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R S, T S, Rajadurai D, Parthasarathy S. Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine 20 mL provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block than 20 mL of 0.5% bupivacaine alone: a randomized double-blinded clinical trial. Reg Anesth Pain Med 2024; 49:104-109. [PMID: 37295795 DOI: 10.1136/rapm-2023-104542] [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: 03/27/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Recent evidence has questioned the advantage of local anesthetic (LA) combinations. This study tested the hypothesis that mixing rapid-onset (lidocaine) and long-duration (bupivacaine) LA would provide faster onset of complete conduction blockade (CCB) compared with bupivacaine alone and longer duration of analgesia compared with lidocaine alone during low-volume (20 mL) ultrasound-guided (USG) supraclavicular brachial plexus block (SCBPB). METHODS Sixty-three patients receiving USG-SCBPB were randomly allocated into: group L: 20 mL 2% lidocaine with epinephrine 1:200 000; group B: 20 mL 0.5% bupivacaine; group LB: 20 mL of equi-volume mixture of both drugs. Sensory and motor blockade was recorded on a three point sensory and motor assessment scale at 10 min intervals for up to 40 min and the total composite score (TCS) at each time point was determined. The duration of analgesia was also noted. RESULTS The mean time to CCB of group LB (16±7 min) was comparable (p>0.05) with group L (14±6 min) and group B (21±8 min) in patients who were attained CCB. However, the proportion of patients attaining complete conduction block (TCS=16/16) was significantly lower (p=0.0001) in group B (48%) when compared with group L (95%) and group LB (95%) at the end of 40 min. The median (IQR) duration of postoperative analgesia was longest in group B; 12.2 (12-14.5) hours, followed by group LB 8.3 (7-11) hours and 4 (2.7-4.5) hours in group L. CONCLUSION At 20 mL LA volume, equal mixture of lidocaine and bupivacaine provided significantly faster onset of CCB compared with bupivacaine alone and longer duration of postoperative analgesia compared with lidocaine alone but shorter than bupivacaine alone during low-volume USG-SCBPB. TRIAL REGISTRATION NUMBER CTRI/2020/11/029359.
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Affiliation(s)
- Sripriya R
- Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - Sivashanmugam T
- Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - Daniel Rajadurai
- Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - S Parthasarathy
- Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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Xie K, Wang YL, Teng WB, He R, Li YH, Huang SQ. The Median Effective Concentration (EC 50) of Epidural Ropivacaine With Different Doses of Oxycodone During Limb Surgery in Elderly Patients. Front Med (Lausanne) 2022; 8:808850. [PMID: 35127764 PMCID: PMC8814631 DOI: 10.3389/fmed.2021.808850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background Oxycodone can be used both intravenously and epidurally in elderly patients because of its strong analgesic effect and more slight respiratory inhibition compared with other opioids at the same effect. In this study, we determined the median effective concentration (EC50) of epidural ropivacaine required for great saphenous vein surgery in elderly patients in order to describe its pharmacodynamic interaction with oxycodone. Methods One hundred forty-one elderly patients scheduled for high ligation and stripping of the great saphenous vein surgery were allocated into three groups in a randomized, double-blinded manner as follows: Q2.5 group (2.5 mg oxycodone), Q5.0 group (5.0 mg oxycodone), and C group (normal saline). Anesthesia, was achieved with epidural ropivacaine and oxycodone. The EC50 of ropivacaine for surgery with different doses of oxycodone was adjusted by using an up-and-down sequential methods with an adjacent concentration gradient at a factor of 0.9 to inhibit analgesia. Anesthesia associated adverse events and recovery, characteristics were also recorded. Results The EC50 of ropivacaine for the great saphenous vein surgery in elderly patients was 0.399% (95% CI, 0.371–0.430%) in the Q2.5 group, 0.396% (95% CI, 0.355–0.441%) in the Q5.0 group, and 0.487% (95% CI, 0.510–0.465%) in the C group, respectively (P < 0.05). Specially, the EC50 of ropivacaine in the Q2.5 and Q5.0 groups was lower than that in the C group (P < 0.01), But the difference between the Q2.5 group and the Q5.0 group was not significant (P > 0.05). There was no significant difference in the Bromage score from the motor block examination, heart rate (HR) or mean arterial pressure (MAP) at each observation time point after epidural administration among the three groups (P > 0.05). No serious adverse reactions occurred in any of the three groups. Conclusion Oxycodone combined with ropivacaine epidural anesthesia can reduce the EC50 of ropivacaine required for elderly patients undergoing the great saphenous vein surgery. There was no significant difference in anesthesia associated adverse events among the three groups. The recommended dose of oxycodone is 2.5 mg.
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Affiliation(s)
- Kai Xie
- Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, China
| | - Yu-Long Wang
- Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, China
| | - Wen-Bin Teng
- Department of Anesthesiology, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Rui He
- Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, China
| | - Yu-Hong Li
- Department of Anesthesiology, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Su-Qin Huang
- Department of Anesthesiology, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
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Vadagandla K, Jahagirdar V, Rama K, Qavi D. Minimum Effective Volume of 0.75% Ropivacaine for Ultrasound-Guided Axillary Brachial Plexus Block. Cureus 2020; 12:e12229. [PMID: 33409105 PMCID: PMC7779144 DOI: 10.7759/cureus.12229] [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] [Indexed: 11/17/2022] Open
Abstract
Background Ultrasound-guided peripheral nerve block provides direct visualization of nerve and reduces the complications associated with classical landmark guided technique, by reducing the dosage of local anesthetic drugs. This study aims to determine the minimum effective volume (MEAV) of 0.75% ropivacaine for ultrasound-guided axillary brachial plexus block. Methodology A total of 23 patients of age group 18-75 years belonging to ASA grade 1, 2, and 3 were selected based on inclusion criteria. The MEAV was determined by using Dixons & Massey Step-up and Step-down method. The initial volume was selected as 15 mL based on previous studies. Depending on block success or failure, 1 mL of the drug was decreased or increased. Block was assessed in terms of motor and sensory components. The study was aborted after attaining five cases of block failure, followed by five cases of a successful block. Results The MEAV to be given for a successful block in 50% of patients (MEAV50) was 8.62 mL (95%CI 3.54-9.89). The MEAV to be given for a successful block in 90% of patients (MEAV 90) was 11.82 mL (95% CI 9.9-75.7). Conclusion Ultrasound guidance reduces the dosage of local anesthetic drugs to be used and provides surgical anesthesia without any complications or adverse effects.
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Affiliation(s)
| | - Vinay Jahagirdar
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
| | - Kaanthi Rama
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
| | - Danish Qavi
- Internal Medicine, Eras Lucknow Medical College, Lucknow, IND
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Tedore TR, Lin HX, Pryor KO, Tangel VE, Pak DJ, Akerman M, Wellman DS, Oden-Brunson H. Dose-response relationship between local anesthetic volume and hemidiaphragmatic paresis following ultrasound-guided supraclavicular brachial plexus blockade. Reg Anesth Pain Med 2020; 45:979-984. [PMID: 33004656 DOI: 10.1136/rapm-2020-101728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND There is no consensus regarding what volume of local anesthetic should be used to achieve successful supraclavicular block while minimizing hemidiaphragmatic paresis (HDP). This study investigated the dose-response relationship between local anesthetic volume and HDP after ultrasound-guided supraclavicular brachial plexus block. METHODS A dose escalation design was used to define the dose response curve for local anesthetic volume and incidence of HDP in subjects undergoing upper extremity surgery with supraclavicular block as the primary anesthetic. Dosing levels of 5, 10, 15, 20, 25, 30, 35 and 40 mL of local anesthetic were administered in cohorts of three subjects per dose. Diaphragm function was assessed with M-mode ultrasound before and after block. Secondary objectives included assessment of negative inspiratory force (NIF), oxygen saturation, subjective dyspnea and extent of sensory and motor blockade. RESULTS Twenty-one subjects completed the study. HDP was present at all doses, with an incidence of 33% at 5 mL to 100% at 30-35 mL. There was a significant decrease in NIF (7.5 cmH2O, IQR (22,0); p=0.01) and oxygen saturation on room air (1%, IQR (2,0); p=0.01) 30 min postblock in subjects experiencing HDP but not in those without HDP. There was no increase in dyspnea in subjects with or without HDP. No subject required respiratory intervention. Motor and sensory block improved with increasing dose, and subjects with HDP exhibited denser blocks than those without (p<0.01). CONCLUSIONS There is no clinically relevant volume of local anesthetic at which HDP can be avoided when performing a supraclavicular block. In our subject population free of respiratory disease, HDP was well tolerated. TRIAL REGISTRATION NUMBER NCT03138577.
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Affiliation(s)
- Tiffany R Tedore
- Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Hannah X Lin
- Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Kane O Pryor
- Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Virginia E Tangel
- Anesthesiology, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
| | - Daniel J Pak
- Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Michael Akerman
- Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - David S Wellman
- Orthopedic Surgery, Westchester Medical Center, Valhalla, New York, USA
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Sivashanmugam T, Sripriya R, Jayaraman G, Ravindran C, Ravishankar M. Truncal injection brachial plexus block: A Description of a novel injection technique and dose finding study. Indian J Anaesth 2020; 64:415-421. [PMID: 32724251 PMCID: PMC7286406 DOI: 10.4103/ija.ija_803_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/21/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Brachial plexus (BP) blocks continue to be described with reference to anatomical landmarks (Interscalene and Supraclavicular), even after the introduction of ultrasound which enables us to directly identify the roots, trunks and divisions of the BP. The aim of this study was to describe a novel injection technique targeting trunks of BP and to determine the minimum effective local anaesthetic volume (MELAV) required to produce BP block with this approach. Methods Twenty-one male patients in the age group 20-40 years, undergoing elective forearm bony procedures received an ultrasound-guided truncal injection BP block. MELAV50 was determined using the Dixon and Mood up-and-down method. Initial volume of local anaesthetic (LA; 50:50 mixture of bupivacaine 0.5% and lignocaine 2% with 5 μg/ml epinephrine) injected was 6 ml in each trunk, which was varied by 1 ml/trunk for each consecutive patient according to the response of the previous patient. The MELAV50, MELAV95 and MELAV99 were calculated using Probit transformation and logistic regression. Results Out of the 21 patients, 13 patients had a successful block. The MELAV50, MELAV95 and MELAV99 were 7.41, 10.47 and 12 ml, respectively. Eight patients in whom block failed had sparing in the ulnar and median nerve territories. Conclusion Trunks of the brachial plexus can be identified and targeted for the injection of local anaesthetics. The MELAV50 and MELAV95 required for ultrasound-guided truncal injection brachial plexus block were 7.4 and 10.4 ml, respectively.
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Affiliation(s)
- T Sivashanmugam
- Department of Anaesthesiology, MGMCRI, SBV University, Pondicherry, India
| | - R Sripriya
- Department of Anaesthesiology, MGMCRI, SBV University, Pondicherry, India
| | - Gobinath Jayaraman
- Department of Anaesthesiology, MGMCRI, SBV University, Pondicherry, India
| | | | - M Ravishankar
- Department of Anaesthesiology, MGMCRI, SBV University, Pondicherry, India
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Interscalene versus supraclavicular plexus block for the prevention of postoperative pain after shoulder surgery. Eur J Anaesthesiol 2019; 36:427-435. [DOI: 10.1097/eja.0000000000000988] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Guo C, Ma J, Ma X, Lu B, Wang Y, Tian A, Sun L, Wang Y, Dong B, Teng Y. Supraclavicular block versus interscalene brachial plexus block for shoulder surgery: A meta-analysis of clinical control trials. Int J Surg 2017; 45:85-91. [DOI: 10.1016/j.ijsu.2017.07.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
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Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7094121. [PMID: 27990435 PMCID: PMC5136641 DOI: 10.1155/2016/7094121] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/31/2016] [Indexed: 01/18/2023]
Abstract
Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively randomized to ultrasound-guided brachial plexus block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group (P < 0.01). Nerve visibility was significantly reduced in the axillary group (P = 0.01). Success-rate was significantly increased in the supraclavicular versus the axillary group (P < 0.025). Total anesthesia-related time was significantly reduced in the supraclavicular compared to the infraclavicular group (P < 0.01). Block duration was significantly increased in the infraclavicular group (P < 0.05). No early adverse effects occurred. Conclusion. Supraclavicular and infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block with the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate without any early adverse events.
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Double-injection technique assisted by a nerve stimulator for ultrasound-guided supraclavicular brachial plexus block results in better distal sensory-motor block: A randomised controlled trial. Eur J Anaesthesiol 2016; 34:127-134. [PMID: 27798452 DOI: 10.1097/eja.0000000000000542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate the efficacy of a nerve stimulator when used with ultrasound-guided double injection in supraclavicular brachial plexus block. OBJECTIVES We hypothesised that targeting the inferior trunk of the plexus guided by a nerve stimulator would obtain a higher success rate of ulnar nerve blockade than the traditional double-injection technique. DESIGN A blinded randomised controlled study. SETTING Conducted at the University Hospital from October 2015 to January 2016. PATIENTS Ninety patients undergoing upper extremity surgery were randomised into two equal groups. INTERVENTIONS Patients were randomly allocated to a modified double-injection group (MDI group) or a traditional double-injection group (DI group). All patients received 23 ml of a 1 : 1 mixture of 2% lidocaine and 1% ropivacaine during ultrasound-guided supraclavicular brachial plexus block. In the MDI group (n = 45), half the volume was deposited within the brachial plexus sheath guided by ultrasound, next to the inferior trunk and verified by nerve stimulation; the remaining volume was deposited in the main neural cluster. In the double-injection group (n = 45), the first half volume was deposited on ultrasound guidance alone. Sensory-motor blockade of the musculocutaneous, median, radial, ulnar nerves and surgical anaesthesia, performance time, number of needle passes and complications were recorded. MAIN OUTCOME MEASURES The success rate of complete sensory block of the ulnar nerve within 15 min after local anaesthetic injection. RESULTS Compared with the DI group the MDI group had higher success rates of complete sensory block of the ulnar nerve (93 vs 67%, P = 0.002) and complete anaesthesia (80 vs 56%, P = 0.014) at 15 min, whereas the average performance time was significantly longer (5.08 ± 1.41 vs 4.10 ± 0.64 min, P < 0.001) and the number of needle passes was significantly higher (4.40 ± 1.14 vs 2.87 ± 0.79, P < 0.001). CONCLUSION The MDI technique has a higher success rate for complete sensory block of the ulnar nerve within 15 min of local anaesthetic injection. The time needed to perform the block is about 1 min longer than the traditional technique. TRIAL REGISTRATION http://www.chictr.org.cn with the registration number of ChiCTR-IOR-15007588.
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Fang G, Wan L, Mei W, Yu HH, Luo AL. The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided supraclavicular brachial plexus block. Anaesthesia 2016; 71:700-5. [PMID: 26945818 DOI: 10.1111/anae.13445] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 12/31/2022]
Affiliation(s)
- G. Fang
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - L. Wan
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - W. Mei
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - H. H. Yu
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - A. L. Luo
- Department of Anesthesiology; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Yadav N, Ayub A, Garg R, Nanda S, Gupta B, Sawhney C. Sonographic assessment of predictors of depth of the corner pocket for ultrasound-guided supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol 2016; 32:25-8. [PMID: 27006536 PMCID: PMC4784208 DOI: 10.4103/0970-9185.175665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS There is wide variation in depth of brachial plexus in patient population at supraclavicular region. We plan to find the depth of the corner pocket and correlate it with age, weight, height and body mass index (BMI). MATERIAL AND METHODS After approval from Ethics Committee, right-sided supraclavicular region of volunteers was scanned. Once an optimal image, which included subclavian artery, pleura, first rib and nerve bundles, was obtained, the corner pocket was kept in the middle of the screen and the image was frozen. Depth of the corner pocket from the skin was measured. Thereafter longest distance (LD) approximating needle trajectory was calculated. The Pearson correlation was used to calculate the relation between these two distances and various predictors such as weight, height, and BMI. RESULTS Mean shortest distance that is, vertical distance from skin to corner pocket for all volunteers was found to be 1.7 ± 0.8 cm and the mean LD that is, distance traveled by needle entering 1 cm from the edge of foot process to the corner pocket in an in-plane approach was 3.7 ± 0.2 cm. We did not find any significant correlation between age, height versus measured distances. However, significant correlation (0.11) was found between weights, BMI versus two lengths. CONCLUSION Prescanning of supraclavicular region for estimating depth of corner pocket should be done before choosing an appropriate size needle. Furthermore, the needle should not be advanced more than the predicted corner pocket depth.
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Affiliation(s)
- Naveen Yadav
- Department of Anaesthesiology, JPNATC, AIIMS, Jaipur, Rajasthan, India
- Address for correspondence: Dr. Naveen Yadav, Room No. 316, Casualty Block, JPNATC, All India Institute of Medical Sciences, Raj Nagar, New Delhi - 110 029, India. E-mail:
| | - Arshad Ayub
- Department of Anaesthesiology, BRAIRCH, AIIMS, Jaipur, Rajasthan, India
| | - Rakesh Garg
- Department of Anaesthesiology, BRAIRCH, AIIMS, Jaipur, Rajasthan, India
| | - Samridhi Nanda
- Department of Anaesthesiology, SMS, Jaipur, Rajasthan, India
| | - Babita Gupta
- Department of Anaesthesiology, JPNATC, AIIMS, Jaipur, Rajasthan, India
| | - Chhavi Sawhney
- Department of Anaesthesiology, JPNATC, AIIMS, Jaipur, Rajasthan, India
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Ryu T, Kil BT, Kim JH. Comparison Between Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective, Randomized, Parallel Study. Medicine (Baltimore) 2015; 94:e1726. [PMID: 26448030 PMCID: PMC4616738 DOI: 10.1097/md.0000000000001726] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Although supraclavicular brachial plexus block (SCBPB) was repopularized by the introduction of ultrasound, its usefulness in shoulder surgery has not been widely reported. The objective of this study was to compare motor and sensory blockades, the incidence of side effects, and intraoperative opioid analgesic requirements between SCBPB and interscalene brachial plexus block (ISBPB) in patients undergoing arthroscopic shoulder surgery. Patients were randomly assigned to 1 of 2 groups (ISBPB group: n = 47; SCBPB group: n = 46). The side effects of the brachial plexus block (Horner's syndrome, hoarseness, and subjective dyspnea), the sensory block score (graded from 0 [no cold sensation] to 100 [intact sensation] using an alcohol swab) for each of the 5 dermatomes (C5-C8 and T1), and the motor block score (graded from 0 [complete paralysis] to 6 [normal muscle force]) for muscle forces corresponding to the radial, ulnar, median, and musculocutaneous nerves were evaluated 20 min after the brachial plexus block. Fentanyl was administered in 50 μg increments when the patients complained of pain that was not relieved by the brachial plexus block. There were no conversions to general anesthesia due to a failed brachial plexus block. The sensory block scores for the C5 to C8 dermatomes were significantly lower in the ISBPB group. However, the percentage of patients who received fentanyl was comparable between the 2 groups (27.7% [ISBPB group] and 30.4% [SCBPB group], P = 0.77). SCBPB produced significantly lower motor block scores for the radial, ulnar, and median nerves than did ISBPB. A significantly higher incidence of Horner's syndrome was observed in the ISBPB group (59.6% [ISBPB group] and 19.6% [SCBPB group], P < 0.001). No patient complained of subjective dyspnea. Despite the weaker degree of sensory blockade provided by SCBPB in comparison to ISBPB, opioid analgesic requirements are similar during arthroscopic shoulder surgery under both brachial plexus blocks. However, SCBPB produces a better motor blockade and a lower incidence of Horner's syndrome than ISBPB.
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Affiliation(s)
- Taeha Ryu
- From the Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
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A triple-masked, randomized controlled trial comparing ultrasound-guided brachial plexus and distal peripheral nerve block anesthesia for outpatient hand surgery. Anesthesiol Res Pract 2014; 2014:324083. [PMID: 24839439 PMCID: PMC4009248 DOI: 10.1155/2014/324083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/14/2014] [Accepted: 03/30/2014] [Indexed: 11/18/2022] Open
Abstract
Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15 mL of 1.5% mepivacaine at the assigned location with 15 mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery. Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength, P = 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery, P = 0.012. Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block.
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Seo BB, Kim YW, Kim JM, Lee MY, Jang YH, Woo SH. Comparison of Axillary and Supraclavicular Approach in Ultrasound-Guided Brachial Plexus Block. ACTA ACUST UNITED AC 2014. [DOI: 10.12790/jkssh.2014.19.3.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Bo-Byoung Seo
- Department of Anesthesiology and Pain Medicine, W Hospital, Daegu, Korea
| | - Young-Woo Kim
- Cheon & Woo's Institute for Hand & Reconstructive Microsurgery, W Hospital, Daegu, Korea
| | - Jong-Min Kim
- Cheon & Woo's Institute for Hand & Reconstructive Microsurgery, W Hospital, Daegu, Korea
| | - Mi-Young Lee
- Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Young-Ho Jang
- Institute of Cancer Rehabilitation and Convalescence, Yoonsung Hospital, Cheongdo, Korea
| | - Sang-Hyun Woo
- Cheon & Woo's Institute for Hand & Reconstructive Microsurgery, W Hospital, Daegu, Korea
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