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Steinfeldt T, Marx A, Dauster M. [Common and New Regional Anaesthesia Techniques Under Review - From Head to Abdomen]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:138-158. [PMID: 38513640 DOI: 10.1055/a-2065-7624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
By implementation of sonography regional anesthesia became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety during needle placement. Thereby new truncal blocks got enabled. Next to the blocking of specific nerve structures, plane blocks got established which can also be described as interfascial compartment blocks. The present review illustrates published and established blocks in daily practice concerning indications and the procedural issues. Moreover, the authors explain potential risks, complications and dosing of local anesthetics.
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Pochebyt M, Herron SM, Pan SJ, Burbridge M, Bombardieri AM. Regional anesthesia for head and neck neurosurgical procedures: a narrative review in adult and pediatric patients. Int Anesthesiol Clin 2024; 62:10-20. [PMID: 38063033 DOI: 10.1097/aia.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Maxim Pochebyt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Medicine, Stanford, California
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Han J, Xu Y, Shan Y, Xie Y, Wang A, Gu C. Could C3, 4, and 5 Nerve Root Block be a Better Alternative to Interscalene Block Plus Intermediate Cervical Plexus Block for Patients Undergoing Surgery for Midshaft and Medial Clavicle Fractures? A Randomized Controlled Trial. Clin Orthop Relat Res 2023; 481:798-807. [PMID: 36730478 PMCID: PMC10013610 DOI: 10.1097/corr.0000000000002479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Variable innervation of the clavicle is a major challenge in surgery of clavicle fractures with patients under regional anesthesia. An interscalene block (ISB) combined with an intermediate cervical plexus block (ICPB) provides analgesia in clavicle fracture surgery, but this combination does not completely block sensation in the midshaft or medial clavicle. Cervical nerve root block is an alternative to deep cervical plexus block and has recently been used as an analgesic method in the neck and shoulder. Whether it should be used as an alternative for midshaft and medial clavicle fractures is unknown. QUESTIONS/PURPOSES In this randomized controlled trial, we compared a C3, 4, and 5 nerve root block to ISB combined with ICPB in surgery of midshaft and medial clavicle fractures in terms of the (1) proportion of patients achieving a sensory block that is sufficient for surgery, (2) onset time and duration of the block, and (3) effectiveness of postoperative analgesia, as measured by pain scores and consumption of analgesics. METHODS Between November 2021 and December 2021, we treated 154 patients for clavicle fractures. A total of 122 were potentially eligible, 91 of whom agreed to participate in this study. Twenty-nine patients were excluded because the patients chose general anesthesia or declined to undergo surgery. Ultimately, 62 patients were randomly allocated into the C3, 4, and 5 group or ISB + ICPB group, with 31 patients in each group; there were no dropouts. All patients were analyzed in the group they were randomized to under intention-to-treat principles. The assessor and patients were blinded to randomization throughout the trial. The two groups did not differ in any important ways, including age, gender, BMI, American Society of Anesthesiologists classification, and type of clavicle fracture. The two groups received either an ultrasound-guided C3, 4, and 5 nerve root block with 2, 3, and 5 mL of 0.5% ropivacaine or ultrasound-guided ISB with ICPB with 20 mL of 0.5% ropivacaine. The primary outcome was the proportion of patients in each group with a successful nerveba block who did not receive general anesthesia; this was defined as nerve block success. Secondary outcomes included the onset time and duration of the sensory block, defined as the onset to the moment when the patients felt pain and sought rescue analgesia; pain assessment in terms of the numeric rating scale (NRS) score (range 0 to 10) for pain after nerve block before and during surgery; and the median amount of sufentanil consumed intraoperatively and postoperatively in the recovery room. The dosing of sufentanil was determined by the assessor when the NRS score was 1 to 3 points. If the NRS score was more than 3 points, general anesthesia was administered as a rescue method. Complications after the two inventions such as toxic reaction, dyspnea, hoarseness, pneumothorax, and Horner syndrome were also recorded in this study. RESULTS A higher proportion of patients in the C3, 4, and 5 group had a successful nerve block than in the ISB + ICPB group (97% [30 of 31] versus 68% [21 of 31], risk ratio 6 [95% CI 1.5 to 37]; p < 0.01). The median onset time was 2.5 minutes (range 2.0 to 3.0 minutes) in the C3, 4, and 5 group and 12 minutes (range 9 to 16 minutes) in the ISB + ICPB group (difference of medians 10 minutes; p < 0.001). The sensory block duration was 10 ± 2 hours in the C3, 4, and 5 group and 8 ± 2 hours in the ISB + ICPB group (mean difference 2 hours [95% CI 1 to 3 hours]; p < 0.001). The median sufentanil consumption was lower in the C3, 4, 5 group than in the ISB + ICPB (median 5 µg [range 0.0 to 5.0 µg] versus median 0 µg [range 0.0 to 0.0 µg]; difference of medians 5.0 µg; p < 0.001). There were no differences between the two groups regarding NRS scores after nerve blocks and NRS score for incision and periosteum separation, with the minimum clinically important difference set at a 2-point difference (of 10). There were no severe complications in this study. CONCLUSION Based on our analysis of the data, a C3, 4, and 5 nerve root block was better than ISB combined with ICPB for surgery to treat medial shaft and medial clavicle fractures. When choosing the anesthesia method, however, the patient's basic physiologic condition and possible complications should be considered. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Junde Han
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yang Xu
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yu Shan
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yaming Xie
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Aizhong Wang
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Chentao Gu
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Tomas VG, Hollis N, Ouanes JPP. Regional Anesthesia for Vascular Surgery and Pain Management. Anesthesiol Clin 2022; 40:751-773. [PMID: 36328627 DOI: 10.1016/j.anclin.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Patients undergoing vascular surgery tend to have significant systemic comorbidities. Vascular surgery itself is also associated with greater cardiac morbidity and overall mortality than other types of noncardiac surgery. Regional anesthesia is amenable as the primary anesthetic technique for vascular surgery or as an adjunct to general anesthesia. When used as the primary anesthetic, regional anesthesia techniques avoid complications associated with general anesthesia in this challenging patient population. In this article, the authors describe regional anesthetic techniques for carotid endarterectomy, arteriovenous fistula creation, lower extremity bypass surgery, and amputation.
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Affiliation(s)
- Vicente Garcia Tomas
- Department of Anesthesiology, Regional Anesthesia and Acute Pain Medicine, Northwestern University Feinberg School of Medicine Chicago, 251 E. Huron St F5-704, Chicago, IL 60611, USA.
| | - Nicole Hollis
- Department of Anesthesiology, West Virginia University, 1 Medical Center Drive PO Box 8255, Morgantown, WV 26508, USA
| | - Jean-Pierre P Ouanes
- Cornell Medicine, Hospital for Special Surgery, Florida, 300 Palm Beach Lakes Boulevard, West Palm Beach, FL 33401, USA
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Li R. Application of Ultrasound-Guided Cervical Plexus Block in Type I Thyroid Cartilage Laryngoplasty and Vocal Cord Medialization Surgery. EAR, NOSE & THROAT JOURNAL 2022:1455613221115114. [PMID: 35861187 DOI: 10.1177/01455613221115114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Under the background that cervical plexus block (CPB) is often adopted for type I thyroid cartilage laryngoplasty (TCL) and vocal cord medialization (VCM), the present study sought to investigate whether ultrasound-guided CPB (USCPB) could improve the efficiency of type I TCL and VCM. METHODS Patients with TCL were enrolled and subjected to deep and superficial USCPBs. Intravenous dexmedetomidine pumping was used to assist the painless sedation and ensure the patients to be awake for phonation during surgery. Blood pressure, electrocardiogram, heart rate (HR), and blood oxygen saturation (SpO2) of patients were recorded. The complications, like local anesthetic toxicity and total spinal anesthesia, were monitored. RESULTS All patients underwent CPB without infiltration anesthesia and complication. The use of Sufentanil at the dose of 5-10 μg was reported in 2 of 15 patients. No Horner syndrome was discovered in patients after anesthesia, and total intravenous anesthesia with intravenous pumping of dexmedetomidine was effective. During surgery, HR, diastolic blood pressure and mean blood pressure were barely changed, but systolic blood pressure was decreased. CONCLUSION Ultrasound-guided CPB with the intravenous dexmedetomidine pumping is a safe anesthesia method for patients during TCL.
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Affiliation(s)
- Ronggang Li
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
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Seidel R, Wree A, Schulze M. Anastomoses (Superficial Cervical Ansa) Between the Cervical Plexus and Peripheral Facial Nerve Branches: Implications for Regional Anesthesia in Carotid Endarterectomies - Anatomical Study. Local Reg Anesth 2021; 14:133-138. [PMID: 34675651 PMCID: PMC8520968 DOI: 10.2147/lra.s328987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/02/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Sensory innervation in the carotid triangle involves the cervical plexus, cranial nerves, and the sympathetic trunk. This innervation also applies to skin incision, including various anatomical structures with potentially different innervation, such as the skin (dermatomes), the platysma (myotomes), and the superficial layer of the cervical fascia (fasciotomes), as well as retromandibular retractor insertion (co-innervation: V, VII). The aim of this anatomical study was to develop an injection technique for carotid endarterectomies to additionally block anastomoses between the transverse cervical nerve (TCN), the cervical branch VII (CB VII), and the marginal mandibular branch VII (MMB VII). These anastomoses are also termed superficial cervical ansa (SCA). Materials and Methods Preparations (n=16) were performed on unembalmed donor cadavers (n=8). Subplatysmal injections (each using 5 mL of Alcian blue) were performed cranially within the carotid triangle between the anterior margin of the sternocleidomastoid muscle and the submandibular gland. Results Anastomoses between the TCN, CB VII, and MMB VII were stained in all preparations (n=16). Conclusion This anatomical study presents an ultrasound-guided subplatysmal SCA block to optimize, in addition to a cervical plexus block, the quality of anesthesia for carotid endarterectomies.
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Affiliation(s)
- Ronald Seidel
- Asklepios Medical Center, Department of Anesthesiology and Intensive Care, Schwedt, 16303, Germany
| | - Andreas Wree
- Rostock University Medical Center, Institute of Anatomy, Rostock, DE-18057, Germany
| | - Marko Schulze
- Bielefeld University Medical Center OWL, Working Group 3: Anatomy and Cell Biology, Bielefeld, DE-33501, Germany
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Uhlig C, Vicent O, Spieth S, Ludwig S, Reeps C, Heller AR, Thea K, Spieth PM, Rössel T. Influence of Anatomic Conditions on Efficacy and Safety of Combined Intermediate Cervical Plexus Block and Perivascular Infiltration of Internal Carotid Artery in Carotid Endarterectomy: A Prospective Observational Trial. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2890-2902. [PMID: 34325958 DOI: 10.1016/j.ultrasmedbio.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/22/2021] [Accepted: 05/11/2021] [Indexed: 06/13/2023]
Abstract
Ultrasound-guided intermediate cervical plexus blockade with perivascular infiltration of the carotid artery bifurcation perivacular block (PVB) is a reliable technique for regional anesthesia in carotid endarterectomy (CEA). We investigated the effect of the carotid bifurcation level (CBL) on PVB efficacy and safety in patients undergoing CEA. This prospective observational cohort study included 447 consecutive CEA patients who received PVB over a 6-y period. Vascular and neurologic puncture-related complications were recorded. The CBL was localized at the low level (C4 and C5 vertebra, low-level [LL] group) in 381 (85.2%) patients and at the high level (C2 and C3 vertebra, high-level [HL] group) in 66 (14.8%) patients. Local anesthetic supplementation by surgeons was necessary in 64 (14.3%) patients in the LL group and 38 (59.4%) patients in the HL group (p < 0.001) and was associated with a higher rate of central neurologic complications in the HL group (p = 0.031). Therefore, the efficacy of the PVB may be influenced by the CBL.
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Affiliation(s)
- Christopher Uhlig
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Oliver Vicent
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Stephanie Spieth
- Department of Radiology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ludwig
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Reeps
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Axel R Heller
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Koch Thea
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Peter Markus Spieth
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Thomas Rössel
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
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Carotid Endarterectomy Under Carotid Sheath Block Combined with Superficial Cervical Plexus Block by Ultrasound Guidance. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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9
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Yilmaz F, Bas K. Which Term Should Be Used for Local Infiltration Anesthesia for Carotid Endarterectomy? A Narrative Review. J Cardiothorac Vasc Anesth 2021; 35:2831-2832. [PMID: 33608191 DOI: 10.1053/j.jvca.2021.01.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Fulya Yilmaz
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
| | - Koray Bas
- Department of General Surgery, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Saranteas T, Kostroglou A, Efstathiou G, Giannoulis D, Moschovaki N, Mavrogenis AF, Perisanidis C. Peripheral nerve blocks in the cervical region: from anatomy to ultrasound-guided techniques. Dentomaxillofac Radiol 2020; 49:20190400. [PMID: 32176537 DOI: 10.1259/dmfr.20190400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cervical plexus nerve blocks have been employed in various head and neck operations. Both adequate anaesthesia and analgesia are attained in clinical practice. Nowadays, ultrasound imaging in regional anaesthesia is driven towards a certain objective that dictates high accuracy and safety during the implementation of peripheral nerve blocks. In the cervical region, ultrasound-guided nerve blocks have routinely been conducted only for the past few years and thus only a small number of publications pervade the current literature. Moreover, the sonoanatomy of the neck, the foundation stone of interventional techniques, is very challenging; multiple muscles and fascial layers compose a complex of compartments in a narrow anatomic region, in which local anaesthetics are injected. Therefore, this review intends to deliver new insights into ultrasound-guided peripheral nerve block techniques in the neck. The sonoanatomy of the cervical region, in addition to the cervical plexus, cervical ganglia, superior and recurrent laryngeal nerve blocks are comprehensively discussed.
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Affiliation(s)
- Theodosios Saranteas
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Andreas Kostroglou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgia Efstathiou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Giannoulis
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nefeli Moschovaki
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, University Medical School, Athens, Greece
| | - Christos Perisanidis
- Department of Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
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Steinfeldt T, Kessler P, Vicent O, Schwemmer U, Döffert J, Lang P, Mathioudakis D, Hüttemann E, Armbruster W, Sujatta S, Lange M, Weber S, Reisig F, Hillmann R, Volk T, Wiesmann T. [Peripheral truncal blocks-Overview and assessment]. Anaesthesist 2020; 69:860-877. [PMID: 32620990 DOI: 10.1007/s00101-020-00809-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
By implementation of sonography for regional anesthesia, truncal blocks became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety and helps to avoid complications during needle placement. Additionally, complex punctures are possible that were associated with higher risk using landmarks alone. Next to the blocking of specific nerve structures, interfascial and compartment blocks have also become established, whereby the visualization of individual nerves and plexus structures is not of relevance. The present review article describes published and clinically established puncture techniques with respect to the indications and procedures. The clinical value is reported according to the scientific evidence and the analgesic profile. Moreover, the authors explain potential risks, complications and dosing of local anesthetic agents.
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Affiliation(s)
- T Steinfeldt
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Diakoneo DIAK Klinikum, Diakoniestr. 10, 74523, Schwäbisch Hall, Deutschland.
- Klinik für Anästhesie und Intensivtherapie, Philipps-Universität Marburg, Baldingerstr., 35033, Marburg, Deutschland.
| | - P Kessler
- Abteilung für Anästhesiologie, Intensiv- und Schmerzmedizin, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland
| | - O Vicent
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Karl-Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - U Schwemmer
- Klinik für Anästhesiologie und Intensivmedizin, Kliniken des Landkreises Neumarkt i.d.OPf., Nürnberger Str. 12, 92318, Neumarkt i.d.OPf., Deutschland
| | - J Döffert
- , Leipzigerstraße 18, 76356, Weingarten, Deutschland
| | - P Lang
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Burger Str. 80, 96049, Bamberg, Deutschland
| | - D Mathioudakis
- Centre Hospitalier Bienne, Chante-Merle 84, Case postale, 2501, Bienne, Schweiz
| | - E Hüttemann
- Klinik für Anästhesiologie und Intensivmedizin, Klinikum Worms gGmbH, Gabriel-von-Seidl-Straße 81, 67550, Worms, Deutschland
| | - W Armbruster
- Klinik für Anästhesiologie, Intensivmedizin, Schmerztherapie, Evangelisches Krankenhaus Unna, Holbeinstraße 10, 59423, Unna., Deutschland
| | - S Sujatta
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Bayreuth GmbH, Preuschwitzer Straße 101, 95445, Bayreuth, Deutschland
| | - M Lange
- Abteilung Anästhesie und Intensivtherapie, Waldkrankenhaus "Rudolf Elle" GmbH, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland
| | - S Weber
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Heilig Geist Krankenhaus Köln, Graseggerstr. 105, 50737, Köln, Deutschland
| | - F Reisig
- Standort Burgdorf, Schweiz. Abteilung für Anästhesiologie, Spital Emmental, Oberburgstraße 54, 3400, Burgdorf, Schweiz
| | - R Hillmann
- , Goethestr. 35, 73614, Schorndorf, Deutschland
| | - T Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Gebäude 57, 66421, Homburg, Deutschland
| | - T Wiesmann
- Klinik für Anästhesie und Intensivtherapie, UKGM Gießen-Marburg, Standort Marburg, Baldingerstr., 35033, Marburg, Deutschland
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Abstract
Regional anesthesia has been an undervalued entity in neuroanesthetic practice. However, in the past few years, owing to the development of more advanced techniques, drugs and the prolific use of ultrasound guidance, the unrecognised potential of these modalities have been highlighted. These techniques confer the advantages of reduced requirements for local anesthetics, improved hemodynamic stability in the intraoperative period, better pain score postoperatively and reduced analgesic requirements in the postoperative period. Reduced analgesic requirement translates into lesser side effects associated with analgesic use. Furthermore, the transition from the traditional blind landmark-based techniques to the ultrasound guidance has increased the reliability and the safety profile. In this review, we highlight the commonly practised blocks in the neuroanesthesiologist's armamentarium and describe their characteristics, along with their individual particularities.
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Affiliation(s)
- Ashutosh Kaushal
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Rudrashish Haldar
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Cervical plexus and greater occipital nerve blocks: controversies and technique update. Reg Anesth Pain Med 2019; 44:623-626. [DOI: 10.1136/rapm-2018-100261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/14/2019] [Accepted: 02/01/2019] [Indexed: 11/03/2022]
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14
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Seidel R, Zukowski K, Wree A, Schulze M. Ultrasound-guided intermediate cervical plexus and additional peripheral facial nerve block for carotid endarterectomy. Anaesthesist 2018; 67:907-913. [DOI: 10.1007/s00101-018-0493-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/25/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
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Postoperative Analgesic Effect of Ultrasound-Guided Intermediate Cervical Plexus Block on Unipolar Sternocleidomastoid Release With Myectomy in Pediatric Patients With Congenital Muscular Torticollis. Reg Anesth Pain Med 2018; 43:634-640. [DOI: 10.1097/aap.0000000000000797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol 2018; 71:274-288. [PMID: 29969890 PMCID: PMC6078883 DOI: 10.4097/kja.d.18.00143] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/24/2018] [Indexed: 12/14/2022] Open
Abstract
Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.
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Affiliation(s)
- Jin-Soo Kim
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Justin Sangwook Ko
- Depatment of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine,, Seoul, Korea
| | - Seunguk Bang
- Depatment of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
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Campoy L, Morris TB, Ducharme NG, Gleed RD, Martin-Flores M. Unilateral cervical plexus block for prosthetic laryngoplasty in the standing horse. Equine Vet J 2018; 50:727-732. [PMID: 29675966 DOI: 10.1111/evj.12956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Locoregional anaesthetic techniques can facilitate certain surgeries being performed under standing procedural sedation. The second and third spinal cervical nerves (C2, C3) are part of the cervical plexus and provide sensory innervation to the peri-laryngeal structures in people; block of these nerves might permit laryngeal lateralisation surgery in horses. OBJECTIVES To describe the anatomical basis for an ultrasound-guided cervical plexus block in horses. To compare this block with conventional local anaesthetic tissue infiltration in horses undergoing standing prosthetic laryngoplasty. STUDY DESIGN Cadaveric study followed by a double-blinded prospective clinical trial. METHODS A fresh equine cadaver was dissected to characterise the distribution of C2 and C3 to the perilaryngeal structures on the left side. A second cadaver was utilised to correlate ultrasound images with the previously identified structures; a tissue marker was injected to confirm the feasibility of an ultrasound-guided approach to the cervical plexus. In the clinical study, horses were assigned to two groups, CP (n = 17; cervical plexus block) and INF (n = 17; conventional tissue infiltration). Data collection and analyses included time to completion of surgical procedure, sedation time, surgical field conditions and surgeon's perception of block quality. RESULTS We confirmed that C2 and C3 provided innervation to the perilaryngeal structures. The nerve root of C2 was identified ultrasonographically located between the longus capitis and the cleidomastoideus muscles, caudal to the parotid gland. The CP group was deemed to provide better (P<0.0002) surgical conditions with no differences in the other variables measured. MAIN LIMITATIONS Further studies with larger numbers of horses may be necessary to detect smaller differences in surgical procedure completion time based on the improved surgical filed conditions. CONCLUSIONS For standing unilateral laryngeal surgery, a cervical plexus block is a viable alternative to tissue infiltration and it improves the surgical field conditions.
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Affiliation(s)
- L Campoy
- Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA
| | - T B Morris
- Cornell Ruffian Equine Specialists, New York, New York, USA
| | - N G Ducharme
- Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA
| | - R D Gleed
- Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA
| | - M Martin-Flores
- Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA
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