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Farrow RA, Shalaby M, Newberry MA, Montes De Oca R, Kinas D, Farcy DA, Zitek T. Implementation of an Ultrasound-Guided Regional Anesthesia Program in the Emergency Department of a Community Teaching Hospital. Ann Emerg Med 2024; 83:509-518. [PMID: 38142373 DOI: 10.1016/j.annemergmed.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/06/2023] [Accepted: 11/09/2023] [Indexed: 12/25/2023]
Abstract
STUDY OBJECTIVE We sought to initiate an emergency department (ED)-based ultrasound-guided regional anesthesia (UGRA) program in our community teaching hospital system. Here, we present our development process and protocol. We also sought to assess the types, indications, and associated adverse event rates for the UGRA procedures in this study. METHODS We conducted a retrospective analysis of prospectively collected quality assurance data from a case series of patients who underwent an UGRA procedure in the ED. In August 2020, we developed an UGRA program for our community teaching hospital and its 2 affiliated freestanding EDs. For quality assurance purposes, we tracked all UGRA procedures performed in the ED, and we specifically assessed adverse events using structured follow-up. We subsequently obtained approval from our institutional review board to perform chart reviews of the patients in our dataset to abstract additional data and formally perform a research study. We determined the frequency with which different UGRA procedures were performed, and we calculated the adverse event rate. RESULTS Between August 24, 2020, and July 15, 2022, a total of 18 different sonographers performed and documented 229 UGRA procedures on 206 unique patients. This included 28 different types of procedures. Follow-up after disposition was successful in 82.0% of patients. In 2 cases, the patient reported no pain relief at all from the procedure, but no patients reported complications related to the procedure. CONCLUSION We successfully initiated a robust ED-based UGRA program in our community teaching hospital system. Among patients with successful follow-up, no adverse events were identified.
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Affiliation(s)
- Robert A Farrow
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL.
| | - Michael Shalaby
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL
| | - Mark A Newberry
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL
| | - Roman Montes De Oca
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL
| | - David Kinas
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL
| | - David A Farcy
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL
| | - Tony Zitek
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL
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Paiva A, Ferreira JB, Serrano S. Does Interventional Pain Management Play a Role in the Treatment of Cervical Post-Surgical Neuropathic Pain? Cureus 2023; 15:e48996. [PMID: 38111415 PMCID: PMC10727450 DOI: 10.7759/cureus.48996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
Post-surgical neuropathic pain is still an underdiagnosed medical condition with persistent pain occurring in 10-50% of patients submitted to surgery. We present a case of a 52-year-old patient with persistent paracervical, supraclavicular, and upper chest neuropathic pain after the excision of a massive deep right cervical tumor, concluded to be an accessory spinal nerve schwannoma. A thorough physical and ultrasound examination helped conclude injury of the superficial cervical plexus. Therefore, an ultrasound-guided hydrodissection of several neuromas was performed at the level of the superficial cervical plexus. After three procedures, pain and quality of life scores improved, with a reduction of anxiety and depression symptoms. Due to the positive response, the patient was referred for a peripheral nerve stimulator implantation, allowing self-control of pain, in a home setting.
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Affiliation(s)
- António Paiva
- Physical Medicine and Rehabilitation, Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, PRT
| | | | - Simão Serrano
- Physical Medicine and Rehabilitation, Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, PRT
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Graglia S, Kornblith A. Point-of-care ultrasound-guided regional anaesthesia: the superficial cervical plexus block for a patient with a clavicle fracture. Emerg Med J 2023; 40:694-697. [PMID: 37604655 DOI: 10.1136/emermed-2023-213071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Sally Graglia
- Emergency Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Emergency Medicine, UCSF, San Francisco, California, USA
- Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Aaron Kornblith
- Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
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Patel H, Shah N, Syed A, Shah P, Macwan S. Evaluating the Analgesic Efficacy of Superficial Cervical Plexus Block for Head and Neck Surgeries: A Comparative Randomized Control Study. Cureus 2023; 15:e39303. [PMID: 37346207 PMCID: PMC10281613 DOI: 10.7759/cureus.39303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION In the present study, the advantages of superficial cervical plexus block (SCPB) were evaluated using a landmark-guided method. Our primary aim was to evaluate the analgesic efficacy of SCPB in various head and neck surgeries by observing intra- and postoperative requirements of the total dose of the systemic analgesic, visual analog scale (VAS) score, and the total duration of analgesia; vital parameters and associated perioperative complications were also observed. MATERIALS AND METHODS Sample size was calculated using reference by taking the parameter pain score at 12 hours using MedCalc software v. 19.5.1 (MedCalc Software, Ostend, Belgium) with a mean difference of score 3±3.5 between two groups, 80% power, and 95% confidence interval (CI); the sample size for each group was 21. There were 30 patients in each group of ASA I, II, and III who were posted for mandibular, tympanomastoid and clavicular surgeries. Group A received general anaesthesia with systemic analgesia and Group B received general anaesthesia followed by SCPB with an injection of bupivacaine 0.25% 10ml on each side according to the site of surgery. VAS score, intra and postoperative analgesic requirement in 24 hours, time of first demand bolus, and peri-operative complications were noted. RESULTS Intraoperative fentanyl requirement for group A was 97.5±13.75 µg as compared to group B (70.16±13.09 µg), postoperative injection paracetamol requirement was also significantly higher in group A (2566.66±504 mg) as compared to group B (833.33±874.28 mg). The total duration of analgesia was significantly higher in Group B (1191.33±375.36 min) as compared to Group A (122.0±50.88 min) with a p-value <0.0001. No significant complications were noted in any patient. CONCLUSION SCPB provides better perioperative analgesia by decreasing intraoperative as well as postoperative systemic analgesic requirements and their associated side effects, with no significant perioperative complications in various head and neck region surgeries.
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Affiliation(s)
- Himani Patel
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Neha Shah
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Afroza Syed
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Panjari Shah
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Sharmy Macwan
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
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Manaswini T, Girish T. U, Anil Kumar M. R. A Clinical Study on Neck Surgeries Under Superficial Cervical Plexus Block as an Alternative to General Anesthesia in High-Risk Cases. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03517-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Ozgun M, Hosten T, Solak M. Effect of Bilateral Superficial Cervical Plexus Block on Postoperative Analgesic Consumption in Patients Undergoing Thyroid Surgery. Cureus 2022; 14:e21212. [PMID: 35174021 PMCID: PMC8840830 DOI: 10.7759/cureus.21212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Patients complain of moderate-intensity pain following thyroid surgery. Superficial cervical plexus block (SCPB) can be employed as a component of multimodal analgesia after thyroid surgery. This double-blind, randomized study aimed to compare the effects of bilateral SCPB (BSCPB) on postoperative analgesic requirements following thyroid surgery. Methods A total of 60 American Society of Anesthesiologists (ASA) I-II patients who underwent elective total thyroidectomy under general anesthesia were randomly assigned to Group 1 and Group 2. After inducing general anesthesia, BSCPB was not administered to Group 1, whereas BSCPB was administered using a three-point injection technique with 0.5% levobupivacaine in Group 2. Patient-controlled analgesia (PCA) was applied by using tramadol in both groups for postoperative analgesia. Tenoxicam was administered as rescue analgesic to patients in case of numeric rating scale (NRS) >4. The postoperative consumption of tramadol, rescue analgesic requirement, and hoarseness, hematoma, signs of local anesthetic toxicity were recorded. Results The consumption of tramadol for PCA at two, six, 12, and 24 hours postoperatively, NRS scores in the recovery room, and the number of patients who used tenoxicam as rescue analgesic were significantly lower in Group 2 than in Group 1. The hemodynamic values were similar between the groups. Conclusions Our study demonstrates that BSCPB, when applied as a component of multimodal analgesia, is an effective method for reducing the analgesic requirements following thyroid surgery.
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El Bendary HM, Abd El-Fattah AM, Ebada HA, Hayes SMS. Levobupivacaine versus levobupivacaine – dexmedetomidine for ultrasound guided bilateral superficial cervical plexus block for upper tracheal resection and reconstruction surgery under general anesthesia. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.2002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Hanaa M. El Bendary
- Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Al Mansurah, Egypt
| | - Ahmed M Abd El-Fattah
- Oto-Rhino-Laryngology Department, Faculty of Medicine, Mansoura University, Al Mansurah, Egypt
| | - Hisham A Ebada
- Oto-Rhino-Laryngology Department, Faculty of Medicine, Mansoura University, Al Mansurah, Egypt
| | - Salwa MS Hayes
- Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Al Mansurah, Egypt
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Zhou HS, Li TT, Pi Y, Wen S, Wang TH, Xiong LL. Ultrasound-Guided Selective Pulsed Radiofrequency Treatment of Great Auricular Nerve for Post-Herpetic Neuralgia of the Head and Neck: A Case Report. J Pain Res 2021; 14:3301-3307. [PMID: 34703305 PMCID: PMC8541760 DOI: 10.2147/jpr.s312805] [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: 03/25/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The current study aimed to further verify the feasibility of ultrasound-guided selective pulsed radiofrequency (PRF) therapy of greater auricular nerve (GAN) in the treatment of head and neck post-herpetic neuralgia (PHN) by observing the efficacy and safety. Methods Under the guidance of high-frequency ultrasound (Frequency: 10 MHz), the GAN was identified by a radiofrequency electrode trocar with a transverse in-plane approach, which was inserted into the GAN, then the inner needle of the trocar was retracted. After adjusting the technical variables (electrode tip temperature: 42°C, output voltage: 60 V, pulse frequency: 2 Hz, pulse width: 22 ms, single duration: 240 s, two times), the radiofrequency electrode placed on the auricle and below the ear for sensory and motor tests began to work. Results The pain in the left head and neck of the patient lasted for more than 1 month, we decided to try selective PRF of GAN guided by ultrasound for the first time. Immediately after the treatment, 11-point pain intensity numerical rating scale (PI-NRS) score ranged from 5 to 1. During his hospitalization, mecobalamine and gabapentin were taken instead of opioids. Seven days after the procedure, PI-NRS score was 2, the degree of numbness the patient he felt by himself in the original lesion area relieved from 100% to 40%, the depression module of the Patient Health Questionnaire-9 (PHQ-9) score was from 7 to 5, the Generalized Anxiety Disorder-7 (GAD-7) score from 8 to 4, the range of pain areas was reduced to external auditory tract, and there were no adverse events occurring. Conclusion The ultrasound-guided selective PRF treatment of GAN was safe and effective in the improvement of PHN in the head and neck, which is worthy of clinical promotion.
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Affiliation(s)
- Hong-Su Zhou
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
| | - Ting-Ting Li
- Editorial Department of Ibrain Journal, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
| | - Yu Pi
- National Traditional Chinese Medicine Clinical Research Base and Western Medicine Translational Medicine Research Center, South West Medical University, Luzhou, 646000, People's Republic of China
| | - Song Wen
- Pain Management, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
| | - Ting-Hua Wang
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
| | - Liu-Lin Xiong
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People's Republic of China
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The emergency medicine management of clavicle fractures. Am J Emerg Med 2021; 49:315-325. [PMID: 34217972 DOI: 10.1016/j.ajem.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Clavicle fractures are common. An emergency physician needs to understand the diagnostic classifications of clavicle fractures, have a plan for immobilization, identify associated injuries, understand the difference between treating pediatric and adult patients, and have an approach to multimodal pain control. It is also important to understand when expert orthopedic consultation or referral is indicated. OBJECTIVE OF THE REVIEW To provide an evidence-based review of clavicle fracture management in the emergency department. DISCUSSION Clavicle fractures account for up to 4% of all fractures evaluated in the emergency department. They can be separated into midshaft, distal, and proximal fractures. They are also classified in terms of their degree of displacement, comminution and shortening. Emergent referral is indicated for open fractures, posteriorly displaced proximal fractures, and those with emergent associated injuries. Urgent referral is warranted for fractures with greater than 100% displacement, fractures with >2 cm of shortening, comminuted fractures, unstable distal fractures, and floating shoulder. Nondisplaced or minimally displaced fractures with no instability or associated neurovascular injury are managed non-operatively with a sling. Pediatric fractures are generally managed conservatively, with adolescents older than 9 years-old for girls and 12 years-old for boys being treated using algorithms that are similar to adults. CONCLUSIONS When encountering a patient with a clavicle fracture in the emergency department the fracture pattern will help determine whether emergent consultation or urgent referral is indicated. Most patients can be discharged safely with sling immobilization and appropriate outpatient follow-up.
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Abdelghany MS, Ahmed SA, Afandy ME. Superficial cervical plexus block alone or combined with interscalene brachial plexus block in surgery for clavicle fractures: a randomized clinical trial. Minerva Anestesiol 2021; 87:523-532. [PMID: 33591139 DOI: 10.23736/s0375-9393.21.14865-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The regional anesthesia technique which is suitable for fracture clavicle is a matter of debate. This study aimed to compare the use of superficial cervical plexus alone or in combination with interscalene block in patients undergoing internal fixation of fractured clavicle. METHODS Seventy patients undergoing internal fixation of fractured clavicle were enrolled in this clinical trial and randomly distributed into two groups; superficial cervical plexus block (CPB) group and combined superficial cervical plexus block and interscalene block (ISB) group. The regional anesthesia techniques were performed before induction of general anesthesia. The intraoperative fentanyl and isoflurane consumption, the postoperative morphine consumption, the postoperative pain score, the duration of postoperative analgesia, the incidence of perioperative complications, and the patient's satisfaction were recorded. RESULTS In comparison to the use of combined CPB and ISB, the use of CPB alone did not significantly change the postoperative morphine consumption (8.4±3.3 mg versus 7.3±3.2 mg [P=0.2]), the time to the first request of postoperative analgesia (396.7 193.4 min versus 407.7±150.0 min [P=0.8]), or the postoperative pain score (P˃0.05). Also, it did not change the intraoperative fentanyl consumption (P=0.3), the intraoperative isoflurane consumption (P=0.7), the incidence of perioperative complication, or the degree of patient's satisfaction (P˃0.05). It significantly decreased the incidence of phrenic nerve palsy (P=0.03). CONCLUSIONS In patients undergoing internal fixation of clavicular fracture, the perioperative analgesic effect of SCP alone is equally effective to its use in combination with ISB.
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Affiliation(s)
- Mohamed S Abdelghany
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sameh A Ahmed
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | - Mohamed E Afandy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
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Çelebioğlu EC, Bilgiç MS. Ultrasound-guided supraclavicular nerve block for implantable port catheters: Does it show a significant difference in pain control? J Vasc Access 2021; 23:206-211. [PMID: 33413021 DOI: 10.1177/1129729820987358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nerve blocks have been used for decades at head and neck region interventions and recently introduced as an alternative option for subcutaneous port implantation. This study aimed to compare two different local anesthesia techniques used during subcutaneous port implantation. METHODS This retrospective study was conducted with 107 patients who were categorized into two groups according to the local anesthesia techniques used during port implantations. Group 1 underwent local infiltration anesthesia and Group 2 received an ultrasound-guided supraclavicular nerve block. In both groups, prilocaine 2% was used for skin anesthesia and no other systemic anesthetic drugs or additional local anesthetics were administered during port implantation. Local anesthetic doses were 400 mg in Group 1 and 200 mg in Group 2. The time required for adequate cutaneous anesthesia, procedure time, complication rate and visual analog scale (VAS) score were recorded for each patient. RESULTS Groups 1 and 2 contained 58 and 49 patients respectively. Both groups showed similar demographic distributions of patients (p > 0.05). Mean procedure times and the time required for adequate cutaneous anesthesia were longer in Group 2 (p < 0.05). Group 2 also showed 12 immediate complications, although they were temporary and recovered without any intervention under surveillance. Mean VAS scores during port implantation were similar in both groups [Group 1: 1.17(±0.60), Group 2: 1.1(±0.62)] (p > 0.05). CONCLUSIONS The VAS scores did not differ significantly between groups. Although a supraclavicular nerve block may require lower local anesthetic doses for similar cutaneous anesthesia, it is associated with higher immediate complication rates due to unintended blockade of the peripheral nerves. Thus, if the nerve block is preferred over local infiltration anesthesia during port implantation, to prevent life-threatening complications, caution needed especially for the patients with contralateral vocal cord or diaphragm paralysis.
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Affiliation(s)
- Emre Can Çelebioğlu
- Department of Radiology/Vascular Interventional Radiolgy, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Sadık Bilgiç
- Department of Radiology/Vascular Interventional Radiolgy, Ankara University School of Medicine, Ankara, Turkey
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Ultrasound-guided interscalene block combined with intermediate or superficial cervical plexus block for clavicle surgery: A randomised double blind study. Eur J Anaesthesiol 2020; 37:979-983. [PMID: 32833851 DOI: 10.1097/eja.0000000000001300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The complex innervation of the clavicle makes general anaesthesia a preferred technique for clavicular surgeries in current practice. The role and approach of regional anaesthesia remains unanswered. OBJECTIVES This study aims to delineate the relative effectiveness between interscalene brachial plexus block with either intermediate cervical plexus or superficial cervical plexus block (CPB) as the anaesthetics for clavicular surgery. DESIGN A randomised, double-blind prospective study. SETTING Single-centre, tertiary care medical college and research institute. PATIENTS Fifty patients with American Society of Anesthesiologist's (ASA) grade I to III, aged 18 to 70 years, scheduled for clavicular surgery, during May 2018 to April 2019 were enrolled in this study. INTERVENTION All patients received interscalene block with 10 ml of 0.5% bupivacaine. Patients were randomised to undergo additional ultrasound-guided intermediate CPB (Group-1) or superficial CPB (Group-2) with 10 ml of 0.5% bupivacaine. MAIN OUTCOME MEASURES The block success rate, sensory block onset time, haemodynamic parameters, duration of postoperative analgesia and complications were noted. Categorical data were analysed using the chi-square test and Fisher's exact test. Continuous data were analysed using Student's t-test. RESULT In Group 1, block success was 100%. In Group 2, five patients failed to achieve adequate surgical anaesthesia (P = 0.02). The average sensory block onset time in Group 1 was 2.5 ± 0.4 min and was longer in Group 2, 4.3 ± 0.5 min (P < 0.001). There was no difference between the groups with respect to haemodynamic parameters and complications. The mean duration of postoperative analgesia was longer in Group 1 (7.5 ± 0.8 h) as compared with Group 2 (5.7 ± 0.4 h, P < 0.001). CONCLUSION Ultrasound-guided combined interscalene and intermediate CPB had a better success rate, with faster sensory block onset time and prolonged postoperative analgesia as compared with interscalene and superficial CPB in patients undergoing clavicle surgery. TRIAL REGISTRATION Clinical trial registry of India (www.ctri.nic.in) - CTRI/2018/05/013785.
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Diaphragm-sparing brachial plexus blocks: a focused review of current evidence and their role during the COVID-19 pandemic. Curr Opin Anaesthesiol 2020; 33:685-691. [DOI: 10.1097/aco.0000000000000911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Olofsson M, Taffé P, Kirkham KR, Vauclair F, Morin B, Albrecht E. Interscalene brachial plexus block for surgical repair of clavicle fracture: a matched case-controlled study. BMC Anesthesiol 2020; 20:91. [PMID: 32312249 PMCID: PMC7171737 DOI: 10.1186/s12871-020-01005-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Innervation of the clavicle is complex and debated, with scarce data on the analgesic and clinical impact of regional anaesthesia after surgical repair of clavicle fracture. METHODS In order to assess the analgesic efficiency of an interscalene brachial plexus block (ISB) for surgical repair of clavicle fracture, 50 consecutive patients scheduled for surgical fixation of middle/lateral clavicle fracture under general anaesthesia with ISB were prospectively enrolled. This cohort was compared to a historical control of 76 retrospective patients without regional block. The primary outcome was total intravenous morphine equivalent consumption at 2 postoperative hours. To assess the ISB impact, both an overall cohort analysis and a case-matched analysis with each ISB-treated patient matched to a Non-ISB-treated patient was performed. Matching employed a 1-to-1, nearest-neighbour approach using the Mahalanobis metric. RESULTS In the overall cohort, patients with ISB had significantly lower i.v. morphine equivalent consumption at 2 postoperative hours (0.7 mg (95% CI 0.1 to 1.2) versus controls 8.8 mg (95% CI 7.1 to 10.4); P < 0.0001). These results persisted after case-matching the cohorts (mean difference for the primary outcome: 8.3 mg (95% CI 6.5 to 10.0); P < 0.001). CONCLUSIONS ISB provides effective analgesia after surgical fixation of middle and lateral clavicle fracture. These results should help physicians in establishing an analgesic strategy for this type of surgery. Further research is needed to identify the optimal regional technique for medial third clavicle fractures and the clinically relevant contributions of the cervical and brachial plexus. TRIAL REGISTRATION Clinicaltrials.gov - NCT02565342, October 1st 2015.
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Affiliation(s)
- Magnus Olofsson
- Department of Anaesthesia, Lausanne University Hospital, Rue du Bugnon 46, BH 05.311, 1011, Lausanne, Switzerland.
| | - Patrick Taffé
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Kyle Robert Kirkham
- Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Frédéric Vauclair
- Department of Orthopaedic, Lausanne University Hospital, Lausanne, Switzerland
| | - Bénédict Morin
- Department of Anaesthesia, Lausanne University Hospital, Rue du Bugnon 46, BH 05.311, 1011, Lausanne, Switzerland
| | - Eric Albrecht
- Department of Anaesthesia, Lausanne University Hospital, Rue du Bugnon 46, BH 05.311, 1011, Lausanne, Switzerland
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Ellison MB, Howell S, Heiraty P, Wilson C, Shepherd J, Ellison PR. A Novel Approach to Postoperative Ear Pain-Greater Auricular Nerve Block Catheter: A Case Report. A A Pract 2020; 14:21-24. [PMID: 31743117 DOI: 10.1213/xaa.0000000000001134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A 70-year-old man presented for repair of an ear avulsion injury sustained from an all-terrain vehicle accident. A continuous technique using a catheter for a greater auricular nerve (GAN) block was performed in the preoperative area followed by general anesthesia in the operating room. No opioids were administered during the surgical procedure or in the immediate postoperative period. The GAN catheter was kept in place for 3 days with near-complete pain relief per the patient. To our knowledge, there are no case reports that describe a continuous GAN technique for surgery and postoperative pain.
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Affiliation(s)
- Matthew B Ellison
- From the Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
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Odom M, Byrnes J, Herrman NWC, Micheller D, Seleno N, Majkrzak A. A Low-Fidelity, High-Functionality Ultrasound-Guided Serratus Plane Block Model. J Emerg Med 2019; 57:844-847. [PMID: 31708313 DOI: 10.1016/j.jemermed.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thoracic injuries present many challenges for management in the acute and inpatient settings, including achieving appropriate pain control. Traditional modalities, such as opioids and spinal epidural anesthesia, are associated with multiple complications. Ultrasound-guided regional nerve blocks are becoming more prevalent, and they have been shown to be an effective modality of pain control for other traumatic injuries. Models comprised of animal tissue to simulate human anatomy are widely utilized to facilitate training of needle-guided procedures, but no such model for the serratus anterior plane block has yet been defined in the literature. OBJECTIVES Our goal was to produce a high-functionality serratus anterior plane block model with reasonable anatomic fidelity from low-cost materials. DISCUSSION We describe the creation of an inexpensive high-functionality serratus anterior plane block model from common materials, including pork ribs and chicken breasts, to realistically simulate human anatomy, including multiple muscle and fascial planes, as well as to allow hydrodissection. CONCLUSIONS This model will facilitate training and can improve success when caring for patients with thoracic trauma.
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Affiliation(s)
- Mitchell Odom
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - James Byrnes
- Clinical Simulation Program for the Advancement of Patient Safety, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - Nicholas W C Herrman
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - Daniel Micheller
- Department of Emergency Medicine, United States Air Force Langley Hospital, Hampton, Virginia
| | - Nicole Seleno
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - Allen Majkrzak
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
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Casaletto E, Lin B, Wolfe SW, Lee SK, Sneag DB, Feinberg JH, Nwawka OK. Ultrasound imaging of nerves in the neck: Correlation with MRI, EMG, and clinical findings. Neurol Clin Pract 2019; 10:415-421. [PMID: 33299669 DOI: 10.1212/cpj.0000000000000767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/25/2019] [Indexed: 01/15/2023]
Abstract
Objective We evaluated the performance of ultrasound in the detection of neuropathy of the suprascapular nerve (SSN), long thoracic nerve (LTN), spinal accessory nerve (SAN), and phrenic nerve and compared this performance with MRI. Methods A retrospective review of 56 patients who had undergone ultrasound imaging of the SSN, LTN, SAN, and phrenic nerve was performed. Diagnoses made by ultrasound, MRI, EMG reports, and clinical and operative notes were recorded. Results Ultrasound was successful in visualizing nerves in the neck in the overwhelming majority of cases. Sonographic findings were typically in agreement with MRI and clinical findings. Conclusion Ultrasound is effective in the visualization and diagnostic evaluation of the SSN, LTN, SAN, and phrenic nerve. Classification of evidence This study provides Class IV evidence that ultrasound can effectively visualize and diagnose neuropathy of the SSN, LTN, SAN, and phrenic nerve in the neck.
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Affiliation(s)
- Emily Casaletto
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Bin Lin
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Scott W Wolfe
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Steve K Lee
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Darryl B Sneag
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Joseph H Feinberg
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - O Kenechi Nwawka
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
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Baran O, Kır B, Ateş İ, Şahin A, Üztürk A. Combined supraclavicular and superficial cervical plexus block for clavicle surgery. Korean J Anesthesiol 2018; 73:67-70. [PMID: 30481946 PMCID: PMC7000276 DOI: 10.4097/kja.d.18.00296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/25/2018] [Indexed: 12/31/2022] Open
Abstract
Background Clavicle fractures occur in 35% of shoulder girdle fractures. Surgical fixation is preferred, especially in young patients for optimal functional outcomes, while nondisplaced fractures are usually treated conservatively. Case A 38-year-old male patient was admitted to the emergency services with a fracture of the left clavicle following a fall. During the preoperative evaluation, the patient requested to be awake during the surgery. Combined supraclavicular and superficial cervical plexus block was performed under ultrasound guidance without complications and the patient experienced no pain. Conclusions This technique may avoid possible complications related to interscalene brachial plexus block. Future studies are required to confirm the safety and efficacy of this approach.
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Affiliation(s)
- Onur Baran
- Clinic of Anesthesiology and Reanimation, Palandöken State Hospital, Erzurum, Turkey
| | - Bünyamin Kır
- Clinic of Anesthesiology and Reanimation, Palandöken State Hospital, Erzurum, Turkey
| | - İrem Ateş
- Clinic of Anesthesiology and Reanimation, Palandöken State Hospital, Erzurum, Turkey
| | - Ayhan Şahin
- Department of Anesthesiology and Reanimation, Medical Faculty of Namık Kemal University, Tekirdağ, Turkey
| | - Ali Üztürk
- Clinic of Orthopedics and Traumatology, Palandöken State Hospital, Erzurum, Turkey
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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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Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain Management in the Emergency Department: a Review Article on Options and Methods. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e45. [PMID: 31172108 PMCID: PMC6548151 DOI: 10.22114/ajem.v0i0.93] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT The aim of this review is to recognizing different methods of analgesia for emergency medicine physicians (EMPs) allows them to have various pain relief methods to reduce pain and to be able to use it according to the patient's condition and to improve the quality of their services. EVIDENCE ACQUISITION In this review article, the search engines and scientific databases of Google Scholar, Science Direct, PubMed, Medline, Scopus, and Cochrane for emergency pain management methods were reviewed. Among the findings, high quality articles were eventually selected from 2000 to 2018, and after reviewing them, we have conducted a comprehensive comparison of the usual methods of pain control in the emergency department (ED). RESULTS For better understanding, the results are reported in to separate subheadings including "Parenteral agents" and "Regional blocks". Non-opioids analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used in the treatment of acute pain. However, the relief of acute moderate to severe pain usually requires opioid agents. Considering the side effects of systemic drugs and the restrictions on the use of analgesics, especially opioids, regional blocks of pain as part of a multimodal analgesic strategy can be helpful. CONCLUSION This study was designed to investigate and identify the disadvantages and advantages of using each drug to be able to make the right choices in different clinical situations for patients while paying attention to the limitations of the use of these analgesic drugs.
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Affiliation(s)
- Ali Abdolrazaghnejad
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Banaie
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury research center, Iran university of medical sciences, Tehran, Iran
| | - Mohammad Safdari
- Department of Neurosurgery, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
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21
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Ho B, De Paoli M. Use of Ultrasound-Guided Superficial Cervical Plexus Block for Pain Management in the Emergency Department. J Emerg Med 2018; 55:87-95. [PMID: 29858144 DOI: 10.1016/j.jemermed.2018.04.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although use of the superficial cervical plexus block (SCPB) by anesthesia for perioperative indications is well described, there is a paucity of research on use of SCPB in the emergency department (ED). OBJECTIVE This prospective observational study aims to prospectively characterize the feasibility, potential for efficacy, and safety of ultrasound-guided SCPB in a convenience sample of ED patients presenting with painful conditions of the "cape" distribution of the neck and shoulder. METHODS Data were gathered prospectively on a convenience sample of 27 patients presenting to a community ED with painful conditions involving the distribution of the SCPB: para-cervical muscle spasm/pain (n = 8), clavicle fractures (n = 7), acromioclavicular joint injuries (n = 3), radicular pain (n = 3), and rotator cuff disorders (n = 6). Pre- and post-block 11-point verbal numeric pain scores (VNPS) were recorded, as was the incidence of any immediate complications. A retrospective chart review looked for delayed complications in the 14-day post-block period. RESULTS The mean 11-point VNPS reduction was 5.4 points (62%). There were no early serious complications and one case each of self-limiting vocal hoarseness and asymptomatic hemi-diaphragmatic paresis. No delayed block-related complications were found. CONCLUSIONS While limited by the fact that this was a nonrandomized observational experience with no control group, our findings suggest that SCBP may be safe and have potential for efficacy, and warrants further evaluation in a randomized controlled trial.
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Affiliation(s)
- Ben Ho
- Emergency Department, Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Nanaimo, British Columbia, Canada
| | - Michael De Paoli
- Department of Family Medicine, University of British Columbia, Nanaimo, British Columbia, Canada
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22
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Ultrasound-Guided Combined Interscalene-Cervical Plexus Block for Surgical Anesthesia in Clavicular Fractures: A Retrospective Observational Study. Anesthesiol Res Pract 2018; 2018:7842128. [PMID: 29973954 PMCID: PMC6008659 DOI: 10.1155/2018/7842128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/29/2018] [Indexed: 11/21/2022] Open
Abstract
Objective We aim to report our experiences regarding the implementation of the ultrasound-guided combined interscalene-cervical plexus block (CISCB) technique as a sole anesthesia method in clavicular fracture repair surgery. Materials and Methods Charts of patients, who underwent clavicular fracture surgery through this technique, were reviewed retrospectively. We used an in-plane ultrasound-guided single-insertion, double-injection combined interscalene-cervical plexus block technique. During the performance of each block, the block areas were visualized by using a linear transducer, and the needles were advanced by using the in-plane technique. Block success and complication rates were evaluated. Results and Discussion 12 patients underwent clavicular fracture surgery. Surgical regional anesthesia was achieved in 100% of blocks. None of the patients necessitated conversion to general anesthesia during surgery. There were no occurrences of acute complications. Conclusions The ultrasound-guided combined interscalene-cervical plexus block was a successful and effective regional anesthesia method in clavicular fracture repair. Prospective comparative studies would report the superiority of the regional technique over general anesthesia.
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Ahmed AS, Ramakrishnan R, Ramachandran V, Ramachandran SS, Phan K, Antonsen EL. Ultrasound diagnosis and therapeutic intervention in the spine. JOURNAL OF SPINE SURGERY 2018; 4:423-432. [PMID: 30069538 DOI: 10.21037/jss.2018.04.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spine pathology afflicts people across the globe and is responsible for a large portion of physician visits and healthcare costs. Imaging such as plain radiographs, CT, MRI, and ultrasound is vital to assess structure, function, and stability of the spine and also provide guidance in therapeutic interventions. Ultrasound utilization in spine conditions is less ubiquitous, but provides benefits in low costs, portability, and dynamic imaging. This study assesses ultrasound efficacy in diagnosis and therapeutic interventions for spine pathology. A systematic review conducted via PubMed, MEDLINE, and Google Scholar identified 3,630 papers with eventual inclusion of 73 papers with an additional 21 papers supplemental papers subsequently added. Findings highlighted ultrasound utilization for different structural elements of the spine such as muscle, bone, disc, ligament, canal, and joints are presented and compared with radiographs, CT, and MRI imaging where relevant. Spinal curvature and mobility are similarly presented. Ultrasound efficacy for guided therapeutics about the spine is presented and assessed against other modalities. Ultrasound is a widely used and efficacious modality to guide injections about the spine. Diagnostic utility is less well studied, but shows promise in assessing fractures, posterior ligamentous stability, and intra-operative hardware placement. The low cost, portability, and dynamic imaging ability make it an attractive modality particularly for developing health systems and resource limited environments such as combat settings and the International Space Station. Further study is recommended before broad adoption in diagnostics.
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Affiliation(s)
- Adil S Ahmed
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | | | | | - Shyam S Ramachandran
- Department of Kinesiology and Health Education, University of Texas, Austin, Texas, USA
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Randwick, Sydney, Australia.,Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, Sydney, Australia
| | - Erik L Antonsen
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.,National Aeronautics and Space Administration, Houston, Texas, USA
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Wilson C. Feeling Blocked? Another Pain Management Tool in the Emergency Department. Ann Emerg Med 2018; 72:120-126. [PMID: 29729812 DOI: 10.1016/j.annemergmed.2018.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Casey Wilson
- Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD.
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25
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Abstract
The use of point-of-care ultrasound in trauma is widespread. Focused Assessment with Sonography for Trauma examination is a prototypical bedside examination used by the treating provider to quickly determine need for intervention and appropriate patient disposition. The role of bedside ultrasound in trauma, however, has expanded beyond the Focused Assessment with Sonography for Trauma examination. Advancements in diagnostics include contrast-enhanced ultrasound, thoracic, and musculoskeletal applications. Ultrasound is also an important tool for trauma providers for procedural guidance including vascular access and regional anesthesia. Its portability, affordability, and versatility have made ultrasound an invaluable tool in trauma management in resource-limited settings. In this review, we discuss these applications and the supporting evidence for point-of-care ultrasound in trauma.
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Affiliation(s)
- Timothy Gleeson
- Department of Emergency Medicine, University of Massachusetts, University of Massachusetts Medical School, Worcester, MA.
| | - David Blehar
- Department of Emergency Medicine, University of Massachusetts, University of Massachusetts Medical School, Worcester, MA
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26
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Elmaddawy AEA, Mazy AE. Ultrasound-guided bilateral superficial cervical plexus block for thyroid surgery: The effect of dexmedetomidine addition to bupivacaine-epinephrine. Saudi J Anaesth 2018; 12:412-418. [PMID: 30100840 PMCID: PMC6044169 DOI: 10.4103/sja.sja_653_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The thyroid gland surgery is a common and painful procedure demanding analgesia. Many regional techniques are applied for anterior neck surgeries mostly assigned in relation to the involved cervical fascia. Dexmedetomidine (Precedex) is a selective alpha 2 adrenoceptor agonist which prolongs the sensory blockade duration of local anesthetics. Our study hypothesis is that ultrasound (US)-guided bilateral superficial cervical plexus block (BSCPB) may provide longer analgesia when adding dexmedetomidine to bupivacaine-epinephrine. Purpose: The aim of this study is to evaluate the analgesic efficacy and possible side effects of US-guided BSCPB and the effect of dexmedetomidine addition to bupivacaine-epinephrine in patients undergoing thyroid surgery. Methods: This prospective, double-blind, randomized study was performed on 42 patients randomized into two equal groups each of 21; bupivacaine Group B and dexmedetomidine Group D. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Total pethidine consumption in 24 h is the primary outcome. The visual analog scale, timing of the first opioid request, and hemodynamics are the secondary outcomes. Results: In Group D, there was a longer time to the first request of opioid postoperatively, a lower total pethidine consumption and pain score postoperatively, and lower fentanyl requirements intraoperatively. Conclusions: Sonographic-guided bilateral SCPB using a combination of bupivacaine, dexmedetomidine, and epinephrine was superior to bupivacaine for prolonged analgesia with less intra- and postoperative opioid consumption and lower side effect profile during thyroid surgery.
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Affiliation(s)
- Alaa Eldin Adel Elmaddawy
- Department of Anesthesia, Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa Eldin Mazy
- Department of Anesthesia, Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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27
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Chang KV, Wu WT, Özçakar L. Ultrasound-Guided Interventions of the Cervical Spine and Nerves. Phys Med Rehabil Clin N Am 2017; 29:93-103. [PMID: 29173667 DOI: 10.1016/j.pmr.2017.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
High-resolution ultrasound (US) enables prompt depiction of muscles, tendons, ligaments, and peripheral nerves. It seems to be the best imaging modality for guiding perineural injections. The most complicated neurovascular network of the musculoskeletal system surrounds the cervical spine; so injection to that region is never an easy task. This article elaborates the regional anatomy and the use of US scanning and guidance for cervical interventions; for example, cervical root, superficial cervical plexus, stellate ganglion, cervical medial branch, greater occipital nerve, and third occipital nerve. The article aims to lead readers to practice US-guided cervical injections precisely and safely.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, 87 Neijiang Street, Wanhua, Taipei City 108, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, 87 Neijiang Street, Wanhua, Taipei City 108, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri Zemin Kat FTR AD, Sıhhıye, Ankara 06100, Turkey.
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Salvadores de Arzuaga CI, Naya Sieiro JM, Salmeron Zafra O, González Posada MA, Marquez Martínez E. Selective Low-Volume Nerve Block for the Open Surgical Fixation of a Midshaft Clavicle Fracture in a Conscious High-Risk Patient. ACTA ACUST UNITED AC 2017; 8:304-306. [DOI: 10.1213/xaa.0000000000000495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Herring AA. Bringing Ultrasound-guided Regional Anesthesia to Emergency Medicine. AEM EDUCATION AND TRAINING 2017; 1:165-168. [PMID: 30051028 PMCID: PMC6001738 DOI: 10.1002/aet2.10027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/31/2017] [Indexed: 05/04/2023]
Affiliation(s)
- Andrew A. Herring
- Department of Emergency MedicineHighland Hospital—Alameda Health SystemOaklandCA
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCA
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30
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Wilson CL, Chung K, Fong T. Challenges and Variations in Emergency Medicine Residency Training of Ultrasound-guided Regional Anesthesia Techniques. AEM EDUCATION AND TRAINING 2017; 1:158-164. [PMID: 30051027 PMCID: PMC6001815 DOI: 10.1002/aet2.10014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 05/15/2023]
Abstract
BACKGROUND Ultrasound guidance has become an integral component to procedural and diagnostic practice for the emergency physician. Whereas landmark-guided methods were used for peripheral nerve blocks in the past, the use of ultrasound has made regional anesthesia procedures faster, more successful, and feasible as a pain management modality in the emergency department. Not only the utilization, but also the teaching of ultrasound has become an essential aspect of emergency medicine residency training. Prior studies have found a substantial variation in practice and policies with regard to ultrasound-guided regional anesthesia (UGRA) and this translates to the education of both residents and fellows. OBJECTIVES The objective was to describe the current state of UGRA education, trends, and barriers in emergency medicine residency and ultrasound fellowship programs in the United States. METHODS A cross-sectional survey was conducted via the Internet utilizing the Qualtrics software platform. It was distributed to ultrasound directors and program directors of both Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) accredited emergency medicine residency programs and ultrasound fellowships. Data analysis, cross-tabulation, and subgroup analysis were performed utilizing the software. RESULTS We received a total of 138 responses (response rate of 66.3%). There was substantial variability with regard to implementing UGRA education. Additionally, there was a trend correlating a greater likelihood of UGRA education among programs with more than two ultrasound faculty members. Faculty training is considered to be the greatest barrier to teaching UGRA to residents and fellows. CONCLUSION Resident and fellow education with regard to UGRA varies significantly among individual programs. Although there are currently no ACGME or AOA guidelines, nearly all residency programs believe that this is a skill that emergency physicians should learn. With the identification of key barriers and the need for an increased number of trained faculty, pain management utilizing UGRA may become an integral part to emergency medicine resident and fellow education.
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Affiliation(s)
| | - Kevin Chung
- Johns Hopkins University School of MedicineBaltimoreMD
| | - Tiffany Fong
- Johns Hopkins University School of MedicineBaltimoreMD
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31
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[Intramedullary nailing in diaphyseal clavicle fractures using minimally invasive percutaneous reduction]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:97-102. [PMID: 28101589 DOI: 10.1007/s00064-016-0479-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Closed reduction and intramedullary nailing is common in diaphyseal clavicle fractures. The aim of this report is to demonstrate a surgical method with minimally invasive percutaneous reduction in cases where closed reduction fails. The procedure is associated with good cosmetic results. INDICATIONS Percutaneous reduction using two reduction forceps enables intramedullary nailing without an open procedure. CONTRAINDICATIONS Open, multifragmented or non-dislocated fractures, oblique fractures due to postoperative dislocation or shortening risk, fracture having potential to become compound fractures, neurovascular complications, pseudoarthroses. SURGICAL TECHNIQUE The patient is in beach-chair position. After an incision, the nail is entered from medial, two reduction forceps are mounted percutaneously at the lateral and medial fragment. After reduction the nail is pushed forward into the lateral fragment. Thereby, the fracture hematoma is not disturbed for the most part. POSTOPERATIVE MANAGEMENT Early functional rehabilitation with maximal abduction and anteversion of 90° for 6 weeks. RESULTS Anatomic reduction can be achieved with mild cosmetic impairment.
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32
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Li NL, Yu BL, Hung CF. Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study. PLoS One 2016; 11:e0166227. [PMID: 27829018 PMCID: PMC5102399 DOI: 10.1371/journal.pone.0166227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 10/17/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Paravertebral block placement was the main anesthetic technique for modified radical mastectomy in our hospital until February 2014, when its combination with blocks targeting the pectoral musculature was initiated. We compared the analgesic effects of paravertebral blocks with or without blocks targeting the pectoral musculature for modified radical mastectomy. METHODS We retrospectively collected data from a single surgeon and anesthesiologist from June 1, 2012, to May 31, 2015. Intraoperative sedatives and analgesic requirements, time to the first analgesic request, postoperative analgesic doses, patient satisfaction, and complications were compared. RESULTS Fifty-four patients received a paravertebral block alone (PECS 0), and 46 received a paravertebral block combined with blocks targeting the pectoral musculature (PECS 1). The highest intraoperative effect-site concentration of propofol was significantly lower in the PECS 1 group than in the PECS 0 group [2.3 (1.5, 2.8) vs 2.5 (1.5, 4) μg/mL, p = 0.0014]. The intraoperative rescue analgesic dose was significantly lower in the PECS 1 group [0 (0, 25) vs 0 (0, 75) mg of ketamine, p = 0.0384]. Furthermore, the PECS 1 group had a significantly longer time to the first analgesic request [636.5 (15, 720) vs 182.5 (14, 720) min, p = 0.0001]. After further adjustment for age, body mass index, American Society of Anesthesiologists Physical Status classification, chronic pain history, incidence of a superficial cervical plexus block placement, and operation duration, blocks targeting the pectoral musculature were determined to be the only significant factor (hazard ratio, 0.36; 95% confidence interval, 0.23-0.58; p < 0.0001). Very few patients used potent analgesics including morphine and ketorolac; the cumulative use of morphine or ketorolac was similar in the study groups. However, the incidence of all analgesic use, namely morphine, ketorolac, acetaminophen, and celecoxib, was significantly lower in the PECS 1 group [3.5 (0, 6) vs 5 (0, 12), p < 0.0001]. CONCLUSIONS Compared with the placement of a paravertebral block alone, combining blocks targeting the pectoral musculature with a paravertebral block for modified radical mastectomy reduced the sedative and analgesic requirements during operation and provided more effective postoperative analgesia.
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Affiliation(s)
- Nai-Liang Li
- Department of Anesthesiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, Republic of China
| | - Ben-Long Yu
- Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, Republic of China
| | - Chen-Fang Hung
- Biostatistics Section, Office of Clinical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, Republic of China
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Choi YS, Jo YY, Jung WS, Lee MG. Ultrasound-guided superficial cervical plexus block for carotid endarterectomy in a patient with Lemierre syndrome -A case report-. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.4.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yun Suk Choi
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, Korea
| | - Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wol Seon Jung
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Mi Geum Lee
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Beals T, Haines L. Ultrasound-guided superficial cervical plexus blockade for acute spasmodic torticollis in the ED. Am J Emerg Med 2016; 35:376.e1-376.e2. [PMID: 27613362 DOI: 10.1016/j.ajem.2016.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Tyler Beals
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY 11219.
| | - Lawrence Haines
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY 11219.
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Ritchie MK, Wilson CA, Grose BW, Ranganathan P, Howell SM, Ellison MB. Ultrasound-Guided Greater Auricular Nerve Block as Sole Anesthetic for Ear Surgery. Clin Pract 2016; 6:856. [PMID: 27478586 PMCID: PMC4943106 DOI: 10.4081/cp.2016.856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/03/2016] [Indexed: 12/02/2022] Open
Abstract
A greater auricular nerve (GAN) block was used as the sole anesthetic for facial surgery in an 80-year-old male patient with multiple comorbidities which would have made general anesthesia challenging. The GAN provides sensation to the ear, mastoid process, parotid gland, and angle of the mandible. In addition to anesthesia for operating room surgery, the GAN block can be used for outpatient or emergency department procedures without the need for a separate anesthesia team. Although this nerve block has been performed using landmark-based techniques, the ultrasound-guided version offers several potential advantages. These advantages include increased reliability of the nerve block, as well as prevention of inadvertent vascular puncture or blockade of the phrenic nerve, brachial plexus, or deep cervical plexus. The increasing access to ultrasound technology for medical care providers outside the operating room makes this ultrasound guided block an increasingly viable alternative.
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Affiliation(s)
- Michael K Ritchie
- Department of Anesthesiology, West Virginia University School of Medicine , Morgantown, WV, USA
| | - Colin A Wilson
- Department of Anesthesiology, West Virginia University School of Medicine , Morgantown, WV, USA
| | - Brian W Grose
- Department of Anesthesiology, West Virginia University School of Medicine , Morgantown, WV, USA
| | - Pavithra Ranganathan
- Department of Anesthesiology, West Virginia University School of Medicine , Morgantown, WV, USA
| | - Stephen M Howell
- Department of Anesthesiology, West Virginia University School of Medicine , Morgantown, WV, USA
| | - Matthew B Ellison
- Department of Anesthesiology, West Virginia University School of Medicine , Morgantown, WV, USA
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Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers. Am J Emerg Med 2016; 34:730-4. [DOI: 10.1016/j.ajem.2016.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 11/22/2022] Open
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Flores S, Herring AA. Ultrasound-guided Greater Auricular Nerve Block for Emergency Department Ear Laceration and Ear Abscess Drainage. J Emerg Med 2016; 50:651-5. [DOI: 10.1016/j.jemermed.2015.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/01/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
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Johnson B, Herring A, Stone M, Nagdev A. Performance accuracy of hand-on-needle versus hand-on-syringe technique for ultrasound-guided regional anesthesia simulation for emergency medicine residents. West J Emerg Med 2015; 15:641-6. [PMID: 25247033 PMCID: PMC4162719 DOI: 10.5811/westjem.2014.7.21717] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/07/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction Ultrasound-guided nerve blocks (UGNB) are increasingly used in emergency care. The hand-on-syringe (HS) needle technique is ideally suited to the emergency department setting because it allows a single operator to perform the block without assistance. The HS technique is assumed to provide less exact needle control than the alternative two-operator hand-on-needle (HN) technique; however this assumption has never been directly tested. The primary objective of this study was to compare accuracy of needle targeting under ultrasound guidance by emergency medicine (EM) residents using HN and HS techniques on a standardized gelatinous simulation model. Methods This prospective, randomized study evaluated task performance. We compared needle targeting accuracy using the HN and HS techniques. Each participant performed a set of structured needling maneuvers (both simple and difficult) on a standardized partial-task simulator. We evaluated time to task completion, needle visualization during advancement, and accuracy of needle tip at targeting. Resident technique preference was assessed using a post-task survey. Results We evaluated 60 tasks performed by 10 EM residents. There was no significant difference in time to complete the simple model (HN vs. HS, 18 seconds vs. 18 seconds, p=0.93), time to complete the difficult model (HN vs. HS, 56 seconds vs. 50 seconds, p=0.63), needle visualization, or needle tip targeting accuracy. Most residents (60%) preferred the HS technique. Conclusion For EM residents learning UGNBs, the HN technique was not associated with superior needle control. Our results suggest that the single-operator HS technique provides equivalent needle control when compared to the two-operator HN technique.
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Affiliation(s)
- Brian Johnson
- Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California
| | - Andrew Herring
- Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California
| | - Michael Stone
- Brigham and Women's Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Arun Nagdev
- Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California
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Seidel R, Schulze M, Zukowski K, Wree A. [Ultrasound-guided intermediate cervical plexus block. Anatomical study]. Anaesthesist 2015; 64:446-50. [PMID: 26013020 DOI: 10.1007/s00101-015-0018-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES The innervation of the human cervical region is complex and subject to relevant anatomical variability involving sections of the cervical plexus, brachial plexus and cranial nerves. AIM The objective was to demonstrate the dissemination of injected dye solution by anatomical preparation and to define a suitable target compartment for an ultrasound-guided block technique. MATERIAL AND METHODS Own anatomical preparations are compared to recent review articles on the subject. The focus is on clinically relevant conclusions for performing cervical plexus blocks. In three non-embalmed cadavers six intermediate ultrasound-guided blocks of the cervical plexus were carried out, each with 20 ml methylene blue. Following preparation of the cervical plexus photographic documentation of the spread of the injected marker was performed. RESULTS In five cases the target compartment was correctly identified. In these cases, a cranio-caudal spread of the injectate within the double layer of the cervical fascia was observed. In addition, the superficial layer was permeable to the injected methylene blue. The injection solution disseminated with the sensitive terminal branches of the cervical plexus below the platysma. In all cases an anastomosis (superficial cervical ansa) between the facial nerve (ramus colli) and the cervical plexus (transverse cervical nerve) could be demonstrated. The prevertebral lamina proved to be impermeable to injected methylene blue and no evidence of a porous structure of the prevertebral lamina was found. CONCLUSION The compartment between the superficial and the prevertebral layer of the cervical fascia is a suitable target for cervical plexus blocks. This injection site describes an intermediate cervical plexus block. As the compartment contains the sensory terminal branches of the spinal nerves C2-4, it may be referred to as C2-C4 compartment. The cranio-caudal spread of the injectate allows lateromedial needle guidance in the horizontal plane. As the superficial lamina is not a barrier to the injectate an additional subcutaneous infiltration of the nerve area appears dispensable. The prevertebral lamina proved to be impermeable to injected methylene blue. Whether phrenic nerve blocks are preventable with more distal intermediate cervical plexus blocks (selective block of the supraclavicular nerves, e.g. for surgery of the clavicle) must be investigated in clinical trials. The permanent anastomosis (superficial cervical ansa) between the cervical plexus and the ramus colli of the facial nerve provides an anatomically reasonable explanation for inadequate cervical plexus blocks.
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Affiliation(s)
- R Seidel
- Klinik für Anästhesiologie und Intensivmedizin, HELIOS-Kliniken Schwerin, Wismarsche Str. 393-397, 19049, Schwerin, Deutschland,
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Flores S, Riguzzi C, Herring AA, Nagdev A. Horner's Syndrome after Superficial Cervical Plexus Block. West J Emerg Med 2015; 16:428-31. [PMID: 25987922 PMCID: PMC4427219 DOI: 10.5811/westjem.2015.2.25336] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 01/18/2015] [Accepted: 02/25/2015] [Indexed: 02/08/2023] Open
Abstract
Ultrasound-guided nerve blocks are becoming more essential for the management of acute pain in the emergency department (ED). With increased block frequency comes unexpected complications that require prompt recognition and treatment. The superficial cervical plexus block (SCPB) has been recently described as a method for ED management of clavicle fracture pain. Horner’s syndrome (HS) is a rare and self-limiting complication of regional anesthesia in neck region such as brachial and cervical plexus blocks. Herein we describe the first reported case of a HS after an ultrasound-guided SCPB performed in the ED and discuss the complex anatomy of the neck that contributes to the occurrence of this complication.
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Affiliation(s)
- Stefan Flores
- Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Christine Riguzzi
- Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California ; Alta Bates Medical Center, Department of Emergency Medicine, Oakland, California
| | - Andrew A Herring
- Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California ; University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Arun Nagdev
- Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California ; University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
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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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Shin HY, Kim DS, Kim SS. Superficial cervical plexus block for management of herpes zoster neuralgia in the C3 dermatome: a case report. J Med Case Rep 2014; 8:59. [PMID: 24548417 PMCID: PMC3942766 DOI: 10.1186/1752-1947-8-59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 12/02/2013] [Indexed: 11/20/2022] Open
Abstract
Introduction Herpes zoster is a well-known reactivating viral disease that gives rise to painful skin lesions. Although this vesicular rash heals up within a few weeks, pain sometimes continues, becoming postherpetic neuralgia. In the case of those at high risk of developing postherpetic neuralgia, early interventional pain management is generally recommended as a preventive measure. Pain specialists usually do not see patients face-to-face for chronic refractory pain until the stage of postherpetic neuralgia. However, active and aggressive management, including antiviral treatment, of herpetic neuralgia during the acute stage of herpes zoster promises better results. In this respect, superficial cervical plexus block can help patients, such as the case reported here, by relieving the pain of herpes zoster involving the C3 dermatome. Case presentation A 65-year-old Korean man with severe pain in his left C3 dermatome due to herpes zoster was admitted to our hospital. His pain was so refractory to medication that he consulted our pain clinic for pain control. Due to the medication limitations imposed by his underlying diseases (hepatitis B, liver cirrhosis, atrial fibrillation, and asthma), early interventional therapy including stellate ganglion block was planned. In addition, because his painful C3 dermatome overlapped significantly with the superficial cervical plexus dermatome, ultrasound-guided superficial cervical plexus block was utilized for pain control of the intractable herpes zoster neuritis in his C3 dermatome. The result with respect to his sporadic neuralgia was satisfactory. Conclusions We found superficial cervical plexus block to be an effective interventional procedure for pain management of herpes zoster, particularly at the C3-dermatomal level.
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Affiliation(s)
- Hye Young Shin
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Republic of Korea.
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Trauma ultrasound in civilian tactical medicine. Emerg Med Int 2012; 2012:781570. [PMID: 23243509 PMCID: PMC3517827 DOI: 10.1155/2012/781570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 11/15/2012] [Indexed: 11/18/2022] Open
Abstract
The term “tactical medicine” can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years' literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making.
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Perisanidis C, Saranteas T, Kostopanagiotou G. Ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in oral and maxillofacial surgery. Dentomaxillofac Radiol 2012; 42:29945724. [PMID: 22933534 DOI: 10.1259/dmfr/29945724] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We examined the application of an ultrasound-guided combined intermediate and deep cervical plexus nerve block for regional anaesthesia in patients undergoing oral and maxillofacial surgery. METHODS A total of 19 patients receiving ultrasound-guided combined intermediate and deep cervical plexus anaesthesia followed by neck surgery were examined prospectively. The sternocleidomastoid and the levator of the scapula muscles as well as the cervical transverse processes were used as easily depicted ultrasound landmarks for the injection of local anaesthetics. Under ultrasound guidance, a needle was advanced in the fascial band between the sternocleidomastoid and the levator of the scapula muscles and 15 ml of ropivacaine 0.75% was injected. Afterwards, the needle was advanced between the levator of the scapula and the hyperechoic contour of the cervical transverse processes and a further 15 ml of ropivacaine 0.75% was injected. The sensory block of the cervical nerve plexus, the analgesic efficacy of the block within 24 h after injection and potential block-related complications were assessed. RESULTS All patients showed a complete cervical plexus nerve block. No patient required analgesics within the first 24 h after anaesthesia. Two cases of blood aspiration were recorded. No further cervical plexus block-related complications were observed. CONCLUSIONS Ultrasound-guided combined intermediate and deep cervical plexus block is a feasible, effective and safe method for oral and maxillofacial surgical procedures.
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Affiliation(s)
- C Perisanidis
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria.
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