.12669/pjms.341.14071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the clinical effects of single femoral nerve block (sFNB) combined with general anesthesia on geriatric patients receiving unilateral total knee arthroplasty (UTKA). Methods: Sixty geriatric UTKA patients who were treated in The First People's Hospital of Changzhou from January 2015 to August 2015 were randomly divided into an sFNB + laryngeal mask airway (FLA) group, an sFNB + tracheal intubation (FGA) group and a tracheal intubation (GA) group. Their clinical parameters and indices were recorded. They were scored by the Visual Analogue Scale (VAS). Results: All patients completed this study. FLA and FGA groups used less propofol, remifentanil and fentanyl than GA group (P<0.01), with shorter recovery time and extubation time (P<0.05). Compared to GA group, FLA and FGA groups had lower systolic blood pressures at T3, T4 and T5 (P<0.05), and lower heart rates at T5 (P<0.05). FLA and FGA groups had fewer cases of adverse reactions after extubation (P<0.01). FLA group was less prone to irritating cough after extubation and pharyngeal pain than FGA and GA groups (P<0.01). The postoperative six hour and 24 hour VAS scores in resting state as well as the postoperative 24 hour and 48 hour scores in training state of FLA and FGA groups were lower than those of GA group (P<0.05). FLA and FGA groups used significantly lower times and total doses of patient-controlled intravenous analgesia pump. Conclusion: sFNB combined with general anesthesia, especially that using laryngeal mask, were superior to general anesthesia alone, which reduced recovery and extubation times, and decreased intraoperative and postoperative drug uses, postoperative early VAS score and adverse reactions.
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Affiliation(s)
- Jing Zhang
- Jing Zhang, Department of Anesthesiology, The First People's Hospital of Changzhou, Changzhou 213000, P. R. China
| | - Yan Yuan
- Yan Yuan, Department of Anesthesiology, The First People's Hospital of Changzhou, Changzhou 213000, P. R. China
| | - Yongjun Zhang
- Yongjun Zhang, Department of Anesthesiology, The First People's Hospital of Changzhou, Changzhou 213000, P. R. China
| | - Ying Wang
- Ying Wang, Department of Anesthesiology, The First People's Hospital of Changzhou, Changzhou 213000, P. R. China
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59
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Ball CM. Neurologic complications of shoulder joint replacement. J Shoulder Elbow Surg 2017; 26:2125-2132. [PMID: 28688932 DOI: 10.1016/j.jse.2017.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/16/2017] [Accepted: 04/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little attention has been given to neurologic complications after shoulder joint replacement (SJR). Previously thought to occur infrequently, it is likely that many are not clinically recognized, and they can result in postoperative morbidity and impair the patient's recovery. The purpose of this study was to document the prevalence of nerve complications after SJR, to identify the nerves involved, and to define patient outcomes. METHODS This was a retrospective review of 211 SJRs in 202 patients during a 5-year period were included, with 89 male and 122 female patients at an average age of 70 years. All patients underwent a comprehensive analysis of any postoperative nerve complication, including onset, duration, investigation, treatment, and symptom resolution. RESULTS Of the 211 SJR procedures, 44 were identified as having sustained a nerve complication (20.9%), with 36 female (81.8%) and 8 male patients (18.2%). Reverse SJR was associated with the highest number of nerve complications. The median nerve (25 patients) and musculocutaneous nerve (8 patients) were most commonly involved. Most nerve complications were transient and resolved within 6 months. Permanent sequelae and injuries that required secondary surgical intervention were rare. CONCLUSION The occurrence of nerve complications after SJR is common, but almost all will fully recover. Most are transient neurapraxias involving the lateral cord of the brachial plexus. Women are more likely to be affected, as are patients who have undergone prior surgery to the affected shoulder. Most are likely to be the result of excessive traction or direct injury to the nerves during glenoid exposure.
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Affiliation(s)
- Craig M Ball
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.
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60
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Evaluation of analgesic regimens in total knee arthroplasty, retrospective study. North Clin Istanb 2017; 4:124-130. [PMID: 28971169 PMCID: PMC5613259 DOI: 10.14744/nci.2017.88598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE: Analgesic therapies have an immense role in early rehabilitation period after total knee arthroplasty (TKA) and multimodal approaches should be considered as the first choice of treatment. In this retrospective study, the aim was to evaluate the effectiveness of multimodal analgesic therapies for TKA, including femoral nerve block (FNB) and patient controlled analgesia (PCA). METHODS: The data of 79 patients who underwent TKA between January and December 2016 were retrospectively evaluated. In all, 63 patients met the inclusion criteria. Hemodynamic records and Visual Analogue Scale (VAS) pain scores for postoperative 0, 2, 4, 6, 9, and 12 hours were evaluated and patients were separated into 3 groups. Group 1: FNB with 0.25% bupivacaine, Group 2: FNB with 0.166% bupivacaine, and Group 3: No FNB. RESULTS: The average age of the patients was 64.3±14.9 years and average body mass index (BMI) was 32.5±5.3 kg/m2. There was no statistical difference between groups in age, gender, American Society of Anesthesiologists (ASA) classification of physical health scores, BMI, or anesthesia type (p<0.05). When VAS scores at postoperative time intervals were compared, there was a statistically significant difference between Group 1 and Group 2 (p>0.05). When difference between Groups 1 and 3 and Groups 2 and 3 were compared, the difference was statistically significant for VAS 0 (p>0.05). Additional analgesic use was highest in Group 3. CONCLUSION: This study demonstrated that FNB significantly decreases postoperative pain intensity and additional analgesia requirement in patients undergoing TKA. A concentration of 0.166% bupivacaine is as effective as a concentration of 0.25% when used as part of a multimodal analgesia regimen in TKA.
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Affiliation(s)
- Neel Desai
- Specialist Registrar in Anaesthetics, Department of Anaesthetics, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP
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Angerame MR, Ruder JA, Odum SM, Hamid N. Pain and Opioid Use After Total Shoulder Arthroplasty With Injectable Liposomal Bupivacaine Versus Interscalene Block. Orthopedics 2017; 40:e806-e811. [PMID: 28617519 DOI: 10.3928/01477447-20170608-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/24/2017] [Indexed: 02/03/2023]
Abstract
Postoperative pain control is a significant concern after total shoulder arthroplasty. Injectable periarticular liposomal bupivacaine, which has been found to decrease opioid use after orthopedic procedures, has been proposed as a viable alternative to regional anesthesia. This study compared the efficacy of liposomal bupivacaine vs interscalene block among patients undergoing total shoulder arthroplasty. A retrospective review was conducted of 79 patients who underwent anatomic total shoulder arthroplasty performed by a single surgeon between January 2013 and April 2015. Patient demographics, in-hospital Numeric Pain Rating Scale (NPRS) score obtained at 12-hour intervals, length of stay, and total in-hospital morphine equivalents in both the bupivacaine (n=25) and block (n=44) groups were recorded. Differences in length of stay, morphine equivalents, and age were assessed with Wilcoxon tests. Sex differences were assessed with the chi-square test. Repeated measures analysis with least square means was used to assess longitudinal changes in NPRS scores. No significant differences were found between groups for sex (P=.89), age (P=.81), American Society of Anesthesiologists classification (P=.50), preoperative opioid use (P=.41), length of stay (P=.32), or morphine equivalents (P=.71). The average NPRS score in the first 12 hours was 3.01 for the bupivacaine group and 4.41 for the interscalene block group (P=.25). By 48 hours postoperatively, average NPRS scores were similar (P=.93) for the 2 groups, 4.90 for the bupivacaine group and 4.19 for the interscalene block group. The findings for this cohort of patients undergoing anatomic total shoulder arthroplasty showed no significant difference for pain scores, postoperative narcotic use, or length of stay with injectable liposomal bupivacaine vs interscalene block. [Orthopedics. 2017; 40(5):e806-e811.].
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Williams BA, Ibinson JW, Gould AJ, Mangione MP. The Incidence of Peripheral Nerve Injury After Multimodal Perineural Anesthesia/Analgesia Does Not Appear to Differ from That Following Single-Drug Nerve Blocks (2011-2014). PAIN MEDICINE 2017; 18:628-636. [PMID: 26896319 DOI: 10.1093/pm/pnv107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/20/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Brian A Williams
- Department of Anesthesiology, University of Pittsburgh; Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - James W Ibinson
- Department of Anesthesiology, University of Pittsburgh; Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Andrew J Gould
- Robert Packer Memorial Hospital, Sayre, Pennsylvania, USA
| | - Michael P Mangione
- Department of Anesthesiology, University of Pittsburgh; Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Sondekoppam RV, Tsui BCH. Factors Associated With Risk of Neurologic Complications After Peripheral Nerve Blocks. Anesth Analg 2017; 124:645-660. [DOI: 10.1213/ane.0000000000001804] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Byram SC, Byram SW, Miller NM, Fargo KN. Bupivacaine increases the rate of motoneuron death following peripheral nerve injury. Restor Neurol Neurosci 2017; 35:129-135. [DOI: 10.3233/rnn-160692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Susanna C. Byram
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL, USA
- Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Scott W. Byram
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL, USA
| | - Nicholas M. Miller
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL, USA
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Perretta DJ, Gotlin M, Brock K, Paksima N, Gottschalk MB, Cuff G, Rettig M, Atchabahian A. Brachial Plexus Blockade Causes Subclinical Neuropathy: A Prospective Observational Study. Hand (N Y) 2017; 12:50-54. [PMID: 28082843 PMCID: PMC5207291 DOI: 10.1177/1558944716650411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: The objective of this study is to determine subclinical changes in hand sensation after brachial plexus blocks used for hand surgery procedures. We used Semmes-Weinstein monofilament testing to detect these changes. We hypothesized that patients undergoing brachial plexus nerve blocks would have postoperative subclinical neuropathy detected by monofilament testing when compared with controls. Methods: In total, 115 hand surgery adult patients were prospectively enrolled in this study. All patients undergoing nerve-related procedures were excluded as well as any patients with preoperative clinically apparent nerve deficits. Eighty-four patients underwent brachial plexus blockade preoperatively, and 31 patients underwent general anesthesia (GA). Semmes-Weinstein monofilament testing of the hand was performed preoperatively on both the operative and nonoperative extremities and postoperatively at a mean of 11 days on both hands. Preoperative and postoperative monofilament testing scores were compared between the block hand and the nonoperated hand of the same patient, as well as between the block hands and the GA-operated hands. Results: There were no recorded clinically relevant neurologic complications in the block group or GA group. A statistically significant decrease in sensation in postoperative testing in the operated block hand compared with the nonoperated hand was noted. When comparing the operated block hand with the operated GA hand, there was a decrease in postoperative sensation in the operated block hand that did not reach statistical significance. Conclusions: Brachial plexus blockade causes subtle subclinical decreases in sensibility at short-term follow-up, without any clinically relevant manifestations.
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Affiliation(s)
- Donato J. Perretta
- Massachusetts General Hospital, Boston, USA,Donato J. Perretta, Massachusetts General Hospital, 55 Fruit Street, Yawkey 2, Boston, MA 02114, USA.
| | | | - Kenneth Brock
- New York University School of Medicine, New York City, USA
| | - Nader Paksima
- New York University School of Medicine, New York City, USA
| | | | - Germaine Cuff
- New York University School of Medicine, New York City, USA
| | - Michael Rettig
- New York University School of Medicine, New York City, USA
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Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty. Reg Anesth Pain Med 2017; 42:683-697. [DOI: 10.1097/aap.0000000000000673] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Munirama S, Zealley K, Schwab A, Columb M, Corner G, Eisma R, McLeod G. Trainee anaesthetist diagnosis of intraneural injection—a study comparing B-mode ultrasound with the fusion of B-mode and elastography in the soft embalmed Thiel cadaver model. Br J Anaesth 2016; 117:792-800. [DOI: 10.1093/bja/aew337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/13/2022] Open
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Nam YS, Panchal K, Kim IB, Ji JH, Park MG, Park SR. Anatomical study of the articular branch of the lateral pectoral nerve to the shoulder joint. Knee Surg Sports Traumatol Arthrosc 2016; 24:3820-3827. [PMID: 26194117 DOI: 10.1007/s00167-015-3703-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to document the distribution of the articular branch of the lateral pectoral nerve (LPN) to the shoulder and to identify a suitable point for its blockade. METHODS This study involved the dissection of 43 shoulders of 22 unembalmed cadavers (6 male and 16 female) to identify the LPN and its articular branch to the shoulder. To identify the suitable anatomical point for blocking the articular branch of the LPN, several anatomical landmarks around the shoulder were measured. RESULTS The articular branch of the LPN to the shoulder was present in 29 of 43 cases (67.4 %). The appropriate point to block the articular branch of the LPN was identified at a mean distance of 1.5 cm below the clavicle, on the line connecting the closest points between the clavicle and the coracoid process, and at a mean depth of 1.0 cm from the skin. CONCLUSION The articular branch of the LPN to the shoulder, as well as the muscular and cutaneous branches of the LPN, covers a portion of the shoulder joint with suprascapular and axillary nerves. Surgeons might consider a peripheral block of the suprascapular, axillary, and LPNs to provide maximum block coverage after shoulder joint surgery.
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Affiliation(s)
- Young-Seok Nam
- Department of Anatomy, Catholic Institute for Applied Anatomy, The Catholic University of Korea, Seoul, South Korea
| | - Karnav Panchal
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, South Korea
| | - In-Beom Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, The Catholic University of Korea, Seoul, South Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, South Korea.
| | - Min-Gyu Park
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, South Korea
| | - Sung-Ryeoll Park
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, South Korea
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Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities. J Clin Anesth 2016; 35:524-529. [DOI: 10.1016/j.jclinane.2016.08.041] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/03/2016] [Accepted: 08/10/2016] [Indexed: 01/22/2023]
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Suprascapular Nerve Block Versus Interscalene Block as Analgesia After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Noninferiority Trial. Arthroscopy 2016; 32:2203-2209. [PMID: 27177436 DOI: 10.1016/j.arthro.2016.03.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/16/2016] [Accepted: 03/10/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the efficacy of suprascapular nerve block (SSB) and interscalene block (ISB) as postoperative analgesia within the first 24 hours after arthroscopic supraspinatus and/or infraspinatus tendon repair. METHODS A single-blind, randomized controlled study was performed between 2013 and 2014. The inclusion criteria were arthroscopic supraspinatus and/or infraspinatus tendon repair confirmed intraoperatively, with or without associated procedures, and informed consent. The exclusion criteria were a previously operated shoulder, repair of the subscapularis tendon, and an allergy to local anesthetics. ISB was performed under ultrasound guidance by an anesthesiologist, whereas SSB was performed based on specific anatomic landmarks by a surgeon. The primary evaluation criterion was mean shoulder pain score during the first postoperative 24 hours assessed on a visual analog scale by the patient. The secondary criteria were complications of locoregional anesthesia, the use of analgesics in the recovery room (the first 2 hours) until postoperative day 7, and pain (visual analog scale) during the first week. Forty-four patients were needed for this noninferiority study. An institutional review board approved the study. RESULTS Seventy-four patients were randomized, and 59 met the intraoperative inclusion criteria. Six patients were excluded (1 for pneumothorax after ISB, 1 for unsuccessful SSB, and 4 for incomplete questionnaires). None of the patients were lost to follow-up. There was no significant difference between the SSB and ISB groups in mean pain score for the first 24 hours (P = .92) or the first 7 days (P = .05). However, there was significantly less pain in the ISB group in the recovery room (P = .01). Consumption of analgesics was comparable between the groups, but the SSB group took significantly more morphine in the recovery room. CONCLUSIONS In this prospective, randomized controlled study, SSB was as effective as ISB for mean pain control within the first 24 hours but ISB was more effective in relieving pain in the recovery room after arthroscopic supraspinatus and/or infraspinatus tendon repair. LEVEL OF EVIDENCE Level I, therapeutic, randomized controlled study.
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Huang J, Gao H. Regional anesthesia practice in China: a survey. J Clin Anesth 2016; 34:115-23. [PMID: 27687357 DOI: 10.1016/j.jclinane.2016.03.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/17/2016] [Accepted: 03/17/2016] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE Neuraxial anesthesia has been widely used in China. Recently, Chinese anesthesiologists have applied nerve stimulator and ultrasound guidance for peripheral nerve blocks. Nationwide surveys about regional anesthesia practices in China are lacking. We surveyed Chinese anesthesiologists about regional anesthesia techniques, preference, drug selections, complications, and treatments. DESIGN A survey was sent to all anesthesiologist members by WeChat. The respondents can choose mobile device or desktop to complete the survey. Each IP address is allowed to complete the survey once. MAIN RESULTS A total of 6589 members read invitations. A total of 2654 responses were received with fully completed questionnaires, which represented an overall response rate of 40%. Forty-one percent of the respondents reported that more than 50% of surgeries in their hospitals were done under regional anesthesia. Most of the participants used test dose after epidural catheter insertion. The most common drug for test dose was 3-mL 1.5% lidocaine; 2.6% of the participants reported that they had treated a patient with epidural hematoma after neuraxial anesthesia. Most anesthesiologists (68.2%) performed peripheral nerve blocks as blind procedures based on the knowledge of anatomical landmarks. A majority of hospitals (80%) did not stock Intralipid; 61% of the respondents did not receive peripheral nerve block training. CONCLUSIONS The current survey can serve as a benchmark for future comparisons and evaluation of regional anesthesia practices in China. This survey revealed potential regional anesthesia safety issues in China.
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Affiliation(s)
- Jeffrey Huang
- Anesthesiologists of Greater Orlando & University of Central Florida, 2699 Lee Rd, Suite 510, Winter Park, FL 32789.
| | - Huan Gao
- Department of Anesthesiology, Fangcheng County Hospital, Henan, China
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Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the Real Benefits of Single-Shot Interscalene Block Please Stand Up? A Systematic Review and Meta-Analysis. Anesth Analg 2016; 120:1114-1129. [PMID: 25822923 DOI: 10.1213/ane.0000000000000688] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Interscalene block (ISB) can provide pain relief after shoulder surgery, but a reliable quantification of its analgesic benefits is lacking. This meta-analysis examines the effect of single-shot ISB on analgesic outcomes during the first 48 hours after shoulder surgery. METHODS We retrieved randomized and quasirandomized controlled trials examining the analgesic benefits of ISB compared with none in shoulder surgery. Severity of postoperative pain measured on a visual analog scale (10 cm scale, 0 = no pain, 10 = worst pain) at rest at 24 hours was the designated primary outcome. Secondary outcomes included pain severity at rest and with motion at 2, 4, 6, 8, 12, 16, 32, 36, 40, and 48 hours postoperatively. Opioid consumption, postoperative nausea and vomiting, patient satisfaction with pain relief, and postanesthesia care unit and hospital discharge time were also assessed. RESULTS A total of 23 randomized controlled trials, including 1090 patients, were analyzed. Patients in the ISB group had more severe postoperative pain at rest by a weighed mean difference (95% confidence interval) of 0.96 cm (0.08-1.83; P = 0.03) at 24 hours compared with no ISB, but there was no difference in pain severity beyond that point. The duration of pain relief at rest and with motion after ISB were 8 and 6 hours, respectively, with a corresponding weighed mean difference in visual analog scale pain scores (99% confidence interval) of -1.59 cm (-2.60 to -0.58) and -2.20 cm (-4.34 to -0.06), respectively, with no additional pain relief benefits beyond these points. ISB reduced postoperative opioid consumption up to 12 hours, decreased postoperative nausea and vomiting at 24 hours, and expedited postanesthesia care unit and hospital discharge. The type, dose, and volume of local anesthetic used did not affect the results. CONCLUSIONS ISB can provide effective analgesia up to 6 hours with motion and 8 hours at rest after shoulder surgery, with no demonstrable benefits thereafter. Patients who receive an ISB can suffer rebound pain at 24 hours but later experience similar pain severity compared with those who do not receive an ISB. ISB can also provide an opioid-sparing effect and reduce opioid-related side effects in the first 12 and 24 hours postoperatively, respectively. These findings are useful to inform preoperative risk-benefit discussions regarding ISB for shoulder surgery.
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Affiliation(s)
- Faraj W Abdallah
- From the *Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada; †Department of Anesthesia and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; ‡Division of Obstetric Anesthesia, Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; §Department of Anesthesia, Hospital for Sick Children, Toronto, Ontario, Canada; ║Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada; and ¶Department of Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Canada
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Koh WU, Kim HJ, Park HS, Choi WJ, Yang HS, Ro YJ. A randomised controlled trial comparing continuous supraclavicular and interscalene brachial plexus blockade for open rotator cuff surgery. Anaesthesia 2016; 71:692-9. [DOI: 10.1111/anae.13419] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- W. U. Koh
- Department of Anesthesiology and Pain Medicine; University of Ulsan; Asan Medical Center; Seoul Korea
| | - H. J. Kim
- Department of Anesthesiology and Pain Medicine; University of Ulsan; Asan Medical Center; Seoul Korea
| | - H. S. Park
- Department of Anesthesiology and Pain Medicine; University of Ulsan; Asan Medical Center; Seoul Korea
| | - W. J. Choi
- Department of Anesthesiology and Pain Medicine; University of Ulsan; Asan Medical Center; Seoul Korea
| | - H. S. Yang
- Department of Anesthesiology and Pain Medicine; University of Ulsan; Asan Medical Center; Seoul Korea
| | - Y. J. Ro
- Department of Anesthesiology and Pain Medicine; University of Ulsan; Asan Medical Center; Seoul Korea
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Maga J, Missair A, Visan A, Kaplan L, Gutierrez JF, Jain AR, Gebhard RE. Comparison of Outside Versus Inside Brachial Plexus Sheath Injection for Ultrasound-Guided Interscalene Nerve Blocks. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:279-285. [PMID: 26715658 DOI: 10.7863/ultra.15.01059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/19/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Ultrasound-guided interscalene brachial plexus blocks are commonly used to provide anesthesia for the shoulder and proximal upper extremity. Some reviews identify a sheath that envelops the brachial plexus as a potential tissue plane target, and current editorials in the literature highlight the need to establish precise and reproducible injection targets under ultrasound guidance. We hypothesize that an injection of a local anesthetic inside the brachial plexus sheath during ultrasound-guided interscalene nerve blocks will result in enhanced procedure success and provide a consistent tissue plane target for this approach with a reproducible and characteristic local anesthetic spread pattern. METHODS Sixty patients scheduled for shoulder surgery with a preoperative interscalene block for postoperative pain management were enrolled in this prospective randomized observer-blinded study. Each patient was randomly assigned to receive a single-shot interscalene block either inside or outside the brachial plexus sheath. RESULTS The rate of complete motor and sensory blocks of the axillary nerve territory 10 minutes after local anesthetic injection for the inside group was 70% versus 37% for the outside group (P < .05). At all measurement intervals beyond 10 minutes, however, neither group showed a statistically significant difference in complete sensory blockade. The incidence rates of transient paresthesia during needle passage were 6.7% for the outside group and 96.7% for the inside group (P < .05). CONCLUSIONS Except for faster onset, this prospective randomized trial did not find any advantages to performing an interscalene block inside the brachial plexus sheath. There was a higher incidence of transient paresthesia when injections were performed inside compared to outside the sheath.
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Affiliation(s)
- Joni Maga
- Departments of Anesthesiology, Perioperative Medicine, and Pain Management (J.M., A.M., A.V., J.F.G., A.R.J., R.E.G.) and Orthopedics and Rehabilitation (L.K., R.E.G.), University of Miami, Miller School of Medicine, Miami, Florida USA
| | - Andres Missair
- Departments of Anesthesiology, Perioperative Medicine, and Pain Management (J.M., A.M., A.V., J.F.G., A.R.J., R.E.G.) and Orthopedics and Rehabilitation (L.K., R.E.G.), University of Miami, Miller School of Medicine, Miami, Florida USA.
| | - Alex Visan
- Departments of Anesthesiology, Perioperative Medicine, and Pain Management (J.M., A.M., A.V., J.F.G., A.R.J., R.E.G.) and Orthopedics and Rehabilitation (L.K., R.E.G.), University of Miami, Miller School of Medicine, Miami, Florida USA
| | - Lee Kaplan
- Departments of Anesthesiology, Perioperative Medicine, and Pain Management (J.M., A.M., A.V., J.F.G., A.R.J., R.E.G.) and Orthopedics and Rehabilitation (L.K., R.E.G.), University of Miami, Miller School of Medicine, Miami, Florida USA
| | - Juan F Gutierrez
- Departments of Anesthesiology, Perioperative Medicine, and Pain Management (J.M., A.M., A.V., J.F.G., A.R.J., R.E.G.) and Orthopedics and Rehabilitation (L.K., R.E.G.), University of Miami, Miller School of Medicine, Miami, Florida USA
| | - Annika R Jain
- Departments of Anesthesiology, Perioperative Medicine, and Pain Management (J.M., A.M., A.V., J.F.G., A.R.J., R.E.G.) and Orthopedics and Rehabilitation (L.K., R.E.G.), University of Miami, Miller School of Medicine, Miami, Florida USA
| | - Ralf E Gebhard
- Departments of Anesthesiology, Perioperative Medicine, and Pain Management (J.M., A.M., A.V., J.F.G., A.R.J., R.E.G.) and Orthopedics and Rehabilitation (L.K., R.E.G.), University of Miami, Miller School of Medicine, Miami, Florida USA
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Snyder MA, Scheuerman CM, Gregg JL, Ruhnke CJ, Eten K. Improving total knee arthroplasty perioperative pain management using a periarticular injection with bupivacaine liposomal suspension. Arthroplast Today 2016; 2:37-42. [PMID: 28326395 PMCID: PMC4957154 DOI: 10.1016/j.artd.2015.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 11/20/2022] Open
Abstract
Patients undergoing total knee arthroplasty (TKA) report low satisfaction with postoperative pain control. The purpose of this study is to examine if there is a difference in post-operative pain for TKA patients without femoral nerve block receiving an intra-operative pericapsular injection of bupivacaine liposome suspension (EXPAREL; Pacira Pharmaceuticals, Inc., San Diego, California) versus a concentrated multi drug cocktail. Seventy TKA patients were randomly assigned to either the bupivacaine liposome or the multi-drug cocktail. Post-operative pain scores, morphine sulfate equivalence consumption values, adverse events, and overall pain control satisfaction scores were collected. Patients reported significantly higher pain level for the cocktail group on post-op day 1 (p < .05) and post-op day 2 (p < .01) versus the bupivacaine liposome group. This same trend was found for morphine sulfate equivalence consumption in the PACU (p < .01) and post-op day 2 (p < .01). Higher satisfaction in pain control (p < .001) and overall experience (p < .01) was also found in the bupivacaine liposome group. Finally, significantly more adverse events were found in the multi-drug group versus the bupivacaine liposome group (p < .05). The study findings demonstrated a non-inferior difference, albeit not a clinically significant difference, in patient-perceived pain scores, morphine sulfate equivalence consumption, adverse events, and overall satisfaction.
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Affiliation(s)
- Mark A. Snyder
- Orthopaedic Center of Excellence, TriHealth Orthopaedic and Spine Institute, Cincinnati, OH, USA
| | - Christina M. Scheuerman
- TriHealth Hatton Research Institute, Cincinnati, OH, USA
- Corresponding author. 375 Dixmyth Ave., Cincinnati, OH 45202, USA. Tel.: +1 513 862 1904.
| | | | | | - Kathryn Eten
- Orthopaedic Center of Excellence, Good Samaritan Hospital, Cincinnati, OH, USA
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The Requisites of Needle-to-Nerve Proximity for Ultrasound-Guided Regional Anesthesia. Reg Anesth Pain Med 2016; 41:221-8. [DOI: 10.1097/aap.0000000000000201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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81
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Karaarslan S, Tekgül ZT, Şimşek E, Turan M, Karaman Y, Kaya A, Gönüllü M. Comparison Between Ultrasonography-Guided Popliteal Sciatic Nerve Block and Spinal Anesthesia for Hallux Valgus Repair. Foot Ankle Int 2016; 37:85-9. [PMID: 26293156 DOI: 10.1177/1071100715600285] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to compare the efficacy, postoperative pain scores, adverse effects, additional analgesic requirements, and patient satisfaction scores of ultrasonography-guided sciatic nerve block by popliteal approach with spinal anesthesia for hallux valgus correction surgery. METHODS Sixty patients scheduled for hallux valgus correction surgery were enrolled in this prospective randomized study. Unilateral spinal block was performed on patients in the spinal anesthesia group. Popliteal block group patients received popliteal sciatic nerve block with guidance by both nerve stimulator and ultrasonography. Durations of anesthetic and operative interventions and time until the initiation of surgery were recorded for both groups. Pain magnitude of the patients at the 2nd, 4th, 6th, 12th, and 24th hours following anesthetic interventions were assessed with a visual analog scale (VAS). Adverse effects such as postoperative urinary retention and postdural puncture headache were recorded. Also, patient satisfaction was recorded. Patients were interviewed by phone for anesthetic and operative complications at 72 hours postoperatively. RESULTS Spinal anesthesia group patients exhibited hypotension, bradycardia, postdural puncture headache, and urinary retention rates of 6.6%, 3.3%, 10%, and 3.3%, respectively. Popliteal block group patients showed none of these adverse effects. Moreover, VAS scores of the patients at the 2nd, 4th, 6th, and 12th hours were significantly lower (P < .001, P = .003, P < .001, P <.001, respectively), postoperative first analgesic requirement times were significantly longer (P < .001), and pain satisfaction scores were significantly higher (P < .001) in the popliteal block group. CONCLUSION Given the complications related to spinal anesthesia and its insufficiency to maintain analgesia postoperatively, we believe the preferred anesthetic method should be peripheral nerve blocks for hallux valgus correction surgeries. LEVEL OF EVIDENCE Level I, randomized prospective study.
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Affiliation(s)
- Sermin Karaarslan
- Department of Anesthesiology and Reanimation, Bozyaka Teaching Hospital, Izmir, Turkey
| | - Zeki Tuncel Tekgül
- Department of Anesthesiology and Reanimation, Bozyaka Teaching Hospital, Izmir, Turkey
| | - Esen Şimşek
- Department of Anesthesiology and Reanimation, Bozyaka Teaching Hospital, Izmir, Turkey
| | - Murat Turan
- Department of Anesthesiology and Reanimation, Bozyaka Teaching Hospital, Izmir, Turkey
| | - Yücel Karaman
- Department of Anesthesiology and Reanimation, Bozyaka Teaching Hospital, Izmir, Turkey
| | - Ahmet Kaya
- Department of Orthopedics and Traumatology, Tepecik Teaching Hospital, Izmir, Turkey
| | - Mustafa Gönüllü
- Department of Anesthesiology and Reanimation, Bozyaka Teaching Hospital, Izmir, Turkey
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Neurologic Outcomes After Low-Volume, Ultrasound-Guided Interscalene Block and Ambulatory Shoulder Surgery. Reg Anesth Pain Med 2016; 41:477-81. [DOI: 10.1097/aap.0000000000000425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Song JH, Kang C, Hwang DS, Hwang JM, Shin BK. Fentanyl Patches to Supplement Ultrasound-Guided Nerve Blocks for Improving Pain Control After Foot and Ankle Surgery: A Prospective Study. J Foot Ankle Surg 2015; 55:121-4. [PMID: 26422649 DOI: 10.1053/j.jfas.2015.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Indexed: 02/03/2023]
Abstract
The analgesic effects of preoperative ultrasound-guided nerve blocks wear off after about 12 hours, leaving some patients in substantial pain. Transdermal fentanyl concentrations peak at 12 to 24 hours after application and maintain this concentration for approximately 72 hours. We sought to determine whether combining the use of a transdermal fentanyl patch with either a sciatic or femoral-sciatic nerve block would improve pain control in patients undergoing foot and/or ankle surgery. Consecutive patients in the no-patch control group (n = 104) were enrolled from July 2011 to October 2011, and those in the treatment group (n = 232) were enrolled from November 2011 to May 2012 and received a transdermal patch (4.125 mg/7.5 cm(2) releasing 25 μg of fentanyl per hour) applied to their chest postoperatively. Pain was assessed using a visual analog scale at 6, 12, 24, and 48 hours after surgery. The primary outcome measure was the number of requests for additional postoperative pain medication. Additional postoperative analgesia was requested by 49 of the 104 control patients (47.1%) and 63 of the 232 treated patients (27.1%; p = .002). The mean pain scores were also lower in the treatment group, with a statistically significant difference (p < .05) at 12, 24, and 48 hours. Thus, patients receiving a fentanyl patch combined with an ultrasound-guided nerve block required less supplemental analgesia to maintain adequate pain control than did those receiving a nerve block alone. In conclusion, a fentanyl patch is a useful adjunct to an ultrasound-guided nerve block in foot and ankle surgery.
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Affiliation(s)
- Jae-Hwang Song
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chan Kang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.
| | - Deuk-Soo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jung-Mo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Byung-Kon Shin
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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Sanel S, Arpaz O, Unay K, Turkmen I, Simsek S, Ugutmen E. Comparison of intra-articular bupivacaine–morphine with bupivacaine–tenoxicam combinations on post-operative analgesia in patients with arthroscopic meniscectomy: a prospective, randomised study. INTERNATIONAL ORTHOPAEDICS 2015; 40:601-5. [DOI: 10.1007/s00264-015-2990-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 09/01/2015] [Indexed: 11/29/2022]
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Helen L, O'Donnell BD, Moore E. Nerve localization techniques for peripheral nerve block and possible future directions. Acta Anaesthesiol Scand 2015; 59:962-74. [PMID: 25997933 DOI: 10.1111/aas.12544] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/24/2015] [Accepted: 04/05/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ultrasound guidance is now a standard nerve localization technique for peripheral nerve block (PNB). Ultrasonography allows simultaneous visualization of the target nerve, needle, local anesthetic injectate, and surrounding anatomical structures. Accurate deposition of local anesthetic next to the nerve is essential to the success of the nerve block procedure. Due to limitations in the visibility of both needle tip and nerve surface, the precise relationship between needle tip and target nerve is unknown at the moment of injection. Importantly, nerve injury may result both from an inappropriately placed needle tip and inappropriately placed local anesthetic. The relationship between the block needle tip and target nerve is of paramount importance to the safe conduct of peripheral nerve block. METHODS This review summarizes the evolution of nerve localization in regional anesthesia, characterizes a problem faced by clinicians in performing ultrasound-guided nerve block, and explores the potential technological solutions to this problem. RESULTS To date, technology newly applied to PNB includes real-time 3D imaging, multi-planar magnetic needle guidance, and in-line injection pressure monitoring. This review postulates that optical reflectance spectroscopy and bioimpedance may allow for accurate identification of the relationship between needle tip and target nerve, currently a high priority deficit in PNB techniques. CONCLUSIONS Until it is known how best to define the relationship between needle and nerve at the moment of injection, some common sense principles are suggested.
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Affiliation(s)
- L. Helen
- Sensing and Separation Group; Chemistry Department and Life Science Interface Group; Tyndall National Institute; University College Cork; Cork Ireland
| | - B. D. O'Donnell
- Department of Anesthesia; Cork University Hospital & ASSERT for Health Centre; University College Cork; Cork Ireland
| | - E. Moore
- Sensing and Separation Group; Chemistry Department and Life Science Interface Group; Tyndall National Institute; University College Cork; Cork Ireland
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Can ultrasound-guided nerve block be a useful method of anesthesia for arthroscopic knee surgery? Knee Surg Sports Traumatol Arthrosc 2015; 23:2090-6. [PMID: 25223966 DOI: 10.1007/s00167-014-3281-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study was performed to compare general anesthesia, spinal anesthesia, and ultrasound (US)-guided nerve block for knee arthroscopic surgery. Also, whether US-guided nerve block is a useful method of anesthesia for arthroscopic knee surgery was investigated. METHODS In this prospective, randomized study, 400 patients who underwent knee arthroscopy surgery between February 2011 and September 2012 were allocated to one of three groups: spinal anesthesia (n = 100), general anesthesia (n = 100), or US-guided nerve block (n = 200). All patients completed a questionnaire with three questions 6 months after surgery. For the nerve block group, the procedure duration, interval between the procedure and onset of the anesthetic effect, the point of loss of the anesthetic effect, intraoperative, postoperative visual analog scale (VAS) pain score, and discomfort during surgery were assessed. RESULTS There was no patient in which the anesthetic was changed to another method during the operation. VAS pain score of postoperative 1 h was significantly different between the nerve block (1.4 ± 1.7), spinal anesthesia (1.5 ± 1.1), and general anesthesia groups (6.2 ± 5.1) (P < 0.05). In addition, VAS pain scores at postoperative 6 and 12 h were significantly different among the regional nerve block group (2.2 ± 1.5 and 3.0 ± 1.8, respectively), spinal anesthesia group (5.2 ± 3.2 and 5.1 ± 4.0, respectively), and general anesthesia group (5.2 ± 3.9 and 5.4 ± 4.5, respectively). One hundred and ninety regional nerve block (95 %), 68 spinal anesthesia (68 %), and 75 general anesthesia patients (75 %) reported that they would prefer the same type of anesthesia if they were to undergo knee surgery again; these differences were significant (P < 0.05). There were no long-term complications, such as neurological deficits or infection, after the procedure in all patients. CONCLUSION Arthroscopic knee surgery, such as meniscal repair or meniscectomy, synovectomy, debridement, and other procedures, was performed safely and effectively under US-guided nerve block. These results indicated that US-guided nerve block for arthroscopic knee surgery is a highly satisfactory and safe procedure without complications and is available for use by any orthopedist. LEVEL OF EVIDENCE Prospective case series, Level IV.
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Kessler J, Marhofer P, Hopkins P, Hollmann M. Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years. Br J Anaesth 2015; 114:728-45. [DOI: 10.1093/bja/aeu559] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Steinfeldt T, Wiesmann T. Needle-nerve proximity during peripheral nerve blocks--where is the right target and how can we get there? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:121-124. [PMID: 25677677 DOI: 10.1016/j.redar.2015.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Affiliation(s)
- T Steinfeldt
- Anaesthesiologist, Consultant; Dep. of Anaesthesia and Intensive Care Therapy, Philipps University Hospital, Philipps-University, Baldingerstr., 35033 Marburg, Germany.
| | - T Wiesmann
- Anaesthesiologist, Staff; Dep. of Anaesthesia and Intensive Care Therapy, Philipps University Hospital, Philipps-University, Baldingerstr., 35033 Marburg, Germany
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Thomasson BG, Matzon JL, Pepe M, Tucker B, Maltenfort M, Austin L. Distal peripheral neuropathy after open and arthroscopic shoulder surgery: an under-recognized complication. J Shoulder Elbow Surg 2015; 24:60-6. [PMID: 25441572 DOI: 10.1016/j.jse.2014.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 08/04/2014] [Accepted: 08/13/2014] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Distal peripheral neuropathy (DPN) is an under-reported complication after anatomic total shoulder arthroplasty (TSA), reverse shoulder arthroplasty (RSA), and arthroscopic rotator cuff repair (RCR). METHODS We conducted a retrospective review of patients undergoing shoulder arthroplasty or arthroscopic RCR by 4 shoulder surgeons during a 2-year period. The primary outcome measure was the diagnosis of DPN, defined as carpal tunnel syndrome, cubital tunnel syndrome, ulnar tunnel syndrome, and distal radial sensory neuropathy. Patient demographics and clinical course of DPN were recorded. Mean follow-up was 21, 15, and 12 months for TSA, RSA, and RCR, respectively. RESULTS Postoperatively, 6 of 85 TSA (7.1%), 7 of 57 RSA (12.3%), and 21 of 753 RCR (2.79%) patients were diagnosed with DPN. The most common neuropathy was cubital tunnel syndrome for TSA and RSA and carpal tunnel syndrome for RCR. The risk of DPN was higher for shoulder arthroplasty (TSA and RSA) compared with the RCR group. After nonsurgical treatment of DPN, complete resolution of symptoms occurred in 33.3% of TSA, 42.86% of RSA, and 71.43% of RCR patients. However, 16.7% of TSA, 14.3% of RSA, and 4.76% of RCR patients with DPN required surgical decompression; 100% of the patients undergoing surgical decompression had complete resolution of symptoms. CONCLUSION DPN is a relatively common complication after shoulder surgery. When it occurs, DPN will often resolve with nonoperative management. Surgical decompression is an effective treatment option in refractory cases.
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Affiliation(s)
- Benjamin G Thomasson
- Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
| | - Jonas L Matzon
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Pepe
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bradford Tucker
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mitchell Maltenfort
- Department of Orthopedic Surgery, Rothman Institute, Clinical Research, Thomas Jefferson University, Philadelphia, PA, USA
| | - Luke Austin
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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90
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The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med 2015; 40:401-30. [DOI: 10.1097/aap.0000000000000286] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Danninger T, Opperer M, Memtsoudis SG. Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks. World J Orthop 2014; 5:225-232. [PMID: 25035824 PMCID: PMC4095014 DOI: 10.5312/wjo.v5.i3.225] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/07/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
Over the last decades, the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically. This very successful intervention, however, is associated with significant postoperative pain, and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery. The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal. Many different approaches and techniques for peripheral nerve blockades, either landmark or, more recently, ultrasound guided have been described over the last decades. This includes but is not restricted to techniques discussed in this review. The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block. Moreover, ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block. In contrast to patient controlled analgesia using opioids, patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction; this is important as hospital rankings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure. This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications, considerations and outcomes.
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93
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Shanthanna H. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle. Indian J Anaesth 2014; 58:327-9. [PMID: 25024480 PMCID: PMC4091003 DOI: 10.4103/0019-5049.135050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We report the anaesthetic management of two cases involving surgeries on the clavicle, performed under superficial cervical plexus block and selective C5 nerve root block under ultrasound (US) guidance, along with general anaesthesia. Regional analgesia for clavicular surgeries is challenging. Our patients also had significant comorbidities necessitating individualised approach. The first patient had a history of emphysema, obesity, and was allergic to morphine and hydromorphone. The second patient had clavicular arthritis and pain due to previous surgeries. He had a history of smoking, Stevens-Johnson syndrome, along with daily marijuana and prescription opioid use. Both patients had an effective regional block and required minimal supplementation of analgesia, both being discharged on the same day. Interscalene block with its associated risks and complications may not be suitable for every patient. This report highlights the importance of selective regional blockade and also the use of US guidance for an effective and safe block.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesiology, McMaster University, Hamilton, ON, Canada
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Bilbao Ares A, Sabaté Pes A. [Reply to "Safety algorithm for ultrasound-guided blocks: The next challenge"]. ACTA ACUST UNITED AC 2014; 62:117-8. [PMID: 24952988 DOI: 10.1016/j.redar.2014.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A Bilbao Ares
- Servicio de Anestesia y Reanimación, Complejo Hospitalario de Pamplona, Navarra, España.
| | - A Sabaté Pes
- Servicio de Anestesia y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Grevstad U, Mathiesen O, Lind T, Dahl J. Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty: a randomized study with individual patient analysis. Br J Anaesth 2014; 112:912-9. [DOI: 10.1093/bja/aet441] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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The Cleveland Clinic experience with supraclavicular and popliteal ambulatory nerve catheters. ScientificWorldJournal 2014; 2014:572507. [PMID: 25535627 PMCID: PMC3996863 DOI: 10.1155/2014/572507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 01/20/2014] [Indexed: 11/18/2022] Open
Abstract
Continuous peripheral nerve blocks (CPNB) are commonly used for intraoperative and postoperative analgesia. Our study aimed at describing our experience with ambulatory peripheral nerve catheters. After Institutional Review Board approval, records for all patients discharged with supraclavicular or popliteal catheters between January 1, 2009 and December 31, 2011 were reviewed. A licensed practitioner provided verbal and written instructions to the patients prior to discharge. Daily follow-up phone calls were conducted. Patients either removed their catheters at home with real-time simultaneous telephone guidance by a member of the Acute Pain Service or had them removed by the surgeon during a regular office visit. The primary outcome of this analysis was the incidence of complications, categorized as pharmacologic, infectious, or other. The secondary outcome measure was the average daily pain score. Our study included a total of 1059 patients with ambulatory catheters (769 supraclavicular, 290 popliteal). The median infusion duration was 5 days for both groups. Forty-two possible complications were identified: 13 infectious, 23 pharmacologic, and 6 labeled as other. Two patients had retained catheters, 2 had catheter leakage, and 2 had shortness of breath. Our study showed that prolonged use of ambulatory catheters for a median period of 5 days did not lead to an increased incidence of complications.
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Merritt CK, Mariano ER, Kaye AD, Lissauer J, Mancuso K, Prabhakar A, Urman RD. Peripheral nerve catheters and local anesthetic infiltration in perioperative analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:41-57. [DOI: 10.1016/j.bpa.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 02/09/2014] [Accepted: 02/19/2014] [Indexed: 11/16/2022]
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Off Side! A Simple Modification to the Parasagittal In-Plane Approach for Paravertebral Block. Reg Anesth Pain Med 2014; 39:240-2. [DOI: 10.1097/aap.0000000000000086] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Miyashita T, Iketani Y, Nagamine Y, Goto T. FaceTime® for teaching ultrasound-guided anesthetic procedures in remote place. J Clin Monit Comput 2013; 28:211-5. [DOI: 10.1007/s10877-013-9514-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/18/2013] [Indexed: 11/27/2022]
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100
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Kessler P, Steinfeldt T, Gogarten W, Schwemmer U, Büttner J, Graf B, Volk T. Periphere Regionalanästhesie beim Patienten in Allgemeinanästhesie. Anaesthesist 2013; 62:483-8. [DOI: 10.1007/s00101-013-2190-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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