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Wu L, Zhang W, Zhang X, Wu Y, Qu H, Zhang D, Wei Y. Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1288697. [PMID: 38035018 PMCID: PMC10687368 DOI: 10.3389/fphar.2023.1288697] [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] [Received: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Aim of the Study: Brachial plexus block (BPB) is widely used for patients undergoing upper limb surgeries. Ropivacaine is the most commonly used local anesthetic for BPB. This study aimed to identify the optimal ropivacaine concentration for BPB in adult patients undergoing upper limb surgeries. Materials and Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched to identify randomized controlled trials (RCTs) that compared the effects of different concentrations of ropivacaine for BPB in adult patients undergoing upper limb surgeries. The primary outcomes were the onset time of sensory and motor block. RevMan 5.4 software was used for analysis. The GRADE approach was used to assess evidence quality. Results: Nine studies involving 504 patients were included. Compared to 0.5% ropivacaine, 0.75% ropivacaine shortened the onset time of sensory (WMD, -2.54; 95% CI; -4.84 to -0.24; <0.0001, moderate quality of evidence) and motor blockade (WMD, -2.46; 95% CI, -4.26 to -0.66; p = 0.01; moderate quality of evidence). However, 0.5% and 0.75% ropivacaine provided similar duration time of sensory (WMD, -0.07; 95% CI, -0.88 to 0.74; p = 0.81; high quality of evidence) and motor blockade (WMD, -0.24; 95% CI, -1.12 to 0.65; p = 0.55; high quality of evidence), as well as time to first request for oral analgesia (WMD, -1.57; 95% CI, -3.14 to 0.01; p = 0.5; moderate quality of evidence). Conclusion: Moderate-quality evidence suggested that, in terms of the onset time of sensory and motor blockade, 0.75% ropivacaine is a preferred concentration for BPB in upper limb surgeries. Systematic Review Registration: identifier CRD42023392145.
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Affiliation(s)
- Lin Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Weiyi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Zhang
- Department of Anesthesiology, First People’s Hospital of Tianshui City, Tianshui, China
| | - Yinglong Wu
- Department of Anesthesiology, Pu’er People’s Hospital, Pu'er, China
| | - Hua Qu
- Department of Anesthesiology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Donghang Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yiyong Wei
- Department of Anesthesiology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
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Spitzer D, Wenger KJ, Neef V, Divé I, Schaller-Paule MA, Jahnke K, Kell C, Foerch C, Burger MC. Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients. J Clin Med 2021; 10:jcm10051013. [PMID: 33801401 PMCID: PMC7958619 DOI: 10.3390/jcm10051013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 12/22/2022] Open
Abstract
Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.
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Affiliation(s)
- Daniel Spitzer
- Institute of Neurology (Edinger Institute), University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany;
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany; (I.D.); (M.A.S.-P.); (K.J.); (C.K.); (C.F.)
| | - Katharina J. Wenger
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany;
| | - Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany;
| | - Iris Divé
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany; (I.D.); (M.A.S.-P.); (K.J.); (C.K.); (C.F.)
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), 60596 Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, 60590 Frankfurt, Germany
| | - Martin A. Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany; (I.D.); (M.A.S.-P.); (K.J.); (C.K.); (C.F.)
| | - Kolja Jahnke
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany; (I.D.); (M.A.S.-P.); (K.J.); (C.K.); (C.F.)
| | - Christian Kell
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany; (I.D.); (M.A.S.-P.); (K.J.); (C.K.); (C.F.)
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany; (I.D.); (M.A.S.-P.); (K.J.); (C.K.); (C.F.)
| | - Michael C. Burger
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany; (I.D.); (M.A.S.-P.); (K.J.); (C.K.); (C.F.)
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), 60596 Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, 60590 Frankfurt, Germany
- Correspondence: ; Tel.: +49-69-6301-87711
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Ahn HJ. Anesthetic management of patients with chronic obstructive pulmonary disease. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.9.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide. It has a prevalence of 14% among Koreans aged above 40 years and a prevalence of 31% among those aged above 65 years. However, only 6% of the COPD patients receive treatment. Most of the patients do not seek medical attention, as they think that dyspnea, cough, and productive sputum, which are the common symptoms of COPD, are normal aging phenomena. Smoking is a major risk factor for COPD, but environmental hazards and genetic susceptibility are also involved. With aging, lung injuries due to these risk factors accumulate, leading to increased prevalence of COPD. The major concerns regarding perioperative management of COPD patients include preoperative evaluation of cardiopulmonary risks, optimization of lung function, and evaluation of COPD-related physiological functions that are easily aggravated during anesthesia. These include respiratory muscle dysfunction, dynamic hyperinflation and auto-positive end-expiratory pressure, hypoxia-hypercarbia, and pulmonary hypertension-associated heart failure. Therefore, anesthesia for COPD patients should focus on preoperative evaluation, risk reduction measures, and prevention of postoperative pulmonary complications.
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Rendeiro DG, Deyle GD, Gill NW, Majkowski GR, Lee IE, Jensen DA, Wainner RS. Effectiveness of translational manipulation under interscalene block for the treatment of adhesive capsulitis of the shoulder: A nonrandomized clinical trial. Physiother Theory Pract 2018; 35:703-723. [PMID: 29658838 DOI: 10.1080/09593985.2018.1457118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Study Design: Nonrandomized controlled trial. Objective: To determine whether translational manipulation under anesthesia/local block (TMUA) adds to the benefit of mobilization and range of motion exercise for improving pain and functional status among patients with adhesive capsulitis of the shoulder (AC). Background: TMUA has been shown to improve pain and dysfunction in patients with AC. This intervention has not been directly compared to physical therapy treatment without TMUA in a prospective trial. Methods: Sixteen consecutive patients with a primary diagnosis of AC were divided into two groups. Patients in the first (TMUA) group received a session of translational manipulation under interscalene block, followed by six sessions of manipulation and exercise. Patients in the comparison group received seven sessions of manipulation and exercise. Outcome measures taken at baseline and 3, 6, 12 months and 4 years included Shoulder Pain and Disability Index (SPADI) scores. Four-year outcomes included percent of normal ratings, medication use, and activity limitations. Results: Both groups showed improved SPADI scores across all follow-up times compared to baseline. The TMUA group showed a greater improvement in SPADI scores than the comparison group at 3 weeks, with no significant differences in SPADI scores at other time points. However, at 4 years, significantly more subjects in the comparison group (5 of 8) had activity limitations versus subjects in the TMUA group (1 of 8). No subject experienced a complication from either intervention protocol. Conclusion: Physical therapy consisting of manual therapy and exercise provides benefit for patients with AC. Translational manipulation under local block may be a useful adjunct to manual therapy and exercise for patients with AC.
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Affiliation(s)
| | - Gail D Deyle
- b Army-Baylor University Doctoral Fellowship Program in Orthopaedic Manual Physical Therapy , Brooke Army Medical Center, Fort Sam Houston , San Antonio, TX , USA
| | - Norman W Gill
- c Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston , San Antonio, TX , USA
| | - Guy R Majkowski
- d US Air Force Health Clinic, United States Air Force, RAF Lakenheath , England
| | - Ian E Lee
- e U.S. Army Office of the Surgeon General , Falls Church , VA , USA
| | - Dale A Jensen
- f Department of Physical Medicine and Rehabilitation , Naval Medical Center Portsmouth , Portsmouth , VA
| | - Robert S Wainner
- g DPT Program, School of Physical Therapy , South College , Knoxville , TN , USA
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Abstract
Hemidiaphragmatic paralysis is initially recognised as postoperative respiratory distress. The subsequent sequential management of the patient following arthroscopic shoulder surgery under interscalene block is described. Ultrasound-guided technique is considered to be the safest for interscalene block. Reducing the volume of anaesthetic used reduces its spread to the phrenic nerve and thus reduces the incidence of hemidiaphragmatic paralysis. Furthermore, a reduction in anaesthetic volume has equivalent analgesic efficacy.
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Baskan S, Cankaya D, Unal H, Yoldas B, Taspinar V, Deveci A, Tabak Y, Baydar M. Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery. J Orthop Surg (Hong Kong) 2017; 25:2309499016684093. [PMID: 28116968 DOI: 10.1177/2309499016684093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. METHODS This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. RESULTS A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. CONCLUSION The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.
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Affiliation(s)
- Semih Baskan
- 1 Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Deniz Cankaya
- 2 Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hidayet Unal
- 1 Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Burak Yoldas
- 2 Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Vildan Taspinar
- 1 Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Alper Deveci
- 2 Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Yalcin Tabak
- 2 Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mustafa Baydar
- 1 Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Webb BG, Sallay PI, McMurray SD, Misamore GW. Comparison of Interscalene Brachial Plexus Block Performed With and Without Steroids. Orthopedics 2016; 39:e1100-e1103. [PMID: 27575034 DOI: 10.3928/01477447-20160819-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/15/2016] [Indexed: 02/03/2023]
Abstract
This prospective comparative clinical study was performed to evaluate the effect of triamcinolone when added to bupivacaine during brachial plexus blockade in patients undergoing shoulder surgery. Interscalene brachial plexus blocks were performed on 910 patients before shoulder surgery. Of the patients, 574 were randomly allocated to receive steroids added to the injected local anesthetic and 336 patients received local anesthetic without steroids. All patients were followed prospectively to evaluate the rate of successful anesthesia, duration of anesthesia, side effects of the block, adverse events, and persistent neurologic complications associated with interscalene brachial plexus block. Patients who received steroids had statistically longer pain relief than those who did not receive steroids (P<.001). No difference was found in adverse events, complications, or side effects. Compared with blocks performed without steroids, a statistically longer duration of block analgesia occurred with the addition of steroids to the local anesthetic solution during brachial plexus blockade. Rates of side effects, adverse events, and persistent neurologic complications were similar between the groups. [Orthopedics. 2016; 39(6):e1100-e1103.].
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Brattwall M, Jildenstål P, Warrén Stomberg M, Jakobsson JG. Upper extremity nerve block: how can benefit, duration, and safety be improved? An update. F1000Res 2016; 5. [PMID: 27239291 PMCID: PMC4874442 DOI: 10.12688/f1000research.7292.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 02/06/2023] Open
Abstract
Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality.
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Affiliation(s)
- Metha Brattwall
- Department of Anaesthesiology and Intensive Care, Unit of Day Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Pether Jildenstål
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden
| | - Margareta Warrén Stomberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesia & Intensive Care, Institution for Clinical Science, Karolinska Institute, Danderyds University Hospital, Stockholm, Sweden
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Abstract
The chronic obstructive pulmonary disease has become a disease of public health importance. Among the various risk factors, smoking remains the main culprit. In addition to airway obstruction, the presence of intrinsic positive end expiratory pressure, respiratory muscle dysfunction contributes to the symptoms of the patient. Perioperative management of these patients includes identification of modifiable risk factors and their optimisation. Use of regional anaesthesia alone or in combination with general anaesthesia improves pulmonary functions and reduces the incidence of post-operative pulmonary complications.
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Affiliation(s)
- Devika Rani Duggappa
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - G Venkateswara Rao
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka, India
| | - Sudheesh Kannan
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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An K, Elkassabany NM, Liu J. Dexamethasone as adjuvant to bupivacaine prolongs the duration of thermal antinociception and prevents bupivacaine-induced rebound hyperalgesia via regional mechanism in a mouse sciatic nerve block model. PLoS One 2015; 10:e0123459. [PMID: 25856078 PMCID: PMC4391940 DOI: 10.1371/journal.pone.0123459] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/04/2015] [Indexed: 11/18/2022] Open
Abstract
Background Dexamethasone has been studied as an effective adjuvant to prolong the analgesia duration of local anesthetics in peripheral nerve block. However, the route of action for dexamethasone and its potential neurotoxicity are still unclear. Methods A mouse sciatic nerve block model was used. The sciatic nerve was injected with 60ul of combinations of various medications, including dexamethasone and/or bupivacaine. Neurobehavioral changes were observed for 2 days prior to injection, and then continuously for up to 7 days after injection. In addition, the sciatic nerves were harvested at either 2 days or 7 days after injection. Toluidine blue dyeing and immunohistochemistry test were performed to study the short-term and long-term histopathological changes of the sciatic nerves. There were six study groups: normal saline control, bupivacaine (10mg/kg) only, dexamethasone (0.5mg/kg) only, bupivacaine (10mg/kg) combined with low-dose (0.14mg/kg) dexamethasone, bupivacaine (10mg/kg) combined with high-dose (0.5mg/kg) dexamethasone, and bupivacaine (10mg/kg) combined with intramuscular dexamethasone (0.5mg/kg). Results High-dose perineural dexamethasone, but not systemic dexamethasone, combined with bupivacaine prolonged the duration of both sensory and motor block of mouse sciatic nerve. There was no significant difference on the onset time of the sciatic nerve block. There was “rebound hyperalgesia” to thermal stimulus after the resolution of plain bupivacaine sciatic nerve block. Interestingly, both low and high dose perineural dexamethasone prevented bupivacaine-induced hyperalgesia. There was an early phase of axon degeneration and Schwann cell response as represented by S-100 expression as well as the percentage of demyelinated axon and nucleus in the plain bupivacaine group compared with the bupivacaine plus dexamethasone groups on post-injection day 2, which resolved on post-injection day 7. Furthermore, we demonstrated that perineural dexamethasone, but not systemic dexamethasone, could prevent axon degeneration and demyelination. There was no significant caspase-dependent apoptosis process in the mouse sciatic nerve among all study groups during our study period. Conclusions Perineural, not systemic, dexamethasone added to a clinical concentration of bupivacaine may not only prolong the duration of sensory and motor blockade of sciatic nerve, but also prevent the bupivacaine-induced reversible neurotoxicity and short-term “rebound hyperalgesia” after the resolution of nerve block.
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Affiliation(s)
- Ke An
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Anesthesiology, The first affiliated hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Nabil M. Elkassabany
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jiabin Liu
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Iwata T, Mitoro M, Kuzumoto N. Feasibility of Early and Repeated Low-dose Interscalene Brachial Plexus Block for Residual Pain in Acute Cervical Radiculopathy Treated with NSAIDS. Korean J Pain 2014; 27:125-32. [PMID: 24748940 PMCID: PMC3990820 DOI: 10.3344/kjp.2014.27.2.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 03/03/2014] [Accepted: 03/06/2014] [Indexed: 11/16/2022] Open
Abstract
Background To improve residual pain management in acute cervical radiculopathy treated with NSAIDs, the feasibility of early and repeated low-dose interscalene brachial plexus block (IS-BPB) needs to be assessed. Methods This was a prospective study on patients receiving NSAIDs (loxoprofen) for cervical radiculopathy of ≤ 2-week onset. Pain was assessed using the visual analogue scale (VAS). A low-dose ultrasonography (USG)-guided IS-BPB (dexamethasone [1.65 mg; 0.5 ml] and mepivacaine [1%; 3.0 ml]) was performed at baseline and weekly thereafter for 4 weeks in an outpatient setting for the intervention group. All patients were evaluated using a visual satisfaction score (VSS) at week 4. Patients with baseline VAS scores < 70 (mild to moderate pain; MM group) and ≥ 70 (severe pain; SE group) were compared to the controls receiving NSAIDs. Results A total of 316 IS-BPBs were performed in the intervention group. There was a significant difference in the decline in the VAS from week 0 to week 3 in the MM and SE groups (P < 0.05); however, from week 3 to week 4, the therapeutic effect exhibited no significant difference. Thirteen patients at week 2 (15.5%; MM: 27.7%; SE: 0%), 43 at week 3 (51.2%; MM: 83.0%; SE: 10.8%), and 47 at week 4 (56.0%; MM: 85.1%; SE: 18.9%) achieved a VAS score of ≤ 20. Patient satisfaction was high, and the decrease in VAS scores in both groups was significant (P < 0.05) compared to the controls. Conclusions Weekly, low-dose, USG-guided IS-BPB can be implemented for early pain relief in acute cervical radiculopathy, with high patient satisfaction.
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Affiliation(s)
- Toshio Iwata
- Department of Anesthesiology, Nara Prefectural Mimuro Hospital, Nara, Japan
| | - Mari Mitoro
- Department of Anesthesiology, Nara Prefectural Mimuro Hospital, Nara, Japan. ; Department of Anesthesiology, Heisei Memorial Hospital, Nara, Japan
| | - Naoya Kuzumoto
- Department of Anesthesiology, Nara Prefectural Mimuro Hospital, Nara, Japan. ; Department of Anesthesiology, Nara Prefectural Nara Hospital, Nara, Japan
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Plancher KD, Petterson SC. Arthroscopic Bankart Repair With Suture Anchors: Tips for Success. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2013.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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The influence of interscalene block technique on adverse hemodynamic events. J Anesth 2013; 28:407-12. [DOI: 10.1007/s00540-013-1748-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
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Mian A, Chaudhry I, Huang R, Rizk E, Tubbs RS, Loukas M. Brachial plexus anesthesia: A review of the relevant anatomy, complications, and anatomical variations. Clin Anat 2013; 27:210-21. [PMID: 23959836 DOI: 10.1002/ca.22254] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 03/18/2013] [Indexed: 11/08/2022]
Abstract
The trend towards regional anesthesia began in the late 1800s when William Halsted and Richard Hall experimented with cocaine as a local anesthetic for upper and lower limb procedures. Regional anesthesia of the upper limb can be achieved by blocking the brachial plexus at varying stages along the course of the trunks, divisions, cords and terminal branches. The four most common techniques used in the clinical setting are the interscalene block, the supraclavicular block, the infraclavicular block, and the axillary block. Each approach has its own unique set of advantages and indications for use. The supraclavicular block is most effective for anesthesia of the mid-humerus and below. Infraclavicular blocks are useful for procedures requiring continuous anesthesia. Axillary blocks provide effective anesthesia distal to the elbow, and interscalene blocks are best suited for the shoulder and proximal upper limb. The two most common methods for localizing the appropriate nerves for brachial plexus blocks are nerve stimulation and ultrasound guidance. Recent literature on brachial plexus blocks has largely focused on these two techniques to determine which method has greater efficacy. Ultrasound guidance has allowed the operator to visualize the needle position within the musculature and has proven especially useful in patients with anatomical variations. The aim of this study is to provide a review of the literature on the different approaches to brachial plexus blocks, including the indications, techniques, and relevant anatomical variations associated with the nerves involved.
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Affiliation(s)
- Asma Mian
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada
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Simeoforidou M, Vretzakis G, Chantzi E, Bareka M, Tsiaka K, Iatrou C, Karachalios T. Effect of interscalene brachial plexus block on heart rate variability. Korean J Anesthesiol 2013; 64:432-8. [PMID: 23741566 PMCID: PMC3668105 DOI: 10.4097/kjae.2013.64.5.432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/24/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022] Open
Abstract
Background Interscalene brachial plexus block (ISB) may be followed by cardiovascular instability. Until date, there is no clear picture available about the underlying mechanisms of ISB. In this study, we aimed to determine the changes in heart rate variability (HRV) parameters after ISB and the differences between right- and left-sided ISBs. Methods We prospectively studied 24 patients operated for shoulder surgery in sitting position and divided them into two respective groups: R (right-sided block = 14 pts) and L (left-sided block = 10 pts). HRV data were taken before and 30 min after the block. Ropivacaine without ephedrine was used for the ISB through an insulated block needle connected to a nerve stimulator. Statistical analysis implemented chi-square, Student's and t-paired tests. Skewed distributions were analyzed after logarithmic transformation. Results All the studied patients had successful blocks. Horner's syndrome signs were observed in 33.3% of the patients (R = 5/14, L = 3/10; [P = 0.769]). There were no significant differences in pre-block HRV between the groups. The application of ISB had differential effect on HRV variables: R-blocks increased QRS and QTc durations and InPNN50, while a statistical decrease was seen in InLF. L-blocks did not show any significant changes. These changes indicate a reduced sympathetic and an increased parasympathetic influence on the heart's autonomic flow after R-block. Conclusions Based on the obtained results we conclude that ISB, possibly through extension of block to the ipsilateral stellate ganglion, alters the autonomic outflow to the central circulatory system in a way depending on the block's side.
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Borgeat A, Ekatodramis G, Guzzella S, Ruland P, Votta-Velis G, Aguirre J. Deltoid, triceps, or both responses improve the success rate of the interscalene catheter surgical block compared with the biceps response. Br J Anaesth 2012; 109:975-80. [DOI: 10.1093/bja/aes296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Christ S, Kaviani R, Rindfleisch F, Friederich P. Identification of the Great Auricular Nerve by Ultrasound Imaging and Transcutaneous Nerve Stimulation. Anesth Analg 2012; 114:1128-30. [DOI: 10.1213/ane.0b013e3182468cc1] [Citation(s) in RCA: 11] [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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Ropivacaine for ultrasound-guided interscalene block: 5 mL provides similar analgesia but less phrenic nerve paralysis than 10 mL. Can J Anaesth 2011; 58:1001-6. [DOI: 10.1007/s12630-011-9568-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 07/27/2011] [Indexed: 10/17/2022] Open
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A prospective analysis of interscalene brachial plexus blocks performed under general anesthesia. J Shoulder Elbow Surg 2011; 20:308-14. [PMID: 20708419 DOI: 10.1016/j.jse.2010.04.043] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 04/20/2010] [Accepted: 04/25/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this prospective study was to assess the safety and efficacy of interscalene brachial plexus block anesthesia when performed on patients who were anesthetized with a general anesthetic prior to the performance of the block. METHODS Patients were assessed postoperatively through surveys, interviews, and physical examinations to document block success, duration of anesthesia, block side effects, and persistent neurological complications. Nine-hundred fifty-one patients were available for the analysis. RESULTS The overall block success rate was 97% and the mean duration of anesthesia provided by the blocks was 23.9 hours. Immediate postoperative block side effects occurred in 16% (142 of 910), persistent neurological complications occurred in 4.4% (40 of 910) of patients, and long-term neurologic complications occurred in 0.8% (8 of 910). CONCLUSION Our study results suggest that the rates of success and complications associated with the performance of interscalene block regional anesthesia performed after induction of general anesthesia are similar to the results demonstrated in prior studies in which brachial plexus block was performed on nonanesthetized patients. Although significant complications were not common, this procedure is not without risk and can result in long-term neurologic complications.
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Samuels LE, Casanova-Ghosh E, Droogan C. Cardiogenic shock associated with loco-regional anesthesia rescued with left ventricular assist device implantation. J Cardiothorac Surg 2010; 5:126. [PMID: 21143858 PMCID: PMC3004883 DOI: 10.1186/1749-8090-5-126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 12/08/2010] [Indexed: 11/18/2022] Open
Abstract
A healthy 53 year old man developed profound cardiogenic shock following instillation of bupivacaine-lidocaine-epinephrine solution as a locoregional anesthetic for elective outpatient shoulder surgery. Intubation, resuscitation, and transfer to the nearby hospital were done: echocardiography showed profound biventricular dysfunction; cardiac catheterization showed normal coronary arteries. Despite placement of an intra-aortic balloon pump and intravenous vasoactive drugs, the patient remained in shock. Stabilization was achieved with emergent institution of cardiopulmonary bypass and placement of a temporary left ventricular assist device (LVAD). Twenty-four hours later, cardiac function normalized and the LVAD was removed. The patient was discharged five days later and remained with normal heart function in three-year follow-up.
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Affiliation(s)
- Louis E Samuels
- Department of Cardiothoracic Surgery, Lankenau Hospital, Wynnewood, PA, USA
| | | | - Christopher Droogan
- Department of Medicine, Division of Cardiology, Lankenau Hospital, Wynnewood, PA, USA
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22
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Interscalene block for shoulder surgery in physician-owned community ambulatory surgery centers. Arthroscopy 2010; 26:1149-52. [PMID: 20810075 DOI: 10.1016/j.arthro.2010.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 11/10/2009] [Accepted: 01/15/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To retrospectively report on a series of patients who had interscalene block regional anesthesia performed for outpatient open and arthroscopic shoulder surgical procedures in a community-based ambulatory surgery center setting. METHODS We reviewed the cases of 1,945 patients who had interscalene block regional anesthesia performed during an 8-year period. RESULTS The complication rate was 0.63%, with all complications occurring in the immediate postoperative period, none of which were permanent. CONCLUSIONS With an expert, experienced anesthesia team, the interscalene block can be a safe method (temporary complication rate, 0.63%) of intraoperative anesthesia and perioperative analgesia for outpatient open and arthroscopic shoulder surgery in physician-owned ambulatory surgery centers. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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23
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Smith HM, Duncan CM, Hebl JR. Clinical utility of low-volume ultrasound-guided interscalene blockade: contraindications reconsidered. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1251-1258. [PMID: 19710225 DOI: 10.7863/jum.2009.28.9.1251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this series is to describe cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely circumventing traditional contraindications to interscalene blockade (ISB). METHODS Targeted low-volume ISB was performed in 3 patients in whom this procedure would typically be contraindicated because of phrenic nerve blockade or risk of local anesthetic toxicity. A patient with severe respiratory dysfunction, a patient undergoing bilateral shoulder surgery, and a patient requiring awake fiberoptic intubation underwent low-volume ultrasound-guided ISB. The ultrasound technique involved the use a low local anesthetic volume, anatomic identification of the brachial plexus trunk, needle placement opposite the phrenic nerve position, and control over local anesthetic spread. RESULTS In both patients in whom diaphragmatic paralysis was a concern, postoperative respiratory parameters indicated successful regional analgesia without evidence of phrenic nerve blockade. In the patient requiring an additional regional anesthetic procedure, ISB was performed with a local anesthetic volume low enough to avoid exceeding toxic safety thresholds. CONCLUSIONS Although further studies are warranted, we report on 3 cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely avoiding standard contraindications to ISB. Ultrasound technology may allow providers to perform low-volume brachial plexus blockade while avoiding issues related to phrenic nerve blockade and systemic local anesthetic toxicity.
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Affiliation(s)
- Hugh M Smith
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55905 USA.
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Kweon KS, Yang HJ, Gill HJ, Seol JH, Kim JH, Lee JY, Kim MK. Interscalene brachial plexus block: depth and angle from the skin insertion point to the brachial plexus and to C 6-7intervertebral foramen. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.5.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kyoung Seok Kweon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Hyeon Jeong Yang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Hyun Jue Gill
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Jung Ho Seol
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Ji Hyoung Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Jong Yeon Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Min Ku Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
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Shah A, Nielsen KC, Braga L, Pietrobon R, Klein SM, Steele SM. Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications. Indian J Orthop 2007; 41:230-6. [PMID: 21139750 PMCID: PMC2989124 DOI: 10.4103/0019-5413.33688] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using interscalene brachial plexus block (ISB). MATERIALS AND METHODS We prospectively examined 82 consecutive patients undergoing total and hemi-shoulder arthroplasty under ISB. Eighty-nine per cent (n=73) of patients received a continuous ISB; 11% (n=9) received a single-injection ISB. The blocks were performed using a nerve stimulator technique. Thirty to 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine was injected perineurally after appropriate muscle twitches were elicited at a current of less than 0.5% mA. Data were collected in the preoperative holding area, intraoperatively and postoperatively including the postanesthesia care unit (PACU), at 24h and at seven days. RESULTS Mean postoperative pain scores at rest were 0.8 ± 2.3 in PACU (with movement, 0.9 ± 2.5), 2.5 ± 3.1 at 24h and 2.8 ± 2.1 at seven days. Mean postoperative nausea and vomiting (PONV) scores were 0.2 ± 1.2 in the PACU and 0.4 ± 1.4 at 24h. Satisfaction scores were 4.8 ± 0.6 and 4.8 ± 0.7, respectively, at 24h and seven days. Minimal complications were noted postoperatively at 30 days. CONCLUSIONS Regional anesthesia offers sufficient analgesia during the hospital stay for shoulder arthroplasty procedures while adhering to high patient comfort and satisfaction, with low complications.
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Affiliation(s)
- Anand Shah
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Correspondence: Dr. Anand Shah, School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Suite 100, Philadelphia, PA, USA 19104. E-mail:
| | - Karen C Nielsen
- The Center for Excellence in Surgical Outcomes, University of Nebraska Medical Center, Omaha, NE,The Division of Ambulatory Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Larissa Braga
- The Center for Excellence in Surgical Outcomes, University of Nebraska Medical Center, Omaha, NE
| | - Ricardo Pietrobon
- The Center for Excellence in Surgical Outcomes, University of Nebraska Medical Center, Omaha, NE,The Division of Ambulatory Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA,The Division of Orthopedic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Stephen M Klein
- The Center for Excellence in Surgical Outcomes, University of Nebraska Medical Center, Omaha, NE,The Division of Ambulatory Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Susan M Steele
- The Center for Excellence in Surgical Outcomes, University of Nebraska Medical Center, Omaha, NE,The Division of Ambulatory Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Feigl G, Fuchs A, Gries M, Hogan QH, Weninger B, Rosmarin W. A supraomohyoidal plexus block designed to avoid complications. Surg Radiol Anat 2006; 28:403-8. [PMID: 16680393 DOI: 10.1007/s00276-006-0113-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 02/23/2006] [Indexed: 11/29/2022]
Abstract
Interscalene blocks of the brachial plexus are used for surgery of the shoulder and are frequently associated with complications such as temporary phrenic block, Horner syndrome or hematoma. To minimize the risk of these complications, we developed an approach that avoids medially directed needle advancement and favors spread to lateral regions only: the supraomohyoidal block. We tested this procedure in 11 cadavers fixed by Thiel's method. The insertion site is at the lateral margin of the sternocleidomastoid muscle at the level of the cricoid cartilage. The needle is inserted in the axis of the plexus with an angle of approximately 35 degrees to the skin, and advanced in lateral and caudal direction. Distribution of solution was determined in ten cadavers after bilateral injection of colored solution (20 and 30 ml) and followed by dissection. In an eleventh cadaver, computerized tomography and 3D reconstruction after radio contrast injection was performed. In additional five cadavers we performed Winnie's technique with bilateral injection (20 and 30 ml). Concerning the supraomohyoidal block the injection mass reached the infraclavicular region surrounded all trunks of the brachial plexus in the supraclavicular region and the suprascapular nerve in all cases. The solution did not spread medially beyond the lateral margin of the anterior scalene muscle into the scalenovertebral triangle. Therefore, phrenic nerve, stellate ganglion, laryngeal nerve nor the vertebral artery were exposed to the injected solution. Distribution was comparable with the use of 20 and 30 ml of solution. Injections on five cadavers performing the interscalene block of Winnie resulted in an extended spread medially to the anterior scalene muscle. We conclude that our method may be a preferred approach due to its safety, because no structures out of interest were reached. Solution of 20 ml is suggested to be enough for a successful block.
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Affiliation(s)
- G Feigl
- Department of Anatomy, Medical University Graz, Graz, Austria.
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Schwemmer U, Greim CA, Boehm TD, Papenfuss T, Markus CK, Roewer N, Gohlke F. Perioperative Schmerzbehandlung in der Schulterchirurgie. Schmerz 2004; 18:475-80. [PMID: 15034776 DOI: 10.1007/s00482-004-0329-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surgical procedures in the region of the shoulder joint are among the most painful interventions in orthopedic practice. For this reason, in addition to intravenous pain therapy with opioids, blockade of the brachial plexus has become established as an effective method to provide analgesia.High-resolution ultrasound offers the possibility of performing nerve blockades under visual monitoring. Studies on interscalene blockade performed under sonographic control provide evidence for both the high efficacy and safety of the procedure. Clinically manifest signs of nerve damage have not appeared with use of this method. Smaller operations can usually be adequately managed with perioperative single-shot blockade. More extensive operations for which severe pain lasting for several days can be expected and surgical interventions involving preexistent shoulder stiffness necessitate catheterization for uninterrupted pain therapy. Successful rehabilitation after shoulder surgery requires diligent perioperative pain blockade, which can primarily be provided by interscalene plexus blockade.
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Affiliation(s)
- U Schwemmer
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg.
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