1
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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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2
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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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3
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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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Opperer M, Kaufmann R, Meissnitzer M, Enzmann FK, Dinges C, Hitzl W, Nawratil J, Koköfer A. In reply to the letter to the editor by Wang et al. Reg Anesth Pain Med 2022; 47:rapm-2022-103715. [PMID: 35705266 DOI: 10.1136/rapm-2022-103715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Mathias Opperer
- Department of Anesthesiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Reinhard Kaufmann
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | | | - Florian K Enzmann
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Dinges
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Hitzl
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Jürgen Nawratil
- Department of Anesthesiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Koköfer
- Department of Anesthesiology, Paracelsus Medical University Salzburg, Salzburg, Austria
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Shao P, Han C, Wang Y. Depth of cervical plexus block and diaphragmatic dysfunction. Reg Anesth Pain Med 2022; 47:rapm-2022-103650. [PMID: 35705265 DOI: 10.1136/rapm-2022-103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Peiqi Shao
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chao Han
- Department of Anesthesiology, Beijing Longfu Hospital, Beijing, China
| | - Yun Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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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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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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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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Anesthetic and Analgesic Efficient of Regional Nerve Blockade in Otoplasty. J Craniofac Surg 2020; 31:1951-1954. [PMID: 32371690 DOI: 10.1097/scs.0000000000006501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM The prominent ear is the most common congenital deformity of the external ear. Otoplasty is performed to correct the appearance of the prominent ear. This study was planned to compare the analgesic and anesthetic effects of local nerve blockade and local infiltration anesthesia in the otoplasties. METHOD Thirty-two patients who underwent otoplasty in both ears between February 2018 and March 2019 were included in the study. Three patients were excluded because they refused regional anesthesia. In the patients included in the study, only local infiltration anesthesia was applied to 1 ear and regional nerve blockade was applied to the other ear. Regional nerve blockade was applied to the study group; local infiltration anesthesia was applied to the control group. Surgical and anesthetic complications were recorded. The onset time, duration and severity of pain were followed. Numerical evaluation scale scores were used to evaluate pain levels. RESULTS It was observed that the first pain of the patients On the side where regional nerve block (RNB) anesthesia was applied after an average of 10.5 hours. On the other hand on the side where local infiltration anesthesia was applied; the pain was observed to start after an average of 3.5 hours. At the 6th and 12th hours postoperatively, the scores of the numerical evaluation scale were significantly lower in the study group than the control group (P < 0.05). At the 24th-hour pain score, the values were lower in the study group, but the difference was not significant between the groups (P > 0.05). In the regional anesthesia group, can develop such as difficulty in swallowing, weakness in the neck, weakness in the upper extremity, nausea, Horner syndrome; but all side effects resolve spontaneously within 6 to 12 hours. CONCLUSION The application of regional anesthesia in prominent ear surgical procedures can be considered as an alternative method to provide better quality preoperative anesthesia and better quality postoperative analgesia in patients.
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Rössel T, Uhlig C, Pietsch J, Ludwig S, Koch T, Richter T, Spieth PM, Kersting S. Effects of regional anesthesia techniques on local anesthetic plasma levels and complications in carotid surgery: a randomized controlled pilot trial. BMC Anesthesiol 2019; 19:218. [PMID: 31771512 PMCID: PMC6878670 DOI: 10.1186/s12871-019-0890-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/12/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The ultrasound guided intermediate cervical plexus block with perivascular infiltration of the internal carotid artery (PVB) is a new technique for regional anesthesia in carotid endarterectomy (CEA). We conducted a pilot study investigating the effects of deep cervical block (DCB), intermediate cervical block alone (ICB) and PVB on perioperative complications in patients undergoing elective CEA. We hypothesized, that the ropivacaine plasma concentration is higher in patients receiving DCB compared to PVB and ICB. METHODS In a randomized controlled pilot study thirty patients scheduled for elective CEA were randomly assigned into three groups: DCB receiving 20 mL ropivacaine 0.5% (n = 10), ICB receiving 20 mL ropivacaine 0.5% (n = 10) and PVB receiving 20 mL ropivacaine 0.5% and 10 mL ropivacaine 0,3% (n = 10). As primary outcome, plasma levels of ropivacaine were measured with high performance liquid chromatography before, 5, 10, 20, 60, and 180 min after the injection of ropivacaine. Secondary outcomes were vascular and neurological complications as well as patients' and surgeons' satisfaction. All analyses were performed on an intention-to-treat basis. Statistical significance was accepted at p < 0.05. RESULTS No conversion to general anesthesia was necessary and we observed no signs of local anesthetic intoxication or accidental vascular puncture. Plasma concentration of ropivacaine was significantly higher in the DCB group compared to PVB and ICB (p < 0.001) and in the PVB group compared to ICB (p = 0.008). Surgeons' satisfaction was higher in the PVB group compared to ICB (p = 0.003) and patients' satisfaction was higher in the PVB group compared to ICB (p = 0.010) and DCB group (p = 0.029). Phrenic nerve paralysis was observed frequently in the DCB group (p < 0.05). None of these patients with hemi-diaphragmatic paralysis showed signs of respiratory distress. CONCLUSION The ultrasound guided PVB is a safe and effective technique for CEA which is associated with lower plasma levels of local anesthetic than the standard DCB. Considering the low rate of complications in all types of regional anesthesia for CEA, larger randomized controlled trials are warranted to assess potential side effects among the blocks. TRIAL REGISTRATION The trial was registered at German Clinical Trials Register (DRKS) on 04/05/2019 (DRKS00016705, retrospectively registered).
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Affiliation(s)
- Thomas Rössel
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Christopher Uhlig
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Pietsch
- Institute of Legal Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ludwig
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thea Koch
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Torsten Richter
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Peter Markus Spieth
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Stephan Kersting
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of General Surgery, University Hospital of Friedrich-Alexander-University, Erlangen, Germany
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Saranteas T, Koliantzaki I, Savvidou O, Tsoumpa M, Eustathiou G, Kontogeorgakos V, Souvatzoglou R. Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations. Minerva Anestesiol 2019; 85:763-773. [DOI: 10.23736/s0375-9393.19.13145-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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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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Zetlaoui PJ, Benhamou D. Where do ultrasounds have to go? Anaesth Crit Care Pain Med 2017; 36:77-78. [PMID: 28366296 DOI: 10.1016/j.accpm.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Paul J Zetlaoui
- Département d'anesthésie-réanimation, hôpital de Bicêtre, université Paris Orsay, 94275 Kremlin-Bicêtre, France.
| | - Dan Benhamou
- Département d'anesthésie-réanimation, hôpital de Bicêtre, université Paris Orsay, 94275 Kremlin-Bicêtre, France
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Alilet A, Petit P, Devaux B, Joly C, Samain E, Pili-Floury S, Besch G. Ultrasound-guided intermediate cervical block versus superficial cervical block for carotid artery endarterectomy: The randomized-controlled CERVECHO trial. Anaesth Crit Care Pain Med 2017; 36:91-95. [DOI: 10.1016/j.accpm.2016.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 03/04/2016] [Accepted: 03/10/2016] [Indexed: 11/30/2022]
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18
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Moon JY, Choi JK, Shin JY, Chon SW, Dev S. A brief report on a technical description of ultrasound-guided lumbar sympathetic block. Korean J Pain 2016; 30:66-70. [PMID: 28119774 PMCID: PMC5256261 DOI: 10.3344/kjp.2017.30.1.66] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 11/09/2022] Open
Abstract
The lumbar sympathetic ganglion block (LSGB) is widely used for diagnosing and treating sympathetically maintained pain disorders. The LSGB has been conventionally carried out under fluoroscopy or computed tomography guidance. However, as ultrasound technology improved, ultrasound-guided interventions have been expanding their territory to deeper structures. Ultrasound guidance provides many benefits including protecting vascular injection, shortening procedure time in some cases, and reducing the emission of radiation. In this report, we describe a successful case of a US-guided LSGB without major complications. We expect that US-guided LSGBs can be implemented and furnished in the daily outpatient clinical setting by highly trained pain physicians.
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Affiliation(s)
- Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Kyu Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeon Shin
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Sung Won Chon
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Sushmitha Dev
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.; Department of Anesthesiology and Pain Medicine, Apollo Speciality Hospitals, OMR, Chennai, India
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19
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Ultrasound-guided intermediate cervical plexus block and perivascular local anesthetic infiltration for carotid endarterectomy. Anaesthesist 2016; 65:917-924. [DOI: 10.1007/s00101-016-0230-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/30/2016] [Accepted: 09/06/2016] [Indexed: 11/25/2022]
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Ropivacaine 0.375% vs. 0.75% with prilocaine for intermediate cervical plexus block for carotid endarterectomy: A randomised trial. Eur J Anaesthesiol 2016; 32:781-9. [PMID: 25782662 DOI: 10.1097/eja.0000000000000243] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carotid endarterectomy is widely performed under regional anaesthesia. Ultrasound guidance is increasingly used in many regional anaesthetic procedures to improve safety and efficacy, and because it can reduce the amount of local anaesthetic required. Despite this, an ideal approach and dosing regimen for cervical plexus block remain elusive. OBJECTIVE The aim of this study was to compare two different concentrations of ropivacaine in terms of analgesic adequacy, haemodynamic effects and plasma concentration using an ultrasound-guided triple approach for intermediate cervical plexus blockade. DESIGN A randomised, placebo-controlled, blinded study. SETTING University Clinic Salzburg, Department of Anaesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Salzburg, Austria, from 16 November 2012 to 17 September 2013. PATIENTS Forty-six patients prospectively randomised to receive ultrasound-guided intermediate cervical block with either 20 ml ropivacaine 0.75% or 20 ml ropivacaine 0.375% each with 20 ml prilocaine 1%. INTERVENTION After subcutaneous infiltration, blocks were performed using ultrasound-guided infiltration below the sternocleidomastoid muscle, and ultrasound-guided infiltration of the carotid sheath. Ropivacaine and prilocaine plasma concentrations were measured at intervals. MAIN OUTCOME The primary study endpoint was the volume of supplementary lidocaine 1% required to achieve adequate surgical anaesthesia. Perioperative haemodynamic variables and pain scores were recorded. RESULTS There was no statistical difference in the volume of supplementary lidocaine given: 5.0 (±3.63) ml in the ropivacaine 0.375% group and 5.17 (±2.76) ml in the ropivacaine 0.75% group (P = 0.846). Pain scores were similarly low across both groups. Measured concentrations of ropivacaine and prilocaine did not reach toxic levels in either group. Levels of ropivacaine were approximately two-fold higher in the 0.75% group [mean area under the curve (AUC) 10 531.11 (±2912.84) vs. 5264.34 ng (±1594.69), P < 0.0001]. Perioperative cardiovascular stability was excellent in both groups. There were no serious block-related complications. CONCLUSION An ultrasound-guided intermediate block provides adequate anaesthesia for carotid thrombendarterectomy with a little need for supplementary local anaesthetic. Use of 0.375% ropivacaine provided similarly effective analgesia as 0.75%, but resulted in significantly lower plasma concentrations. TRIAL REGISTRATION The study was registered at the European Clinical Trial Database (Eudra CT No.: 2012-002769) as well as at ClinicalTrials.gov (NCT01759940).
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Sait Kavaklı A, Kavrut Öztürk N, Umut Ayoğlu R, Sağdıç K, Çakmak G, İnanoğlu K, Emmiler M. Comparison of Combined (Deep and Superficial) and Intermediate Cervical Plexus Block by Use of Ultrasound Guidance for Carotid Endarterectomy. J Cardiothorac Vasc Anesth 2016; 30:317-22. [DOI: 10.1053/j.jvca.2015.07.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Indexed: 11/11/2022]
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Leblanc I, Chterev V, Rekik M, Boura B, Costanzo A, Bourel P, Combes M, Philip I. Safety and efficiency of ultrasound-guided intermediate cervical plexus block for carotid surgery. Anaesth Crit Care Pain Med 2016; 35:109-14. [DOI: 10.1016/j.accpm.2015.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 07/15/2015] [Accepted: 08/11/2015] [Indexed: 11/16/2022]
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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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Calderon AL, Zetlaoui P, Benatir F, Davidson J, Desebbe O, Rahali N, Truc C, Feugier P, Lermusiaux P, Allaouchiche B, Boselli E. Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach: a two-centre prospective observational study. Anaesthesia 2014; 70:445-51. [DOI: 10.1111/anae.12960] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 11/26/2022]
Affiliation(s)
- A. L. Calderon
- Department of Anaesthesiology and Intensive Care; Édouard Herriot Hospital; Hospices Civils de Lyon; Lyon France
| | - P. Zetlaoui
- Department of Anaesthesiology and Intensive Care; Bicêtre Hospital; Assistance Publique - Hôpitaux de Paris; Le Kremlin-Bicêtre France
| | - F. Benatir
- Department of Anaesthesiology and Intensive Care; Édouard Herriot Hospital; Hospices Civils de Lyon; Lyon France
| | - J. Davidson
- Department of Anaesthesiology and Intensive Care; Édouard Herriot Hospital; Hospices Civils de Lyon; Lyon France
| | - O. Desebbe
- Department of Anaesthesiology and Intensive Care; Louis Pradel Hospital; Hospices Civils de Lyon; Lyon France
| | - N. Rahali
- Department of Anaesthesiology and Intensive Care; Édouard Herriot Hospital; Hospices Civils de Lyon; Lyon France
| | - C. Truc
- Department of Anaesthesiology and Intensive Care; Édouard Herriot Hospital; Hospices Civils de Lyon; Lyon France
| | - P. Feugier
- Department of Vascular Surgery; Édouard Herriot Hospital; Hospices Civils de Lyon; Lyon France
| | - P. Lermusiaux
- Department of Vascular Surgery; Édouard Herriot Hospital; Hospices Civils de Lyon; Lyon France
| | - B. Allaouchiche
- Department of Anaesthesiology and Intensive Care; Édouard Herriot Hospital; Hospices Civils de Lyon; Lyon France
| | - E. Boselli
- Department of Anaesthesiology and Intensive Care; Édouard Herriot Hospital; Hospices Civils de Lyon; Lyon France
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Abstract
Patients presenting for vascular surgery present a challenge to anesthesiologists because of their severe systemic comorbidities. Regional anesthesia has been used as a primary anesthetic technique for many vascular procedures to avoid the cardiovascular and pulmonary perturbations associated with general anesthesia. In this article the use of regional anesthesia for carotid endarterectomy, open and endovascular abdominal aortic aneurysm repair, infrainguinal arterial bypass, lower extremity amputation, and arteriovenous fistula formation is described. A focus is placed on reviewing the literature comparing anesthetic techniques, with brief descriptions of the techniques themselves.
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Affiliation(s)
- James Flaherty
- Stanford Hospital and Clinics, 300 Pasteur Drive, Room H3580, Stanford, CA 94305, USA.
| | - Jean-Louis Horn
- Stanford Hospital and Clinics, 300 Pasteur Drive, Room H3580, Stanford, CA 94305, USA
| | - Ryan Derby
- Stanford Hospital and Clinics, 300 Pasteur Drive, Room H3580, Stanford, CA 94305, USA
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Abstract
Summary Regional anaesthesia is a popular choice for patients undergoing carotid endarterectomy (CEA). Neurological function is easily assessed during carotid cross-clamping; haemodynamic control is predictable; and hospital stay is consistently shorter compared with general anaesthesia (GA). Despite these purported benefits, mortality and stroke rates associated with CEA remain around 5% for both regional anaesthesia and GA. Regional anaesthetic techniques for CEA have improved with improved methods of location of peripheral nerves including nerve stimulators and ultrasound together with a modification in the classification of cervical plexus blocks. There have also been improvements in local anaesthetic, sedative, and arterial pressure-controlling drugs in patients undergoing CEA, together with advances in the management of patients who develop neurological deficit after carotid cross-clamping. In the UK, published national guidelines now require the time between the patient's presenting neurological event and definitive treatment to 1 week or less. This has implications for the ability of vascular centres to provide specialized vascular anaesthetists familiar with regional anaesthetic techniques for CEA. Providing effective regional anaesthesia for CEA is an important component in the armamentarium of techniques for the vascular anaesthetist in 2014.
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Affiliation(s)
- M D Stoneham
- Nuffield Division of Anaesthetics, Level 2, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| | - D Stamou
- Nuffield Division of Anaesthetics, Level 2, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
| | - J Mason
- Nuffield Division of Anaesthetics, Level 2, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK
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Ciccozzi A, Angeletti C, Guetti C, Pergolizzi J, Angeletti PM, Mariani R, Marinangeli F. Regional anaesthesia techniques for carotid surgery: the state of art. J Ultrasound 2014; 17:175-83. [PMID: 25177390 DOI: 10.1007/s40477-014-0094-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This review will analyse some aspects of regional anaesthesia (RA) for carotid endarterectomy (CEA), a surgical procedure which requires a strict monitoring of patient's status. RA remains an important tool for the anaesthesiologist. Some debates remain about type and definition of regional anaesthesia, efficacy and safety of the different cervical block techniques, the right dose, concentration and volume of local anaesthetic, the use of adjuvants, the new perspectives: ultrasonography, the future directions. METHODS A literature search was performed for journal articles in English language in the PubMed Embase and in The Cochrane Library database, from January 2000 to December 2013. The electronic search strategy contained the following medical subject headings and free text terms: local anaesthesia versus general anaesthesia for endarterectomy, superficial and deep cervical block, complications of cervical nerve block, ultrasound guidance of superficial and deep cervical plexus block. CONCLUSIONS The gold standard for RA will be achieved after overcoming a number of limitations by a more extensive use of ultrasonography, by combining general and regional anaesthesia, including conscious anaesthesia, by defining the appropriate volume, concentration and dosage of local agents and by addition of adjuvants.
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Affiliation(s)
- Alessandra Ciccozzi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Chiara Angeletti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Cristiana Guetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Joseph Pergolizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA ; Department of Anesthesiology, Georgetown University School of Medicine, Washington D.C, USA ; Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA USA ; Association of Chronic Pain Patients, Houston, TX USA
| | - Paolo Matteo Angeletti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Roberta Mariani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
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