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Jo Y, Oh C, Lee WY, Lee D, Shin S, Chung W, Lim C, Lee SY, Hong B. Diaphragm-sparing efficacy of subparaneural upper trunk block for arthroscopic shoulder surgery: A randomised controlled trial. Eur J Anaesthesiol 2024:00003643-990000000-00201. [PMID: 38961806 DOI: 10.1097/eja.0000000000002034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
BACKGROUND Inter-scalene block (ISB) is associated with an inevitable risk of hemi-diaphragmatic paresis (HDP). To reduce the risk of HDP, an upper trunk block (UTB) has been proposed at the brachial plexus division level. OBJECTIVE We hypothesised that UTB would be associated with a lower incidence of HDP than ISB while providing sufficient analgesia following arthroscopic shoulder surgery. DESIGN Randomised controlled trial. SETTING A tertiary teaching hospital. PATIENTS Seventy patients aged 20 to 80 years undergoing arthroscopic rotator cuff repair. INTERVENTION Ultrasound-guided ISB or UTB was performed with 5 ml 0.75% ropivacaine. MAIN OUTCOME MEASURES The primary outcome was the incidence of complete HDP, assessed by diaphragm excursion using ultrasound, defined as a decrease to 25% or less of baseline or occurrence of paradoxical movement. Postoperative pulmonary function change, pain scores, opioid consumption and pain-related outcomes were the secondary outcomes. RESULTS The UTB group had a significantly lower incidence of complete HDP than the ISB group [5.9% (2/34) vs. 41.7% (15/36); absolute difference, 35.8%; 95% confidence interval (CI), 17.8 to 53.7%; P < 0.001]. The postblockade decline in pulmonary function was more pronounced in the ISB group than that in the UTB group. The pain score at 1 h postoperatively was not significantly different between the groups (ISB vs. UTB group: median 0 vs. 1; median difference, -1; 95% CI, -2 to 0.5). No significant difference was observed in any other secondary outcomes. CONCLUSION UTB was associated with a lower incidence of HDP compared with ISB while providing excellent analgesia in arthroscopic shoulder surgery. TRIAL REGISTRATION Clinical Trial Registry of Korea (https://cris.nih.go.kr) identifier: KCT0007002. IRB NUMBER Chungnam National University Hospital Institutional Review Board No. 2021-12-069.
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Affiliation(s)
- Yumin Jo
- From the Department of Anaesthesiology and Pain Medicine (YJ, CO, DL, SS, WC, CL, SYL, BH) and Department of Orthopaedic Surgery, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, South Korea (W-YL)
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Lee B, Jang J, Lim JR, Kim EJ, Kim D, Chun YM, Choi YS. Continuous Superior Trunk Block versus Single-Shot Superior Trunk Block with Intravenous Dexmedetomidine for Postoperative Analgesia in Arthroscopic Shoulder Surgery: A Prospective Randomized Controlled Trial. J Clin Med 2024; 13:1845. [PMID: 38610610 PMCID: PMC11012364 DOI: 10.3390/jcm13071845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Background/Objectives: Intravenous dexmedetomidine (DEX) can increase the analgesia duration of peripheral nerve block; however, its effect in combination with superior trunk block (STB) remains unclear. We examined whether combining single-shot STB (SSTB) with intravenous DEX would provide noninferior postoperative analgesia comparable to that provided by continuous STB (CSTB). Methods: Ninety-two patients scheduled for elective arthroscopic rotator cuff repair were enrolled in this prospective randomized trial. Patients were randomly assigned to the CSTB or SSTB + DEX group. Postoperatively, each CSTB group patient received 15 mL of 0.5% ropivacaine and a continuous 0.2% ropivacaine infusion. Each SSTB group patient received a 15 mL postoperative bolus injection of 0.5% ropivacaine. DEX was administered at 2 mcg/kg for 30 min post anesthesia, then maintained at 0.5 mcg/kg/h till surgery ended. Pain scores were investigated every 12 h for 48 h post operation, with evaluation of rebound pain incidence and opioid consumption. Results: The SSTB + DEX group had significantly higher median pain scores at 12 h post operation (resting pain, 8.0 vs. 3.0; movement pain, 8.0 vs. 5.0) and a higher incidence of rebound pain (56% vs. 20%) than the CSTB group. However, no significant between-group differences were observed in pain scores postoperatively at 24, 36, or 48 h. The CSTB group required less opioids and fewer rescue analgesics within 12-24 h post operation than the SSTB + DEX group. Conclusions: Compared with CSTB, SSTB + DEX required additional adjuvant or multimodal analgesics to reduce the risk and intensity of postoperative rebound pain in patients who underwent arthroscopic rotator cuff repair.
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Affiliation(s)
- Bora Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Jaewon Jang
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Joon-Ryul Lim
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Eun Jung Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Donghu Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
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Jo Y, Oh C, Lee WY, Chung HJ, Park H, Park J, Lee J, Kim YH, Ko Y, Chung W, Hong B. Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial. Korean J Anesthesiol 2024; 77:85-94. [PMID: 37679899 PMCID: PMC10834710 DOI: 10.4097/kja.23260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Among the various diaphragm-sparing alternatives to interscalene block, costoclavicular block (CCB) demonstrated a low hemidiaphragmatic paresis (HDP) occurrence but an inconsistent analgesic effect in arthroscopic shoulder surgery. We hypothesized that a larger volume of local anesthetic for CCB could provide sufficient analgesia by achieving sufficient supraclavicular spreading. METHODS Sixty patients scheduled for arthroscopic rotator cuff repair were randomly assigned to receive CCB using one of two volumes of local anesthetic (CCB20, 0.75% ropivacaine 20 ml; CCB40, 0.375% ropivacaine 40 ml). The primary outcome was the rate of complete analgesia (0 on the numeric rating scale of pain) at 1 h postoperatively. The secondary outcomes included a sonographic assessment of local anesthetic spread, diaphragmatic function, pulmonary function, postoperative opioid use, and other pain-related experiences within 24 h postoperatively. RESULTS The rates of complete analgesia were not significantly different (23.3% [7/30] and 33.3% [10/30] in the CCB20 and CCB40 groups, respectively; risk difference 10%, 95% CI [-13, 32], P = 0.567). There were no significant differences in other pain-related outcomes. Among the clinical factors considered, the only factor significantly associated with postoperative pain was the sonographic observation of supraclavicular spreading. There were no significant differences in the incidence of HDP and the change in pulmonary function between the two groups. CONCLUSIONS Using 40 ml of local anesthetic does not guarantee supraclavicular spread during CCB. Moreover, it does not result in a higher rate of complete analgesia compared to using 20 ml of local anesthetic in arthroscopic shoulder surgery.
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Affiliation(s)
- Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Woo-Yong Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyung-Jin Chung
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hanmi Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Juyeon Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jieun Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
| | - Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
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Sivakumar RK, Karmakar MK, Reina MA, Sala-Blanch X. High-definition ultrasound imaging of the paraneural sheath and fascial compartments surrounding the brachial plexus at the supraclavicular fossa. Reg Anesth Pain Med 2023; 48:622-624. [PMID: 35973780 DOI: 10.1136/rapm-2022-103822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Ranjith Kumar Sivakumar
- Department of Anesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China
| | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China
| | - Miguel Angel Reina
- Department of Anesthesiology, Faculty of Medicine, CEU San Pablo University, Madrid, Spain
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Xavier Sala-Blanch
- Department of Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Jo Y, Lee D, Baek D, Choi BK, Aryal N, Jung J, Shin YS, Hong B. Optimal view detection for ultrasound-guided supraclavicular block using deep learning approaches. Sci Rep 2023; 13:17209. [PMID: 37821574 PMCID: PMC10567700 DOI: 10.1038/s41598-023-44170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023] Open
Abstract
Successful ultrasound-guided supraclavicular block (SCB) requires the understanding of sonoanatomy and identification of the optimal view. Segmentation using a convolutional neural network (CNN) is limited in clearly determining the optimal view. The present study describes the development of a computer-aided diagnosis (CADx) system using a CNN that can determine the optimal view for complete SCB in real time. The aim of this study was the development of computer-aided diagnosis system that aid non-expert to determine the optimal view for complete supraclavicular block in real time. Ultrasound videos were retrospectively collected from 881 patients to develop the CADx system (600 to the training and validation set and 281 to the test set). The CADx system included classification and segmentation approaches, with Residual neural network (ResNet) and U-Net, respectively, applied as backbone networks. In the classification approach, an ablation study was performed to determine the optimal architecture and improve the performance of the model. In the segmentation approach, a cascade structure, in which U-Net is connected to ResNet, was implemented. The performance of the two approaches was evaluated based on a confusion matrix. Using the classification approach, ResNet34 and gated recurrent units with augmentation showed the highest performance, with average accuracy 0.901, precision 0.613, recall 0.757, f1-score 0.677 and AUROC 0.936. Using the segmentation approach, U-Net combined with ResNet34 and augmentation showed poorer performance than the classification approach. The CADx system described in this study showed high performance in determining the optimal view for SCB. This system could be expanded to include many anatomical regions and may have potential to aid clinicians in real-time settings.Trial registration The protocol was registered with the Clinical Trial Registry of Korea (KCT0005822, https://cris.nih.go.kr ).
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Affiliation(s)
- Yumin Jo
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chungnam National University and Hospital, 282 Munhwar-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Dongheon Lee
- Department of Biomedical Engineering, College of Medicine, Chungnam National University and Hospital, Daejeon, Republic of Korea
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Donghyeon Baek
- Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | | | | | - Jinsik Jung
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chungnam National University and Hospital, 282 Munhwar-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Yong Sup Shin
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chungnam National University and Hospital, 282 Munhwar-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| | - Boohwi Hong
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chungnam National University and Hospital, 282 Munhwar-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Republic of Korea.
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Chen S, Zhang J, Fei Y, Cui X, Shen L, Huang Y. Proposal of a Route Map for Cervical Spinal Ultrasonography: A Simple and Clear Learning Tool for Beginners. Pain Ther 2023; 12:1293-1305. [PMID: 37517030 PMCID: PMC10444723 DOI: 10.1007/s40122-023-00545-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
Spinal ultrasonography has increasingly been used to image axial structures from the cervical to sacral region in recent years. In this work, we propose a comprehensive, systematic cervical scanning protocol that we refined as a route map, especially for beginners, to facilitate teaching, learning, diagnosis, and treatment in clinical pain practice. As a simple and clear tool to demonstrate the scanning protocol, the route map is delineated with rectangles, lines, and arrows. The rectangles represent the positions of the transducer, the arrows indicate route directions, and the lines show the routes of transducer movement. In this article, we describe cervical spinal ultrasonography to illustrate the route map interpretation, scanning protocol and target anatomical structures in detail. We believe that this comprehensive, clear, systematic, and portable route map will be beneficial for inexperienced pain clinicians and ultrasound beginners.
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Affiliation(s)
- Si Chen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Jiao Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yuda Fei
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xulei Cui
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
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Trivedi S, Gupta S, Bhardwaj H, Sahoo TK, Gupta S, Trivedi G. Efficacy of intertruncal and corner-pocket approaches of ultrasound-guided supraclavicular block in terms of ulnar nerve blockade: A randomised controlled study. Indian J Anaesth 2023; 67:778-784. [PMID: 37829792 PMCID: PMC10566651 DOI: 10.4103/ija.ija_45_23] [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: 01/18/2023] [Revised: 06/27/2023] [Accepted: 07/09/2023] [Indexed: 10/14/2023] Open
Abstract
Background and Aims The incidence of ulnar nerve sparing has declined with the corner-pocket approach of the supraclavicular block (SCB), however, it continues to persist. A recent technique of SCB, the intertruncal approach, separately blocks each trunk of the brachial plexus. Thus, we hypothesised that the intertruncal approach results in a complete ulnar nerve blockade. Methods Eighty-eight patients were randomised to undergo SCB using an ultrasound (USG)-guided corner-pocket or intertruncal approach and were compared primarily regarding the complete sensory and motor blockade of the ulnar nerve and all four nerves (ulnar, radial, median and musculocutaneous nerves) at 15 min. Secondary objectives included time required for block performance, patient discomfort score, time to readiness for surgery and duration of sensory blockade of the ulnar nerve. Continous data were compared using an independent t-test, and categorical data were compared using the Chi-square test. Results The proportion of participants with complete sensory (30/44 vs. 14/44, P < 0.001) and complete motor (22/44 vs. 7/44, P < 0.001) blocks in the ulnar nerve and all four nerves at 15 min was significantly higher in the intertruncal group. Block performance time and patient discomfort score were higher in the intertruncal group (P < 0.001). The total duration of sensory blockade in the ulnar nerve was more in the corner-pocket group (P < 0.001). Conclusion USG-guided intertruncal approach is superior to the corner-pocket approach of SCB regarding a complete ulnar nerve blockade.
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Affiliation(s)
- Saurabh Trivedi
- Department of Anaesthesia and Critical Care, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Srishti Gupta
- Department of Emergency Medicine, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Hemendra Bhardwaj
- Department of Anaesthesia and Critical Care, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Tapan Kumar Sahoo
- Department of Anaesthesia and Critical Care, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Seema Gupta
- Department of Anaesthesia and Critical Care, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Gaurav Trivedi
- Department of Radiation Oncology, Command Hospital, Lucknow, Uttar Pradesh, India
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Gungor I, Ozdemir MG, Emmez G, Ucar M, Kaptan AI, Gunaydin DB. A new anatomical brachial plexus variation during interscalene block. Niger J Clin Pract 2023; 26:362-364. [PMID: 37056114 DOI: 10.4103/njcp.njcp_474_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
We aimed to present our anesthetic management for an ultrasound-guided (USG) interscalene block in the presence of a new brachial plexus variation in a 59-year-old male patient underwent shoulder arthroscopy. An accessory muscle between the anterior scalene (ASM) and middle scalene muscle (MSM) was viewed via ultrasound. When four roots that the accessory muscle separated into two groups, which should be normally present between the ASM and MSM were displayed, we decided to use nerve stimulator to perform block. The contraction response from the deltoid muscle group from both root groups was regarded as a possible new brachial plexus variation in the C5 nerve root. For interscalene block, 30 ml of 0.375% bupivacaine was used via multi-injection. We confirmed this new brachial plexus variation with magnetic resonance neurography for the first time in a patient. Interscalene block should be definitely performed under USG and when a new anatomical variation is suspected, roots should be separated with a nerve stimulator to increase the success of the block.
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Affiliation(s)
- I Gungor
- Department of Anesthesiology, Gazi University, School of Medicine, Ankara, Turkey
| | - M G Ozdemir
- Department of Anesthesiology, Gazi University, School of Medicine, Ankara, Turkey
| | - G Emmez
- Department of Anesthesiology, Gazi University, School of Medicine, Ankara, Turkey
| | - M Ucar
- Department of Radiology, Gazi University, School of Medicine, Ankara, Turkey
| | - A I Kaptan
- Department of Anesthesiology, Gazi University, School of Medicine, Ankara, Turkey
| | - D B Gunaydin
- Department of Anesthesiology, Gazi University, School of Medicine, Ankara, Turkey
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Zhao Y, Qin S, Yang X, Gao C, Yuan X, Li T, Chen Z. Comparison of the anesthesia effect of ultrasound-guided middle and low interscalene brachial plexus block: a randomized, controlled, non-inferiority trial. BMC Anesthesiol 2023; 23:1. [PMID: 36597045 PMCID: PMC9808947 DOI: 10.1186/s12871-022-01963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Ultrasound-guided low interscalene brachial plexus block (LISB) can provide satisfactory anesthesia for surgery at or below the elbow. However, the anesthesia effect of ultrasound-guided middle interscalene brachial plexus block (MISB) has not been fully investigated. We hypothesized that MISB provides a non-inferior anesthesia effect to LISB for surgery at or below the elbow. METHODS A total of 82 patients with ASA I-III (18-65 years) scheduled for elective surgery at or below the elbow were randomized to the MISB group or the LISB group equally, located 1/2 or 2/3 of the caudal distance from C6 to the clavicle. Both groups were administered 15 mL 0.5% ropivacaine at the lower part of the brachial plexus with the first injection and equivalent volume at the upper part with the second injection. RESULTS For the primary outcome, 92.3% in the MISB group experienced successful anesthesia compared to 94.6% in the LISB group [difference: -2.3%, 95% confidence interval (CI) -13.4% to 8.8%], exceeding the predefined non-inferiority margin -15%. For the secondary outcomes, the incidence of pleura suppression for the first injection (7.7% vs. 45.9%, P < 0.001) and the time to perform the block (9.9 ± 1.3 vs. 10.7 ± 1.3 min, P = 0.006) were significantly less in MISB compared to LISB. No significant differences were observed in the consumption of perioperative rescue analgesics, VAS score, and adverse events within the two groups. CONCLUSIONS MISB provides a non-inferior anesthesia effect to LISB for surgery at or below the elbow. TRIAL REGISTRATION Chinese Clinical Trial Register (identifier: ChiCTR2100054196).
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Affiliation(s)
- Yang Zhao
- grid.413387.a0000 0004 1758 177XDepartment of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, No. 1 The South of Maoyuan Road, Nanchong, Sichuan 637000 People’s Republic of China ,grid.412594.f0000 0004 1757 2961Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, No. 22 Shuangyong Road, 530021 Guangxi, People’s Republic of China
| | - Shiming Qin
- grid.203458.80000 0000 8653 0555Department of Anesthesiology, Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), No.1 Shuanghu Branch Road, Chongqing, 401120 China
| | - Xue Yang
- grid.203458.80000 0000 8653 0555Department of Anesthesiology, Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), No.1 Shuanghu Branch Road, Chongqing, 401120 China
| | - Chongmei Gao
- grid.203458.80000 0000 8653 0555Department of Anesthesiology, Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), No.1 Shuanghu Branch Road, Chongqing, 401120 China
| | - Xia Yuan
- grid.203458.80000 0000 8653 0555Department of Anesthesiology, Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), No.1 Shuanghu Branch Road, Chongqing, 401120 China
| | - Tao Li
- grid.440164.30000 0004 1757 8829Department of Radiology, Chengdu Second People’s Hospital, Chengdu, 610017 Sichuan China
| | - Zhaohui Chen
- grid.203458.80000 0000 8653 0555Department of Anesthesiology, Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), No.1 Shuanghu Branch Road, Chongqing, 401120 China
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Sivakumar RK, Samy W, Pakpirom J, Songthamwat B, Karmakar MK. Ultrasound-guided selective trunk block: Evaluation of ipsilateral sensorimotor block dynamics, hemidiaphragmatic function and efficacy for upper extremity surgery. A single-centre cohort study. Eur J Anaesthesiol 2022; 39:801-809. [PMID: 35950709 DOI: 10.1097/eja.0000000000001736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Selectively locating and blocking the individual trunks of the brachial plexus with small volumes of local anaesthetic, a selective trunk block (SeTB), may produce anaesthesia of the entire upper extremity except for the T2 dermatome. OBJECTIVE This study aimed to evaluate the effects of an ultrasound-guided (USG) SeTB on ipsilateral sensorimotor block dynamics, hemidiaphragmatic function, and efficacy as an all-purpose regional anaesthetic technique for upper extremity surgery. DESIGN Prospective cohort study. SETTING Single-centre, university hospital in Hong Kong, China from February 2021 to July 2021. PATIENTS Thirty patients (aged 53.2 ± 14.8 years and BMI 23.8 ± 3.6 kg m - 2 ), ASA physical status I to III, scheduled for upper extremity surgery under a brachial plexus block. INTERVENTIONS USG SeTB with 25 ml (7, 8 and 10 ml to the superior, middle and inferior trunks, respectively) of a 1 : 1 mixture of 2% lidocaine with 1 : 200 000 epinephrine and 0.5% levobupivacaine. MAIN OUTCOME MEASURES Ipsilateral sensorimotor blockade of the suprascapular (only motor), axillary, radial, ulnar, median and musculocutaneous nerves were assessed at regular intervals for 45 min. Ipsilateral hemidiaphragmatic excursion was also measured, at 30 min after the SeTB, using M-mode ultrasound. The SeTB was considered a success if it was possible to complete surgery without any rescue analgesia or conversion to general anaesthesia. RESULTS Complete motor blockade of the suprascapular nerve was achieved in median [range] 5 [5 to 15] min. Complete sensory and motor blockade were achieved in all the other 5 nerves in 17.5 [10 to 30] and 15 [10 to 30] min respectively. The SeTB was successful in 93% and ipsilateral hemidiaphragmatic paresis (HDP) was present in 82%, of patients. CONCLUSION SeTB produces sensorimotor blockade of the entire upper extremity, causes ipsilateral HDP, and is effective as the sole anaesthetic for surgery from the proximal humerus to the hand. TRIAL REGISTRION ClinicalTrials.gov, Trial Registration No: NCT04752410, Date submitted for Registration: 09 February 2021, Date first posted: 12 February 2021, Dates of patient enrolment: 19 February 2021 to 27 July 2021 ( https://clinicaltrials.gov/ct2/show/NCT04752410 ).
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Affiliation(s)
- Ranjith Kumar Sivakumar
- From the Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China (RKS, WS, JP, BS, MKK)
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Songthamwat B, Luangjarmekorn P, Kampitak W, Sivakumar RK, Karmakar MK. Ultrasound-guided selective trunk block (SeTB): a cadaver anatomic study to evaluate the spread of dye after a simulated injection. Reg Anesth Pain Med 2022; 47:414-419. [PMID: 35450932 DOI: 10.1136/rapm-2022-103630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent reports suggest that a selective trunk block (SeTB) can produce sensorimotor blockade of the entire upper extremity, except for the T2 dermatome. There are no data demonstrating the anatomic mechanism of SeTB. This cadaver study aimed to evaluate the spread of an injectate after a simulated ultrasound-guided (USG) SeTB. METHODS USG SeTB (n=7) was performed on both sides of the neck in four adult human cadavers with 25 mL of 0.1% methylene blue dye. Anatomic dissection was performed to document staining (deep, faint, and no stain) of the various elements of the brachial plexus from the level of the roots to the cords, including the phrenic, dorsal scapular, and long thoracic nerves. Only structures that were deeply stained were defined as being affected by the SeTB. RESULTS All the trunks and divisions of the brachial plexus, as well as the ventral rami of C5-C7 and suprascapular nerve, were deeply stained in all (100%) the simulated injections. The ventral rami of C8 and T1 (86%), dorsal scapular and long thoracic nerve (71%), and the phrenic nerve (57%) were also deeply stained in a substantial number of the injections. CONCLUSION This cadaver study demonstrates that an USG SeTB consistently affects all the trunks and divisions of the brachial plexus, as well as the suprascapular nerve. This study also establishes that SeTB may not be phrenic nerve sparing. Future research to evaluate the safety and efficacy of SeTB as an all-purpose brachial plexus block technique for upper extremity surgery is warranted. TRIAL REGISTRATION NUMBER Registered at https://www.thaiclinicaltrials.org on December 13, 2021 under the trial registration number TCTR20211213005.
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Affiliation(s)
- Banchobporn Songthamwat
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Pobe Luangjarmekorn
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Wirinaree Kampitak
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Ranjith Kumar Sivakumar
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Faculty of Medicine, Shatin, New Territories, Hong Kong, SAR, China
| | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Faculty of Medicine, Shatin, New Territories, Hong Kong, SAR, China
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Songthamwat B, Pakpirom J, Pangthipampai P, Vorapaluk P, Karmakar MK. Reliability of a sequential ultrasound imaging technique (SUIT) to identify the individual elements of the brachial plexus above the clavicle. Reg Anesth Pain Med 2021; 46:1107-1109. [PMID: 33952686 DOI: 10.1136/rapm-2021-102701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Banchobporn Songthamwat
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Jatuporn Pakpirom
- Department of Anesthesiology, Prince of Songkla University, Hat Yai, Thailand
| | - Pawinee Pangthipampai
- Department of Anesthesiology, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Pannika Vorapaluk
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensive Care, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong,Prince of Wales Hospital, Shatin, NT, Hong Kong, China
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Jo Y, Park J, Oh C, Chung W, Song S, Lee J, Kang H, Ko Y, Kim YH, Hong B. Comparison of the ulnar nerve blockade between intertruncal and corner pocket approaches for supraclavicular block: a randomized controlled trial. Korean J Anesthesiol 2021; 74:522-530. [PMID: 33840177 PMCID: PMC8648510 DOI: 10.4097/kja.21028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/08/2021] [Indexed: 01/29/2023] Open
Abstract
Background The corner pocket (CP) approach for supraclavicular block (SCB) prevents ulnar nerve (UN) sparing due to needle proximity to the lower trunk. Improved ultrasound resolution has suggested that the intertruncal (IT) approach is a suitable alternative method. We compared efficiency of these two approaches on the UN blockade. Methods Sixty patients were randomized to undergo SCB using the ultrasound-guided CP or IT approach. For lower trunk blockade, 10 ml of local anesthetic agents (1 : 1 mixture of 0.75% ropivacaine and 1% lidocaine) were injected in the CP (CP approach) or between the lower and middle trunks (IT approach). Additional 15 ml was injected identically to block the middle and upper trunks in both groups. Sensory and motor blockade was evaluated after intervention. Results Complete sensory blockade (75.9% [22/29] vs. 43.3% [13/30], P = 0.023) and complete motor blockade (82.8% [24/29] vs. 50.0% [15/30], P = 0.017) of the UN at 15 min after SCB were significantly more frequent in the IT than in the CP group. Sensory block onset time of the UN was significantly shorter in the IT compared to the CP group (15.0 [10.0, 15.0] min vs. 20.0 [15.0, 20.0] min, P = 0.012). Conclusions The IT approach provided a more rapid onset of UN blockade than the CP approach. These results suggest that the IT approach is a suitable alternative to the CP approach and can provide faster surgical readiness.
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Affiliation(s)
- Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jiho Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seunghyun Song
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jieun Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hansol Kang
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Karmakar MK, Areeruk P, Mok LYH, Sivakumar RK. Ultrasound-Guided Selective Trunk Block to Produce Surgical Anesthesia of the Whole Upper Extremity: A Case Report. A A Pract 2020; 14:e01274. [PMID: 32909721 DOI: 10.1213/xaa.0000000000001274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
None of the classical brachial plexus block techniques can reliably produce surgical anesthesia of the whole upper extremity that is from shoulder to hand. We describe ultrasound-guided "selective trunk block" (SeTB) that was successfully used to produce surgical anesthesia of the whole ipsilateral upper extremity in a patient undergoing intramedullary nailing of the humerus for a pathological fracture. The 3 trunks of the brachial plexus were individually identified and selectively blocked with 2 separate injections. We conclude that SeTB is a viable option when surgical anesthesia of the whole upper extremity, except for the intercostobrachial nerve (T2) territory, is being considered.
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Affiliation(s)
- Manoj Kumar Karmakar
- From the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
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Brachial plexus blockade with anomalous location of the T1 ventral ramus at the supraclavicular fossa. Br J Anaesth 2020; 125:e412-e414. [PMID: 32828490 DOI: 10.1016/j.bja.2020.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/07/2020] [Accepted: 07/24/2020] [Indexed: 11/22/2022] Open
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Coşarcan SK, Gürkan Y, Doğan AT, Erçelen Ö. Anterior suprascapular block may not avoid diaphragmatic paralysis. Reg Anesth Pain Med 2020; 46:461-462. [PMID: 32665453 DOI: 10.1136/rapm-2020-101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Yavuz Gürkan
- Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey
| | | | - Ömür Erçelen
- Anesthesiology, American Hospital, Istanbul, Turkey
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Sivakumar RK, Areeruk P, Karmakar MK. Selective trunk block (SeTB): a simple alternative to hybrid brachial plexus block techniques for proximal humeral fracture surgery during the COVID-19 pandemic. Reg Anesth Pain Med 2020; 46:376-378. [PMID: 32522860 DOI: 10.1136/rapm-2020-101733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Ranjith Kumar Sivakumar
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Faculty of Medicine, Shatin, New Territories, Hong Kong
| | - Pornpatra Areeruk
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Faculty of Medicine, Shatin, New Territories, Hong Kong
| | - Manoj Kumar Karmakar
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Faculty of Medicine, Shatin, New Territories, Hong Kong
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