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Girón-Arango L, Peng P. Spread of injectate in pericapsular nerve group block: a Rashomon effect? Reg Anesth Pain Med 2024:rapm-2024-105870. [PMID: 39106987 DOI: 10.1136/rapm-2024-105870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 08/09/2024]
Affiliation(s)
- Laura Girón-Arango
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Philip Peng
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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2
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Diwan S, Shivamallappa S, Timane R, Pai P, Gupta A. Anatomic evaluation to compare the dye spread with ultrasound-guided pericapsular nerve group (PENG) injection with or without an additional suprainguinal fascia iliaca (SIFI) injection in soft embalmed cadavers. J Anesth 2024; 38:445-454. [PMID: 38466404 DOI: 10.1007/s00540-024-03333-5] [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] [Received: 10/24/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Novel interfascial plane blocks like PEricapsular Nerve Group (PENG) and SupraInguinal Fascia Iliaca (SIFI) blocks are effective for management of hip fracture pain. We compared the difference in the distribution of the dye injected and nerves stained by the addition of the SIFI block to the PENG block. METHODS A total of 24 designated dye injections were performed in eight soft-embalmed cadavers. Under ultrasound guidance 20 ml green ink injected bilaterally in PENG block and 30 ml methylene blue dye was injected in the SIFI block on the right side. The cadavers were dissected 24 h later to assess the extent of dye spread. RESULTS Extensive spread of dyes was seen on both side of iliacus muscle on the right side, but blue dye was not visible medial to the psoas tendon. The subcostal and iliohypogastric nerves were stained green in the infra-inguinal region. On the left side (PENG alone), the anterior division of the obturator, femoral and saphenous nerve (7/8) and iliohypogastric nerves (3/8) were stained in the infrainguinal region. In the suprainguinal region, the femoral nerve (5/8), accessory obturator nerve (3/8), lateral femoral cutaneous (1/8) and nerve to rectus femoris (4/8) were stained. The main obturator nerve trunk was spared with both injections while its anterior branch and accessory obturator nerve were stained with the PENG injection. CONCLUSION The study findings indicate that combined PENG + SIFI injections lead to an extensive craniocaudal and longitudinal spread along the iliacus muscle. We perceive that the combination of these two injections will have a superior clinical outcome.
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Affiliation(s)
- Sandeep Diwan
- Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India
| | | | - Rasika Timane
- Department of Anaesthesia and critical care, Critizone Hospital, Nagpur, Maharashtra, India
| | - Pallavi Pai
- Department of Anaesthesiology, Dinanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Anju Gupta
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), No. 6, 4th Floor, Porta Cabin, Teaching Block, New Delhi, 110029, India.
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Ramlogan R, Uppal V. Hip fracture analgesia: how far ahead are we? Can J Anaesth 2024; 71:692-697. [PMID: 38097816 DOI: 10.1007/s12630-023-02664-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 08/31/2023] [Accepted: 09/19/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Reva Ramlogan
- Department of Anesthesiology & Pain Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave., Ottawa, ON, K1Y 4E9, Canada.
| | - Vishal Uppal
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
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Genc C, Tulgar S, Unal M, Genc AS, Kehribar L, Erdivanli B, Vermeylen K, Koksal E. The minimum effective concentration (MEC90) of bupivacaine for an ultrasound-guided suprainguinal fascia iliaca compartment block for analgesia in knee surgery: a dose-finding study. Korean J Anesthesiol 2024; 77:364-373. [PMID: 38480982 PMCID: PMC11150113 DOI: 10.4097/kja.23710] [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] [Received: 10/04/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. METHODS This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the mid-thigh six hours postoperatively. RESULTS According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]). CONCLUSIONS Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.
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Affiliation(s)
- Caner Genc
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Murat Unal
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ahmet Serhat Genc
- Department of Orthopedics and Traumatology, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Lokman Kehribar
- Department of Orthopedics and Traumatology, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Basar Erdivanli
- Department of Anesthesiology and Reanimation, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Kris Vermeylen
- Department of Anesthesia, AZ Turnhout, Turnhout, Belgium
| | - Ersin Koksal
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
- Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Leurcharusmee P, Kantakam P, Intasuwan P, Malatong Y, Maikong N, Navic P, Kitcharanant N, Mahakkanukrauh P, Tran DQ. Cadaveric study investigating the femoral nerve-sparing volume for pericapsular nerve group (PENG) block. Reg Anesth Pain Med 2023; 48:549-552. [PMID: 37028817 DOI: 10.1136/rapm-2023-104419] [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] [Received: 02/06/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND This cadaveric study investigated the maximum effective volume of dye in 90% of cases (MEV90) required to stain the iliac bone between the anterior inferior iliac spine (AIIS) and the iliopubic eminence (IPE) while sparing the femoral nerve during the performance of pericapsular nerve group (PENG) block. METHODS In cadaveric hemipelvis specimens, the ultrasound transducer was placed in a transverse orientation, medial and caudal to the anterior superior iliac spine in order to identify the AIIS, the IPE and the psoas tendon. Using an in-plane technique and a lateral-to-medial direction, the block needle was advanced until its tip contacted the iliac bone. The dye (0.1% methylene blue) was injected between the periosteum and psoas tendon. Successful femoral-sparing PENG block was defined as the non-staining of the femoral nerve on dissection. Volume assignment was carried out using a biased coin design, whereby the volume of dye administered to each cadaveric specimen depended on the response of the previous one. In case of failure (ie, stained femoral nerve), the next one received a lower volume (defined as the previous volume with a decrement of 2 mL). If the previous cadaveric specimen had a successful block (ie, non-stained femoral nerve), the next one was randomized to a higher volume (defined as the previous volume with an increment of 2 mL), with a probability of b=1/9, or the same volume, with a probability of 1-b=8/9. RESULTS A total of 32 cadavers (54 cadaveric hemipelvis specimens) were included in the study. Using isotonic regression and bootstrap CI, the MEV90 for femoral-sparing PENG block was estimated to be 13.2 mL (95% CI: 12.0 to 20.0). The probability of a successful response was estimated to be 0.93 (95% CI: 0.81 to 1.00). CONCLUSION For PENG block, the MEV90 of methylene blue required to spare the femoral nerve in a cadaveric model is 13.2 mL. Further studies are required to correlate this finding with the MEV90 of local anesthetic in live subjects.
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Affiliation(s)
- Prangmalee Leurcharusmee
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Perada Kantakam
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pittayarat Intasuwan
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yanumart Malatong
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Naraporn Maikong
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pagorn Navic
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Pasuk Mahakkanukrauh
- Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Forensic Osteology Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - De Q Tran
- St.Mary's Hospital, Department of Anesthesiology, McGill University, Montreal, Québec, Canada
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Genc C, Akdeniz S, Canikli S, Selcuk Kusderci H, Kefeli Celik H, Tulgar S. Ultrasound-Guided Suprainguinal Fascia Iliaca Block as Part of Anesthesia Management for Lower Extremity Surgeries: A Single-Center Retrospective Cohort Feasibility Study. Cureus 2023; 15:e47795. [PMID: 38021938 PMCID: PMC10676621 DOI: 10.7759/cureus.47795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Study objective The ultrasound-guided (US-guided) suprainguinal fascia iliaca block (SIFIB) is a regional anesthesia procedure that targets the lumbar plexus. It offers versatility in clinical practice, serving as both a standalone method for adequate pain management and a primary anesthesia option. Our aim was to present clinical insights gained from the application of US-guided SIFIB, whether as a standalone procedure or in conjunction with another block, across various clinical indications for lower extremity surgeries. Methodology Our study is a retrospective cohort analysis designed to identify cases in which the SIFIB was used as a component of the main anesthetic method and to determine the success of the anesthetic method in patients undergoing lower extremity surgery between March 2022 and March 2023 in a tertiary hospital. Data such as block success, perioperative additional analgesic need, patients' demographic details, and block characteristics were obtained from electronic and paper-based patient records and analyzed. Main results We analyzed data from 16 patients who underwent lower extremity surgeries under SIFIB. Among these, 10 patients received SIFIB as their sole anesthesia method, while six underwent surgery with a combination of sciatic block and SIFIB. Briefly, the types of surgery were amputations, soft tissue excision, revision of knee prostheses, excision of knee tumors, patella implant removal, patellar ligament repair, patellar fracture repair, distal femur fractures (internal fixation), and vascular surgery. Six patients necessitated additional analgesics. No statistically significant differences were observed in demographic details, block onset time, and surgical duration between patients requiring and not requiring sedoanalgesia during surgery (p>0.05). Conclusion For patients planning lower extremity surgery, considering SIFIB alone or combined with a sciatic block as part of anesthesia management is a valid option, offering an alternative to a lumbar plexus block.
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Affiliation(s)
- Caner Genc
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, TUR
| | - Sevda Akdeniz
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, TUR
| | - Senay Canikli
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, TUR
| | - Hatice Selcuk Kusderci
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, TUR
| | - Hale Kefeli Celik
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, TUR
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, TUR
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Kefeli Çelik H, Tulgar S, Güler S, Koç K, Küçükordulu BB, Ferli RB, Kehribar L, Genç AS, Süren M. Evaluation of Postoperative Analgesic Efficacy of Ultrasound-Guided Suprainguinal Fascia Iliaca Block in Knee Arthroplasty: Prospective, Randomized, Feasibility Study. J Clin Med 2023; 12:6076. [PMID: 37763016 PMCID: PMC10531897 DOI: 10.3390/jcm12186076] [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: 08/16/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Total Knee Arthroplasty (TKA) is one of the most commonly performed orthopedic procedures, and patients complain of severe pain in the postoperative period. The supra-inguinal fascia iliaca block (SIFIB) works as an anteriorly applied lumbar plexus block and is frequently used in hip surgeries. In this study, we evaluated the effect of SIFIB in patients undergoing TKA under spinal anesthesia. METHODS This study is a prospective, randomized, assessor-blinded feasibility study conducted in a tertiary hospital. Eighty-six patients with ASA I-III were initially enrolled, and after exclusions, 80 patients were randomized into two equal groups (SIFIB and control groups). The standard multimodal analgesia was applied to the control group, while SIFIB was additionally applied to the block group. The study measured the morphine requirement in PCA and pain intensity using Numeric Rating Scores between the two groups. RESULTS the 24-h cumulative morphine consumption was lower in Group SIFIB. Although there was a decrease in NRS at rest scores in the SIFIB group during some time periods, pain was moderate, and no differences in pain scores were recorded during exercise in all patients. CONCLUSIONS In patients undergoing TKA under spinal anesthesia, a single shot of SIFIB results in a significant reduction in the amount of morphine consumed in hours. This effect was most likely related to a decrease in pain at rest in the SIFIF group.
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Affiliation(s)
- Hale Kefeli Çelik
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Serkan Güler
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Kadem Koç
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Büşra Burcu Küçükordulu
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Ramazan Burak Ferli
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
| | - Lokman Kehribar
- Department of Orthopedics and Traumatology, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (L.K.); (A.S.G.)
| | - Ahmet Serhat Genç
- Department of Orthopedics and Traumatology, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (L.K.); (A.S.G.)
| | - Mustafa Süren
- Department of Anesthesiology and Reanimation, Samsun Education and Research Hospital, Barış Bulvarı No: 199, Samsun 55090, Turkey; (S.T.); (S.G.); (K.K.); (B.B.K.); (R.B.F.); (M.S.)
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Ten Hoope W, Smulders PSH, Baumann HM, Hermanides J, Beenen LFM, Oostra RJ, Marhofer P, Lirk P, Hollmann MW. A radiological cadaveric study of obturator nerve involvement and cranial injectate spread after different approaches to the fascia iliaca compartment block. Sci Rep 2023; 13:12070. [PMID: 37495606 PMCID: PMC10372149 DOI: 10.1038/s41598-023-39041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
Whether the fascia iliaca compartment block (FICB) involves the obturator nerve (ON) remains controversial. Involvement may require that the injectate spreads deep in the cranial direction, and might thus depend on the site of injection. Therefore, the effect of suprainguinal needle insertion with five centimeters of hydrodissection-mediated needle advancement (S-FICB-H) on ON involvement and cranial injectate spread was studied in this radiological cadaveric study. Results were compared with suprainguinal FICB without additional hydrodissection-mediated needle advancement (S-FICB), infrainguinal FICB (I-FICB), and femoral nerve block (FNB). Seventeen human cadavers were randomized to receive ultrasound-guided nerve block with a 40 mL solution of local anesthetic and contrast medium, on both sides. Injectate spread was objectified using computed tomography. The femoral and lateral femoral cutaneous nerves were consistently covered when S-FICB-H, S-FICB or FNB was applied, while the ON was involved in only one of the 34 nerve blocks. I-FICB failed to provide the same consistency of nerve involvement as S-FICB-H, S-FICB or FNB. Injectate reached most cranial in specimens treated with S-FICB-H. Our results demonstrate that even the technique with the most extensive cranial spread (S-FICB-H) does not lead to ON involvement and as such, the ON seems unrelated to FICB. Separate ON block should be considered when clinically indicated.
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Affiliation(s)
- Werner Ten Hoope
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Anesthesiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Pascal S H Smulders
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Holger M Baumann
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Ludo F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Roelof-Jan Oostra
- Department of Medical Biology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Peter Marhofer
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Philipp Lirk
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Duan L, Zhang L, Shi CG, Huang LG, Ao H, Wang ZP, Deng Y, Sun ML. Comparison of continuous pericapsular nerve group (PENG) block versus continuous fascia iliaca compartment block on pain management and quadriceps muscle strength after total hip arthroplasty: a prospective, randomized controlled study. BMC Anesthesiol 2023; 23:233. [PMID: 37434138 DOI: 10.1186/s12871-023-02190-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND This investigation aimed to evaluate the impact of continuous pericapsular nerve group (PENG) block and continuous fascia iliac compartment block (FICB) on postoperative pain following total hip arthroplasty (THA). METHODS This prospective, randomized, and controlled trial recruited a cohort of fifty-seven patients with unilateral femoral neck fractures from Xi'an Aerospace General Hospital in northwest China between July 2020 and November 2021. These patients were randomly assigned to two groups: the continuous PENG block group (PENG group, n = 29) and the continuous FICB group (FICB group, n = 28). Under ultrasound guidance, PENG block and FICB procedures were performed prior to spinal anesthesia, utilizing 20 ml of 0.25% ropivacaine for PENG block and 30 ml of 0.25% ropivacaine for FICB. Subsequently, a catheter was inserted. All study participants received a standardized postoperative multimodal analgesic regimen, including intravenous administration of 30 mg Ketorolac tromethamine every eight hours and patient-controlled neural analgesia (PCNA) after surgery. Numerical rating scale (NRS) scores at rest and during exercise were recorded at various time points: prior to block (T0), 30 min post-blockade (T1), and 6 h (T2), 12 h (T3), 24 h (T4), and 48 h (T5) postoperatively. Additional data collected encompassed postoperative quadriceps muscle strength, the time of initial ambulation after surgery, the number of effective PCNA activations, rescue analgesia requirements, and occurrences of adverse events (such as nausea and vomiting, hematoma, infection, catheter detachment, or displacement) within 48 h following surgery. RESULTS In the PENG group, the resting NRS pain scores exhibited lower values at T1, T4, and T5 than those at T0. Furthermore, exercise NRS pain scores at T1-T5 were lower in the PENG group than in the FICB group. Similarly, during the same postoperative period, the PENG group demonstrated enhanced quadriceps strength on the affected side compared to the FICB group. Additionally, the PENG group displayed earlier postoperative ambulation and reduced occurrences of effective PCNA activations and rescue analgesia requirements compared to the FICB group. CONCLUSION Continuous PENG block exhibited superior analgesic efficacy after THA compared to continuous FICB, promoting recovery of quadriceps strength on the affected side and facilitating early postoperative ambulation. TRIAL REGISTRATION This clinical trial was registered in the China Clinical Trials Center ( http://www.chictr.org.cn ) on 20/07/2020, with the registration number ChiCTR2000034821.
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Affiliation(s)
- Lei Duan
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Liang Zhang
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Chuang-Guo Shi
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Li-Gang Huang
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Hui Ao
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Ze-Peng Wang
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Yue Deng
- Department of Joint Surgery, Xi 'an Aerospace General Hospital, Xi'an, China
| | - Meng-Liang Sun
- Intensive Care Medicine Center of Xi'an People's Hospital, No. 155, Cross of East Aero-East Road and Hangkai Road, Chang'an District, Xi'an City, 710100, Shaanxi Province, China.
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10
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King SA, Salerno A, Flanagan KJ, Euerle BD. Mixed-Model Curriculum for Nerve Block Education in Emergency Medicine Residency. Cureus 2023; 15:e37621. [PMID: 37197129 PMCID: PMC10185297 DOI: 10.7759/cureus.37621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/19/2023] Open
Abstract
Introduction With the rising opioid epidemic, there has been a push for multimodal pain management within the emergency department. Nerve blocks have been shown to be an effective pain management strategy for many conditions, with improved success when used with ultrasound. However, there is no generally accepted method for teaching residents how to perform nerve blocks. Materials and methods Seventeen residents from a single academic center were enrolled. The residents were surveyed pre-intervention regarding demographics, confidence, and use of nerve blocks. The residents then completed a mixed-model curriculum that included an electronic module (e-module) on three plane nerve blocks and a practice session. Three months later, residents were tested on their ability to independently perform the nerve blocks and resurveyed regarding confidence and use. Results Of the 56 residents in the program, 17 enrolled in the study; 16 participated in the first session, and nine participated in the second session. Each resident had < four ultrasound-guided nerve blocks prior to participation with a slight increase in the total number of nerve blocks after the sessions. Residents were able to perform, on average, 4.8 of seven tasks independently. Residents who completed the study reported feeling more confident in their ability to perform ultrasound-guided nerve blocks (p = 0.01) and to complete associated tasks (p < 0.01). Conclusion This educational model resulted in residents completing the majority of tasks independently with improved confidence in ultrasound-guided nerve blocks. There was only a slight increase in clinically performed blocks.
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Affiliation(s)
- Samantha A King
- Emergency Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Alexis Salerno
- Emergency Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Kevin J Flanagan
- Emergency Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Brian D Euerle
- Emergency Medicine, University of Maryland School of Medicine, Baltimore, USA
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Zhang C, Dai W, He K. 95% effective volume of ropivacaine for ultrasound‑guided supra‑inguinal fascia iliaca compartment block. BMC Anesthesiol 2023; 23:98. [PMID: 36991333 PMCID: PMC10053470 DOI: 10.1186/s12871-023-02049-5] [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: 11/07/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Hip arthroplasty is effective in treating hip diseases, such as osteoarthritis and hip fracture, but it often brings severe trauma and pain. In recent years, ultrasound-guided supra-inguinal fascia iliaca compartment block(S-FICB) has become a widely used nerve block method for analgesia in hip arthroplasty. METHODS Fifty-three patients preparing for hip arthroplasty were prospectively enrolled. S-FICB was performed under ultrasound guidance, and inject 0.33% ropivacaine into the space. Using the biased-coin design (BCD) sequential allocation method. The initial volume of 0.33% ropivacaine was 30ml. In case of failure, the next patient received a higher volume (defined as the previous volume with an increment of 1.2 mL). If the previous patient had a successful block, the next patient was randomized to a lower volume (defined as the previous volume with a decrement of 1.2 mL), with a probability of b = 0.05, or the same volume, with a probability of 1 - b = 0.95. The study was stopped when 45 successful blocks were achieved. RESULTS Forty-five patients (84.9%) were blocked successfully. The 95% effective volume (EV95) was 34.06ml (95%CI 33.35 ~ 36.28ml). There were 31 patients with non-fracture in this study. The quadriceps muscle strength decreased in only two patients. Moreover, they both received 34.8ml of ropivacaine for S-FICB. Twenty-two patients had hip fractures. There were 3 patients (14%) with failed blocks and 19 patients (86%) with successful blocks. However, all fracture patients experienced less pain after S-FICB. CONCLUSION EV95 of 0.33% ropivacaine for ultrasound-guided S-FICB was 34.06ml. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100052214, registration date: 2021 October 22).
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Affiliation(s)
- Can Zhang
- anesthesiology department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Dai
- anesthesiology department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kaihua He
- anesthesiology department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Gong WY, Fan K. A novel anterior approach for ultrasound-guided lumbar plexus combined with sacral plexus blocks with one-point puncture. Response to Br J Anaesth 2022; 129: e71-e72. Br J Anaesth 2022; 129:e131-e132. [PMID: 36028391 DOI: 10.1016/j.bja.2022.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Wen-Yi Gong
- Department of Anaesthesiology, Wusong Branch, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Kun Fan
- Department of Anaesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.
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13
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Carella M, Beck F, Piette N, Denys S, Kurth W, Lecoq JP, Bonhomme VL. Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial. Reg Anesth Pain Med 2022; 47:rapm-2021-103427. [PMID: 35705263 DOI: 10.1136/rapm-2021-103427] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/05/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Posterolateral-approached total hip arthroplasty (PLTHA) is followed by moderate to severe postoperative pain. Suprainguinal fascia iliaca compartment block (SFICB) has been proposed as a promising analgesia technique. METHODS Data from 86 patients scheduled for PLTHA with spinal anesthesia were analyzed in this prospective randomized controlled trial. Patients were randomly divided into two groups of 43 patients each. As opposed to the control group (group C), ropivacaine group (group R) received additional SFICB using 40 mL of 0.375% ropivacaine. As primary endpoint, blind observers noted total morphine consumption at postoperative 48 hours. Secondary endpoints were pain at rest and mobilization on 0-10 Numeric Rating Scale (rest and dynamic NRS) at fixed time points (1 hour and 6 hours after surgery, and at day 1 and day 2 at 8:00, 13:00 and 18:00 hours), walking performance at day 1 and day 2; postoperative complications including morphine-related side effects or orthostatic intolerance symptoms such as dizziness, nausea, blurred vision or vasovagal syncope. RESULTS A 48-hour morphine consumption (mg; median (IQR)) was significantly lower in group R than in group C (11 (8.5-15.5)) vs 26 (21-33.5), p<0001), as well as incidence of morphine-related side effects such as nausea at day 1 (p=0.04) and day 2 (p<0.01). Rest and dynamic NRS were globally significantly lower in group R than in group C (p<0.01). Group R showed less orthostatic intolerance at day 1 (p<0.001) and day 2 (p<0.01) and better functional walking performance at day 1 (<0.001) and day 2 (<0.001). DISCUSSION In PLTHA, SFICB provides opioid sparing, improved postoperative pain control, and enhanced functional recovery. TRIAL REGISTRATION NUMBER NCT04574479.
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Affiliation(s)
- Michele Carella
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
| | - Florian Beck
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
| | - Nicolas Piette
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
| | - Sébastien Denys
- Department of Physical Medicine, Rehabilitation and Sports Traumatology, Central University Hospital of Liege, Liege, Belgium
| | - William Kurth
- Department of Locomotor System Surgery, Central University Hospital of Liege, Liege, Belgium
| | - Jean-Pierre Lecoq
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
| | - Vincent L Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
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14
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Aliste J, Layera S, Bravo D, Jara Á, Muñoz G, Barrientos C, Wulf R, Brañes J, Finlayson RJ, Tran DQ. Reply to Dr Pascarella and colleagues. Reg Anesth Pain Med 2021; 47:201. [PMID: 34518370 DOI: 10.1136/rapm-2021-103125] [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: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Julián Aliste
- Anesthesiology and Perioperative Medicine, University of Chile School of Medicine, Santiago, Chile
| | - Sebastián Layera
- Anesthesiology and Perioperative Medicine, University of Chile School of Medicine, Santiago, Chile
| | - Daniela Bravo
- Anesthesiology and Perioperative Medicine, University of Chile School of Medicine, Santiago, Chile
| | - Álvaro Jara
- Anesthesiology and Perioperative Medicine, University of Chile School of Medicine, Santiago, Chile
| | - Gonzalo Muñoz
- Anesthesiology and Perioperative Medicine, University of Chile School of Medicine, Santiago, Chile
| | | | - Rodrigo Wulf
- Orthopedic Surgery, University of Chile, Santiago, Chile
| | - Julián Brañes
- Orthopedic Surgery, University of Chile, Santiago, Chile
| | - Roderick J Finlayson
- Pain and Research, The University of British Columbia, Kelowna, Columbia, Canada
| | - De Q Tran
- Anesthesiology, McGill University, Montreal, Quebec, Canada
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15
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Aliste J, Layera S, Bravo D, Jara Á, Muñoz G, Barrientos C, Wulf R, Brañes J, Finlayson RJ, Tran D. Reply to Brown et al. Reg Anesth Pain Med 2021; 47:199-200. [PMID: 34452983 DOI: 10.1136/rapm-2021-103106] [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: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Julián Aliste
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | - Sebastián Layera
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | - Daniela Bravo
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | - Álvaro Jara
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | - Gonzalo Muñoz
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | | | - Rodrigo Wulf
- Department of Orthopedic Surgery, University of Chile, Santiago, Chile
| | - Julián Brañes
- Department of Orthopedic Surgery, University of Chile, Santiago, Chile
| | - Roderick J Finlayson
- Pain and Research Center, The University of British Columbia, Kelowna, British Columbia, Canada
| | - D Tran
- Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
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16
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Maikong N, Kantakam P, Sinthubua A, Mahakkanukrauh P, Tran DQ, Leurcharusmee P. Cadaveric study investigating the phrenic-sparing volume for anterior suprascapular nerve block. Reg Anesth Pain Med 2021; 46:769-772. [PMID: 34083356 DOI: 10.1136/rapm-2021-102803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND This cadaveric study investigated the maximum effective volume of dye in 90% of cases (MEV90), required to stain the suprascapular nerve while sparing the phrenic nerve during the performance of an anterior suprascapular nerve block. METHODS In cadaveric neck specimens, using ultrasound guidance, the block needle was advanced until its tip was positioned underneath the omohyoid muscle next to the suprascapular nerve. The dye was injected in order to achieve circumferential spread around the latter. Successful phrenic-sparing suprascapular nerve block was defined as the non-staining of the phrenic nerve on dissection. Volume assignment was carried out using a Biased Coin Design, whereby the volume of dye administered to each cadaveric specimen depended on the response of the previous one. In case of failure (ie, stained phrenic nerve), the next one received a lower volume (defined as the previous volume with a decrement of 2 mL). If the previous cadaveric specimen had a successful block (ie, non-stained phrenic nerve), the next one was randomized to a higher volume (defined as the previous volume with an increment of 2 mL), with a probability of b=0.11, or the same volume, with a probability of 1 - b=0.89. RESULTS Thirty-one cadavers (56 cadaveric neck specimens) were included in the study. Using isotonic regression and bootstrap CI, the MEV90 for phrenic-sparing anterior suprascapular nerve block was estimated to be 4.2 mL (95% CI 3.0 to 5.0 mL). The probability of a successful response was estimated to be 0.90 (95% CI 0.84 to 0.96). CONCLUSION For ultrasound-guided anterior suprascapular nerve block, the MEV90 of dye required to spare the phrenic nerve is 4.2 mL. Further studies are required to correlate this finding with the MEV90 of local anesthetic in live subjects.
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Affiliation(s)
- Naraporn Maikong
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Perada Kantakam
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Sinthubua
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - De Q Tran
- Department of Anesthesiology, St.Mary's Hospital, McGill University, Montreal, Quebec, Canada
| | - Prangmalee Leurcharusmee
- Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand .,Department of Anesthesiology, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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17
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Bendtsen TF, Pedersen EM, Moriggl B, Hebbard P, Ivanusic J, Børglum J, Nielsen TD, Peng P. Suprainguinal fascia iliaca block: does it block the obturator nerve? Reg Anesth Pain Med 2021; 46:832. [PMID: 33911023 DOI: 10.1136/rapm-2021-102712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 02/01/2023]
Affiliation(s)
| | | | - Bernhard Moriggl
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Hebbard
- Department of Anesthesia, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
| | - Jason Ivanusic
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jens Børglum
- Department of Anesthesiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | - Philip Peng
- Department of Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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18
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Tran DQ, Kantakam P, Maikong N, Sinthubua A, Mahakkanukrauh P, Leurcharusmee P. Reply to Dr Bendtsen and colleagues. Reg Anesth Pain Med 2021; 46:832-833. [PMID: 33911026 DOI: 10.1136/rapm-2021-102782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/04/2022]
Affiliation(s)
- De Q Tran
- Department of Anesthesiology, St.Mary's Hospital, McGill University, Montreal, Quebec, Canada
| | - Perada Kantakam
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Naraporn Maikong
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Sinthubua
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Prangmalee Leurcharusmee
- Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand .,Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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