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Cakmak HŞ, Ertas G, Akdeniz S, Polat E, Sonmez A, Gumus M. A Comparison of Distal Nerve Blocks and Brachial Plexus Blocks in Terms of Block Success, Block-related Characteristics, Time to Discharge and Patient Satisfaction. J Hand Surg Asian Pac Vol 2023; 28:446-452. [PMID: 37758499 DOI: 10.1142/s2424835523500509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: Ultrasound-guided brachial plexus blocks (BPB) are used as an anaesthetic method in hand and wrist surgeries. The radial, median and ulnar nerves can also be selectively blocked. The objective of this retrospective cohort study was to compare distal nerve blocks (DNB) and BPB in terms of block success, block-related characteristics, time to discharge and patient satisfaction. Methods: The data of patients who underwent elective hand and wrist surgery under regional anaesthetic procedures between 01.01.2022 and 01.09.2022 were analysed. Standard multimodal analgesia was performed in all groups, in addition to either ultrasound-guided BPB or DNB. Demographic characteristics, American Society of Anaesthesiology (ASA) classes, presence of additional diseases, block and volume applied, block-related data such as block performance time, onset time, initial analgesia times, perioperative additional anaesthetic or analgesic requirement, surgery times, types of surgery, discharge times and the presence of additional complaints were recorded. In addition, the anaesthesia quality score were determined using a 5-point Likert scale. Results: There was no difference between demographic data. Average surgical time was similar between the DNB and BPB groups (46.0 ± 8.92 vs. 59.95 ± 22.04 min, p < 0.05). Block onset time was significantly lower in the DNB group (26.4 ± 2.73 vs. 32.17 ± 2.94 min, p < 0.001). When patients discharged before and after 12 hours were compared, 11/22 of the patients in the DNB group and 4/23 of the patients in the BPB group were discharged in the first 12 hours (p < 0.05). Patient satisfaction scores were similar between groups (14.22 ± 0.86 vs. 13.65 ± 1.11, p > 0.05). Conclusions: In surgeries of the hand and wrist, the radial, median and ulnar nerves can be used individually or in combination as an alternative to proximal BPB. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Hamiyet Şenol Cakmak
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Gamze Ertas
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Sevda Akdeniz
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ebru Polat
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ayhan Sonmez
- Department of Plastic Surgery, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Murat Gumus
- Department of Plastic Surgery, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
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Wang J, Deng L, Xu A. Evaluation of prediction effect of perfusion index for supraclavicular brachial plexus block in children: protocol for a randomized trial. Trials 2022; 23:629. [PMID: 35927745 PMCID: PMC9351202 DOI: 10.1186/s13063-022-06597-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Pulse perfusion index (PI) reflects blood perfusion. It has been reported that PI can be used to evaluate the effect of nerve block, but currently, it is mainly focused on awake adults. In pediatric general anesthesia, it has been reported that PI can evaluate the effect of the sacral block. Still, there is a lack of relevant research on the impact of brachial plexus blocks. Our objective is to assess the prediction effects of PI on the success of supraclavicular brachial plexus block in pediatric patients under sevoflurane or propofol general anesthesia. Methods/design This is a mono-center, parallel, 2-arm randomized superiority trial. One hundred four children aged 1 month to 12 years who undergo upper limb surgery will be enrolled in this study. According to anesthesia induction and maintenance medication, they will be divided into sevoflurane and propofol groups. The PI values of the index and little finger will be recorded on the blocked and non-blocked sides of supraclavicular brachial plexus block (SCB) in all children. The primary outcome is to assess the effects of PI on the success of supraclavicular brachial plexus block in pediatric patients under sevoflurane or propofol general anesthesia. The secondary outcome includes mean arterial blood pressure (MAP), heart rate (HR), and correlation between baseline PI and 10 min after SCB (PI ratio). Discussion This trial will provide evidence on the changes in PI after SCB in sevoflurane or propofol anesthesia in children. SCB may lead to changes in PI values under sevoflurane or propofol anesthesia. After the children wake up at the end of the surgery, the changes in PI values on the block side and non-block side may be helpful to judge the effect of nerve block when excluding the influence of anesthetics. Trial registration ClinicalTrials.gov NCT04216823. Registered on 15 July 2020.
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Affiliation(s)
- Jinxu Wang
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Lingli Deng
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Aijun Xu
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
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Miyatake K, Fujisawa T, Otoshi A, Kawabata Y, Kusaba Y, Tsujiku S, Inaba Y. Silent Manipulation for Adhesive Capsulitis. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00332-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Erdogmus NA, Baskan S, Zengin M, Demirelli G. What Is the Minimum Effective Volume of Local Anaesthetic Applied in Brachial Plexus Blockage With an Axillary Approach Under Ultrasonography Guidance? Cureus 2021; 13:e16865. [PMID: 34513440 PMCID: PMC8413900 DOI: 10.7759/cureus.16865] [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] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
Peripheral nerve blocks with the use of ultrasonography (USG) allow visualisation of both the structures and nerves and make the block administrations safe, quick, and comfortable. However, few publications concerning the minimum local anesthetic (LA) volume are capable of providing blocks. This study aimed to find the minimum effective LA volume in brachial plexus blockage administrations with an axillary approach accompanied by ultrasonography in hand, elbow, and forehand operations. Materials and Method The study included a total of 55 patients (classified as American Society of Anesthesiologists (ASA) I-II) who underwent hand surgery by administering USG-guided axillary brachial plexus blockage. The ulnar, median, and radial nerves were located, and the minimum effective LA volume was investigated starting with a total of 21 ml of bupivacaine 0.5%. After accomplishing the blockage, the volume was decreased by 0.5 ml for each nerve. Block administration time, block onset times, anesthesia times, and time to first analgesic requirement were recorded. Results The minimum effective LA volume for each nerve was 2.5 ml for a total of 7.5 ml. In comparing block administration times, there were no differences between high or low volume groups. It was found that sensory block onset time was 17 minutes for 7.5 ml and 11 minutes for 21 ml; sensory block regression time was six hours for 7.5 ml and 10.4 hours for 21 ml, respectively. This regression was statistically significant. The first analgesic requirement was 5.8 - 16.6 hours, respectively, for each group. Conclusion In the administration of an USG-guided axillary block, sufficient anesthesia can be achieved by administering 2.5 ml of bupivacaine 0.5% for each nerve. However, it might be kept in mind that motor and sensory block onset time will be extended and regression time and time to the first analgesic requirement will be shorter with this volume. In addition, more advanced studies must be done for the determination of the optimum volume which can be used.
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Affiliation(s)
- Necati A Erdogmus
- Intensive Care Clinic, Ankara University Faculty of Medicine, Ankara, TUR
| | - Semih Baskan
- Anesthesiology and Reanimation Clinic, Ankara City Hospital, Ankara, TUR
| | - Musa Zengin
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Gokhan Demirelli
- Anesthesiology and Reanimation Clinic, Bafra State Hospital, Samsun, TUR
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[Central neurological complication of an interscalene plexus catheter]. Anaesthesist 2021; 70:937-941. [PMID: 34324036 DOI: 10.1007/s00101-021-01007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
A 78-year-old patient received an interscalene plexus catheter for perioperative pain therapy during implantation of an inverse shoulder prothesis. After stimulation-assisted puncture under sonographic control, 25 ml of local anesthetic (LA) were first administered and then the catheter was placed using the through the needle technique. Immediately after the administration of another 5 ml of local anesthetic via the inserted catheter, the patient showed symptoms of total spinal anesthesia, so that she had to be intubated and ventilated. The following computed tomographic diagnostics of the neck revealed an intrathecal misalignment of the plexus catheter, the tip of which was lying dorsal to the vertebral artery at the level of the 5/6 cervical vertebrae. The catheter could then be removed without any problems and there were no neurological sequelae. The use of ultrasound with clear identification of the nerve roots C5-C7 and the surrounding structures provides additional security when installing an intrascalene catheter. The spread of the LA should be traceable at all times using ultrasound and should otherwise be immediately terminated. Furthermore, a strict adherence to the needle position while inserting the catheter without manipulation of the needle depth is necessary. The first injection of the catheter has to be performed under controlled conditions, preferably connected to surveillance monitors with neurological monitoring of the awake patient and control of vital signs with direct access to the emergency equipment.
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Sauter AR, Luedi MM. Effektive Schmerzbehandlung durch Blockadetechniken im Rahmen multimodaler Therapie. Anaesthesist 2020; 69:857-859. [DOI: 10.1007/s00101-020-00834-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Samar P, Dhawale TA, Pandya S. Comparative Study of Intravenous Dexmedetomidine Sedation With Perineural Dexmedetomidine on Supraclavicular Approach Brachial Plexus Block in Upper Limb Orthopaedic Surgery. Cureus 2020; 12:e10768. [PMID: 33154840 PMCID: PMC7606249 DOI: 10.7759/cureus.10768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Dexmedetomidine is being used as an adjuvant analgesic, both as intravenous (IV) and intrathecal infusion. The role of perineural (P) dexmedetomidine has evoked attention recently. The aim of this study was to compare the effect of IV dexmedetomidine and P dexmedetomidine as an adjunct to supraclavicular brachial plexus block in upper limb orthopaedic surgery. Methods Patients were randomly divided into two equal groups (n=20). Group I (IV dexmedetomidine) received dexmedetomidine 1 mcg/kg IV as loading dose over 10 minutes, followed by continuous infusion of dexmedetomidine 0.4 mcg/kg/hr IV. Group P (P dexmedetomidine) received dexmedetomidine at 1 mcg/kg perineurally. After adequate motor response with the aid of peripheral nerve stimulator a supraclavicular block with 40 ml solution containing 5 mg/kg lignocaine (2%) with adrenaline (1:200,000) and 2 mg/kg of bupivacaine (0.5%) was injected to both the groups. Group P also received dexmedetomidine perineurally with block. Onset and duration of sensory and motor block, Ramsay sedation score, hemodynamic parameters, and postoperative analgesia requirement were assessed along with side effects. The data obtained were recorded as mean ± SD, ranges, numbers, and ratios. Results were analyzed using the chi-square test, the Mann-Whitney test for non-parametric data, and an unpaired ‘t’-test for parametric data. Statistical analysis was carried out using the SPSS (version 10, 2002; SPSS Inc., Chicago, IL, USA) for Windows statistical package. P value less than 0.05 was considered statistically significant. Results Mean onset of sensory block was earlier in group I than in group P (p<0.05) although mean onset of motor block was not significantly different (p>0.05). Duration of sensory and motor blockade was longer in group I (p<0.05). Patients in group I demonstrated lower pulse rate and lower systolic and diastolic blood pressures throughout the period with comparable SpO2 values. There was no difference in intraoperative Ramsay sedation scores in both groups, but postoperative Ramsay sedation scores at 9, 12, and 15 hours were better in group I (p<0.05). The average time to rescue analgesia (visual analogue scale >4) was higher in group I (p>0.05). Conclusion IV dexmedetomidine produced early onset of sensory block, longer duration of sensory and motor block, and longer duration of analgesia as compared with P dexmedetomidine as an adjuvant to supraclavicular block with 5 mg/kg lignocaine (2%) and 2 mg/kg bupivacaine (0.5%) in upper limb orthopaedic surgeries.
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Affiliation(s)
- Priyank Samar
- Anesthesiology, K.J. Somaiya Medical College and Hospital, Mumbai, IND
| | - Tanvi A Dhawale
- Anesthesiology, K.J. Somaiya Medical College and Hospital, Mumbai, IND
| | - Sarla Pandya
- Anesthesiology, K.J. Somaiya Medical College and Hospital, Mumbai, IND
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Patient satisfaction with intravenous regional anaesthesia or an axillary block for minor ambulatory hand surgery: A randomised controlled study. Eur J Anaesthesiol 2020; 37:847-856. [PMID: 32925435 DOI: 10.1097/eja.0000000000001259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intravenous regional anesthesia (IVRA) and the axillary brachial plexus block are popular alternatives to general anaesthesia in ambulatory hand surgery. Although both have proven their effectiveness, patients' preferences have never been evaluated. OBJECTIVES We investigated patient satisfaction with both techniques and hypothesised that satisfaction after IVRA is noninferior compared with axillary brachial plexus block. DESIGN A prospective, randomised controlled trial. SETTING Ambulatory surgical day care centre, University Hospitals of Leuven, Belgium, from September 2016 to November 2017. PATIENTS One hundred and twenty adults undergoing minor ambulatory hand surgery were included in this study. INTERVENTION Patients received either IVRA with 300 mg lidocaine or an axillary block with 280 mg mepivacaine. MAIN OUTCOME MEASURES The primary endpoint was the evaluation of patient satisfaction using the 'Evaluation du Vécu de l'Anésthesie Locoregional' (EVAN-LR) questionnaire. Secondary outcomes included different procedural times, block quality, tourniquet discomfort, the incidence of block failure and postoperative nausea and vomiting (PONV), the severity of postoperative pain and the need for postoperative analgesics during the first 24 h. RESULTS Noninferiority of IVRA was shown for the median [IQR] total score on the EVAN-LR questionnaire, IVRA-group: 92 [87 to 96] vs. axillary brachial plexus block-group: 91[87 to 97]; Hodges--Lehmann estimator (95% confidence interval (CI)] for the shift: -0.25 (-2.60 to 2.20). Induction of anaesthesia and time to discharge, requiring partial recovery of the motor block, were significantly longer in the axillary brachial plexus block group. The IVRA-group had a lower block quality, a higher incidence of tourniquet-discomfort and higher median intra-operative and postoperative pain scores on day 0; 0 [0 to 2] vs. 0 [0 to 0] and 0.8 [0 to 1.8] vs. 0 [0 to 0.25], respectively, but no increase in the need for supplementary analgesics or conversion rate to general anaesthesia. CONCLUSION IVRA and axillary brachial plexus block result in comparably high patient satisfaction in ambulatory hand surgery. CLINICAL TRIAL REGISTRATION EudraCT 2016-002325-11.
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Lim JA, Sung SY, Lee JH, Lee SY, Kwak SG, Ryu T, Roh WS. Comparison of ultrasound-guided and nerve stimulator-guided interscalene blocks as a sole anesthesia in shoulder arthroscopic rotator cuff repair: A retrospective study. Medicine (Baltimore) 2020; 99:e21684. [PMID: 32871884 PMCID: PMC7458219 DOI: 10.1097/md.0000000000021684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ultrasound-guided interscalene block (US-ISB) and nerve stimulator-guided interscalene block (NS-ISB) have both been commonly used for anesthesia in shoulder arthroscopic surgery.This study aims to compare which method provides surgical block as a sole anesthesia. In this retrospective study, 1158 patients who underwent shoulder arthroscopic rotator cuff tear repair surgery under ISB between October 2002 and March 2018 were classified into either the US-ISB or NS-ISB anesthesia groups. Demographic and anesthetic characteristics and intraoperative medications were analyzed after propensity score matching and compared between the 2 groups.There was a 0.5% rate of conversion to general anesthesia in the US-ISB group and a 6.7% rate in the NS-ISB group (P < .001). The volume of local anesthetics used for ISB was 29.7 ± 8.9 mL in the US-ISB group versus 38.1 ± 4.8 mL in the NS-ISB group (P < .001). The intraoperative use of analgesics and sedatives such as fentanyl, midazolam and propofol in combination was significantly lowered in the US-ISB group (P < .001).US-ISB is a more effective and safer approach for providing intense block to NS-ISB because it can decrease the incidence of conversion to general anesthesia and reduce the use of analgesics and sedatives during arthroscopic shoulder surgery.
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Affiliation(s)
- Jung A. Lim
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
| | | | - Ji Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
| | - So Young Lee
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
| | - Sang Gyu Kwak
- Department of Medical Statistics, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Taeha Ryu
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
| | - Woon Seok Roh
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
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Datta R, Agrawal J, Narula G, Pahwa B. A fluoroscopic assessment of brachial plexus block by the supraclavicular approach: Have we been overmedicating? Med J Armed Forces India 2019; 76:410-417. [PMID: 33162649 DOI: 10.1016/j.mjafi.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/18/2019] [Indexed: 10/25/2022] Open
Abstract
Background Ultrasonography-guided supraclavicular brachial plexus block has demonstrated safety as compared with landmark or nerve stimulation techniques. However, the minimum effective analgesic volume (MEAV) necessary for adequate blockade has not been determined. This study was undertaken to assess under fluoroscopy the postinjection spread of different drug volumes with clinical correlation. Secondary outcome measures included correlation of onset of block, block quality, and incidence of side effects. Methods This randomized, multiarm, cross-sectional, observational study was conducted at a single tertiary care center. A total of 549 patients were randomly allocated to 3 groups (20 ml, 30 ml, and 40 ml of drug mixture). A local anesthetic drug mixture with a radiopaque dye was administered under ultrasonographic guidance, and postinjection fluoroscopic drug spread was studied. Results Surgical anesthesia was achieved in 494 (89.98%) patients with 85.25%, 92.97%, and 91.71% in 20-, 30-, and 40-ml groups, respectively, being significantly low (p = 0.0317) in the 20-mL group. Cephalad and infraclavicular spread was higher in the 40-mL group than in other two groups (p = 0.103). Horner syndrome (HS) was seen in 51.18% of patients. First, ipsilateral superficial cervical plexus block was also observed in 40.22% of patients. Among patients who developed both, ∼60% of patients (99/167) belonged to the 40-mL group. Conclusions Optimal MEAV appears between 20 and 30 mL. Higher drug volumes are associated with more cephalad spread and side effects. Drug spread can predict block efficacy as well. It is postulated that loss of sensation in the ipsilateral neck can be used to predict development of hemidiaphragmatic paresis similar to HS.
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Affiliation(s)
| | - Jyotsna Agrawal
- Associate Professor, Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Gagan Narula
- Addl Director, Critical Care, Park Hospital, Gurgaon, India
| | - Bhavna Pahwa
- Graded Specialist (Anaesthesia), 179 Military Hospital, C/o 99 APO, India
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The efficacy of maxillary and mandibular nerve blockade using electrical nerve stimulation for guidance. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:352-356. [PMID: 31568890 DOI: 10.1016/j.jormas.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND In oral and maxillofacial surgical procedures, sometimes conventional loco-regional anesthesia techniques could be insufficient in daily clinical practice. The aim of this study was to evaluate the efficacy of analgesia using electrical nerve stimulation (ENS) for maxillary or mandibular nerve blockade, in comparison with conventional loco-regional anesthesia techniques. METHODS The study comprised 52 patients who were attending the department for advanced surgery of the upper and lower jaw. Patients were randomly divided into 2 groups: ENS and Local group. The predictor variable was the anesthesia technique (ENS and Local groups). The outcome variables were patient assessed pain levels (VAS scores) and total anesthetic dose. RESULTS Both the administered anesthetic dose and patient-assessed pain levels were significantly lower in the ENS group than in the Local group, despite there being no difference in age, sex or any hemodynamic parameters between the groups. CONCLUSIONS Maxillary and mandibular nerve blockade is more efficient with ENS guidance, with lower amounts of anesthetic required, compared to conventional loco-regional anesthesia.
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The concept of protective nerve stimulation for ultrasound guided nerve blocks. Med Hypotheses 2017; 107:72-73. [DOI: 10.1016/j.mehy.2017.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/14/2017] [Indexed: 11/18/2022]
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Falyar CR, Shaffer KM, Perera RA. Localization of the brachial plexus: Sonography versus anatomic landmarks. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:411-415. [PMID: 27028598 DOI: 10.1002/jcu.22354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/03/2016] [Accepted: 02/14/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE Interscalene brachial plexus blocks are performed for perioperative management of surgeries involving the shoulder. Historically, these procedures employed anatomic landmarks (AL) to determine the location of the brachial plexus as it passes between the anterior and middle scalene muscles in the neck. In this study, we compared the actual location of the brachial plexus as found with sonography (US) to the anticipated location using AL. METHODS The location of the brachial plexus was evaluated using US and AL in 96 subjects. The distance between the two locations was measured. A multivariate analysis of variance was used to determine the significance of the difference and a 2 × 2 analysis of variance was used to compare differences in gender, height, and body mass index. RESULTS The brachial plexus was located on average 1.8 cm inferior (p = 0.0001) and 0.2 cm lateral (p = 0.09) to the location determined with AL. A significant difference was also associated with gender (p = 0.03), but not with height or body mass index. CONCLUSIONS US is a reliable method that accurately pinpoints the roots of the brachial plexus. The brachial plexus is often located inferior to the location anticipated using AL. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:411-415, 2016.
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Affiliation(s)
- Christian R Falyar
- Department of Nurse Anesthesia, School of Allied Health Professions, Virginia Commonwealth University, PO Box 980226, 1200 East Broad Street, Richmond, VA, 23298-0226
| | | | - Robert A Perera
- Virginia Commonwealth University, VCU Medical Center, Department of Biostatistics, PO Box 980932, Richmond, VA 23298-0032
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Harris-Love MO, Seamon BA, Teixeira C, Ismail C. Ultrasound estimates of muscle quality in older adults: reliability and comparison of Photoshop and ImageJ for the grayscale analysis of muscle echogenicity. PeerJ 2016; 4:e1721. [PMID: 26925339 PMCID: PMC4768702 DOI: 10.7717/peerj.1721] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/31/2016] [Indexed: 12/25/2022] Open
Abstract
Background. Quantitative diagnostic ultrasound imaging has been proposed as a method of estimating muscle quality using measures of echogenicity. The Rectangular Marquee Tool (RMT) and the Free Hand Tool (FHT) are two types of editing features used in Photoshop and ImageJ for determining a region of interest (ROI) within an ultrasound image. The primary objective of this study is to determine the intrarater and interrater reliability of Photoshop and ImageJ for the estimate of muscle tissue echogenicity in older adults via grayscale histogram analysis. The secondary objective is to compare the mean grayscale values obtained using both the RMT and FHT methods across both image analysis platforms. Methods. This cross-sectional observational study features 18 community-dwelling men (age = 61.5 ± 2.32 years). Longitudinal views of the rectus femoris were captured using B-mode ultrasound. The ROI for each scan was selected by 2 examiners using the RMT and FHT methods from each software program. Their reliability is assessed using intraclass correlation coefficients (ICCs) and the standard error of the measurement (SEM). Measurement agreement for these values is depicted using Bland-Altman plots. A paired t-test is used to determine mean differences in echogenicity expressed as grayscale values using the RMT and FHT methods to select the post-image acquisition ROI. The degree of association among ROI selection methods and image analysis platforms is analyzed using the coefficient of determination (R (2)). Results. The raters demonstrated excellent intrarater and interrater reliability using the RMT and FHT methods across both platforms (lower bound 95% CI ICC = .97-.99, p < .001). Mean differences between the echogenicity estimates obtained with the RMT and FHT methods was .87 grayscale levels (95% CI [.54-1.21], p < .0001) using data obtained with both programs. The SEM for Photoshop was .97 and 1.05 grayscale levels when using the RMT and FHT ROI selection methods, respectively. Comparatively, the SEM values were .72 and .81 grayscale levels, respectively, when using the RMT and FHT ROI selection methods in ImageJ. Uniform coefficients of determination (R (2) = .96-.99, p < .001) indicate strong positive associations among the grayscale histogram analysis measurement conditions independent of the ROI selection methods and imaging platform. Conclusion. Our method for evaluating muscle echogenicity demonstrated a high degree of intrarater and interrater reliability using both the RMT and FHT methods across 2 common image analysis platforms. The minimal measurement error exhibited by the examiners demonstrates that the ROI selection methods used with Photoshop and ImageJ are suitable for the post-acquisition image analysis of tissue echogenicity in older adults.
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Affiliation(s)
- Michael O. Harris-Love
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
- Geriatrics and Extended Care Service, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
| | - Bryant A. Seamon
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
- Physical Medicine & Rehabilitation Service, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
| | - Carla Teixeira
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
- The School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Catheeja Ismail
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
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15
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Pei Q, Yang Y, Liu Q, Peng Z, Feng Z. Lack of Sex Difference in Minimum Local Analgesic Concentration of Ropivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block. Med Sci Monit 2015; 21:3459-66. [PMID: 26556653 PMCID: PMC4648125 DOI: 10.12659/msm.894570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Sex differences, which may be an important variable for determining anesthetic requirements, have not been well investigated in the aspect of local anesthetic. This investigation aimed to compare the minimum local analgesic concentration (MLAC) of ropivacaine for ultrasound-guided supraclavicular brachial plexus block (US-SCB) between men and women. Material/Method Patients aged 18–45 years undergoing elective forearm, wrist, or hand surgeries under US-SCB were divided into 2 groups according to sex. The initial concentration was 0.375% ropivacaine 20 mL and the concentration for the next patient was determined by the up-down technique at 0.025% intervals. Success was defined as the absence of any pain in response to a pinprick in the region of all 4 terminal nerves and the skin incision within 45 min. The primary outcome was the MLAC of ropivacaine, which was estimated by the Dixon and Massey method. The analgesia duration, which was defined as the time from the end of the US-SCB injection to the time of feeling discomfort and need for additional analgesics, was observed for each patient. Results The MLAC of ropivacaine 20 mL for US-SCB was 0.2675% (95% confidence interval [CI], 0.2512–0.2838%) in men and 0.2675% (95% CI, 0.2524–0.2826%) in women. There was no significant difference in MLAC or the analgesia duration between the 2 groups (P>0.05). Conclusions We found no significant sex-related differences in MLAC or analgesia duration of ropivacaine for US-SCB.
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Affiliation(s)
- Qingqing Pei
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Yanqing Yang
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Qin Liu
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Zhiyou Peng
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Zhiying Feng
- Department of Anesthesiology and Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
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16
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Kalvøy H, Sauter AR. Detection of intraneural needle-placement with multiple frequency bioimpedance monitoring: a novel method. J Clin Monit Comput 2015; 30:185-92. [PMID: 25902898 PMCID: PMC4792358 DOI: 10.1007/s10877-015-9698-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 04/17/2015] [Indexed: 11/01/2022]
Abstract
Electrical impedance measurements have been used to detect intraneural needle placement, but there is still a lack of precision with this method. The purpose of the study was to develop a method for the discrimination of nerve tissue from other tissue types based on multiple frequency impedance measurements. Impedance measurements with 25 different frequencies between 1.26 and 398 kHz were obtained in eight pigs while placing the tip of a stimulation needle within the sciatic nerve and in other tissues. Various impedance variables and measurement frequencies were tested for tissue discrimination. Best tissue discrimination was obtained by using three different impedance parameters with optimal measurement frequencies: Modulus (126 kHz), Phase angle (40 kHz) and the Delta of the phase angle (between 126 and 158 kHz). These variables were combined in a Compound variable C. The area under the curve in a receiver operating characteristic was consecutively increased for the Modulus (78 %), Phase angle (86 %), Delta of the phase angle (94 %), and the Compound variable C (97 %), indicating highest specificity and sensitivity for C. An algorithm based on C was implemented in a real-time feasibility test and used in an additional test animal to demonstrate our new method. Discrimination between nerve tissue and other tissue types was improved by combining several impedance variables at multiple measurement frequencies.
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Affiliation(s)
- Håvard Kalvøy
- Department of Clinical and Biomedical Engineering, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Axel R Sauter
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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17
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Potential of ultrasound in the pediatric chest. Eur J Radiol 2014; 83:1507-18. [DOI: 10.1016/j.ejrad.2014.04.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 11/17/2022]
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18
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Ultrasonographic anatomy of the sacrococcygeal region and ultrasound-guided epidural injection at the sacrococcygeal space in dogs. Vet Rec 2014; 175:68. [DOI: 10.1136/vr.102453] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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Kim HJ, Park SH, Shin HY, Choi YS. Brachial plexus injury as a complication after nerve block or vessel puncture. Korean J Pain 2014; 27:210-8. [PMID: 25031806 PMCID: PMC4099233 DOI: 10.3344/kjp.2014.27.3.210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 12/03/2022] Open
Abstract
Brachial plexus injury is a potential complication of a brachial plexus block or vessel puncture. It results from direct needle trauma, neurotoxicity of injection agents and hematoma formation. The neurological presentation may range from minor transient pain to severe sensory disturbance or motor loss with poor recovery. The management includes conservative treatment and surgical exploration. Especially if a hematoma forms, it should be removed promptly. Comprehensive knowledge of anatomy and adept skills are crucial to avoid nerve injuries. Whenever possible, the patient should not be heavily sedated and should be encouraged to immediately inform the doctor of any experience of numbness/paresthesia during the nerve block or vessel puncture.
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Affiliation(s)
- Hyun Jung Kim
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Hyun Park
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hye Young Shin
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yun Suk Choi
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
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20
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Gupta RK, Lane J, Allen B, Shi Y, Schildcrout JS. Improving Needle Visualization by Novice Residents During an In-Plane Ultrasound Nerve Block Simulation Using an In-Plane Multiangle Needle Guide. PAIN MEDICINE 2013; 14:1600-7. [DOI: 10.1111/pme.12160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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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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22
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DUGER C, ISBIR AC, KAYGUSUZ K, KOL IOZDEMIR, GURSOY S, OZTURK H, MIMAROĞLU C. The importance of needle echogenity in ultrasound guided axillary brachial plexus block: a randomized controlled clinical study. Int J Med Sci 2013; 10:1108-12. [PMID: 23869186 PMCID: PMC3714386 DOI: 10.7150/ijms.6598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/18/2013] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery. METHODS 90 patients were enrolled to the study. The patients were allocated into three groups randomly: Group E (n=30): ultrasound guided axillary block using echogenic needle, Group N (n=30): ultrasound guided axillary block using non-echogenic needle, Group NS (n=30): ultrasound guided axillary block using non-echogenic needle with nerve stimulator assistance. Duration of block procedure, mean arterial pressure, heart rate, pulse-oximetry, onset time of sensory and motor block, duration of sensory and motor block, time to first analgesic use, total need for analgesics, postoperative pain scores, patient and surgeon satisfaction scores were recorded. RESULTS Duration of block procedure values were lower in group E and NS, sensory and motor block durations, were significantly lower in group N. Sensorial and motor block onset time values were found lower in group NS but higher in group N. Patient and surgeon satisfaction scores were found lower in group N. CONCLUSION We conclude that ultrasound guided axillary block may be performed successfully using both echogenic needles and nerve stimulation assisted non-echogenic needles.
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Affiliation(s)
- Cevdet DUGER
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Ahmet Cemil ISBIR
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Kenan KAYGUSUZ
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Iclal OZDEMIR KOL
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Sinan GURSOY
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Hayati OZTURK
- 2. Department of Orthopedics, Cumhuriyet University, School of Medicine, Sivas, TURKEY
| | - Caner MIMAROĞLU
- 1. Department of Anesthesiology, Cumhuriyet University, School of Medicine, Sivas, TURKEY
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23
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Application of the Continual Reassessment Method to Dose-finding Studies in Regional Anesthesia. Anesthesiology 2013; 119:29-35. [DOI: 10.1097/aln.0b013e31829764cf] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
Previously reported estimates of the ED95 doses for local anesthetics used in brachial plexus blocks vary. The authors used the continual reassessment method, already established in oncology trials, to determine the ED95 dose for 0.5% bupivacaine for the ultrasound-guided supraclavicular block.
Methods
A double-blind, prospective trial was scheduled for 40 patients of American Society of Anesthesiologists class I–III presenting for upper limb surgery and supraclavicular block. The study dose to be administered was arbitrarily divided into six dose levels (12, 15, 18, 21, 24, and 27 ml) with a priori probabilities of success of 0.5, 0.75, 0.90, 0.95, 0.98, and 0.99 respectively. A continual reassessment method statistical program created a dose–response curve, which would shift direction depending on the success or failure of the block. Our starting dose was 21 ml and the next allocated dose was reestimated by the program to be the dose level with the updated posterior response probability closest to 0.95.
Results
After recruitment of eight patients, our initial dose levels and associated probabilities were deemed too low to determine the ED95. Updated a prioris were calculated from the statistical program, and the study recommenced with a new starting dose of 30 ml. On completion, the ED95 dose was estimated to be 27 ml (95% CI, 24–28 ml).
Conclusions
The continual reassessment method trial design provided a credible estimate for the ED95 dose for 0.5% bupivacaine for our technique of supraclavicular block and may be of value as a statistically robust method for dose-finding studies in anesthesiology.
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24
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Viscasillas J, Benigni L, Brodbelt D, Alibhai H. Use of needle enhancing software to improve injection technique amongst inexperienced anaesthetists performing ultrasound-guided peripheral nerves blocks in dogs. Vet Anaesth Analg 2013; 40:e83-90. [PMID: 23621354 DOI: 10.1111/vaa.12043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 12/04/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if the use of needle enhancing software facilitate injection technique in ultrasound-guided peripheral nerve blocks. STUDY DESIGN Prospective, blinded, randomized controlled trial. ANIMALS Eight hind limbs from canine cadavers. METHODS The limbs were randomly allocated to two groups; software on (group I) and software off (group II). Eight anaesthetists with no previous experience of ultrasound-guided regional anaesthesia were recruited. Thirty-six procedures were carried out (18 per group). After sciatic nerve visualisation via ultrasonography, the anaesthetist introduced a needle guided by ultrasonography. When the tip of the needle was considered by the anaesthetist to be as close as possible to the nerve without touching it, 0.05 mL of methylene blue dye was injected. Parameters evaluated included: number of attempts to visualise the needle with ultrasonography, time spent to perform the technique, subjective evaluation of ease of needle visualisation, proximity of the tip of the needle to the nerve, and, at dissection of the leg, inoculation site of the dye in relation to the nerve. RESULTS Significant differences between groups were identified in relation to the number of attempts (group I: median 1, IQR: 1 - 1 attempts versus group II: median 1, IQR: 1 - 4 attempts, p = 0.019), and the relationship between the dye and the nerve during hind limb dissection (72.2% of the nerves were stained in group I versus 16.6% in group II, p = 0.003). No significant difference between groups was observed with respect to the time taken to perform the procedure (group I: median 25.5, IQR: 18.4 - 44.3 seconds versus group II: median 35.7, IQR: 18.6-78.72 seconds, p = 0.31), subjective evaluation of the needle visualization (p = 0.45) or distance between the tip of the needle and the nerve as measured from the ultrasound screen (p = 0.23). CONCLUSIONS AND CLINICAL RELEVANCE This study identified greater success rate in nerve staining when the needle enhancing software was used. The results suggest that the use of this technique could improve injection technique amongst inexperienced anaesthetists performing ultrasound-guided peripheral nerve blocks in dogs.
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Affiliation(s)
- Jaime Viscasillas
- Veterinary Clinical Science, Royal Veterinary College, University of London, Hatfield, UK
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25
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Flohr-Madsen S, Ytrebø LM, Kregnes S, Wilsgaard T, Klaastad Ø. Minimum effective volume of ropivacaine 7.5 mg/ml for an ultrasound-guided infraclavicular brachial plexus block. Acta Anaesthesiol Scand 2013; 57:495-501. [PMID: 23418881 DOI: 10.1111/aas.12078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ultrasound guidance has been shown to reduce the minimum effective volume (MEV) of local anaesthetics for several peripheral nerve blocks. Although the lateral sagittal infraclavicular block (LSIB) is a well-established anaesthesia method, MEV for this technique has not been established. Our aim with this study was to determine the MEV using ropivacaine 7.5 mg/ml for the LSIB method. METHODS Twenty-five adult American Society of Anesthesiologists physical status I-II patients scheduled for hand surgery received an ultrasound-guided LSIB with ropivacaine 7.5 mg/ml. A successful block was defined as anaesthesia or analgesia for all five sensory nerves distal to the elbow, 30 min after local anaesthetic injection. The MEV for a successful block in 50% of the patients was determined by using the staircase up-and-down method introduced by Dixon and Massey. Logistic regression and probit transformation were applied to estimate the MEV for a successful block in 95% of the patients. RESULTS The patients received ropivacaine 7.5 mg/ml volumes in the range of 12.5-30 ml. The MEVs in 50% and 95% of the patients were 19 ml [95% confidence interval (CI), 14-27] and 31 ml (95% CI, 18-45), respectively. CONCLUSIONS For surgery distal to the elbow, the MEV in 95% of patients for an ultrasound-guided LSIB with ropivacaine 7.5 mg/ml was estimated to be 31 ml (95% CI, 18-45 ml). Further studies should determine the factors that influence the volume of local anaesthetic required for a successful infraclavicular block.
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Affiliation(s)
- S Flohr-Madsen
- Department of Anaesthesiology, University Hospital of North Norway, Tromsø, Norway.
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26
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Gupta K, Bhandari S, Singhal D, Bhatia PS. Pneumothorax following ultrasound guided supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol 2012; 28:543-4. [PMID: 23225954 PMCID: PMC3511971 DOI: 10.4103/0970-9185.101962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kapil Gupta
- Department of Anesthesia and Critical Care, V.M.M.C and Safdarjung Hospital, New Delhi, India
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27
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Mandim BL, Alves RR, Almeida R, Pontes JPJ, Arantes LJ, Morais FP. Pneumothorax Post Brachial Plexus Block Guided by Ultrasound: a Case Report. Braz J Anesthesiol 2012; 62:741-7. [DOI: 10.1016/s0034-7094(12)70173-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 03/20/2012] [Indexed: 11/16/2022] Open
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28
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Gerrard C, Roberts S. Ultrasound-Guided Regional Anaesthesia in the Paediatric Population. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/169043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ultrasound-guided regional anaesthesia is rapidly growing in popularity. Initially, most evidence was for the benefits when used in adults, but there is now a multitude of well-documented benefits in children. The practice of regional anaesthesia in children differs somewhat from that of adults in that in the majority of cases it is used for analgesia and performed under general anaesthesia to allow placement, rather than alone for anaesthesia as in adults. The purpose of this paper is to review the basic aspects of ultrasound regional anaesthesia before going into detail regarding specific techniques.
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29
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Groen GJ, Krediet AC, Moayeri N, Bruhn J, Geffen GJ. Brachial plexus sonoanatomy explained by multiplanar reformatting of digitized anatomy. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.eujps.2010.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Errando CL, Muñoz-Devesa L, Soldado MA. [Ultrasound-guided interscalene block in a patient with supraclavicular anatomical abnormalities due to radiotherapy and surgery]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:312-314. [PMID: 21688510 DOI: 10.1016/s0034-9356(11)70067-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Regional blocks can be difficult in surgical patients with certain superficial anatomical abnormalities. Such blocks may be possible, however, under ultrasound guidance. We report a case in which a man with a fractured right humerus required an ultrasound-guided interscalene brachial plexus block. Secondary to radiotherapy, the patient had right cervical and facial abnormalities that had altered the location of external anatomical landmarks. We describe the approach used to insert the catheter and the exploration of the region by ultrasound. Nerve stimulation was not used to avoid painful contractions. Analgesia was excellent during surgery and over the following 24 hours.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia
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31
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Englbrecht JS, Langer M, Hahnenkamp K, Ellger B. Ultrasound-guided axillary plexus block in a child with dystrophic epidermolysis bullosa. Anaesth Intensive Care 2011; 38:1101-5. [PMID: 21226445 DOI: 10.1177/0310057x1003800623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the use of ultrasound-guided axillary brachial plexus block in a child with dystrophic epidermolysis bullosa needing surgical treatment of the right hand. The regional anaesthesia was used in association with sedation/ anaesthesia. This technique is suitable for these difficult patients because it can minimise the risk of new bullae formation due to palpation of landmarks or unintentional intra- or subcutaneous injections. Initial anaesthesia/sedation was provided with sevoflurane until intravenous access was obtained, following which intravenous propofol infusion with ketamine boluses without any invasive airway management was continued for performance of the block and the procedure. This management plan provided good surgical conditions, early postoperative analgesia, minimised stress for the patient and avoided the need to manipulate the airway with instruments and the associated risk of mucosal bullae. The classification and breadth of clinical manifestation of epidermolysis bullosa is complex and briefly summarised. The anaesthetist should clarify the details of a particular patient's form of epidermolysis bullosa, especially in terms of mucosal involvement, as this may greatly influence planning for a procedure.
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Affiliation(s)
- J S Englbrecht
- Department of Anaesthesiology and Intensive Care Medicine, Muenster University Hospital, Muenster, Germany.
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32
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Kim JH, Chen J, Bennett H, Lesser JB, Resta-Flarer F, Barczewska-Hillel A, Byrnes P, Santos AC. A low approach to interscalene brachial plexus block results in more distal spread of sensory-motor coverage compared to the conventional approach. Anesth Analg 2011; 112:987-9. [PMID: 21288970 DOI: 10.1213/ane.0b013e31820b5e8e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A low approach to the interscalene block (LISB) deposits local anesthetic farther caudad on the brachial plexus compared with the conventional interscalene block (ISB). We compared the efficacy of LISB and ISB in achieving anesthesia of the distal extremity in 254 patients having upper extremity surgery. The most frequent elicited motor response was the deltoid for ISB and wrist for LISB. There was significantly greater sensory-motor block of regions below the elbow with the LISB compared with ISB (P < 0.001 for both sensory and motor coverage). Our data indicate that LISB results in a higher incidence of distal elicited motor response and greater sensory-motor blockage of the wrist and hand.
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Affiliation(s)
- Jung H Kim
- Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, 1000 10th Ave., New York, NY 10019, USA
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Determination of Spread of Injectate After Ultrasound-guided Interscalene and Supraclavicular Brachial Plexus Block: A Fresh Cadaveric Study. Tzu Chi Med J 2010. [DOI: 10.1016/s1016-3190(10)60069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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34
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Bloc interscalénique échoguidé : variations anatomiques et implication clinique. ACTA ACUST UNITED AC 2010; 29:770-5. [DOI: 10.1016/j.annfar.2010.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 07/19/2010] [Indexed: 11/22/2022]
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35
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Current world literature. Neuroanaesthesia. Pain medicine. Regional anaesthesia. Curr Opin Anaesthesiol 2010; 23:671-8. [PMID: 20811177 DOI: 10.1097/aco.0b013e32833f3f68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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36
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Affiliation(s)
- Jeong Uk Han
- Department of Anesthesiology and Pain Medicine, Inha University Hospital, Incheon, Korea
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37
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Gürkan Y, Tekin M, Acar S, Solak M, Toker K. Is nerve stimulation needed during an ultrasound-guided lateral sagittal infraclavicular block? Acta Anaesthesiol Scand 2010; 54:403-7. [PMID: 20085542 DOI: 10.1111/j.1399-6576.2009.02206.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The objective of the study was to evaluate the influence of ultrasound (US) guidance alone vs. neurostimulation (NS) and US (NSUS) guidance techniques on block performance time and block success rate for the lateral sagittal infraclavicular block (LSIB). METHODS In a randomized and prospective manner, 110 adult patients scheduled for distal upper limb surgery were allocated to the US or the NSUS groups. In the US group, a local anesthetic (LA) was administered only with US guidance to produce a 'U'-shaped distribution around the axillary artery. In the NSUS group, LA was administered under US guidance only after electrolocation of one of the median, ulnar or radial nerve-type responses. A total of 30 ml of LA (10 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml) was administered in both groups. Sensory block was tested at 10 min intervals for 30 min. Successful block was defined as analgesia or anesthesia of all five nerves distal to the elbow. RESULTS Block success rate was 94.5% in both groups. Block performance time was significantly shorter in the US than the NSUS group (157 +/- 50 vs. 230 +/- 104 s) (P=0.000). Block onset time was similar in both groups (12.5 +/- 4.8 in the US vs. 12.8 +/- 5.4 min in the NSUS groups). There were two arterial punctures in the NSUS group. CONCLUSIONS During LSIB performance US guidance alone produces block success rate identical to both US and NS guidance yet with a shorter block performance time.
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Affiliation(s)
- Y Gürkan
- Department of Anesthesiology, Kocaeli University Hospital, Kocaeli, Turkey.
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