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Żyluk A. 13 years of hand surgery without an anesthesiologist. An analysis of efficacy and safety of presurgical anesthesia as delivered by surgeons without the assistance of anesthesiologists. POLISH JOURNAL OF SURGERY 2023; 96:30-35. [PMID: 38348976 DOI: 10.5604/01.3001.0053.9843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
<b><br>Introduction:</b> The assistance of anaesthesiologist is considered an inseparable part of most surgical procedures, with the exception of a small proportion of minor procedures performed under local anaesthesia. In hand surgery, a vast majority of procedures, even those lasting several hours, can be carried out under regional (brachial plexus block) or local (infiltration) anaesthesia. These can be delivered by the surgeons themselves, allowing the surgeries to be carried out without the assistance of anesthesiologists.</br> <b><br>Aim:</b> The aim of this study was to analyze the efficacy and safety of presurgical anesthesia as delivered by surgeons without the assistance of anesthesiologists in the course of hand surgery procedures performed within the institution headed by the author of this article.</br> <b><br>Material and methods:</b> The analysis was based on the records of anesthesia protocols filled out by the surgeons who delivered the anesthesia and who operated on the patients. The variables considered included the efficacy of anesthesia and the anesthesia-related adverse effects and complications.</br> <b><br>Results:</b> Over a period of 13 years (2010-2022), a total of 24,703 surgeries were delivered; of these, 22,228 (91%) surgeries were carried out without anesthesiologists, with anesthesia being delivered by the surgeon him/herself. The efficacy of these procedures (local anasthesia and brachial plexus blocks combined) was 99%. A total of 631 (2.8%) anesthesia-related adverse reactions were recorded, most of them being transient, requiring immediate interventions and not leading to any serious sequelae. In only 17 cases (0.07%), adverse effects resulted in cancellation and rescheduling of the elective surgery.</br> <b><br>Conclusions:</b> Pre-surgical anesthesia as delivered prior to hand surgery procedures by the surgeons without the assistance of anesthesiologists is effective and safe while being associated with numerous benefits for patients, surgeons and the health care system's budget.</br>.
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Affiliation(s)
- Andrzej Żyluk
- Department of General Surgery and Transplantation, Pomeranian Medical University in Szczecin, Poland
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Cakmak HŞ, Ertas G, Akdeniz S, Polat E, Sonmez A, Gumus M. A Comparison of Distal Nerve Blocks and Brachial Plexus Blocks in Terms of Block Success, Block-related Characteristics, Time to Discharge and Patient Satisfaction. J Hand Surg Asian Pac Vol 2023; 28:446-452. [PMID: 37758499 DOI: 10.1142/s2424835523500509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: Ultrasound-guided brachial plexus blocks (BPB) are used as an anaesthetic method in hand and wrist surgeries. The radial, median and ulnar nerves can also be selectively blocked. The objective of this retrospective cohort study was to compare distal nerve blocks (DNB) and BPB in terms of block success, block-related characteristics, time to discharge and patient satisfaction. Methods: The data of patients who underwent elective hand and wrist surgery under regional anaesthetic procedures between 01.01.2022 and 01.09.2022 were analysed. Standard multimodal analgesia was performed in all groups, in addition to either ultrasound-guided BPB or DNB. Demographic characteristics, American Society of Anaesthesiology (ASA) classes, presence of additional diseases, block and volume applied, block-related data such as block performance time, onset time, initial analgesia times, perioperative additional anaesthetic or analgesic requirement, surgery times, types of surgery, discharge times and the presence of additional complaints were recorded. In addition, the anaesthesia quality score were determined using a 5-point Likert scale. Results: There was no difference between demographic data. Average surgical time was similar between the DNB and BPB groups (46.0 ± 8.92 vs. 59.95 ± 22.04 min, p < 0.05). Block onset time was significantly lower in the DNB group (26.4 ± 2.73 vs. 32.17 ± 2.94 min, p < 0.001). When patients discharged before and after 12 hours were compared, 11/22 of the patients in the DNB group and 4/23 of the patients in the BPB group were discharged in the first 12 hours (p < 0.05). Patient satisfaction scores were similar between groups (14.22 ± 0.86 vs. 13.65 ± 1.11, p > 0.05). Conclusions: In surgeries of the hand and wrist, the radial, median and ulnar nerves can be used individually or in combination as an alternative to proximal BPB. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Hamiyet Şenol Cakmak
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Gamze Ertas
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Sevda Akdeniz
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ebru Polat
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ayhan Sonmez
- Department of Plastic Surgery, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Murat Gumus
- Department of Plastic Surgery, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
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Jalil H, Polfliet F, Nijs K, Bruckers L, De Wachter G, Callebaut I, Salimans L, Van de Velde M, Stessel B. Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial. PLoS One 2021; 16:e0246863. [PMID: 33606754 PMCID: PMC7895351 DOI: 10.1371/journal.pone.0246863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 01/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background and objectives Distal upper extremity surgery is commonly performed under regional anaesthesia, including intravenous regional anaesthesia (IVRA) and ultrasound-guided forearm nerve block. This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release. Methods In this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0–10) was recorded. Surgeon satisfaction with hemostasis, surgical time, and OR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1. Results In total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay were observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block. Conclusion An ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release. Trial registration This trial was registered as NCT03411551.
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Affiliation(s)
- Hassanin Jalil
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Florence Polfliet
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Kristof Nijs
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Liesbeth Bruckers
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | | | - Ina Callebaut
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium
| | - Lene Salimans
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Marc Van de Velde
- Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium
- Department of Anaesthesiology, University Hospital, Leuven, Belgium
| | - Björn Stessel
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium
- * E-mail:
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Liu J, Yuan K, Zhou H, Li L, Wang G, Li T. A randomized controlled trial evaluating the hemodynamic impact of ultrasound-guided great auricular nerve block in middle ear microsurgery. BMC Anesthesiol 2020; 20:234. [PMID: 32933470 PMCID: PMC7491143 DOI: 10.1186/s12871-020-01155-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The peri-operative effectiveness of ultrasound-guided great auricular nerve block (GANB) in patients, especially in adult patients undergoing middle ear microsurgery remains unclear. We hypothesized that ultrasound-guided GANB would decrease the hemodynamic responsiveness to incision and opioid consumption in middle ear microsurgery as well as the post-operative analgesia requirement. METHODS Sixty patients undergoing middle ear microsurgery were randomized into two equal groups to receive either a GANB with 2 ml of 0.25% ropivacaine under ultrasound guidance (GANB group) or to receive a blank control intervention (without any performed injection) before general anesthesia inductions. The primary outcomes were hemodynamic changes of MAP (mean artery pressure) and HR (heart rate) to skin incision. The secondary endpoints were to determine the consumptions of propofol and remifentanil during the operation and the incidence of remedial analgesia 48 h post-operation to maintain VAS ≤ 3. RESULTS The MAP post incision in GANB group was significantly lower than that in control group (GANB group 93.83 ± 11.72 mmHg vs. control group 100.87 ± 12.65 mmHg, P = 0.029). The increases for MAP and HR post incision were also lower in GANB group (∆MAP GANB group 11.90 ± 8.32 mmHg vs. control group 19.83 ± 10.37 mmHg, P = 0.002; ∆HR GANB group 3.67 ± 5.30 beat min- 1 vs. control group 8.23 ± 8.56 beat min- 1, P = 0.016). Remifentanil consumption was significantly decreased in GANB group (GANB group 401.55 ± 100.51 μg h- 1 vs. control group 697.34 ± 215.45 μg h- 1, P = 0.000). The incidence of remedial analgesia post-operation in GANB group (5/30) was significantly lower than that in control group (20/30, P = 0.000). CONCLUSION Ultrasound-guided GANB decreases the hemodynamic responsiveness to incision and remifentanil consumption in middle ear microsurgery as well as the post-operative analgesia requirement. TRIAL REGISTRATION This trial was retrospectively registered at http://www.chictr.org.cn with the registration number of ChiCTR1800014333 on 6 January, 2018.
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Affiliation(s)
- Jinsheng Liu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kezhi Yuan
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongling Zhou
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Li Li
- Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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Ince I, Ozmen O, Aksoy M, Zeren S, Ulas AB, Aydin Y. Erector Spinae Plane Block Catheter Insertion under Ultrasound Guidance for Thoracic Surgery: Case Series of Three Patients. Eurasian J Med 2018; 50:204-206. [PMID: 30515044 DOI: 10.5152/eurasianjmed.2018.18147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The erector spinae plane (ESP) block is a novel plane block first reported for thoracic analgesia. It affects the dorsal and ventral rami of the thoracic nerves. Owing to the ease of the technique and decreased risk of complication of the ESP block under ultrasound guidance, it can be a preferable procedure compared with other invasive techniques, such as neuraxial and nerve blocks. In this case report, we presented three patients who had thoracic surgery under general anesthesia. The ESP block and catheter placement was applied to the patients before operation. The catheter was inserted deep into the erector spinae muscle and was used successfully for postoperative pain management.
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Affiliation(s)
- Ilker Ince
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ozgur Ozmen
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Sumeyra Zeren
- Department of Anaesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ali Bilal Ulas
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Yener Aydin
- Department of Thoracic Surgery, Atatürk University School of Medicine, Erzurum, Turkey
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