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Arnaut DA, Maltbia T, Sadeghipour H. Continuous Interscalene Nerve Block for a Midshaft Clavicle Fracture: An Opioid-Sparing Postoperative Analgesic Strategy. Cureus 2023; 15:e49027. [PMID: 38116355 PMCID: PMC10728011 DOI: 10.7759/cureus.49027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Postoperative pain after surgical clavicle fixation is difficult to treat and often responds incompletely to opioid analgesics. Unfavorable side effects and the risk of misuse of opioid analgesics make regional anesthetic techniques an attractive strategy for treating clavicular pain. Literature on continuous nerve blocks with catheter placement for more prolonged pain control for clavicle fractures is scarce, while such techniques are common for other shoulder surgeries. This case report presents a successful continuous interscalene brachial plexus block (ISB) after surgical fixation of a midshaft clavicle fracture. The patient was discharged home on the day of the operation with a portable pump, which provided a local anesthetic infusion for five days postoperatively. The patient was very satisfied with her pain control and only required one dose of oral opioid analgesic postoperatively.
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Affiliation(s)
- Daniel A Arnaut
- Anesthesiology and Critical Care, Saint Louis University School of Medicine, Saint Louis, USA
| | - Theodis Maltbia
- Anesthesiology and Critical Care, Sisters of St. Mary (SSM) Saint Louis University Hospital, Saint Louis, USA
| | - Hamed Sadeghipour
- Anesthesiology and Critical Care, Sisters of St. Mary (SSM) Saint Louis University Hospital, Saint Louis, USA
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Adamczyk K, Koszela K, Zaczyński A, Niedźwiecki M, Brzozowska-Mańkowska S, Gasik R. Ultrasound-Guided Blocks for Spine Surgery: Part 1-Cervix. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2098. [PMID: 36767465 PMCID: PMC9915556 DOI: 10.3390/ijerph20032098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia beforehand, and regional anesthesia is a critical component of it. The purpose of this study is to examine the existing techniques for regional anesthesia in cervical spine surgery and to determine their effect and safety on pain reduction and postoperative patient's recovery. The electronic databases were searched for all literature pertaining to cervical nerve block procedures. The following peripheral, cervical nerve blocks were selected and described: paravertebral block, cervical plexus clock, paraspinal interfascial plane blocks such as multifidus cervicis, retrolaminar, inter-semispinal and interfacial, as well as erector spinae plane block and stellate ganglion block. Clinicians should choose more superficial techniques in the cervical region, as they have been shown to be comparably effective and less hazardous compared to paravertebral blocks.
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Affiliation(s)
- Kamil Adamczyk
- Department of Anaesthesiology and Intensive Therapy, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
- Department of Anaesthesiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
| | - Kamil Koszela
- Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Artur Zaczyński
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Marcin Niedźwiecki
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Sybilla Brzozowska-Mańkowska
- Department of Anaesthesiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
| | - Robert Gasik
- Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
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Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain. Anesthesiology 2020; 133:1127-1149. [PMID: 32898231 DOI: 10.1097/aln.0000000000003532] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Two regional analgesic modalities currently cleared by the U.S. Food and Drug Administration hold promise to provide postoperative analgesia free of many of the limitations of both opioids and local anesthetic-based techniques. Cryoneurolysis uses exceptionally low temperature to reversibly ablate a peripheral nerve, resulting in temporary analgesia. Where applicable, it offers a unique option given its extended duration of action measured in weeks to months after a single application. Percutaneous peripheral nerve stimulation involves inserting an insulated lead through a needle to lie adjacent to a peripheral nerve. Analgesia is produced by introducing electrical current with an external pulse generator. It is a unique regional analgesic in that it does not induce sensory, motor, or proprioception deficits and is cleared for up to 60 days of use. However, both modalities have limited validation when applied to acute pain, and randomized, controlled trials are required to define both benefits and risks.
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Shio H, Sakura S, Motooka A, Sakai Y, Saito Y. Severe and persistent nerve palsy after ultrasound-guided continuous interscalene brachial plexus block in a teenager undergoing shoulder surgery: a case report. JA Clin Rep 2020; 6:15. [PMID: 32062710 PMCID: PMC7024071 DOI: 10.1186/s40981-020-0315-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although neurologic sequela is a recognized complication after interscalene brachial plexus block (ISB), there is a paucity of information on how severe and persistent neuropathy occurs and develops. CASE PRESENTATION A healthy high school soccer goalkeeper was scheduled for an arthroscopic Bankart repair. After continuous ISB for 2 days, sensation in the C5 and C6 areas and motor function did not return. With symptomatic drug treatment for neuropathic pain and rigorous rehabilitation, recovery of sensory loss and muscle weakness were gradually observed around 1 to 2 months after surgery. He returned to sport 1 year after surgery. CONCLUSION This report is the first detailed description of a case who incurred severe and persistent nerve injury after continuous ISB yet recovered nearly fully to return to being an athlete. The present case should also underscore the importance of close observation after surgery in cases where a patient receives continuous ISB.
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Affiliation(s)
- Hisashi Shio
- Department of Anesthesiology, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo City, Shimane, 693-8501, Japan.
| | - Shinichi Sakura
- Surgical Operation Center, Shimane University Hospital, 89-1 Enya-Cho, Izumo City, Shimane, 693-8501, Japan
| | - Akihiro Motooka
- Department of Anesthesiology, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo City, Shimane, 693-8501, Japan
| | - Yasuo Sakai
- Department of Rehabilitation Medicine, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo City, Shimane, 693-8501, Japan
| | - Yoji Saito
- Department of Anesthesiology, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo City, Shimane, 693-8501, Japan
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King R, Mariano ER, Yajnik M, Kou A, Kim TE, Hunter OO, Howard SK, Mudumbai SC. Outcomes of Ambulatory Upper Extremity Surgery Patients Discharged Home with Perineural Catheters from a Veterans Health Administration Medical Center. PAIN MEDICINE 2019; 20:2256-2262. [DOI: 10.1093/pm/pnz023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
The feasibility and safety of managing ambulatory continuous peripheral nerve blocks (CPNB) in Veterans Health Administration (VHA) patients are currently unknown. We aimed to characterize the outcomes of a large VHA cohort of ambulatory upper extremity surgery patients discharged with CPNB and identify differences, if any, between catheter types.
Methods
With institutional review board approval, we reviewed data for consecutive patients from a single VHA hospital who had received ambulatory CPNB for upper extremity surgery from March 2011 to May 2017. The composite primary outcome was the occurrence of any catheter-related issue or additional all-cause health care intervention after discharge. Our secondary outcome was the ability to achieve regular daily telephone contact.
Results
Five hundred one patients formed the final sample. The incidence of any issue or health care intervention was 104/274 (38%) for infraclavicular, 58/185 (31%) for interscalene, and 14/42 (33%) for supraclavicular; these rates did not differ between groups. Higher ASA status was associated with greater odds of having any issue, whereas increasing age was slightly protective. Distance was associated with an increase in catheter-related issues (P < 0.01) but not additional health care interventions (P = 0.51). Only interscalene catheter patients (3%) reported breathing difficulty. Infraclavicular catheter patients had the most emergency room visits but rarely for CPNB issues. Consistent daily telephone contact was not achieved.
Conclusions
For VHA ambulatory CPNB patients, the combined incidence of a catheter-related issue or additional health care intervention was approximately one in three patients and did not differ by brachial plexus catheter type. Serious adverse events were generally uncommon.
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Affiliation(s)
- Roderick King
- Stanford University School of Medicine, Stanford, California
| | - Edward R Mariano
- Stanford University School of Medicine, Stanford, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Meghana Yajnik
- Stanford University School of Medicine, Stanford, California
| | - Alex Kou
- Stanford University School of Medicine, Stanford, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - T Edward Kim
- Stanford University School of Medicine, Stanford, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Oluwatobi O Hunter
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Steven K Howard
- Stanford University School of Medicine, Stanford, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Seshadri C Mudumbai
- Stanford University School of Medicine, Stanford, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Why Continuous Peripheral Nerve Blocks Fail. Tech Orthop 2017. [DOI: 10.1097/bto.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huang Y, Chiu F, Webb CA, Weyker PD. Review of the evidence: best analgesic regimen for shoulder surgery. Pain Manag 2017; 7:405-418. [PMID: 28936915 DOI: 10.2217/pmt-2017-0013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Multimodal pain management has been advocated in patients experiencing acute pain after surgical procedures due to tissue damage and the subsequent inflammatory response. For patients undergoing shoulder surgeries, studies have definitively shown that interscalene blocks (ISBs) via single-injection or continuous infusion can reduce the total opioid consumption and can lower pain scores after surgery. In some cases, ISBs can be used as the sole anesthetic during shoulder surgeries and spare patients of receiving general anesthesia. However, clinicians should be fully aware of potential pulmonary complications of ISBs and weigh the risk-benefit ratio in patients with limited pulmonary reserve.
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Affiliation(s)
- Yolanda Huang
- Department of Anesthesiology, Division of Orthopedic & Regional Anesthesia, Columbia University Medical Center
| | - Felicia Chiu
- Department of Anesthesiology, Division of Orthopedic & Regional Anesthesia, Columbia University Medical Center
| | - Christopher Aj Webb
- The Permanente Medical Group, Kaiser Permanente Northern California.,Adjunct Assistant Clinical Professor. Department of Anesthesia & Perioperative Care. University of California San Francisco School of Medicine
| | - Paul David Weyker
- Department of Anesthesiology, Divisions of Critical Care, Liver Transplant Anesthesia, Pain Medicine & Regional Anesthesia, Columbia University Medical Center
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Park HS, Kim HJ, Ro YJ, Yang HS, Koh WU. Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation: A lesson why we should use low concentrated local anesthetics for continuous blocks. Medicine (Baltimore) 2017; 96:e6598. [PMID: 28403100 PMCID: PMC5403097 DOI: 10.1097/md.0000000000006598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
RATIONALE Recurrent laryngeal nerve block is an uncommon complication that can occur after an interscalene brachial plexus block (ISB), which may lead to vocal cord palsy or paresis. However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion. To the best of our knowledge, there are no reports of bilateral vocal cord paresis, which occurred after a continuous ISB and endotracheal intubation in a patient with no history of vocal cord injury or surgery of the neck. PATIENT CONCERNS A 59 year old woman was planned for open acromioplasty and rotator cuff repair under general anesthesia. General anesthesia was induced following an ISB using 0.2% ropivacaine and catheter insertion for postoperative pain control. DIAGNOSES While recovering in the postanesthesia care unit (PACU), however, the patient complained of a sore throat and hoarseness without respiratory insufficiency. On the morning of the first postoperative day, she still complained of mild dyspnea, dysphonia, and slight aspiration. She was subsequently diagnosed with bilateral vocal cord paresis following an endoscopic laryngoscopy examination. INTERVENTIONS The continuous ISB catheter was immediately removed and the dyspnea and hoarseness symptoms improved, although mild aspiration during drinking water was still present. OUTCOMES On the 4th postoperative day, a laryngoscopy examination revealed that the right vocal cord movement had returned to normal but that the left vocal cord paresis still remained. LESSONS When ISB is planned, a detailed history-taking and examination of the airway are essential for patient safety and we recommend that any local anesthetics be carefully injected under ultrasound guidance. We also recommend the use of low concentration of local anesthetics to avoid possible paralysis of the vocal cord.
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Schwenk ES, Gandhi K, Baratta JL, Torjman M, Epstein RH, Chung J, Vaghari BA, Beausang D, Bojaxhi E, Grady B. Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study. Anesth Pain Med 2015; 5:e31111. [PMID: 26705526 PMCID: PMC4688811 DOI: 10.5812/aapm.31111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Continuous interscalene blocks provide excellent analgesia after shoulder surgery. Although the safety of the ultrasound-guided in-plane approach has been touted, technical and patient factors can limit this approach. We developed a caudad-to-cephalad out-of-plane approach and hypothesized that it would decrease pain ratings due to better catheter alignment with the brachial plexus compared to the in-plane technique in a randomized, controlled study. OBJECTIVES To compare an out-of-plane interscalene catheter technique to the in-plane technique in a randomized clinical trial. PATIENTS AND METHODS Eighty-four patients undergoing open shoulder surgery were randomized to either the in-plane or out-of-plane ultrasound-guided continuous interscalene technique. The primary outcome was VAS pain rating at 24 hours. Secondary outcomes included pain ratings in the recovery room and at 48 hours, morphine consumption, the incidence of catheter dislodgments, procedure time, and block difficulty. Procedural data and all pain ratings were collected by blinded observers. RESULTS There were no differences in the primary outcome of median VAS pain rating at 24 hours between the out-of-plane and in-plane groups (1.50; IQR, [0 - 4.38] vs. 1.25; IQR, [0 - 3.75]; P = 0.57). There were also no differences, respectively, between out-of-plane and in-plane median PACU pain ratings (1.0; IQR, [0 - 3.5] vs. 0.25; IQR, [0 - 2.5]; P = 0.08) and median 48-hour pain ratings (1.25; IQR, [1.25 - 2.63] vs. 0.50; IQR, [0 - 1.88]; P = 0.30). There were no differences in any other secondary endpoint. CONCLUSIONS Our out-of-plane technique did not provide superior analgesia to the in-plane technique. It did not increase the number of complications. Our technique is an acceptable alternative in situations where the in-plane technique is difficult to perform.
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Affiliation(s)
- Eric S. Schwenk
- Department of Anesthesiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
- Corresponding author: Eric S. Schwenk, Department of Anesthesiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA. Tel: +1-2159556161, Fax: +1-2159550677, E-mail:
| | - Kishor Gandhi
- Princeton University Medical Center, Princeton University, Plainsboro Township, USA
| | - Jaime L. Baratta
- Department of Anesthesiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Marc Torjman
- Department of Anesthesiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Richard H. Epstein
- Department of Anesthesiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Jaeyoon Chung
- Department of Anesthesiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | | | - David Beausang
- Department of Anesthesiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Elird Bojaxhi
- Department of Anesthesiology, Mayo Clinic, Jacksonville, USA
| | - Bernadette Grady
- Department of Nursing, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, USA
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Affiliation(s)
- Herman Sehmbi
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ushma J Shah
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
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Interscalene brachial plexus blocks under general anesthesia in children: is this safe practice?: A report from the Pediatric Regional Anesthesia Network (PRAN). Reg Anesth Pain Med 2014; 39:502-5. [PMID: 25304482 DOI: 10.1097/aap.0000000000000166] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES A practice advisory on regional anesthesia in children in 2008, published in this journal, supported the placement of regional blocks in children under general anesthesia (GA). Interscalene brachial plexus (IS) blocks were specifically excluded, based on case reports (level 3 evidence) of injury, which occurred predominantly in heavily sedated or anesthetized adult patients. Apart from case reports, there is a paucity of data that explore the safety of IS blocks placed in patients under GA, and the level of evidence available on which to base recommendations is limited. METHODS Querying the database of the Pediatric Regional Anesthesia Network (PRAN), we report on the incidence of postoperative neurological symptoms, local anesthetic systemic toxicity, and other reported adverse events in children receiving IS blocks under GA or sedated. RESULTS A total of 518 interscalene blocks were performed, 390 under GA and 123 with the patient sedated or awake (5 cases had missing status); 472 of these were single injection, and 46 involved the placement of infusion catheters. Eighty-eight percent of blocks were placed with ultrasound guidance, 7.7% with no location device, and 2.5% with a nerve stimulator. No local anesthetic systemic toxicity, postoperative neurological symptoms, cardiovascular complications, or dural puncture was reported in this cohort. There were 1 vascular puncture and 1 postoperative infection. These negative results are compatible with 0 to 7.7/1000 events for each of these complications for IS blocks placed under GA. There was no paralysis, motor block, or sensory deficit beyond the expected block duration time. CONCLUSIONS Analyzing interscalene blocks in children placed under GA, we identified no serious adverse events. The upper limit of the confidence interval for these events is similar to that in awake or sedated adults receiving IS blocks. Based on these prospectively collected data, placement of IS blocks under GA in children is no less safe than placement in awake adults, calling into question the American Society of Regional Anesthesia and Pain Medicine advisory proscribing GA during IS block in pediatric patients.
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Merritt CK, Mariano ER, Kaye AD, Lissauer J, Mancuso K, Prabhakar A, Urman RD. Peripheral nerve catheters and local anesthetic infiltration in perioperative analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:41-57. [DOI: 10.1016/j.bpa.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 02/09/2014] [Accepted: 02/19/2014] [Indexed: 11/16/2022]
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Perioperative management of interscalene block in patients with lung disease. Case Rep Anesthesiol 2013; 2013:986386. [PMID: 24369510 PMCID: PMC3863477 DOI: 10.1155/2013/986386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/27/2013] [Indexed: 11/18/2022] Open
Abstract
Interscalene nerve block impairs ipsilateral lung function and is relatively contraindicated for patients with lung impairment. We present a case of an 89-year-old female smoker with prior left lung lower lobectomy and mild to moderate lung disease who presented for right shoulder arthroplasty and insisted on regional anesthesia. The patient received a multimodal perioperative regimen that consisted of a continuous interscalene block, acetaminophen, ketorolac, and opioids. Surgery proceeded uneventfully and postoperative analgesia was excellent. Pulmonary physiology and management of these patients will be discussed. A risk/benefit discussion should occur with patients having impaired lung function before performance of interscalene blocks. In this particular patient with mild to moderate disease, analgesia was well managed through a multimodal approach including a continuous interscalene block, and close monitoring of respiratory status took place throughout the perioperative period, leading to a successful outcome.
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Saporito A. Dorsal scapular nerve injury: a complication of ultrasound-guided interscalene block. Br J Anaesth 2013; 111:840-1. [PMID: 24108729 DOI: 10.1093/bja/aet358] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Abstract
BACKGROUND Historically, the anterolateral interscalene block--deposition of local anesthetic adjacent to the brachial plexus roots/trunks--has been used for surgical procedures involving the shoulder. The resulting block frequently failed to provide surgical anesthesia of the hand and forearm, even though the brachial plexus at this level included all of the axons of the upper-extremity terminal nerves. However, it remains unknown whether deposition of local anesthetic adjacent to the seventh cervical root or inferior trunk results in anesthesia of the hand and forearm. METHODS Using ultrasound guidance and a needle-in-plane posterior approach, a Tuohy needle was positioned with the tip located between the deepest and next-deepest visualized brachial plexus root/trunk, followed by injection of mepivacaine (1.5%). Grip strength and the tolerance to cutaneous electrical current in 5 terminal nerve distributions were measured at baseline and then every 5 minutes following injection for a total of 30 minutes. The primary end point was the proportion of cases in which the interscalene nerve block resulted in a decrease in grip strength of at least 90% and hand and forearm anesthesia (tolerance to >50 mA of current in all 5 terminal nerve distributions) within 30 minutes. The primary hypothesis was that a single-injection interscalene brachial plexus block produces a similar rate of anesthesia of the hand and forearm to the published success rate of 95% for other brachial plexus block approaches. RESULTS Of 55 subjects with blocks placed per protocol, all had a successful block of the shoulder as defined by inability to abduct at the shoulder joint. Thirty-three subjects had measurements at 30 minutes following local anesthetic deposition, and only 5 (15%) of these subjects had a surgical block of the hand and forearm (P < 0.0001; 95% confidence interval, 6%-33%). We therefore reject the hypothesis that the interscalene block as performed in this study provides equivalent anesthesia to the hand and forearm compared with other brachial plexus block techniques. Block failures of the hand and forearm were due to inadequate cutaneous anesthesia of the ulnar (n = 27; 82%), median (n = 26; 78%), or radial (n = 22; 67%) distributions; the medial forearm (n = 25; 76%); and/or the lateral forearm (n = 14; 42%). Failure to achieve at least a 90% reduction in grip strength occurred in 16 subjects (48%). CONCLUSIONS This study did not find evidence to support the hypothesis that local anesthetic injected adjacent to the deepest brachial plexus roots/trunks reliably results in surgical anesthesia of the hand and forearm.
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Kucera TJ, Boezaart AP. Regional Anesthesia Does Not Consistently Block Ischemic Pain: Two Further Cases and a Review of the Literature. PAIN MEDICINE 2013; 15:316-9. [DOI: 10.1111/pme.12235] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tomas J. Kucera
- Department of Anesthesiology; University of Florida College of Medicine; Gainesville Florida USA
| | - André P. Boezaart
- Department of Anesthesiology; University of Florida College of Medicine; Gainesville Florida USA
- Department of Orthopaedic Surgery; Division of Acute and Perioperative Pain Medicine; University of Florida College of Medicine; Gainesville Florida USA
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Thackeray EM, Swenson JD, Gertsch MC, Phillips KM, Steele JW, Burks RT, Tashjian RZ, Greis PE. Diaphragm function after interscalene brachial plexus block: a double-blind, randomized comparison of 0.25% and 0.125% bupivacaine. J Shoulder Elbow Surg 2013; 22:381-6. [PMID: 22947235 DOI: 10.1016/j.jse.2012.06.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 06/19/2012] [Accepted: 06/22/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Interscalene brachial plexus block (ISBPB) provides excellent analgesia after rotator cuff surgery but is associated with diaphragm dysfunction. In this study, ISBPB with 20 mL of 0.125% or 0.25% bupivacaine were compared to assess the effect on diaphragm function, oxygen saturation, pain control, opioid requirements, and patient satisfaction. MATERIALS AND METHODS In this prospective, randomized, double-blind study, 30 adults undergoing outpatient arthroscopic rotator cuff repair were enrolled to receive ultrasound-guided interscalene brachial plexus catheter placement with 20 mL of 0.125% (n = 15) or 0.25% bupivacaine (n = 15). Diaphragm function and oxygen saturation were assessed before ISBPB placement and on discharge from the postanesthesia care unit. Postoperative pain scores, opioid requirements, and patient satisfaction were compared. RESULTS Diaphragm function and oxygen saturation were superior in the low concentration group. Absent or paradoxic motion of the diaphragm was present in 78% of the 0.25% group compared with 21% of patients in the 0.125% group (P = .008). Oxygen saturation decreased 4.3% in the 0.25% group compared with a decrease of 2.6% in the 0.125% group (P = .04). Pain scores averaged 1 of 10 in the 0.25% group and 0 of 10 in the 0.125% group (P = .02). Opioid requirements and patient satisfaction were not different between the two groups. CONCLUSIONS In this randomized, double-blind comparison of ISBPB performed with 20 mL of 0.125% or 0.25% bupivacaine, diaphragm function and oxygen saturation were superior in patients treated with more dilute bupivacaine. Furthermore, there were no clinically significant differences in pain scores, and no statistically significant differences in opioid requirements and patient satisfaction.
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Affiliation(s)
- Elizabeth M Thackeray
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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WADA M, SAKURA S. Ultrasound-Guided Nerve Blocks (1)Practice of Upper Extremity Nerve Blocks: Brachial Plexus Blocks. ACTA ACUST UNITED AC 2013. [DOI: 10.2199/jjsca.33.493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Systematic Ultrasound Identification of the Dorsal Scapular and Long Thoracic Nerves During Interscalene Block. Reg Anesth Pain Med 2013; 38:54-7. [DOI: 10.1097/aap.0b013e31826f0a63] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Estebe JP. [Ultrasound-guided perineural catheters]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:e203-e206. [PMID: 22836140 DOI: 10.1016/j.annfar.2012.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- J-P Estebe
- Service d'anesthésie-réanimation chirurgicale-2, université Rennes-1, hôpital Hôtel-Dieu, 2, rue de l'Hôtel-Dieu, 35000 Rennes, France.
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Retained stimulating perineural catheter placed with hydrodissection but without nerve stimulation. Can J Anaesth 2012; 59:997-8. [DOI: 10.1007/s12630-012-9753-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022] Open
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Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract 2012; 2012:560879. [PMID: 22761615 PMCID: PMC3385590 DOI: 10.1155/2012/560879] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/10/2012] [Accepted: 04/17/2012] [Indexed: 12/29/2022] Open
Abstract
A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of postoperative joint inflammation and inflammatory markers, sleep disturbances and opioid-related side effects, increase of patient satisfaction and ambulation/functioning improvement, an accelerated resumption of passive joint range-of-motion, reducing time until discharge readiness, decrease in blood loss/blood transfusions, potential reduction of the incidence of postsurgical chronic pain and reduction of costs. Evidence deriving from randomized controlled trials suggests that in some situations there are also prolonged benefits of regional anesthesia after catheter removal in addition to the immediate postoperative effects. Unfortunately, there are only few data demonstrating benefits after catheter removal and the evidence of medium- or long-term improvements in health-related quality of life measures is still lacking. This review will give an overview of the advantages and adverse effects of cPNBs.
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Affiliation(s)
- José Aguirre
- Division of Anesthesiology, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Alicia Del Moral
- Department of Anesthesiology, General University Hospital of Valencia, 46014 Valencia, Spain
| | - Irina Cobo
- Department of Anesthesiology, General University Hospital of Valencia, 46014 Valencia, Spain
| | - Alain Borgeat
- Division of Anesthesiology, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Stephan Blumenthal
- Department of Anesthesiology, Triemli Hospital, 8063 Zurich, Switzerland
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Mariano ER, Brodsky JB. Comparison of procedural times for ultrasound-guided perineural catheter insertion in obese and nonobese patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1357-1361. [PMID: 21968486 DOI: 10.7863/jum.2011.30.10.1357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Perineural catheter insertion with ultrasound guidance alone has been described, but it remains unknown whether this new technique results in the same procedural time and success rate for obese and nonobese patients. We therefore tested the hypothesis that obese patients require more time for perineural catheter insertion compared to nonobese patients despite using ultrasound. METHODS Data from 5 previously published randomized clinical trials comparing ultrasound- and stimulation-guided perineural catheter insertion techniques were reviewed, and patients who received ultrasound-guided catheters were divided into 2 groups: obese (body mass index ≥30 kg/m(2)) and nonobese (body mass index <30 kg/m(2)). A standardized ultrasound-guided nonstimulating catheter technique was used with mepivacaine, 1.5% (40 mL), as the initial bolus via the placement needle for the primary surgical nerve block. The primary outcome was the procedural time for perineural catheter insertion. Secondary outcomes included block efficacy, procedure-related pain, fluid leakage, vascular puncture, and catheter dislodgment. RESULTS A sample of 120 patients was identified: 51 obese and 69 nonobese. All obese patients had successful catheter placement compared to 68 of 69 (98%) nonobese patients (P = .388). The time for perineural catheter insertion [median (10th-90th percentiles)] was 7 (4-12) minutes for obese patients versus 7 (4-15) minutes for nonobese patients (P = .732). There were no statistically significant differences in other secondary outcomes. CONCLUSIONS On the basis of this retrospective analysis, perineural catheter insertion is not prolonged in obese patients compared to nonobese patients when an ultrasound-guided technique is used. However, these results are only suggestive and require confirmation through prospective study.
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Affiliation(s)
- Edward R Mariano
- Department of Anesthesia, University of California, San Diego, California, USA.
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Abstract
A single-injection peripheral nerve block using long-acting local anesthetic provides analgesia for 12 to 24 hours; however, many surgical procedures result in pain that lasts far longer. One relatively new option is a continuous peripheral nerve block (CPNB): local anesthetic is perfused via a perineural catheter directly adjacent to the peripheral nerve(s) supplying the surgical site, providing potent, site-specific analgesia. CPNB results in decreased pain, opioid requirements, opioid-related side effects, and sleep disturbances; in some cases, accelerating resumption of tolerated passive joint range-of-motion and increasing patient satisfaction. Ambulatory perineural infusion may be provided using a portable infusion pump, in some cases resulting in decreased hospitalization duration and related costs. Serious complications are rare, but may result in significant morbidity.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, MC 8770, San Diego, CA 92103-8770, USA.
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Ultrasound-guided perineural catheter insertion: three approaches but few illuminating data. Reg Anesth Pain Med 2011; 35:123-6. [PMID: 20216031 DOI: 10.1097/aap.0b013e3181d245a0] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010; 65:608-624. [DOI: 10.1111/j.1365-2044.2009.06231.x] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: Part 2-recent developments in block techniques. Br J Anaesth 2010; 104:673-83. [PMID: 20418267 DOI: 10.1093/bja/aeq086] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The use of ultrasound guidance for regional anaesthesia has gained enormous popularity in the last 10 yr. The first part of this review article provided information on safety, technical developments, economic aspects, education, advantages, needle guidance techniques, and future developments in ultrasound. The second part focuses on practical and technical details of individual ultrasound-guided nerve blocks in adults. We present a comprehensive review of the relevant literature of the last 5 yr with a commentary based on our own clinical experience in order to provide information relevant to patient management. Upper limb blocks, including interscalene, supra- and infraclavicular, and axillary approaches, are described and discussed. For the lower limb, psoas compartment, femoral, obturator, sciatic, and lateral cutaneous nerve blocks are described, as are some abdominal wall blocks. The potential role of ultrasound guidance for neuraxial block is addressed. The need for further large-scale studies of the role of ultrasound is emphasized.
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Affiliation(s)
- P Marhofer
- Department of Anaesthesia, Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
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Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth 2010; 104:538-46. [PMID: 20364022 DOI: 10.1093/bja/aeq069] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Ultrasound guidance for regional anaesthesia has gained enormous popularity in the past decade. The use of ultrasound guidance for many regional anaesthetic techniques is common in daily clinical practice, and the number of practitioners using it is increasing. However, alongside the enthusiasm, there should be a degree of informed scepticism. The widespread use of the various techniques of ultrasound-guided regional blocks without adequate training raises the danger of malpractice and subsequent impaired outcome. Adequate education in the use of regional block techniques under ultrasound guidance is essential. This review article addresses ultrasound guidance for regional anaesthesia, and is divided into two parts because of the size of the topic and the number of issues covered. This first part includes a review and preview of ultrasound guidance in regional anaesthesia and discusses all aspects of ultrasound for regional anaesthesia with a focus on recent technical developments, the positive implications in economics, further potential advantages (e.g. detection of anatomical variants, painless performance of blocks) and education. It also attempts to define a 'gold standard' in regional anaesthesia with the most recent findings in adequate volumes of local anaesthetics for peripheral nerve blocks. This standard should include an extraneural needle position, a high success rate, and wide application of ultrasound guidance in regional anaesthesia. The second part describes the impact of ultrasound on the development of nerve block techniques in the past 5 yr.
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Affiliation(s)
- P Marhofer
- Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Tanoubi I, Drolet P, Blanchette D. [Late subcutaneous emphysema and pneumothorax after shoulder arthroscopy]. Can J Anaesth 2010; 57:383-4. [PMID: 20087709 DOI: 10.1007/s12630-009-9258-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 12/16/2009] [Indexed: 11/30/2022] Open
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Boezaart AP, Tighe P. New trends in regional anesthesia for shoulder surgery: Avoiding devastating complications. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2010; 4:1-7. [PMID: 20922086 PMCID: PMC2940165 DOI: 10.4103/0973-6042.68410] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surgeons and patients are often reluctant to support regional anesthesia (RA) for shoulder and other orthopedic surgeries. This is because of the sometimes true but usually incorrectly perceived "slowing down" of operating room turnover time and the perceived potential for added morbidity. Recently, severe devastating and permanent nerve injury complications have surfaced, and this article attempts to clarify the modern place of RA for shoulder surgery and the prevention of these complications. A philosophical approach to anesthesiology and regional anesthesiology is offered, while a fresh appreciation for the well-described and often forgotten microanatomy of the brachial plexus is revisited to explain and avoid some of the devastating complications of RA for shoulder surgery.
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Affiliation(s)
- André P. Boezaart
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Orthopaedic Surgery & Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
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Ultrasound guidance: posterior approach to brachial plexus nerve roots, trunks. Reg Anesth Pain Med 2009; 34:609. [PMID: 19901777 DOI: 10.1097/aap.0b013e3181b4c939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Le LT, Loland VJ, Mariano ER, Gerancher JC, Wadhwa AN, Renehan EM, Sessler DI, Shuster JJ, Theriaque DW, Maldonado RC, Ilfeld BM. Effects of local anesthetic concentration and dose on continuous interscalene nerve blocks: a dual-center, randomized, observer-masked, controlled study. Reg Anesth Pain Med 2009; 33:518-25. [PMID: 19258966 DOI: 10.1016/j.rapm.2008.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES It is currently unknown if the primary determinant of continuous peripheral nerve block effects is simply total drug dose, or whether local anesthetic concentration and/or volume have an influence. We therefore tested the null hypothesis that providing ropivacaine at different concentrations and rates--but at an equal total basal dose--produces similar effects when used in a continuous interscalene nerve block. METHODS Preoperatively, an anterolateral interscalene perineural catheter was inserted using the anterolateral approach in patients undergoing moderately painful shoulder surgery. Subjects were randomly assigned to receive a postoperative perineural infusion of either 0.2% ropivacaine (basal 8 mL/h, bolus 4 mL) or 0.4% ropivacaine (basal 4 mL/h, bolus 2 mL) through the second postoperative day. Our primary endpoint was the incidence of an insensate hand/finger during the 24 hours beginning the morning following surgery. RESULTS The incidence of an insensate hand/finger did not differ between the treatment groups (n = 50) to a statistically significant degree (0.2% ropivacaine, mean [SD] of 0.8 [1.3] times; 0.4% ropivacaine, mean 0.3 [0.6] times; estimated difference = 0.5 episodes, 95% confidence interval, -0.1 to 1.1 episodes; P = .080). However, this is statistically inconclusive given the confidence interval. In contrast, pain (P = .020) and dissatisfaction (P = .011) were greater in patients given 0.4% ropivacaine. CONCLUSIONS For continuous interscalene nerve blocks, given the statistically inconclusive primary endpoint results and design limitations of the current study, further research on this topic is warranted. In contrast, providing a lower concentration of local anesthetic at a higher basal rate provided superior analgesia.
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Affiliation(s)
- Linda T Le
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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Mariano ER, Afra R, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Cheng GS, Choy LP, Maldonado RC, Ilfeld BM. Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study. Anesth Analg 2009; 108:1688-94. [PMID: 19372355 PMCID: PMC2745838 DOI: 10.1213/ane.0b013e318199dc86] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The posterior approach for placing continuous interscalene catheters has not been studied in a controlled investigation. In this randomized, triple-masked, placebo-controlled study, we tested the hypothesis that an ultrasound-guided continuous posterior interscalene block provides superior postoperative analgesia compared to a single-injection ropivacaine interscalene block after moderately painful shoulder surgery. METHODS Preoperatively, subjects received a stimulating interscalene catheter using an ultrasound-guided, in-plane posterior approach. All subjects received an initial bolus of ropivacaine. Postoperatively, subjects were discharged with oral analgesics and a portable infusion device containing either ropivacaine 0.2% or normal saline programmed to deliver a perineural infusion over 2 days. The primary outcome was average pain on postoperative day (POD) 1 (scale: 0-10). Secondary outcomes included least and worst pain scores, oral opioid requirements, sleep disturbances, patient satisfaction, and incidence of complications. RESULTS Of the 32 subjects enrolled, 30 perineural catheters were placed per protocol. Continuous ropivacaine perineural infusion (n = 15) produced a statistically and clinically significant reduction in average pain (median [10th-90th percentile]) on POD 1 compared with saline infusion (n = 15) after initial ropivacaine bolus (0.0 [0.0-5.0] versus 3.0 [0.0-6.0], respectively; P < 0.001). Median oral opioid consumption (oxycodone) was lower in the ropivacaine group than in the placebo group on POD 1 (P = 0.002) and POD 2 (P = 0.002). Subjects who received a ropivacaine infusion suffered fewer sleep disturbances than those in the placebo group (P = 0.005 on POD 0 and 1 nights) and rated their satisfaction with analgesia higher than subjects who received normal saline (P < 0.001). CONCLUSIONS Compared to a single-injection interscalene block, a 2-day continuous posterior interscalene block provides greater pain relief, minimizes supplemental opioid requirements, greatly improves sleep quality, and increases patient satisfaction after moderate-to-severe painful outpatient shoulder surgery.
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Affiliation(s)
- Edward R. Mariano
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Robert Afra
- Department of Orthopedic Surgery, University of California, San Diego Medical Center, San Diego, California
| | - Vanessa J. Loland
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - NavParkash S. Sandhu
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Richard H. Bellars
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Michael L. Bishop
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Gloria S. Cheng
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Lynna P. Choy
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Rosalita C. Maldonado
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
| | - Brian M. Ilfeld
- Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California
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Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJL, Franco CD, Hogan QH. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med 2009; 34:134-70. [PMID: 19282714 PMCID: PMC2779737 DOI: 10.1097/aap.0b013e31819624eb] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine's commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research.
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Affiliation(s)
- Joseph M Neal
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA, USA.
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That Which We Call a Rose by Any Other Name Would Smell as Sweet-and Its Thorns Would Hurt as Much. Reg Anesth Pain Med 2009; 34:3-7. [DOI: 10.1097/aap.0b013e318194cf23] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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